The Covid-19 pandemic exposed many of the flaws within CDC, but some of those flaws can be addressed and fixed with three reforms, Tom Frieden, former CDC director, writes in The Atlantic.

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The problems with public health in the US

Public health in the United States is "ailing," Frieden writes, largely for reasons outside of the control of CDC.

The country "suffers from chronic underfunding of local, city, and state public health departments; a health care system that is not structured to provide consistent care to patients; lack of standardization across states for collecting and reporting anonymized data for disease detection and response; and a broad increase in political polarization that shrinks the space for nonpartisan action and organizations," Frieden writes.

However, there are several flaws within CDC, Frieden adds, many of which were particularly exposed during the Covid-19 pandemic.

The agency failed to clearly, promptly, and effectively communicate about emerging health threats, manage data that was timely and accurate, provide practical and easy-to-implement guidance, and properly explain its rationale for that guidance, Frieden writes.

3 reforms CDC can make

According to Frieden, many of CDC's issues can be addressed with three reforms. First, Congress needs to provide CDC with "sufficient, stable, and efficient funding, including flexible emergency-contracting authority."

CDC's budget as of now is 25% lower than it was in 2004 after adjusting for inflation, Frieden writes, and the United States spends at least 300 times CDC's budget on military defense.

As a result of its lack of funding, CDC "lacks sufficient authority to work quickly in an emergency," Frieden writes. "And it faces a tangled mess of budget lines that constrain the agency from reallocating resources when it needs to mount a swift response."

Second, CDC "must exponentially increase collaboration with state, city, and local health departments," Frieden writes.

While there are currently over 600 staff members within health departments around the country, CDC needs "five to 10 times that many," according to Frieden. On top of that, staff require at least two to five years in the field to gain the experience necessary to rotate back to CDC headquarters and "infuse the organization with a renewed focus on rapid, practical action," Frieden writes.

For this to happen, Congress must provide "more resources and mechanisms" for CDC's local workforce, Frieden writes. "Just as we would never subject ourselves to surgery by a doctor who had only textbook familiarity with a complex operation, we shouldn't accept a CDC workforce that lacks frontline experience implementing public-health programs in the field."

Finally, CDC "needs to regain its voice and rebuild trust with the American people," Frieden writes. To do this, the White House and HHS need to allow CDC's subject-matter experts the independence and freedom to speak with the media and share the knowledge of CDC's scientists as well as the "reasoning, dilemmas, and potential shortcomings behind their recommendations and guidance."

Specifically, people from CDC's headquarters in Atlanta who have worked on disease outbreaks for decades need to speak to the American public, rather than White House or HHS appointees, Frieden writes.

1 'dangerous' proposed CDC reform

Frieden also acknowledged one reform "favored by the tobacco, alcohol, and junk-food industries" that he believes would be "dangerous" for the United States: a "return to the agency's founding mission," which Frieden writes is "code for eliminating programs that reduce the burden of the country's leading causes of death."

CDC's core mission is saving lives and protecting Americans from health threats, Frieden writes. "If we swallow this miracle cure of limiting the CDC's reach to only infectious disease … more Americans will die."

In fact, a review published in CDC's Morbidity and Mortality Weekly Report found that CDC's first 50 years led to significant progress in fatalities from car accidents, workplace injury and exposures, food safety, maternal and child health, safe family planning access, dental caries, and tobacco use, Frieden writes.

"Removing these programs would reverse decades of progress, further diminish the U.S.'s already lagging health status relative to our global peers, and force the CDC to confront health threats with the equivalent of one arm tied behind its back," Frieden writes.

For three generations, CDC "has been the flagship of public health," Frieden writes, "and the world is counting on the U.S. to restore the institution." To do that, CDC "requires accurate diagnosis, appropriate prescriptions for change, and persistence in seeing needed changes through to actual implementation." (Frieden, The Atlantic, 8/31)