Commentary: CDC is a national treasure; it must be reformed

As expert as its staff is, underfunding and bureaucracy hobbled its response to this pandemic.

By Saad B. Omer / Special To The Washington Post

As the Covid-19 pandemic ravages communities, the federal agency responsible for outbreak control, the Centers for Disease Control and Prevention, is conspicuously absent from leading the U.S. response. There’s now a cottage industry of plans for opening up America in the midst of the pandemic. But any plan that will keep us safe in the long run will have to include reforming the CDC.

The men and women at the CDC are some of the most well-trained and dedicated civil servants in the country. But even those of us who have been cheerleaders for the CDC’s role in keeping America and the world safe recognize the need for fixing this venerable institution.

It is reasonable to ask why the CDC was unable to quickly develop and scale up testing for SARS-CoV-2. Why was there no backup plan? How come SARS-CoV-2 circulation in many parts of the United States remained undetected by the CDC’s early warning systems for at least several weeks after January? Why did the CDC not take the lead in developing, or at least systematically collating, projection models for the pandemic’s spread, which would have decreased confusion among decision-makers and the public?

If we want to avoid asking similar questions again the next time a new virus appears, the CDC needs some changes.

Over the years, there has been a substantial expansion in the types of activities the CDC is involved with. The federal agency whose original name was the Communicable Disease Center now deals with issues ranging from birth defects to injury prevention. Critics have charged that this expanded focus has resulted in dilution of the CDC’s outbreak response mission. The CDC should not ignore other health issues such as obesity and noncommunicable diseases. But it cannot afford to lose focus as the nation’s insurance policy against infectious disease threats.

Reform efforts should focus on increasing CDC’s infectious disease laboratory capacity and enhancing its expertise in scaling-up testing during public health emergencies. One of the most effective ways to get ahead of outbreaks is to have a highly sensitive epidemiological surveillance system. CDC currently maintains several surveillance systems, but they were of limited utility as early warning systems for Covid-19. CDC will have to reassess the data it acquires, how fast these data get transmitted and what analytical tools it uses to detect signals. CDC will also have to modernize the types of data it routinely uses. For example, rapidly sequencing and analyzing genomes of circulating viruses can provide important information, such as where the virus was imported from. To better prepare for fast-spreading outbreaks, CDC will have to expand the use of genomic epidemiology and other modern tools for surveillance.

The CDC also badly needs more money, and Congress has to change the way it funds the agency. Public health investments yield very high returns: For every dollar spent on prevention, there is a five times return on investment within five years. Despite this, Congress has tried to fund public health on the cheap. As a result, the CDC has been chronically underresourced. For example, CDC’s Public Health Emergency Preparedness (PHEP) program that supports states and local areas in their preparations for pandemics and other emergencies has had its funding shrunk from $940 million in 2002 to $675 million in 2020. PHEP funds can be used to develop laboratory and contact tracing capacity; which could have come in handy in this pandemic.

CDC’s programs are micromanaged by Congress through detailed line-item budgeting, which means lawmakers and their aides have undue influence over CDC priorities. A stroll through the CDC campus can be illustrative: You arrive at the (Rep. Edward R.) Roybal campus to check in at the (Sen.) Tom Harkin communication center to walk to the (Sen.) Arlen Specter Emergency Operations Center. The instinct to appease political leadership was criticized by the National Academy of Sciences during another infectious disease emergency: the smallpox bioterrorism threat in 2005. A nimble, evidence-driven CDC would require flexibility in resource allocation based on scientific acumen and experience of public health professionals, rather than ideological leanings of vested interests.

The Epidemiological Intelligence Service (EIS), CDC’s flagship training program for its staff, needs to be modernized. This postdoctoral program trains CDC scientists in epidemiologic field work through a combination of classroom training and experiential learning. Career CDC leaders usually come from this cadre of staff; it is rare for a non-EIS trained CDC staff to rise to the senior echelons.

EIS officers are trained in conventional methods for investigating and responding to outbreaks, such as fast-paced studies that compare exposures among those with illness labeled as “cases” and those without disease labeled as “controls.”

But the science of disease control has evolved substantially and now includes tools such as advanced mathematical modeling, genomic epidemiology, and high-end laboratory methods. CDC does employ scientists with expertise in these and other emerging subfields. These skills are increasingly so seminal to modern disease control approaches, though, that they should be a major part of the core EIS training requirements. Moreover, EIS officers should be well-versed in the science of behavioral interventions; designing a smart social-distancing strategy is as much about human behavior as it is about biological characteristics of the virus.

Just over a year ago in a U.S. Senate committee hearing, I was asked about the value of the CDC. Without hesitation, I described the CDC as a national treasure. I continue to believe this. And it is precisely because I have such faith in the abilities of the men and women of the CDC that I know we must reform this American institution of global significance. We need it to be as excellent as it can be.

Saad B. Omer is director of the Yale Institute for Global Health and a professor at the Yale University schools of medicine and public health.

Talk to us

More in Opinion

Catherine Berwicks loads ballots into a tray after scanning them at the Snohomish County Elections Ballot Processing Center on Tuesday, Aug. 4, 2020 in Everett, Wa.  (Andy Bronson / The Herald)
Editorial: Remove unhelpful ‘advisory’ measures from ballots

The measures provide no useful information to lawmakers and offer no context to inform voters.

toon
Editorial cartoons for Wednesday, Jan. 27

A sketchy look at the news of the day.… Continue reading

Ian Terry / The Herald

Brian Henderson, of Renton, plugs in his Kia Soul EV electric vehicle at a charging station in Sultan on Wednesday, June 7. Henderson and a group of fellow electric car drivers made the trip from Everett's City Hall to Spokane's City Hall late last week in an effort to raise awareness about convenient charging locations along U.S. Highway 2.

Photo taken on 06072017
Editorial: Yes to gas tax hike, but this has to be the last

Transportation needs must be funded, but the gas tax is dwindling as a sustainable revenue source.

Arlington Fire Chief Dave Kraski outside Station #46 downtown. (Arlington Times)
Editorial: Arlington voters should approve fire agency merger

Merger of its fire department with North County Fire will maintain those services affordably.

The U.S. Capitol building is prepared for the inauguration ceremonies for President-elect Joe Biden as the "Field of Flags" are placed on the ground on the National Mall on Monday, Jan. 18, 2021. in Washington, DC. Approximately 191,500 flags will cover part of the National Mall and will represent the American people who are unable to travel to Washington, for the inauguration. (Joe Raedle/Pool vias AP)
Editorial: The oath we must take after every election

We can’t address solutions to our challenges until we accept the election of those who represent us.

Comment: Biden’s amnesty won’t bring new wave of immigrants

Things have changed since Reagan’s amnesty. Economic conditions have improved and rules are tougher.

Saunders: BIden, seeking unity, should let Catholic charity be

Supreme Court decision should have ended efforts to force group to offer contraception to staff.

Vote in the Feb. 9, other elections

The Arlington Fire Department will ask Arlington voters to vote by Feb.… Continue reading

Sound Transit light rail’s detour Boeing no longer viable

I couldn’t help but laugh reading your article (“Sound Transit projects ahead… Continue reading

Most Read