CDC’s credibility is eroded by internal blunders and external attacks as coronavirus vaccine campaigns loom



The CDC had been preparing for decades for this moment — the arrival of a virus rampaging across the planet, inflicting widespread death and suffering.

But 2020 has been a disaster for the CDC.

The agency’s response to the worst public health crisis in a century — the coronavirus pandemic — has been marked by technical blunders and botched messaging. The agency has endured false accusations and interference by Trump administration political appointees. Worst of all, the CDC has experienced a loss of institutional credibility at a time when the nation desperately needs to know whom to trust.

This harsh assessment does not come from political or ideological enemies of the CDC. It comes from the agency’s friends and supporters — and even from some of the professionals within the agency’s Atlanta headquarters.

“Since late February, the CDC has lost massive amounts of credibility,” said Jody Lanard, a physician who worked for nearly two decades as a pandemic communications adviser consulting with the World Health Organization.

With a budget just under $8 billion, the nation’s chief public health agency is responsible for everything from investigating disease outbreaks to figuring out how best to prevent the leading causes of death in the United States, such as heart disease and cancer.

“It’s been a terrible year for the CDC,” said Ross McKinney Jr., chief scientific officer at the Association of American Medical Colleges. “There’s no question that their credibility and effectiveness have been damaged by a combination of external threats, leadership that has been perceived to be ineffective and mistakes they have made internally.”

Career staff members remain proud of the expertise, talent and professionalism that the agency can bring to bear in a crisis. But they see the agency’s situation clearly. One veteran researcher, who spoke on the condition of anonymity because he was not authorized to speak on the record, said Friday that morale is at an all-time low.

CDC Director Robert Redfield, appointed by Health and Human Services Secretary Alex Azar in 2018, is a well-known AIDS researcher who had never led an organization so large and complex. While his credentials are solid, he does not cut an effective, confidence-inspiring figure on television. He often speaks in a monotone, his eyes frequently closed.

President Trump directly contradicted the CDC chief this month after Redfield testified to Congress that a coronavirus vaccine would not be widely distributed until the middle of next year, similar to what other top officials have said. Trump said Redfield was “confused.”

The CDC declined to make Redfield available for an interview. After this article published online Monday, Redfield issued a statement.

“It’s unfortunate that the extraordinary work by the world’s greatest public health workforce, has not been duly recognized,” he said, citing the broad deployment of staff members across the country and publication of more than 3,000 pieces of guidance. “It’s truly an honor for me to lead this extraordinary group of scientists, and I will do everything in my power to support them as I maintain my commitment to lead this agency for the foreseeable future.”

Inside the CDC, staffers acknowledge Redfield’s limitations as a leader but are fearful that, if he is ousted or quits, the White House will install someone of a more distinctly political or ideological bent — such as Scott Atlas, a Stanford University neuroradiologist and Trump pandemic adviser. Atlas, who has said pandemic fears are overblown, has become a Trump favorite and has publicly criticized Redfield in recent days. Atlas has no experience in public health but attends all meetings of the White House coronavirus task force.

Moving to replace Redfield with someone such as Atlas would further erode morale and probably lead to resignations, staffers say.

Asked Friday whether Trump still had confidence in Redfield, the White House sidestepped the question.

“President Trump has always followed the science and done what was in the best interest of the American people,” White House press secretary Kayleigh McEnany said in a statement. “His early actions and therapeutic breakthroughs have saved American lives.”

A senior administration official who spoke on the condition of anonymity to share internal discussions noted that coronavirus task force members often have differing viewpoints: “President Trump takes these views into consultation and follows the science.”

“The American people are fortunate to have Dr. Redfield leading the CDC,” HHS spokeswoman Katherine McKeogh said. CDC guidelines receive “appropriate attention, consultation and input” from task force experts, she said. “Throughout the COVID-19 response, science and data have driven the decisions at HHS.”

The timing of the CDC’s troubles could not be worse. The country is poised to embark on a vaccination campaign against the novel coronavirus, and although many federal, state and local agencies will play a role, the CDC has to lead the effort and persuade people to get their shots.

There is no precedent for a vaccine rollout of this scale, said Michael Fraser, chief executive of the Association of State and Territorial Health Officials. That’s why the CDC’s troubles are so inopportune.

“It’s just unnerving,” he said. “It comes at the worst time possible.”

Never has faith in a health agency mattered more, said Carlos del Rio, executive associate dean of Emory University School of Medicine in Atlanta.

“Nobody is trusting the CDC when we need to be trusting the CDC,” del Rio said. “When you lose trust, you are essentially crippled.”

Inside the CDC, officials say honest mistakes are now widely perceived as signs of something nefarious. The prime example: the aerosol fiasco.

On Sept. 18, with no fanfare, the CDC updated a page on its website that described how the coronavirus is spread. The new wording included a reference to aerosols — tiny particles that can float through the air, potentially a significant distance. Growing evidence exists that these aerosols play a role in the pandemic. To what extent is unknown and difficult to measure. The consensus is that larger respiratory droplets, such as those emitted by a cough or sneeze, are the main drivers of viral spread, not aerosols. The new guidance added aerosols as one of the potential mechanisms of transmission.

Amid a flurry of headlines suggesting that this was a major change, the CDC backtracked. On Sept. 21, the agency removed the new language, saying it was a rough draft that still needed to be reviewed.

“Unfortunately, an early draft of a revision went up without any technical review,” Jay Butler, the CDC’s deputy director for infectious diseases, told The Washington Post in a rare on-the-record interview. He said the agency feared the guidance, as written and initially posted, could be misinterpreted as suggesting that aerosols are the main cause of infections.

But many people outside the Trump administration, aware that the agency has endured political interference, have become skeptical about public statements from the CDC. One veteran CDC scientist, speaking on the condition of anonymity because he was not authorized to comment, expressed frustration about the skepticism. He said there was no political pressure to pull the revised guidance.

“No White House interference,” the scientist said. “We shot our own foot.”

The CDC isn’t done with the aerosol guidance. Career staffers are still working on the wording, the scientist said. When it is finished, he said, the language will probably be similar to what was first posted. He acknowledged that the reversals are confusing.

“When everyone is paranoid and angry, it looks like intrigue with lots of smoke and mirrors,” he said.

‘The worst is the silence’

The stumbles started early in the pandemic, with the botched rollout of test kits suspected of being contaminated at a CDC lab in late January. That led to critical delays in states’ ability to know where the virus was circulating.

But the agency’s most chronic problem has been the inability to speak directly and persuasively to the American public. To a large extent, that’s because it has been muzzled — and sometimes directly criticized — by political operatives in the Trump administration.

Michael Caputo, a political appointee and the top spokesman at HHS, this month falsely declared that CDC scientists were political partisans dedicated to opposing the president. He later apologized and is on medical leave.

That accusation came after Caputo and one of his advisers had tried to get the CDC to alter or delay its regular scientific missives, the Morbidity and Mortality Weekly Reports, if they deviated from the president’s upbeat coronavirus message. Redfield told Congress this month that the “scientific integrity” of his agency’s reports “has not been compromised and it will not be compromised under my watch.”

In August, the CDC, under political pressure from White House and HHS officials, posted guidelines saying that asymptomatic people “do not necessarily need a test” — even if they had come in close contact with someone infected by the virus. Following an outcry from scientists inside and outside the agency, the CDC reversed itself. But the damage was done: Its scientific integrity had been undermined again.

The public has not heard consistently from CDC scientists who possess the expertise to help people understand the virus; the disease it causes, covid-19; and how to respond effectively. Requests for interviews with CDC experts must be approved by HHS and the White House. A senior administration official speaking on the condition of anonymity to share internal discussions said the White House has encouraged Redfield and others to speak to regional media outlets, which tend to focus more on local issues. The CDC has not held a briefing in three months.

“The worst is the silence,” said the CDC scientist. “You can’t explain what’s going on, correct mistakes, clarify things quickly before they spin up and out of control.”

Briefings must be approved by officials at HHS. By comparison, when the H1N1 swine flu pandemic hit the United States in spring 2009, the CDC held briefings almost every day for six consecutive weeks.

A top CDC infectious-diseases official, Nancy Messonnier, generated headlines in late February when she said at a news conference that the United States would inevitably see community spread of the coronavirus — that it was not by any means contained. She was rarely heard from again.

Lanard said the CDC’s biggest failure this year has been the lack of one or two “strong, warm” experts to serve as agency representatives.

“We needed someone who would have showed their own humanity, treated the public like grown-ups, shared the public’s anxiety, and validated the public’s skepticism and doubts,” she said.

Expressing a widely held sentiment among experts inside and outside the agency, Lanard said that person should be Anne Schuchat, the CDC’s principal deputy director. Schuchat, who has more than 30 years of experience, helped lead the agency’s response to the 2001 anthrax attacks, the 2003 outbreak of severe acute respiratory syndrome (SARS), the 2009 H1N1 flu pandemic and last year’s vaping-related lung injuries.

“Dr. Redfield does not inspire,” Lanard said. “He also comes across more as an extension of the executive branch, even though I know he cares passionately about giving the best advice.”

Redfield’s latest rocky moment came Wednesday in a hearing before the Senate Health, Education, Labor and Pensions Committee. Sen. Tim Kaine (D-Va.) asked Redfield whether the director believed that aerosols play a role in transmission, as the revised guidance stated before the CDC reverted to earlier language.

“There’s definitely evidence of that, sir,” Redfield answered.

“There’s no inaccuracy in the statement,” Kaine said.

“There’s definitely evidence of that,” Redfield said.

Kaine expressed bafflement that an apparently accurate statement had been taken down, saying this “contributes to the massive confusion that is so, so troubling to scientists and so troubling to people. And then that leads to, well, gosh, is the vaccine going to be safe?”

Redfield reiterated that the process was flawed: “I just want to stress for the American public and for everyone here that that document that went up was a draft, had not been technically reviewed by CDC.”

The awkwardness of the moment did not go unnoticed elsewhere in the administration.

“That exchange was devastating,” said a senior administration official who spoke on the condition of anonymity to speak frankly.

Redfield has been widely criticized by experts inside and outside the agency for failing to defend CDC career scientists against political interference and criticism. But in testimony Wednesday, Redfield, without naming Caputo, said he found “offensive” comments from people at HHS about “a deep state down at CDC.” He said CDC staff members are hard-working and dedicated as they confront “the greatest public health crisis of our time,” and said the criticism can “suck energy out of people working 24/7.”

After Redfield told Congress in no uncertain terms this month that a vaccine will take months to deliver and that people should wear masks — drawing a public rebuke from Trump — he received an email from Robert C. Gallo, a close colleague who in 1996 co-founded the Institute of Human Virology at the University of Maryland School of Medicine. Gallo told Redfield that people were praising him for “taking off the gloves and being so strong.” Gallo said Redfield called him that night to thank him for the support.

A person close to Redfield said the former Army physician has struggled with his ethics because of a belief in the importance of the chain of command. In the Army, he would lay down his life for his commander in chief.

“I said, ‘Bob, you can’t go wrong with following your conscience,’ ” said the person, who spoke on the condition of anonymity to speak frankly.

Redfield has told colleagues he plans to leave at the end of his term, regardless of who wins in November.

A matter of trust

In recent days, Trump and his allies have attacked the agency and its director in extraordinarily public ways, creating confusion about what scientists know about the virus and the timetable for when most Americans will have access to a vaccine.

On Wednesday, Atlas stood at the White House press room podium and contradicted Redfield’s sworn testimony that about 90 percent of Americans remain vulnerable to the coronavirus. Pressed by reporters about whom Americans should believe — the CDC director or him — Atlas replied: “You’re supposed to believe the science and I’m telling you the science.”

Atlas’s public attack on Redfield was “absolutely unconscionable,” the administration official said.

The conflicting messages from Washington and Atlanta break every rule in the CDC’s 450-page manual about communicating in a crisis.

People start to ask, “‘Can we trust the experts, can we trust what they tell us, should we follow their recommendations about what to do?’” said Jason Schwartz, an assistant professor of health policy at the Yale School of Public Health.

White House officials have pressured the CDC to change guidance over the last several months to align the guidelines more closely with the administration’s message that the pandemic is under control, federal health officials have said. Those actions include revised CDC guidance on mask-wearing and the reopening of religious institutions and schools.

“Every big public health response has two components: the public health emergency and the political emergency. It’s something epidemiologists begrudgingly accept,” said a CDC epidemiologist who spoke on the condition of anonymity out of fear of retaliation.

“We hate the political component, and do everything we can to focus on the science and the people,” the disease tracker said. “I never would have expected the level of political interference we’re seeing now. It’s so sad.”

Democratic lawmakers are calling for the HHS inspector general to investigate allegations that the White House and its appointees interfered for political purposes with the work of the CDC and its scientists.

Within the agency, some believe problems could be reversed with a different director. Some public health experts say the CDC can regain credibility only with a wholesale change at the top. The CDC director is appointed by the HHS secretary, but unlike the heads of the FDA and the National Institutes of Health, the position does not require Senate confirmation.

Dorit Rubinstein Reiss, a professor at the University of California Hastings College of the Law, is calling for the CDC director to be replaced by a board, along the lines of the Federal Reserve system, to strengthen the agency’s institutional independence.

“You have to do something visible to allow the trust to be reestablished,” she said. Otherwise, future presidential administrations may be tempted to continue such interference, she said.

Reiss is the author of a forthcoming article in ConLawNOW, an online legal journal. The paper, “Institutionalizing the Centers for Disease Control and Prevention’s Independence,” describes a seven-member governing board with staggered terms longer than the sitting president.

The CDC’s predecessor, the Communicable Disease Center, was founded in 1946 in Atlanta to suppress the spread of malaria in the South. The early challenges of the agency, which was armed with a budget of $10 million and fewer than 400 employees, included obtaining enough trucks, sprayers and shovels to wage war on mosquitoes.

Nearly all of the CDC’s U.S. staff, including its director, are based in Atlanta. While career staff have long prided themselves on being physically independent from Washington, CDC’s distance has hindered its ability to build political support that is so crucial in times of crisis, experts say.

And unlike other health agencies, much of its work is designed to prevent bad things from happening — a mission that can prove challenging to highlight.

“Even in normal times, NIH can promise research breakthroughs, FDA can bring products to market to cure disease, but CDC is a public health agency and when public health is working, it’s invisible,” Yale’s Schwartz said. “We don’t see the individual victims; we don’t know whose lives are being saved.”

Carolyn Y. Johnson contributed to this report.



First Published at www.washingtonpost.com on 2020-09-28 22:00:57

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