After acknowledging that CDC's Covid-19 response "did not reliably meet expectations," CDC Director Rochelle Walensky on Wednesday called for an "ambitious" overhaul of the agency.

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CDC faces criticism over public health emergency response

While CDC has faced criticism on its response to public health issues for years, public upset with the agency increased significantly during the Covid-19 pandemic. And dissatisfaction with the agency has continued into the monkeypox public health emergency as well.

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Many experts believe the agency took too long to acknowledge the coronavirus's spread from Europe to the United States, to recommend masking, to announce the virus was airborne, and to implement systematic testing for emerging variants, the Associated Press reports.

"We saw during COVID that CDC's structures, frankly, weren't designed to take in information, digest it and disseminate it to the public at the speed necessary," said Jason Schwartz, a health policy researcher at the Yale School of Public Health.

In addition, many experts have criticized the agency for prioritizing the collection and analysis of data rather than taking steps to address emerging public health threats.

"CDC is a great organization, but it has always functioned like a big academic health system and not an emergency response entity," said Georges Benjamin, executive director of the American Public Health Association. "And the world has changed a lot."

On Wednesday, Walensky acknowledged CDC's shortcomings in its pandemic response. "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," Walensky said.

"It's not lost on me that we fell short in many ways" responding to the Covid-19 pandemic, Walensky said. "We had some pretty public mistakes, and so much of this effort was to hold up the mirror ... to understand where and how we could do better."

Walensky calls for an 'ambitious' overhaul

In April, Walensky requested an in-depth review of CDC, which would help inform an "ambitious" overhaul of the agency, which CDC leaders are calling a "reset."

"The goal was to learn how to pivot our long-standing practices and adapt to pandemics and other public health emergencies, then to apply those lessons across the organization," Walensky said.

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"As a long-time admirer of this agency and a champion for public health, I want us all to do better," she said. " … I feel like it's my responsibility to lead this agency to a better place after a really challenging three years."

"My goal is a new, public health, action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness," Walensky added.

"For CDC to be more effective, we must build on the lessons learned from COVID-19 to improve how we deliver our science and programs," Walensky noted, adding that this must include sharing scientific data and findings more quickly, and "translating science into practical, easy-to-understand policy."

To accomplish the agency's goals, Walensky said "there are some areas that will require a reorganization," which include:

• Publishing preprint reports to quickly distribute actionable data, rather than waiting for research to undergo peer review and publication by CDC's Morbidity and Mortality Weekly Report
• Reorganizing CDC's communications office and improving the agency's websites to make its guidance more accessible to the public
• Setting a six-month minimum CDC leaders can devote to outbreak responses to address a turnover problem that has resulted in knowledge gaps and miscommunications
• Creating a new executive council to help the CDC director determine the agency's strategies and priorities
• Naming Mary Wakefield, who previously headed the Health Resources and Services Administration and served as the no. 2 administrator at HHS during the Obama administration, as CDC's senior counselor to implement the proposed changes
• Notifying CDC's organization chart to undo certain changes made during the Trump administration
• Creating an office of intergovernmental affairs to foster partnerships with other agencies
• Establishing a higher-level office on health equity

In addition, Walensky said she plans to "get rid of some of the reporting layers that exist, and I'd like to work to break down some of the silos." While she did not go into further detail, she emphasized that the overall changes are more focused on rethinking how the agency conducts business and motivates employees, and less about redrawing the organization chart, AP reports.

"This will not be simply moving boxes" on the organization chart, Walensky noted.

While the reorganization proposal must be approved by the HHS secretary, CDC officials said they hope to have a finalized set of changes approved and implemented by early 2023. (Saric, Axios, 8/17; Branswell, STAT, 8/17; Frieden, MedPage Today, 8/17; Stobbe, Associated Press, 8/17)