Reviving the US CDC

The Lancet
May 16, 2020 Volume 395 Number 10236 p1521-1586, e83-e89
https://www.thelancet.com/journals/lancet/issue/current

 

Editorial
Reviving the US CDC
The Lancet
The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

The US Centers for Disease Control and Prevention (CDC), the flagship agency for the nation’s public health, has seen its role minimised and become an ineffective and nominal adviser in the response to contain the spread of the virus. The strained relationship between the CDC and the federal government was further laid bare when, according to The Washington Post, Deborah Birx, the head of the US COVID-19 Task Force and a former director of the CDC’s Global HIV/AIDS Division, cast doubt on the CDC’s COVID-19 mortality and case data by reportedly saying: “There is nothing from the CDC that I can trust”. This is an unhelpful statement, but also a shocking indictment of an agency that was once regarded as the gold standard for global disease detection and control. How did an agency that was the first point of contact for many national health authorities facing a public health threat become so ill-prepared to protect the public’s health?

In the decades following its founding in 1946, the CDC became a national pillar of public health and globally respected. It trained cadres of applied epidemiologists to be deployed in the USA and abroad. CDC scientists have helped to discover new viruses and develop accurate tests for them. CDC support was instrumental in helping WHO to eradicate smallpox. However, funding to the CDC for a long time has been subject to conservative politics that have increasingly eroded the agency’s ability to mount effective, evidence-based public health responses. In the 1980s, the Reagan administration resisted providing the sufficient budget that the CDC needed to fight the HIV/AIDS crisis. The George W Bush administration put restrictions on global and domestic HIV prevention and reproductive health programming.

The Trump administration further chipped away at the CDC’s capacity to combat infectious diseases. CDC staff in China were cut back with the last remaining CDC officer recalled home from the China CDC in July, 2019, leaving an intelligence vacuum when COVID-19 began to emerge. In a press conference on Feb 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, warned US citizens to prepare for major disruptions to movement and everyday life. Messonnier subsequently no longer appeared at White House briefings on COVID-19. More recently, the Trump administration has questioned guidelines that the CDC has provided. These actions have undermined the CDC’s leadership and its work during the COVID-19 pandemic.

There is no doubt that the CDC has made mistakes, especially on testing in the early stages of the pandemic. The agency was so convinced that it had contained the virus that it retained control of all diagnostic testing for severe acute respiratory syndrome coronavirus 2, but this was followed by the admission on Feb 12 that the CDC had developed faulty test kits. The USA is still nowhere near able to provide the basic surveillance or laboratory testing infrastructure needed to combat the COVID-19 pandemic.

But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets—vaccines, new medicines, or a hope that the virus will simply disappear. But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today’s complicated effort.

The Trump administration’s further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic. Americans must put a president in the White House come January, 2021, who will understand that public health should not be guided by partisan politics.