May 17, 2023

In The News: COVID-19 Pandemic Tested CDC and FDA, Exposing Cracks

Healio details the results of a CDC internal and external review of pandemic performance. The results were not good. The issues discovered included: the agency was too slow to share science and data, struggled to translate findings into practical policy, and fell short of prioritizing public health communications, especially for the public. CDC director Rochelle Walensky added the CDC was too academic, too focused on publishing, and not nimble enough to keep pace with the scope of the crisis.

In an email obtained by the news outlet, Dr. Walensky announced internal changes that would require a ‘cultural shift’ following a performance that did not meet expectations. The outlet interviewed infectious diseases and public health experts on the performance by CDC and FDA during the deadliest health crisis in more than a century as well as remarks of admiration for effort during an unknown, complex pandemic. Included in the experts were PIDS members David Kimberlin, Pablo Sanchez and Sarah Long.

The article is further broken down into several sections. ‘Unsung heroes’ lauds the work of CDC and FDA staff working under intense pressure to, among other things, get vaccines tested, approved and available to the public. In ‘Things were chaotic back then,’ the explosion in U.S. cases is discussed along with the failures to develop a reliable, accessible test and how to do better in the future on doing so.

‘Surveillance silos’ delves the myriad issues of data surveillance and reporting to the CDC that exacerbated the COVID-19 response. The systems are referred to as “outdated, unreliable and siloed.” Peer nations have stronger health data systems and could be emulated. In December of last year CDC awarded $3.2 billion to state, local and territorial jurisdictions to improve on the current system and bolster the workforce. In ‘Communication breakdown,’ the agency’s inconsistent, often delayed, occasionally unclear messaging on topics such as masks, vaccine effectiveness, and data trends made CDC a poor communication source, which caused problems in trust and adherence to recommendations.

The final sections detail the influence of politics and what to do next. ‘Unconscionable political pressure’ made it difficult to evaluate what and how CDC and FDA were doing. Announcements from both administrations during the pandemic were identified as unhelpful and not always adhering to science. Lastly, ‘We really ought to do a postmortem,’ looks at how the country could approach pandemic preparedness if it were to examine what happened. A special, independent investigation akin to the 9/11 Commission is recommended. Actionable recommendations that result from the commission would then be instituted to better prepare the nation to respond to the next pandemic.

On the country’s public health personnel Dr. Kimberlin said, “These are unsung heroes. Did they do everything right? No, none of us do. Did they do most things right? I would say probably yes. Could they improve? Yes, as we all can.” On communicating vaccines preventing serious disease Dr. Sanchez said, “If it kept them out of the hospital, kept them out of the ICU, kept them from having multisystem inflammatory syndrome in children, if it kept them from dying, then the vaccine was working. I think that message was not made clear from the beginning.” On ACIP working on nonpandemic vaccines Dr. Long said, “It’s fantastic, because we make decisions and look at the data unfettered that the president possibly could announce a White House plan pre-emptively or a public health policy…that is not based solely on ACIP’s due diligence.”

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