CDC announces sweeping reorganization, aimed at changing agency culture and restoring public trust

CDC Director Dr. Rochelle Walensky met with the agency’s senior leadership this morning to outline her plans to overhaul the way the agency works. She plans to remake the culture to help the agency act faster when responding to a public health crisis. She also wants to make it easier for other parts of government to work with the CDC and wants to simplify and streamline the website to eliminate overlapping and conflicting public health guidance.

“My goal is a new culture of public health action at CDC that emphasizes accountability, collaboration, communication, and timeliness. I look forward to working with the amazing people at CDC and our partners. to realize the agency’s full potential to benefit the health and well-being of all Americans,” Walensky said in a statement Wednesday.

Staff were informed of the plans by email. More than 12,000 people work at the agency, which is headquartered in Atlanta.

The changes will aim to improve the culture and restore public confidence after the agency’s acknowledged missteps in its response to the Covid-19 pandemic.

The reforms follow a period of review and soul-searching at the CDC. In April, Walensky announced Jim Macrae, an administrator for the US Department of Health and Human Services, would lead a month-long review of the agency’s Covid-19 response efforts. At the same time, she assigned three of her deputies to scrutinize operations and recommend strategic changes. Walensky met with groups of employees in person as employees return to their desks after months of working remotely.
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The new marching orders come after significant stumbles at the agency in response to the Covid-19 pandemic. The United States had little capacity to test for the infection in the early months of the pandemic, largely because the agency released a flawed test for public health labs. This kept the nation blind, for months, to the extent of the spread of the virus.

The agency has also been criticized throughout the pandemic for issuing public health advice that some viewed as confusing and ineffective. Many also felt that he was not moving fast enough to react.

“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,” Walensky acknowledged in his statement.

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Walensky will bring former HHS deputy secretary Mary Wakefield to the CDC to oversee the reorganization.

Among the key changes announced today, the Laboratory Science Division and Office of Science will now report directly to the CDC Director, a change aimed at making them more accountable and accelerating the results of their work to the public.

The agency will also create a new Office of Intergovernmental Affairs — a hub where state health departments and other federal agencies interact with the CDC.

Walensky will convene an executive council that will determine the agency’s priorities, monitor its progress and weigh in on budget decisions.

The agency will open a new equity office that aims to both increase diversity in the CDC’s workforce and add that lens to its public health work.

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The CDC also plans to create a new online mechanism for advance science dissemination, and it will give its website a makeover, streamlining and simplifying its advice to the public and healthcare providers..

Walensky also plans to ask Congress to grant the agency new powers, including requiring jurisdictions to share their data. Currently, the CDC depends on states and counties to do this voluntarily.

It will also ask for new flexibility in the financing of the agency. Right now, when Congress appropriates money for the CDC, it must be spent on specific programs. This created over 150 individual budget lines that fund the agency. This can be a problem when a public health emergency occurs. In 2014, when the Ebola outbreak began, Dr. Tom Frieden, then CDC director, had to borrow money from other parts of the federal government to respond.

“We literally had no money for airfare and per diems to send personnel into the field,” said Frieden, who was interviewed by Macrae for his review.

“I had, literally, 20 times more flex dollars as New York City health commissioner than as CDC director,” Frieden said in an interview with CNN. Frieden now heads the nonprofit Resolve to Save Lives.

Some of these changes have already begun, including a reorganization of the agency’s communications operations.

Earlier this year, the CDC filled a long-vacant position when it hired Kevin Griffis, a public affairs veteran with the Department of Health and Human Services and Planned Parenthood, to lead its communications efforts. In addition to communicating CDC health information, part of his job is to manage “risk communication and reputational issues for the agency,” according to the CDC’s website. The agency has not had a communications officer for four years, according to a senior official with knowledge of the changes who was not authorized to speak to reporters.

A final version of Macrae’s review is expected to be released on Wednesday. Key recommendations will include:

• Share discoveries and scientific data faster

• Better translate science into practical and easy-to-understand policies

• Prioritize public health communications

• Reduce the importance of the publication of scientific discoveries for career advancement

• New training for agency staff so multiple people can fulfill the same role in public health emergencies

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