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Opinion: CDC needs these 4 reforms

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The CDC must undergo four vital reforms, they say Sandra Galeadean of the Boston University School of Public Health and Georgetown University Lawrence A. Guest:

On August 17, Centers for Disease Control and Prevention (CDC) Director Rachel Walensky acknowledged the CDC’s flawed response to the COVID-19 pandemic and announced restructuring the entire agency.

We commend Walensky for having the courage to review and rethink the agency’s structure and organizational culture. While we recognize that it is much easier to criticize complex organizations from the outside, and much more difficult for those charged with formulating and implementing the agency’s mission, we propose four reforms that we believe are vital to restoring CDC as a premier agency. health of the country.

The country’s public health system was in decline for decades, with funding for core functions cut over several presidential administrations and professional staff feeling exhausted and underappreciated during Pandemic of the coronavirus infection covid-19. The underfunded, fragmented health system, where federal, state and territory jurisdictions often collide, was already showing signs of faltering and barely contained Ebola in 2014, when travel-related cases emerged from West Africa.

Faced with COVID-19, the biggest public health crisis during our lifetime the United States has been one of the world’s worst performers. From faulty COVID-19 test kits at the start of the pandemic and weak data systems throughout to confusing health reporting, the CDC has failed to meet a moment of unprecedented health crisis. And the agency repeated many of the same failures during the ongoing monkey pox response. The nation needs a high-level 9/11-style commission to learn lessons from COVID-19. But for now, we’re offering a perspective on what the agency’s exact weaknesses are and how that can lead directly to solutions in four critical areas.

1. Professional health communication and inclusive engagement

Clear and authoritative health information is perhaps the most important responsibility of public health, particularly during emergencies. And yet, the national and perhaps the world’s leading public health agency has stumbled time and time again conveying useful and timely information– from airborne transmission, masks and isolation to closing businesses and schools. Poor communication was also a feature of the monkeypox response, particularly for the LGBTQIA+ communities most at risk. CDC has an organizational culture and capabilities that favor peer-reviewed research expertise over health education. And the agency has failed to get its messages heard and believed in the age of social media, where ideas spread quickly in distilled form, quickly overwhelming complex messages that are buried deep on many web pages.

How does the agency solve this problem? Clearly, CDC should have its own experienced communications experts who are actually in charge of communications. In addition to such expertise, the agency needs to be structured to ensure that the director or his designee can communicate quickly and effectively about rapidly evolving threats and that the agency’s full suite of communications materials is quickly responsive to those messages. Ensuring effective health communication also requires ongoing active and inclusive engagement with at-risk communities. Meaningful engagement also requires an agency to invest in staff who build relationships that can facilitate communication long before a crisis creates the need for rapid communication.

2. Strong leadership in the face of jurisdictional challenges

One of the glaring challenges facing the NHS during COVID-19 has been the fragmentation of the US public health system. While the CDC is the national health agency, states, tribes, and territories have their own health departments and jurisdictional responsibilities. Our constitutional construction favors state, tribal, and local health authorities. CDC cannot participate in many jurisdictions unless invited to do so. It cannot compel government agencies to share data. This has led to the proliferation of different approaches to COVID-19 across the country, which has played a huge role in sowing confusion and mistrust.

We recognize that this problem extends far beyond CDC, but only CDC has the moral and regulatory authority to create partnerships that avoid chaotic and disparate responses across the country when faced with future health emergencies. Essentially, the country would be well served, especially early in a crisis, by a federal agency that speaks clearly and on behalf of the entire country, and partners across the country align their messages and actions with CDC’s messages and actions. Even if there have been differences in national approaches, such differences may well be explained by a broader, coherent framework that was simply absent during COVID-19. Achieving greater national cohesion will require significant efforts to build partnerships and systems of coordination and communication well in advance of the next crisis. It also requires a significant federal investment in CDC staff, who are tasked with building the necessary coalitions and activating them as needed.

3. Modern data systems

The result of a fragmented public health system across the country is data fragmentation across the country. Time and time again, the CDC has failed to provide timely and authoritative policy recommendations based on sound evidence. Therefore, streamlined and modernized data systems across the agency and across the nation’s public health agencies must become a worthy priority. Even more challenging will be the need to integrate data from clinical settings across claims databases and electronic health record systems. While the CDC can’t force states to share data, it can to stimulate the state report data and coordinate with other federal agencies, including Medicaid, Medicare, and the Veterans Affairs Administration. In addition to having comprehensive data and up-to-date data systems, the agency must ensure that it has the expertise to make optimal use of that data. Public health agencies in general, and the CDC in particular, lag behind private sector actors who have ready access to approaches such as artificial intelligence to find patterns in data. Several public sector agencies, such as the Department of Defense, are investing heavily in these approaches, and CDC should do the same. This will require significant investment in modern data systems and a new, data-driven approach to CDC functions going forward.

4. Updating the workforce

CDC has long prided itself on having the best public health workforce in the world. We deeply admire the CDC staff who have worked tirelessly throughout the COVID-19 pandemic in the face of harsh (and often unwarranted) criticism in the public sphere. One can celebrate the excellence of the CDC staff while recognizing that the public health needs of the world are changing faster than the ability of our staff to meet these challenges, especially with emerging pathogens that are rapidly spreading.

This is a moment to honestly assess the skill sets currently at CDC, the skill sets needed to complement and expand them, and how to create a pipeline of future CDC employees who are ready to stay ahead of public health threats. There is a wide range of expertise that appears to be weak or absent at CDC, including mathematical modeling, systems and data science, high-end laboratory techniques, and “omics” capabilities (the ability to rapidly characterize a range of biological molecules to better understand organisms). If the CDC had this in-house expertise, it would do a much better job, for example, in developing a rapid test for COVID-19, identifying variants of SARS-CoV-2, and making more accurate predictions of infectious diseases.

The agency’s failure to be the first and most authoritative in all of these areas has had a profound impact on CDC’s functioning as well as the public’s perception of the agency during COVID-19. This will require an honest wholesale assessment of what the public health workforce will look like in the future and the implementation of a plan to get there. It won’t be easy, especially with low employee morale and a long-standing culture of doing things a certain way. A remote work culture, with most CDC staff located outside of Atlanta, Georgia, [home of the CDC’s headquarters], contributed to the CDC’s problems. Changing the organizational culture will not be easy or popular, but it is absolutely necessary if CDC is to meet its purpose in the 21st century.

Walensky’s overhaul of the CDC is a defining moment for the agency’s future. We will encourage a reform process that is transparent and evidence-based, focused on maximizing public health impact. Therefore, the reform process must begin with a clear definition of what needs to be fixed and what the objectives of the renewed agency should be. But the CDC update can’t just happen in Atlanta. It will require a statewide approach, and a nation that wants the agency to succeed and will do whatever it takes to help it succeed. If the COVID-19 pandemic has taught us nothing else, it’s that our collective well-being and safety are closely tied to a highly professional national health agency. The CDC has always been the envy of the world. There’s a reason that from China to Africa to Europe, national or regional agencies take their name from the US CDC. We now have a shared responsibility to reimagine the CDC to once again make it the world’s premier public health agency.

(A version of this article was originally published in Milbank Quarterly August 23.)

Source: Boston University

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