Resident Physician, George Washington University
Alonzo and Virginia Decker Professor, Johns Hopkins University
By Brian J. Miller, Niraj Gowda, Padmini Ranasinghe, Phillip Phan, Theresa A. Cullen, and Boris D. Lushniak
The COVID-19 pandemic marks the greatest public health crisis since the 1918 influenza pandemic, with more than 1,000,000 Americans dead and more than one in three of those previously infected with COVID-19 suffering from long-term ill-effects. Historically, the Centers for Disease Control and Prevention (CDC) has played a pivotal role in planning for, participating in, or leading both domestic and international responses to disease outbreaks. Recent successes include responses to the 2001 Anthrax attack, the 2009 H1N1 influenza strain, and the 2014 Ebola outbreak. Key to historic successes in our country’s public health emergency responses has been a political understanding that public health security is national security.
The scale and scope of the COVID-19 pandemic has overshadowed past success and exposed longstanding challenges in the CDC, which functions as the US’s public health fire department. While the agency succeeded in creating a contact tracing playbook for local and state health officials and industry-specific guidance (such as for the meat and poultry industry), in other areas it has exhibited dual strategic and operational failures in launching a single channel diagnostic testing strategy and an inability to follow its own recommended best practices in crisis communication. These failures have resulted in conflicting messaging regarding non-pharmaceutical interventions, quarantine and isolation guidelines, and challenges with pharmaceutical supply chains.
Policy experts and stakeholders have proposed oversight boards, technology infrastructure, and increased funding. None of these ideas alone will work to effect permanent positive change ensuring that the agency can retake its place as the nation’s and the world’s premiere public health agency. With Democrats and Republicans calling for institutional reform, along with the current CDC director, there is an opportunity to constructively re-focus the CDC on its historical mission. Our nonpartisan group of public health practitioners, policy experts, and clinicians suggest a path forward. We propose a three-pronged strategy for supporting and reforming the CDC: a return to the agency’s founding mission, a tight focus on communicable disease policy and supporting programs, and a readiness-oriented staffing model built around a reinvigorated the US Public Health Service ( USPHS).
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