CDC director discusses efforts to reform the agency amid COVID, monkeypox criticisms

Two and a half years into the pandemic, CDC Director Rochelle Walensky is calling for a major overhaul of the agency. The changes would attempt to modernize operations and improve health messaging amid criticism over how the CDC managed COVID-19 and the monkeypox outbreak. Dr. Walensky joined Amna Nawaz to discuss the proposal.

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  • Amna Nawaz:

    Two-and-a-half years into the pandemic, CDC Director Dr. Rochelle Walensky is calling for a major overhaul of the agency. The changes will attempt to modernize operations and improve health messaging.

    All of this comes amid heavy criticism over how the agency has managed the COVID-19 response and now the response to monkeypox as well.

    Dr. Walensky joins me now.

    Doctor, welcome back to the "NewsHour." Thank you for joining us.

    You have come right out…

  • Dr. Rochelle Walensky, CDC Director:

    Thanks.

  • Amna Nawaz:

    … and you have said that the CDC failed to meet the moment, right, that ambitious reforms are needed, as you have put it. You have to make the agency more nimble, more responsive to emergencies.

    That is a huge task. So could you be more specific? What's the priority? Where do you begin?

  • Dr. Rochelle Walensky:

    First of all, thanks so much for having me.

    Look, in its 76-year history, CDC CDC has never confronted an outbreak the size and scope of what we have to confront for COVID-19. And I think what was clear is that we didn't reliably meet the expectations in the moment.

    And so now what I really am calling for is to pivot to a new action-oriented, public health action-oriented culture, where we're emphasizing accountability, collaboration, communication, and timeliness of the information we're putting forward.

  • Amna Nawaz:

    But changing culture is an enormous task, right?

    I just want to put to you some assessment that we have heard from some folks. Jay Varma, who, as you know, is a 20-year CDC vet, talked about this culture. And this is what he said — quote — "It's an agency run by geeks," he said. "It's run by doctors and Ph.D.s. What are doctors and scientists notoriously bad at? Managing," is what he said.

    Is he right? Is there some truth to it? And does that mean you have to change your team?

  • Dr. Rochelle Walensky:

    You know, I have an exceptional agency full of exceptional subject matter experts, some of whom are geeks.

    And then I embrace that, because those are the people who are doing the hard science that we need to do every day. What I will say is that some of the structures and systems and policies that we have in place have not allowed us to be — to navigate in a nimble fashion.

    For example, we have infrastructure in place that promotes people for public health publications. Some of those publications take a long time. But if our promotion process relies on publications, then we're incentivizing based on publications, not rapid action, not deployment.

    And some of the — some of those are the structures that we're actively working on to say, how is it that we can get that information out faster and still have you promoted to — for the good work that you're doing?

  • Amna Nawaz:

    Do you need more funding as well? And do you think that there's political appetite to offer more funding to an agency that didn't effectively respond to the pandemic?

  • Dr. Rochelle Walensky:

    You know, this is not something where we're asking for money in this moment.

    What I will say, though, is one of the things that we are asking for is long-term, sustainable resources, resources that are nimble. So, if we have many different line items that are disease-specific, it is hard to be nimble for those in a moment where we have a new public health outbreak.

    So a lot of what this reset is going to do is to elevate those key public health components, those key public health infrastructure, like our work force, like our data modernization efforts, like our testing and laboratory capacity, so that those really are overarching import at the CDC and truly public health across the country.

    It is the case that we don't know what the challenge, the public health challenge of tomorrow will be, but if we have a nimble public health infrastructure that is sustainably funded, that is a disease-agnostic, that focuses on our work force and our lab and our core capabilities, then we have the opportunity, whatever is thrown our way, to pivot and be in really good shape.

  • Amna Nawaz:

    So, speaking of things thrown your way, there are concerns about the response to the monkeypox outbreak, and they are worryingly similar to a lot of the concerns about the COVID response.

    People we have talked to this summer would tell us that they'd been exposed and they didn't know where they could get a test. They couldn't get clear answers on how they should behave or how they could get treatment.

    Local health officials are now saying the guidance from the CDC on vaccines is confusing, and it's not working, and it's setting them back in their response.

    So why didn't the lessons from the early COVID response work their way into the monkeypox response now?

  • Dr. Rochelle Walensky:

    You know, I think that there are some similarities and some parallels, though, and some dissimilarities that we can take in comparing COVID to monkeypox.

    Some of the things that were dissimilar were that we had a test for monkeypox. We — almost as soon as we had a case, we put online the paper that demonstrated what that test was and how one could design that test.

    And that is because we have had decades of work ongoing in the monkeypox area. This was not a new pathogen, but it was new to this country. It was new to every clinician around this country who had never likely seen a case of monkeypox, and it was new to the community who'd likely never heard of monkeypox.

    So we had a huge amount of education to do. There was also challenges because people had been understanding how we operate in COVID. How do I go get a test for COVID if I'm asymptomatic? Well, you can go and get a swab or you can do an antigen test. That's not possible in monkeypox. You need a rash in order to do a test for monkeypox.

    So this was a lot of the education and outreach that we were doing. We scaled up testing. We have to this day not had more — a desire for testing than we have had tests available. But we have had access challenges in getting to those tests. And that's been a lot of what we have been working forward.

    The other challenge that we have had that is true for COVID, was true for monkeypox is our visibility in the data. And we're working really closely with our public health partners across the country. We at CDC cannot compel those data to come in. We rely on the voluntary reporting of data in cases, in vaccination, in breakdown of demographics for us to receive those data.

    And that has been a real challenge. It was a challenge in COVID. It has again been a challenge for monkeypox for the CDC.

  • Amna Nawaz:

    But, Dr. Walensky, to drill down on this, though, when you look at the numbers — I mean, to educate the public and to get the word out on monkeypox is one thing.

    The response, I think, we can say fairly, is another that. The first U.S. case was recorded in mid-May. The cases are now at over 16,500. And a lot of people are saying, it didn't have to be this way.

    So was there, should there have been something different the CDC did to keep the numbers from getting where they are?

  • Dr. Rochelle Walensky:

    You know, I think that we have done an extraordinary job in educating, in working with our public health partners, in getting vaccine out. Again, this was a vaccine that was not intended for widespread use for this pathogen, in and of itself.

    Just this past week, we put out data before pre-publication, before it had been published, really putting data out faster, working with our public health partners. So we are learning some of the lessons that we learned in COVID-19. And we will continue to do that outreach. And I have continued to say, in areas where we can improve, please tell us where and how we can improve our outreach.

  • Amna Nawaz:

    We should point out, all of this, especially after the last two-and-a-half years of the pandemic, really means millions of people right now do not trust the CDC, right? Some polls show around 40 percent of Americans.

    And you see that in behavior with the low COVID booster uptake, very low vaccine rates among children in particular. How do you fix that?

  • Dr. Rochelle Walensky:

    You know, I came into this agency about halfway through the pandemic. And that was something that I inherited and something that we need to continue to work towards.

    There has been politicizing of the CDC. Among the challenges that I inherited, some challenges early on, some challenges that I too have to own. But what I will say is, one of the things that we have to do is work on our communications.

    And this has been one of the issues that came through in our review. And there are several things related to that. One is, for the most part, prior to this pandemic, CDC was talking to scientific experts. They were talking to public health experts. And through this pandemic, it has become very clear that we're now talking to the American people.

    We need to distill the science that we're learning to the American people, so it's actionable, and it's implementable, it's understandable and accessible.

    The other thing that has been really challenging through this pandemic is that the science has changed. That which was true for the original variant, for the Alpha variant was not true for the Delta variant and the Omicron variant. And so we have had to shift and we have had to update our guidances in the context, not just of evolving science that's new, but also in an evolving variant that has changed.

  • Amna Nawaz:

    When you look ahead to the fall and winter, we're still in the middle of this pandemic. There's concerns about surges in cases as people spend more time indoors. We know there's going to be a fall booster campaign.

    How should people decide if they should even get that shot, especially when so many people have now been infected and have some level of immunity?

  • Dr. Rochelle Walensky:

    You know, I certainly don't want to get ahead of any FDA action.

    What I will say is, right now, we have people who are not yet fully up to date on their vaccines. They haven't received a booster. And we do know that we continue to see 300, 350 to 400 new deaths every single day and that, for the most part, as we look into those, those folks are people who are unvaccinated or undervaccinated.

    So the most important thing you can do is to stay up to date on your COVID vaccines, to get your children up to date on their COVID vaccines, because so much of what we know right now with this infection is that so many of these severe outcomes are preventable.

  • Amna Nawaz:

    CDC Director Dr. Rochelle Walensky, thank you so much for your time, for joining us.

    Appreciate it.

  • Dr. Rochelle Walensky:

    Thanks for having me, Amna.

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