CDC, under fire, lays out plan to become more nimble and accountable

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The nation’s top public health official acknowledged on Wednesday that the Centers for Disease Control and Prevention has failed to respond effectively to the coronavirus pandemic and pledged to make significant changes, including faster publication of findings. science and easier to understand advice.

CDC Director Rochelle Walensky told senior leaders that she had embraced a long-awaited overhaul of the CDC’s culture based on an internal review that called for a more agile and better-trained workforce and changing incentives to reward action rather than publication, among others.

“For 75 years, the CDC and public health have been preparing for COVID-19, and in our big moment, our performance has not reliably met expectations,” she said in a statement. “My goal is a new culture of public health action at CDC that emphasizes accountability, collaboration, communication, and timeliness. ”

Walensky appointed Mary Wakefield, former assistant secretary of health in the Obama administration, to lead the effort, which she warned, “will take time and commitment at all levels of the organization. “. Recommendations were shared Wednesday morning, first to senior executives and then through the Atlanta-based agency, which employs about 13,000 people, according to a senior CDC official who provided details but was not authorized to speak officially.

Several changes are already underway. “Work on virtually everything else is kicking off today,” the official said.

Walensky briefed White House and Department of Health and Human Services officials last week on plans to modernize the agency. “They are supportive,” the official said.

Since the beginning of the coronavirus pandemic 2 and a half years ago, the historical agency has come under intense fire for its response, from initial delays in developing a coronavirus test, to severe eligibility limits for getting tested, to missteps often attributed to interference by the Trump administration. But even under the Biden administration, which named Walensky as director, his orientation and decision-making on masking, insulation and quarantine, and booster doses have repeatedly been accused of being slow, opaque and confusing. A constant criticism has been that of the agency lack of agility, especially with real-time data analysis and publication.

How CDC data issues put the U.S. behind on the delta variant

White House officials also grew frustrated with the CDC and other health agencies over their response to monkeypox, with patients, doctors and even some administration officials asking why it was so hard to speed up testing and treatment.

Outside experts said Wednesday they support Walensky’s proposal.

The CDC director “did a really good job diagnosing the problems” at his agency, said Scott Gottlieb, who led the Food and Drug Administration under Donald Trump and criticized CDC bureaucracy in “Uncontrolled Spread,” a book he wrote about America’s coronavirus response. .

“The CDC is a very academic organization – and I think Dr. Walensky recognized that when she says they need to change the reward structure, people are not being rewarded for publications but for operational execution,” Gottlieb said. He also praised Walensky for promising a new communications approach, adding that his plans to simplify CDC language and release data faster would better reach those confused by the agency’s guidance. “They need to learn how to post background information,” Gottlieb said.

Caitlin Rivers, senior researcher at the Johns Hopkins Center for Health Security, who helped launch The CDC’s new forecasting initiative, said she supported the plan and called on the agency to go even further. “The Preparedness and Response Center is a wonderful resource within the CDC. I think they could handle being brought in earlier in [an outbreak]because they have so much expertise to share,” Rivers said.

Recommendations for change come from a internal review structure, systems and processes of CDC commissioned by Walensky this year. It was headed by Jim Macrae, a senior official with the Health Resources and Services Administration, which is part of the Health and Human Services department. Macrae interviewed 120 people inside and outside the agency from mid-April to early June, the senior CDC official said.

Wakefield will create an executive board of agency staff that will monitor progress and report directly to Walensky.

A backgrounder shared with The Washington Post lays out some of the CDC’s most pressing problems and offers solutions.

Certain measures, such as the new power to mandate reporting state data, hiring people faster, and offering competitive salaries to recruit and retain the best will require congressional action. Others are internal changes Walensky can make, such as having the Offices of Science and Laboratory Sciences, two key divisions that would be at the forefront of a public health crisis, report directly to she. And some will require negotiations with unions.

The document exposed several issues, including the CDC’s lack of agility during public health emergencies. “It takes too long for the CDC to release its data and its science for decision-making,” he said.

Agency officials acknowledge this problem and blame it on the CDC’s incentive structure for promotions, which privileges publication in agency reports and scientific journals, delaying the release of public health findings. , especially in an emergency.

“This idea where people say, ‘we don’t want to pick ourselves up and release this information before we can do an MMWR should be shameful,’ said an official who spoke on condition of anonymity to speak candidly about the practice of withholding data. data until it is published in the agency’s Morbidity and Mortality Weekly Report. “That’s not true. And part of that has to do with the incentive structure within the CDC to get promoted.

One solution under consideration, according to the briefing paper, is to create an online “pre-publication delivery” mechanism for faster public health responses.

Another is simply to share actionable material faster. For example, agency officials do not plan to wait to release a CDC survey of gay men to determine if they have changed their behaviors due to the spread of monkeypox, the senior CDC official said.

Wakefield will be responsible for changing the CDC’s culture “by prioritizing and encouraging public health action and impact on the number of scientific publications,” the briefing document states. “Produce data for action (not data for publication).”

The senior official acknowledged that such a change in culture could cause some at the CDC to leave, adding, “There will be people…who would prefer to work in a more academic institution and feel like they’re not the right fit.”

The changes also include efforts to introduce clarity to the CDC’s guidance documents, which “are confusing and overwhelming,” the document says, highlighting one of the most frequent consumer complaints.

Recommendations include communicating in plain language, reducing the number and length of guidance documents, including scientific rationales, and using FAQs that can be updated in real time.

To reinforce training and prevent burnout, Walensky plans to require a minimum rotation of six months for managers conducting emergency response. During the pandemic, some senior managers have been exhausted from deployments that have lasted more than six months. It has also been difficult to persuade officials to step away from their regular duties to perform a tour of duty at the helm of covid or monkeypox responses.

“Leaving your position, where you publish articles, to direct [an outbreak response]it’s not being rewarded at the moment,” the senior CDC official said.

The agency also plans to create a one-stop shop to help outside groups “navigate the agency and receive timely information,” the document says.

In addition, he will establish a new equity office that will work across the agency, including recruiting and retaining employees from diverse backgrounds.

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