The alarm bells set off by a 1997 Hong Kong bird flu outbreak, one that leapt from poultry to humans, spurred years of work to modernize pandemic planning. But the detailed frameworks that followed failed to an envision a scenario that has come to pass in 2020: the sidelining of what has long been one of the world's premier public health agencies — the U.S. Centers for Disease Control and Prevention (CDC).
The agency entrusted to lead the world's fight against Ebola earlier this decade stumbled this year with delays developing a COVID-19 test and never regained its footing. Its director, Dr. Robert Redfield, was a bit player at best at White House press briefings. The public rarely heard from the agency's world-class career scientists. Allegations of political interference at the agency and of efforts by CDC leadership to cover it up have dealt further blows to its once sterling reputation.
"A train wreck" is how Laurie Garrett, an award-winning science writer, author and member of the Council on Foreign Relations, described the CDC's current state to an editorial writer this week. A widely respected new director appointed by President-elect Joe Biden this month will help right things, but the damage done requires a broad, bipartisan effort to revitalize this global health bulwark.
This should be a priority not just for Biden but for the U.S. Congress as well. Lawmakers have begun to examine what went wrong during the CDC's pandemic response. They must go beyond that to strengthen the agency, with a top-to-bottom review of the resources and reforms the agency needs to carry out its vital mission in years to come.
"We have the world's leading public health agency and they were not allowed to do what they do best during this [pandemic], and trust in the agency has taken a big blow," said Dr. Rich Besser, a former CDC acting director who now leads the respected Robert Wood Johnson Foundation. "There has to be an intentional effort to help the public regain that trust."
Funding is a logical priority for examination. A 2017 Trust for America's Health report concluded that the CDC's core budget was essentially flat during the previous 10 years. In recent years, Congress has blocked cuts proposed in Trump budget plans. The agency's operating budget this year is just under $8 billion, up from around $7.3 billion in 2019 but less than its $8.3 billion in 2018.
Whether the agency needs additional investment is the obvious question, particularly to retain and recruit talented scientists. But another question, Besser pointed out, is whether the CDC has the flexibility it needs to move dollars around to respond to a crisis. That also merits scrutiny.
The most glaring concern is which protections are needed to prevent political interference. That a presidential administration would do end runs around the CDC during a pandemic or meddle with scientific findings shared in the agency's revered publications would have strained credulity before 2020. But these were unfortunate realities this year. New safeguards are clearly needed.
