CDC Director Dr. Rochelle Walensky on Revamping the CDC

TThe U.S. Centers for Disease Control and Prevention was not ready for COVID-19. After more than two years, it still isn’t. The CDC’s response to COVID-19 has been widely criticized as slow, confusing, and mostly ineffective.

This is the moment when the agency takes a serious look at itself. On Aug. 17, CDC director Dr. Rochelle Walensky proposed sweeping changes in how the agency communicates with Americans and publishes data—two of its most critical roles as the nation’s leading public-health agency.

“I don’t think moving boxes around on an organization chart will fix the problem,” she tells TIME of the changes, which she has already begun to implement. “What we’re talking about is a culture change. We’re talking about timeliness of data, communication of data, and policies guidance. Reorganization is hard, but I think this is even harder than that.”

It took several months for the revamp to be completed. Walensky demanded an agency-wide review in April 2017, just more than a full year since he took over as director. While previous directors have ordered such reviews to assess the CDC’s operations, this particular analysis was especially urgent because of the pandemic and low trust in the CDC, after the Trump Administration sidelined the agency, ignored its advice, and at times contradicted its guidance. Walensky sought honest feedback from more than 200 staff, academics and outside experts.

Walensky stated that while the results of her review have not been released to the public yet, they were sobering, but not unexpected. “To be frank, we are responsible for some pretty dramatic and pretty public mistakes, from testing to data to communications,” she said in a video message to CDC employees, which TIME viewed.

Here’s what Walensky says went wrong—and how she plans to improve the CDC.

A need for nimbler data

The CDC “has been developed on an infrastructure of academia,” Walensky says. Until COVID-19 forced the agency into the spotlight, the CDC’s target audience was mostly other public-health experts and academics, and its main mode of communication was through periodically publishing scientific papers. “In these pandemic moments, we found ourselves having to talk to a broader audience,” Walensky says. “We didn’t have to convince the scientific audience—we had to convince the American people.”

Americans demanded accurate, timely and current information regarding how they should deal with this new virus. But since the very start of the pandemic, the CDC’s advice has seemed confusing and often contradictory—especially around how the virus spreads, who should wear masks, and what types of face coverings are most effective. It was slow to provide critical information on how contagious SARS/CoV-2 is. “We all didn’t like the headlines, especially when we knew all of the good work that was going on,” says Walensky about media coverage of the CDC’s missteps. “So how do we address the challenge of what people are saying about us?”

Walensky stated that she now pushes for the CDC’s collection and analysis of data to be more efficient in order to quickly convert this information into useful advice. Researchers relied more heavily on preprint servers during COVID-19. They published COVID-19 scientific studies before experts reviewed them and verified their validity. “The peer-review process generally makes papers better,” she says, “but it is also the case that if you’re trying to take public-health action with actionable data, then you don’t need the fine-tuning of peer review before you make [the results] public.”

She and her team are discussing ways to post data that would be relevant to the public earlier—not to replace the peer-review process, but to supplement it, so that both the public and health experts can see the evidence on which the agency is basing its recommendations. The agency may upload the data on a preprint site or publish separate technical reports in order to differentiate the initial data from the peer-reviewed final product.

Currently, the agency’s advice is only official once it is published in the CDC’s publication, MMWRThis is a lengthy process that requires peer-review. Walensky states that such data should be available faster in an emergency situation. “I have called journal editors and said, ‘I know we have a paper under review, but the public needs to know, and I am going to break this embargo,’” she says.

This was the result of data collected at an indoor event in Barnstable (Mass.) last July. The results showed that vaccinated individuals were becoming infected even though their mask policies had been relaxed. The CDC then recommended wearing masks in public areas before publishing the study. MMWR. Another instance: CDC scientists also had data regarding the effectiveness and safety of vaccines. MMWRThe information was revealed by the U.S. Food and Drug Administration to a group of vaccination experts.

“We can’t be loose with the data,” she says. “But there needs to be something between dotting every YouCrossing every T.”

Better, clearer messaging

Clear, unambiguous language is key to make such data easier to understand. In her video message to employees, she stressed that producing “plain language, easy-to-understand materials for the American people” would become a priority, along with making sure scientists develop talking points and FAQs.

They’ve already started putting this into practice, she says, pointing to the CDC’s revised Aug. 11 isolation recommendations. Compared to past guidance, the new version is written more for the public and addresses people’s practical concerns, such as when to start counting isolation days and which precautions to take in the home, she says.

Walenksy believes that the culture change Walenksy hopes to make is a simple one-question question. “We really need to talk about public-health action, and not just public-health publications,” she says.

That won’t happen overnight, she acknowledges. But now that other viral diseases—including monkeypox and even polio—have joined COVID-19, the stakes are high for CDC to catch up fast. The agency is still being criticized by doctors, public-health professionals, and the public because it made the same errors as COVID-19 with the handling of the monkeypox crisis. The data on monkeypox victims is still very slow. “To this day, we have race and ethnicity data on less than 50% of monkeypox cases,” she says. “We’re still working on getting complete case report forms and still working on getting immunization data.” Testing for monkeypox was also not widely accessible for months—delays reminiscent of the early days of COVID-19—because the agency’s testing protocols were too long and inefficient to combat a rapidly spreading virus. But, Walensky says, “within a week of the first case, we were reaching out to commercial labs to expand testing capacity quickly.”

The changes she’s implementing won’t be immediately apparent to the public, but she’s confident they will eventually lead to clearer communication and faster data on emerging outbreaks. “People won’t wake up after Labor Day and think, everything is different,” she says. “We have a lot of work to do to get there.”

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