National Response Agency or University? Why C.D.C.’s Culture is Doing Americans a Disservice
A warning hit the airwaves over the Thanksgiving holiday: yet another COVID-19 variant, dubbed Omicron, has been discovered — possibly more contagious than Delta — and Americans should take steps to protect themselves from another COVID surge before the holidays. Fortunately, booster shots were recently approved, giving most adults an important tool to stay safe as we gather with loved ones.
But getting here wasn’t straightforward. The booster timeline stretched all the way back to the summer. Unfortunately, the White House and CDC were sometimes not on the same page, and the evolving guidance on who would be eligible and the efficacy of mixing and matching vaccines created confusion. So what happened, and how can our public health institutions evolve to do better?
If we view the CDC — our preeminent public health institution — as a university, then its actions throughout its history make sense. But if we view it as our country’s (and the world’s?) public health response agency (which, by CDC’s definition, it is), it has sadly fallen short.
Don’t get me wrong, the CDC is full of dedicated civil servants and experts at the top of their field committed to its public health mission. But its long standing culture is doing our country a disservice.
Part one of the problem: the CDC would rather be right than be fast.
This translates to prioritizing exhaustive testing and evaluation over speedy approvals. But if boosters are a major part of the strategy to fight a potential winter surge, why couldn’t they cut to the chase sooner and authorize them for everybody as quickly as possible? Supply is no longer an issue, so prioritizing the highest-risk groups wasn’t strictly necessary. So, in this case, was the CDC acting as a policy and response agency or as a glorified research institution? The latter better explains the CDC’s actions.
Part two of the problem: the CDC would rather reinvent the wheel themselves than leverage innovation built anywhere else.
Back in the first weeks of the pandemic, the WHO shipped test kits to 57 countries — but the CDC decided to create its own, and thanks to a failed reagent, the tests didn’t work, seriously hampering the response at a critical time.
“The bigger lesson, Dr. Butler-Wu said, is that the responsibility for developing diagnostic tests should be distributed more widely during a public health emergency. Rather than relying on the C.D.C. to be the sole test developer, officials could also enlist clinical and commercial labs to create and deploy tests.”
The New York Times
Experimentation (and subsequent failure) is par for the course in an academic setting, but as the country’s policy and response agency for a global pandemic, it’s sadly inadequate.
Getting ahead of the next novel pathogen — everything from stopping an outbreak from becoming an epidemic or a pandemic to developing the next generation of vaccines — will require innovation and experimentation, and the ability to move quickly and take some risks. I am not saying that the CDC should be reckless, but the “CDC University” model likely won’t get us where we need to go.
Instead, the CDC should think of itself as a convener of the best and brightest from both government and the private sector. Imagine combining forces with a slew of companies — long established and startups alike — that can bring novel solutions to augment the CDC in all aspects of epidemic response, such as implementing early warning systems to detect emerging outbreaks and better understanding seasonal illness, and quickly developing tests and vaccines. Public-private partnerships, with CDC acting as the central coordinator between a consortium of innovative companies, is the best way to leverage decades of public health expertise with the technological advancements we need to stay safe.
So far, the CDC has been slow to embrace this way of thinking. From my own experience, it has long resisted working with the private sector. But the pandemic has shaken things up: the agency has received billions in new funding for pandemic prevention and response, and they must now figure out how to rise to the challenge. I’m encouraged by the formation of a new epidemic forecasting center, which has indicated it will look beyond the traditional way of doing things and bring more innovation to the agency. There are exciting innovations taking place across the spectrum of pandemic response — from early detection to developing diagnostics to genomic sequencing — and the CDC would be wise to efficiently employ these solutions, no matter where they are developed.
At the end of the day, I’m an optimist but also a realist. We will see another major epidemic in our lifetimes. We have a once-in-a-generation opportunity to remake our public health system and give it the resources it needs to protect us. Let’s be open minded and creative about how we do it.