The purpose of the article is to highlight the problems in the CDC from the unfolding of the pandemic, what efforts have been made in response to them, and possible next steps.
The article covers the many issues in the CDC. In general, the CDC suffers from lack of funding, authority, communication and unity. For example, although the CDC spans across the country, they lack the authority to ensure state cooperation or enforce measures, so their impact is severely limited. In addition, the CDC’s budget barely keeps up with inflation and is often too thinly distributed between states and the over ~200 different line items. The lack of funding means there is no money that can be used to prepare for events like Zika or COVID-19. Critics say this lack of resources and the poor coordination with other agencies (i.e. Department of Health and Human Services) results in an inflexible organization that cannot get much done.
Another issue was lack of appropriate surveillance. Most genomic surveillance labs focus on foodborne diseases, and thus had trouble adapting their tools to COVID-19. Also, the level of tracking varies widely on region, forcing CDC to use less than ideal data for very important decisions. Surveillance was further complicated by slow communication or lack thereof between health departments. As a result, some created temporary solutions such as starting new sequencing programs and encouraging collaboration with other scientists and commercial labs. These temporary solutions do not address the problems deeply rooted in the CDC’s system. The difficulty in getting departments to report serious diseases quickly and deciding what to do was first made apparent in outbreaks like the recent E. coli outbreak and the 2018 vaping outbreak. This problem was seen again in the COVID-19 pandemic when the CDC had trouble collecting, updating, tracking, and sharing data about the coronavirus, making even basic questions unknown. The CDC’s problem with data affected its advisories as well. The article focuses on the CDC’s mask guidelines, which advocated for wearing masks outside despite most experts stating that outdoor transmission was rare. The CDC also used flawed interpretation of research, which led to them stating that the risk of outdoor transmission was 10% (many times higher than other estimates), and led to them delaying their announcement that COVID-19 was airborne.
Toward the end, the article discusses possible next steps, mainly how the CDC can fix its issues. Although the CDC received an increased budget and there are efforts to reform, there is no plan to address some larger issues (i.e. leadership). The year has seen some high profile resignations, which some see as an opportunity to reform the CDC culture, while others point out that the CDC’s pride and lack of innovation are significant problems that won’t be solved that easily. The CDC receives far less funding than other agencies, which accounts for the culture and the insufficient surveillance. Therefore, the CDC’s funding system must be greatly improved so that more money is allocated to public health and money for line items can be used more flexibly. Another possible reform is giving the CDC more authority, such as forcing states to share data and enforce quarantines.
Read the full article here