The pandemic has not been the CDC’s finest hour


One of the things that this pandemic has revealed is how diminished the Centers of Disease Control (CDC) has become. This organization was once highly respected around the world and should have been front and center during the crisis because it has the expertise and resources to marshal all the information and provide guidance to the public. The experts from the CDC should have been the people holding daily press conferences, calling upon other experts in the field of infectious disease like Anthony Fauci who heads the Infectious Diseases division of the National Institutes of Health.

One of the things that is recommended during health crises is that the people briefing the public should be scientists and public health experts because they are seen as nonpartisan. When political leaders take the lead and become the face of the response, about half the country is immediately skeptical about what they recommend, thinking that there might be a political agenda behind it. The CDC would have been the natural choice for this public leadership role, the way it led during previous health threats such as the H1N1 flu pandemic and the Zika outbreak. And yet, you would be forgiven for thinking that the CDC has been AWOL during the pandemic. Even worse, in the early days it bungled the rollout of the covid-19 tests and failed to properly separate test results for the virus and for the antibodies. Its director Robert Redfield has hardly been seen. Instead we had Trump creating a task force that was headed by the vice-president. While that task force had experts like Fauci and Deborah Birx, the press conferences were soon hijacked by Trump who seemed to view them as a replacement for the rallies he so sorely misses, where he could use up all the time railing about various issues and proposing crackpot remedies.

Tim Dickinson writes that from the beginning, Redfield seemed more interested in promoting the messaging of the White House than providing the best impartial scientific advice, and that this enabled Trump to delay taking the actions that could have saved many lives.

Patty Murray is the ranking member of the Senate’s top health committee, and represents Washington state, the nation’s first coronavirus hot spot. She blames the administration for a delay that “overwhelmed the health care system and resulted in tens of thousands of deaths.” And she singles out Redfield, in particular, for “dereliction of duty.”

The background of the current head of the CDC does not inspire much confidence.

The front-line agency built to respond to a pandemic, the CDC, was placed in unreliable hands. Dr. Robert Redfield is a right-wing darling with a checkered scientific past. His 2018 nomination was a triumph for the Christian right, a coup in particular for evangelical activists Shepherd and Anita Smith, who have been instrumental in driving a global AIDS strategy centered on abstinence.

Redfield’s tight-knit relationship with the Smiths goes back at least three decades, beginning when Shepherd Smith recruited him to join the board of his religious nonprofit, Americans for a Sound AIDS/HIV Policy (ASAP). The Smiths made their views plain in the 1990 book Christians in the Age of AIDS, which argued HIV infection resulted from “people’s sinfulness,” and described AIDS as a consequence for those who “violate God’s laws.” Redfield, a devout Catholic who was then a prominent HIV researcher in the Army, wrote the introduction, calling for the rejection of “false prophets who preach the quick-fix strategies of condoms and free needles.”

Redfield’s Army career derailed after he was accused of “sloppy or, possibly, deceptive” research for touting a trial HIV therapy that later proved useless. An investigation found no wrongdoing, but called out his “inappropriately close” relationship with Shepherd Smith, who also hyped the drug. Redfield insisted there was “no basis for any of the allegations,” but the scandal spurred his departure to a research lab at the University of Maryland.

When his CDC appointment was announced in March 2018, Sen. Murray warned of Redfield’s “pattern of ethically and morally questionable behavior,” as well as his “lack of public-health expertise,” and urged Trump to “reconsider.” But the CDC post does not require Senate approval.

It would be tempting to blame the sidelining of the CDC entirely on Trump or on Redfield but Charles Seife writes that the decline of the CDC began some time ago during the presidency of George W. Bush and continued under Barack Obama, though the process has accelerated under Trump. He says that we are only now noticing how diminished the CDC has become. He says that the decline of the CDC is similar to the decline of other federal agencies that were once pointed to with pride, such as the FAA (Federal Aviation Agency) and the FDA (the Food and Drug Agency).

[T]he CDC seems baffled—bumbling, cowed, and, above all, silent. Veteran science and health journalists are stunned by the CDC’s lack of leadership in the very sort of crisis it was born to combat. As one said to CDC head Robert Redfield early last month: “You’re invisible now, sir. Your agency is invisible.”

Sometimes an agency doesn’t decline from the zenith like a falling star, but its reputation slouches, bit by bit, toward mediocrity.

Seife says that all these agencies have suffered from the lack of transparency that came with severely restricting the access that reporters used to have to their technical people. It used to be that these agencies had public phone books so that reporters could call up experts and talk to them directly. During times of crisis, you want to provide the widest access to the best information. But all those online phone directories have disappeared and now reporters have to talk to a press officer who may or may not connect them to a technical person. As a result, the administration now controls the message. This top-down control and lack of transparency has hurt the agencies’ credibility and made them less effective.

Not all American government agencies are internationally recognized for their excellence, but the ones that are have a lot in common. They attempt to base their decisions on scientific or engineering data or, at the very least, objective criteria that leave little wiggle room for political interference. They invite scrutiny; a high degree of transparency keeps them from departing from their standards on the fly. And above all, they maintain and nurture a pool of expert staff that is as good as or better than anything one can find in the commercial sector on a scale that no private company could ever hope to match. These are the attributes that make an institution healthy enough to resist the crushing political pressure that bears on all high-stakes regulatory agencies.

Yet transparency is under attack seemingly everywhere in government. The CDC has forbidden its scientists from speaking to journalists without clearance from headquarters. I’ve had to take the FDA to court to get it to release certain basic information about clinical trials—information that its European sister agency, the EMA, releases as a matter of course—deeming the records confidential. In-house experts are gainsaid by leadership or even made entirely irrelevant as their duties are passed off to the commercial sector. The FAA was dependent on Boeing employees to vouch for the 737 Max rather than independently verifying the plane’s safety itself. The FDA’s dependence on test manufacturers to vouch for the accuracy of its coronavirus tests is unlikely to have much better results.

How Trump has sidelined the CDC is revealed by what happened to the guidelines that the agency prepared in the first week of May to help businesses reopen, specifying what needs to be in place before they do. Apparently Trump refused to allow it to be released because it would slow down the reopening.

According to a report by the AP on Thursday, a new guide “created by the nation’s top disease investigators” from the Centers for Disease Control and Prevention titled “Guidance for Implementing the Opening Up America Again Framework” was set for publication last Friday. But, according to a CDC official, the Trump administration told the agency its advice “would never see the light of day.”

The CDC’s 17-page report included step-by-step advice guidance for “faith leaders, business owners, educators and state and local officials” who are beginning to reopen across the country. One official told the AP that the now-scrapped guide was to be used as a “blueprint” for the CDC to then create “detailed advice” and included flowcharts and “different scenarios” for helping with “reopening schools, restaurants, summer camps, churches, daycare centers and other institutions.”

So for a while no one had any guidance on how they should start the reopening process. But the guidelines were leaked anyway and the CDC later released scaled-back guidelines that had been watered down.

Comments

  1. says

    CDC has been destroyed by the religious right and the republicans. It was a great organization but (like NIH) it’s been severely damaged. If we ever get a sane government for a while, they should dissolve and re-constitute those organizations with a self-governing management stack. I.e.: doctors should be deciding what doctor runs CDC, not politicians. Hit ctrl-Z and start over.

  2. jrkrideau says

    I think the rest of the world watched with shock and horror as first the FAA and then the CDC seem to crumble. It has done incredible damage to US prestige around the world and the FDA is not looking good.

    I don’t watch TV but the routine here seems to be 30-40 minutes of tho Prime Minister addressing general problems with a handover to the responsible ministers who address “political’ considerations and hand over to the technical experts for detailed briefings. Some Chief Medical Officers seem to have groupies.

    We, here in Canada, had a Gov”t under Steven Harper that throttled any scientific communications between government scientists and the outside world.It was so bad that one scientist reported breaking into tears on the bus to work when she realized that with a new Gov’t in office she could publish freely but we were not is a pandemic at the time. Thank heavens Harper is gone.

  3. Sam N says

    @2 the FDA has already been thoroughly compromised. There is a revolving door of FDA to corporate well-paying gigs, where they take advantage of their connections. It functions at a basic, but only very basic level. It should not be the envy of any other nation.

    I don’t have quite the pessimism Marcus has regarding the NIH. The actual, highly placed scientists are rather impressive, and making it into their ranks rather difficult. The lead position feels somewhat of a joke. Their bureaucracy seems to be a fairly difficult one to manipulate toward political aims. Perhaps somewhat because once you have your grant, you can actually do whatever you want with the money. Though you can take my view as somewhat biased as my former doctorate advisor is now an NIH section chief (though not when he mentored me).

  4. jrkrideau says

    @ 3 Sam N
    the FDA has already been thoroughly compromised.

    I have suspected this but at least until now it has maintained a good international reputation. The people working there, like those at the CDC are/were highly respected.

    The blatant politicization/corruption at the higher levels seems to be destroying this respect or trust.

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