Centers for Disease Control and Prevention. Georgia, Atlanta USA March 6, 2020.

For Whom Does the CDC Think it Works?

By Jennifer S. Bard

As weekly deaths from COVID in the U.S. soar into thousands, monkeypox continues to spread, and New York reports the country’s first case of paralytic polio since 1979, it is fair to question the U.S. Centers for Disease Control and Prevention (CDC)’s effectiveness and ability to achieve its mission to “to protect America from health, safety and security threats” and its pledge to “base all public health decisions on the highest quality scientific data that is derived openly and objectively” and “place the benefits to society above the benefits to our institution.”

Earlier this week, the agency faced criticism from the public health community that its back-to-school COVID guidance pares back already weak protections against the spread of disease by dropping its recommendations for asymptomatic screening and quarantine after exposure. And, at the same time, CDC faces criticism for being over-cautious from those who seek to end all COVID protections in the interest of going back to life as it was before the pandemic.

But recent events are not what motivated CDC Director Rochelle Walensky’s announcement of a complete overhaul of the agency in the face of failure to provide “information in a way that ordinary people and state and local health authorities can understand and put to use.” Instead, she was relaying findings of a report she commissioned several months ago, although in response to similar complaints. Based on its findings, she pledged “faster release of scientific findings and easier-to-understand guidance.”

But, while she blames the agency she has led for eighteen months for not meeting its ”big” moment, she failed to address the larger issue of CDC’s role of advancing the policy goals of the administration in which it is a part. While this administration was quick to criticize their predecessor’s “silencing” of CDC warnings, they have instead instrumentalized the CDC to support their claims that COVID is no longer a threat, citing it 30 times in a recent 35-minute press briefing. Propaganda always serves the interests of the government presenting it to the public.

Communication alone isn’t at the core of Walensky’s or the agency’s problem. The problem is that protecting the public’s health stands in direct conflict to the business interests of those who fund political elections and to those who currently hold political power.

Should the CDC provide the best available information, even though it might lead to discontent, or should it appease the public by assuring them that what they already had done was enough? The risks of being truthful are obvious. Facts about the dangers of mixing in crowded public places have and may continue to lead people to stay home rather than spend money on travel or restaurants. Publicizing the effectiveness of masks (and the absence of any evidence of harm) in preventing the spread of COVID inside and outside the classroom, would lead to backlash among vocal opponents. Acknowledging the increasingly concerning information about the long term harm, including brain damage, caused to almost everyone infected with COVID, and the likelihood that no existing vaccine or even previous case can effectively prevent most infections would strengthen calls for political change and would highlight the cataclysmic gaps in both the system for providing health care and supporting people too ill to work.

By providing guidance that minimizes the threat of COVID, or, most recently, monkeypox and polio, to the public at large, the CDC creates an environment in which the public is not worried and does not demand change. While the Director blames the structure of the institution and its staff, she has vigorously defended its willingness to support whatever narrative the administration finds most helpful. By providing guidance that emphasizes a decreasing need for community-wide protection against the spread of disease, CDC also abandons communities that historically have been disparately harmed by health inequalities for, among many other reasons, race, gender identity, or national origin. In January, while acknowledging that her remarks dismissive of people with chronic illness, compromised immune systems, or a disability were “hurtful,” there was little change in guidance.

No improvement in communication methods can ever address the inherent conflict of interest between providing information that protects the public’s health and that which protects business interests or current office holders. This shaping of guidance was evidenced by the Director’s responses to questions about the President’s extended period of isolation while positive for COVID. She acknowledged it was twice as long as CDC guidance recommended for other people, but that it was important for the CDC to provide advice that was “relevant, feasible, followable by Americans” because “some communities have fewer resources and greater work constraints.”

This is sad. Until recently, the CDC had been the voice of public health within a federal government that, by necessity, has many competing priorities. CDC is empowered neither to regulate nor to treat patients. Its ability to conduct and fund research pales in comparison to the resources available to National Institutes of Health or the Department of Defense. By its location, 600 miles away from Washington, D.C., and its decidedly nonbiomedical staff, CDC stands apart from both the politics and mission of biomedically-oriented agencies like NIH and the Food and Drug Administration.

By minimizing the threat of COVID to the public’s health, CDC makes it impossible for the government or private industry to make the large-scale investment in the kind of pharmaceuticals or vaccines that would prevent infection and allow us to “live” with COVID as we have been living with any number of “endemic” diseases in the United States and may soon being doing again with polio, or measles, or whooping cough. It also makes it impossible for politicians to make unpopular decisions, which seem unwarranted without a better understanding of the threat our nation and our world face from the unmitigated spread of COVID.

It is particularly unfair of CDC or the administration to deny responsibility for the effect of its “guidance” by claiming it defers to local health departments when it knows how different its mission is from theirs. State, territorial, and regional health departments work on the front lines, they cannot exist without the CDC’s support. It plays similar supportive role around the globe because few countries can duplicate its resources. More to the point, many of the resources that local departments do have already come directly from CDC.

CDC can do its job better. Even though the Supreme Court has made it near impossible for the federal government to make anyone do anything, no force can stop it from telling the truth. The CDC plays in a major role in that by sharing what it knows about the short and long term dangers of the infectious diseases we face.

If the Director is serious about sharing scientific knowledge in the public’s interest, then a good place to start is by rebutting the myths about COVID and monkeypox that have prevented the public from demanding better protection from the entities like schools, businesses, airlines, and retail establishments that could easily provide them. If the agency is truly “following the science,” then it should add references to its guidance, rather than hiding behind what is still, to many people, a mantle of public protection. It should also continue to support initiatives like that of the White House’s Office of Science and Technology to promote additional layers of protection like effective air filtration.

Improving communication may disguise the reality that the CDC shapes guidance to avoid discontent with the status quo, but that’s not the same as providing the kind of protection the public expects and deserves from the CDC.

Jennifer S. Bard

Jennifer S. Bard is a professor of law at the University of Cincinnati College of Law where she also holds an appointment as professor in the Department of Internal Medicine at the University of Cincinnati College of Medicine. Prior to joining the University of Cincinnati, Bard was associate vice provost for academic engagement at Texas Tech University and was the Alvin R. Allison Professor of Law and director of the Health Law and JD/MD program at Texas Tech University School of Law. From 2012 to 2013, she served as associate dean for faculty research and development at Texas Tech Law.

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