Cultural, structural changes to shift focus from scientific publishing to public health action.

cdc to restructure after covid failure, “confusing and overwhelming” guidance

/ CDC Director Rochelle Walensky testifies during a Senate committee hearing in July 2021. Stefani Reynolds-Pool/Getty Images

After persistent and often harsh criticism for its handling of the COVID-19 pandemic and now the monkeypox emergency, the Centers for Disease Control and Prevention will undergo a significant overhaul, involving cultural and structural changes aimed at realizing its prior reputation as the world’s premier public health agency.

“For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” CDC Director Rochelle Walensky said in an email to CDC’s 11,000-person staff Wednesday, which was seen by The New York Times and Stat News. “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”

Though the CDC endured meddling and undermining during the Trump administration, many of the agency’s pandemic misfires were unforced errors—such as the failure to stand up reliable SARS-CoV-2 testing in the early days and muddled messaging on masks. In a meeting with senior staff Wednesday, Walensky made a startling acknowledgement of the failures while outlining the overhaul in broad strokes.

The cultural changes appear aimed at stamping out pedantic data analyses that have slowed and hampered the agency’s public health responses. A briefing document provided to the Times said the goal is for CDC staff to “produce data for action” as opposed to “data for publication.” As such, the agency will cut down on the time allowed to review studies before they’re released. The agency will also change the way it grants promotions to staff, placing more emphasis on public health impact rather than the number of scientific publications.

Public health impact

The CDC will also focus on improving health messaging to the public, which the briefing document described as “confusing and overwhelming” during the pandemic. Future communication will aim to be “plain language, easy to understand.”

As for structural changes, two scientific divisions in the agency will now report directly to Walensky’s office. Walensky will also create a new executive council, which will report to her as well. The council will help set agency priorities and direct spending of the agency’s $12 billion annual budget using a “bias toward public health impact.” The changes will also include the creation of an equity office. Last, the agency will expand emergency response teams and require members to stay in their positions for at least six months. Previously, staff members were allowed to rotate out of teams after just a few months, slowing and confusing a team’s response efforts.

Walensky announced the appointment of Mary Wakefield, an Obama-era health official, to lead a team to implement and oversee the agency’s overhaul. The overhaul may also require the CDC to get more data from states and jurisdictions, which it currently does not have the power to require. Walensky reportedly suggested that she plans to ask Congress to mandate data-sharing with the CDC.

The overhaul comes after Walensky received the results of an external review of the agency, which she ordered in April, conducted by James Macrae, a senior official with the Department of Health and Human Services. Macrae’s review included interviews with 120 CDC staff as well as external experts.

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