Loss for everyone as CDC’s standing erodes
In recent weeks it has come to light that the White House blocked an effort by the U.S. Centers for Disease Control to require the use of face masks on public and commercial transportation and initiated, against the wishes of CDC scientists, a March 2020 CDC order to close the U.S. border to asylum seekers – both moves widely and publicly condemned by public health experts. These are just the latest revelations that demonstrate how the administration has hobbled the CDC’s work during the COVID-19 crisis and diminished its scientific standing. On issues related to COVID-19, reports document that the White House has edited CDC publications and altered advisories on testing contacts, on school opening strategies, and on the danger of singing in churches.
The danger of allowing political motives to sculpt the CDC’s messages during a pandemic risks something far larger than “just” adding a few million cases and an extra couple hundred thousand deaths from COVID-19. Unlike the EPA or FDA, which wield regulatory power, the CDC achieves its goals mostly by directly communicating evidence and advice to the public and health professionals. Over 1,000 past and present CDC researchers signed an open letter condemning the politicization of CDC. Today, young people cannot remember when the CDC released evidence on the dangers of guns in the home or the relative safety for women of a legal abortion over full-term births without vicious condemnation from Washington DC.
In 1999, I had the epidemiological success of a lifetime while working for an NGO in the Democratic Republic of the Congo (DRC) at the peak of their war that involved five neighboring armies. In a rural district, we documented that around 1,600 children had died of measles in the previous few weeks. Immediately, UNICEF pledged to get the vaccine needed, and my NGO and the Ministry of health prepared to vaccinate the population. After 3 weeks of preparation, UNICEF announced that they had searched across the entire African continent and there was no measles vaccine available.
Five years earlier, I had finished the CDC’s Epidemic Intelligence Services fellowship or EIS. The two-year fellowship, started in 1951, was designed to create a close-nit cadre of public health professionals and spread them across the centers and branches with the various areas of expertise that constitute the CDC. Somehow, 60 trainees at a time managed to build the CDC into a tight-knit, expert community. While there, I had met “the” CDC expert on measles control, Stan. I called his office with a satellite phone and, miraculously, he answered. I explained the situation and pleaded, “Stan, I desperately need 60,000 doses of measles vaccine!” He asked me to call him back in four hours. When I did, and he gleefully said, “Les, I found you 60,000 doses, and the syringes and vitamin A tablets to go with it.” I was astonished and asked where the vaccine was? It was ready for us to pick up the next day, in UNICEF’s Rwandan warehouse, less than 200 miles away. There were so many elements of this that were astonishing. Still, chief among them was the ability of an American sitting in Atlanta to do in four hours what a large team of UNICEF staff in Africa could not do in three weeks.
The vaccine arrived a couple of days later, the vaccination program was undertaken, and the measles outbreak stopped completely, probably preventing 4-6000 child deaths. My chance connection that empowered this response was exactly the kind of CDC-based human network envisioned a half-century earlier and exactly what the EIS was intended to do. Most of my EIS peers have had similar experiences.
You can destroy a house in a day, but you cannot build a house in a day. That human network of professionals called the EIS took half a century to create and reached into almost every city and state health department in America. It exuded strength based on the foundation of credibility at the CDC. Today, as the U.S. withdraws from the WHO and as outbreaks like COVID-19 show us how interconnected our health is with the entire world, there are still dozens of luminaries like Stan in their fields at the CDC. What good will they be – what influence can they have to save lives – if the CDC is seen as political or not credible?
The recent degradations of the CDC’s trustworthiness could compromise our ability to cope with emergencies for generations to come. Scientific integrity can only exist when politicians and political candidates are publicly committed to scientific independence: regarding airplane safety, on drug approval procedures, and especially for public health guidelines. The Associated Press describes this faux CDC Order, used to achieve the White House’s anti-immigration goals, as “a profound dereliction of duty for a CDC director.” It is hard to emphasize what a gross understatement that is.
Leslie Roberts is a professor at the Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health.