More than a reorg: the CDC needs a new mindset
The fact that Covid will remain a part of life well into the future represents both a public health failure and an opportunity. The CDC’s missteps are well documented, and so are Americans’ frustrations. Its leaders have committed to reforms — but will the changes solve root problems or band-aid the symptoms? Will the Director’s pledge to reorganize be enough to ensure the agency will protect us from the next pandemic?
Others have prescribed fixes: the CDC must move faster, communicate more clearly, and modernize its systems. But from my vantage point as the CEO of a disease detection company, which in March 2020 spotted the emergence of Covid-19 weeks before the public health system, it will take even more.
A CDC capable of anticipating rather than reacting to the next public health threat will need to evolve. First, it needs to think of itself as an action agency, not a research institution. Second, it needs to embrace the innovation of others, especially in the realm of data and informatics, and work with the private sector rather than snubbing it. Finally, it needs to embrace a market-based approach to public health.
Right now the CDC acts like a university, rather than as the Department of Defense Against Emerging Bio-threats. While its professionals are undeniably talented and committed to its mission, the agency’s long-standing culture hampers its impact. Some staff are promoted based on whether they publish research articles, not on whether they save lives. They’re incentivized to keep data close. There’s little cover for taking calculated risks. The CDC would rather be right than be fast — and all too often, it is neither. Just look at the convoluted messaging around whether or not to wear masks or who should get booster shots.
By refusing to work with the private sector, it takes all the risks of fumbling on itself. When it tried to create its own Covid test, it didn’t work. Instead of purchasing existing versions, this misadventure critically delayed the nation’s ability to track the virus. Its data is only as good as its data sources, but unfortunately, it has always been two steps behind the virus. That’s because it relies on lagging indicators like case counts, test results and hospital reports, which tells you what happened weeks ago. It needs an early warning system, not a “Huh? What just happened?” chart.
This has already been developed by the private sector. Startups like Kinsa and Bluedot had already developed next-generation illness tracking systems. Sadly, those advancements sit on the shelf because the CDC is stuck in a hyper cautious past and does not know how to engage the private sector. If NASA can use SpaceX rockets to supply the space station, what’s holding the C.D.C. back?
One key reason is the CDC’s skepticism of the private sector. As a result, the agency misses out on a great deal of innovation. This sufficed in the past, when the public sector was the center of scientific research and development. In a bygone era, the government was responsible for major health advancements, from food safety to fluoridating drinking water. But these developments weren’t developed and deployed at the speed of a pandemic. Startups and large companies alike, rather than the government, are producing the advancements that have actually helped us overcome this pandemic and are positioning us to get ahead of the next, like reliable tests and groundbreaking vaccines.
However, the CDC still has a powerful tool up its sleeve: the ability to create markets for public health solutions. One such market-based mechanism, often termed Advanced Purchase Commitments (APC) or Advanced Market Commitments (AMC), uses competition to its advantage. In this model, the government clearly defines a problem that needs to be solved and commits to paying for solutions (for example, a data science approach, a new vaccine, or other innovation), thus incentivizing the private sector to compete with each other to deliver higher quality, lower cost solutions.
This has worked in many areas of global health, such as expanding access to HIV drugs in developing countries. It worked during Operation Warp Speed. It even worked for monkeypox: the government took bids from vaccine companies to produce millions of doses of a new, safer smallpox vaccine in case of a bioterrorism threat — and it turned out to be useful in stopping an epidemic we had not anticipated. If the private sector had not been mobilized years ago, monkeypox would be a much greater threat than it now is.
Other branches of government do this all the time. The Pentagon does not build tanks or planes, it makes private companies compete to do it. But this model is the exception rather than the norm at the CDC. By regularly failing to embrace private sector innovation and market solutions, the CDC remains dependent on universities. Universities have also become cautious, lethargic bureaucracies and many of their best minds decamp to form private-sector companies. If Operation Warp Speed had contracted with universities, we would still be waiting for a vaccine.
The CDC needs to rein in its ego, change its academic mindset, get over the pervasive misconception that profits are evil and harness the innovative power of the private sector to help it do its job faster and better. Since new pandemics are always on the way, our lives may depend on it.
