CDC Director, Dr. Rochelle Walensky on CDC Improvement

BILLIONThe US Centers for Disease Control and Prevention (CDC) did not prepare for COVID-19. After more than two years, it still isn’t. The CDC’s response to COVID-19 has been criticized by many as slow, confusing, and mostly ineffective.

Now, the agency is taking a long and hard look at itself. On August 17, CDC director Dr. Rochelle Walensky proposed sweeping changes to the way the agency communicates with Americans and publishes data — two of its most important roles with as the nation’s premier public health agency.

“I don’t think moving the boxes around on the org chart will solve the problem,” she told TIME of the changes she has begun making. “What we are talking about is a cultural change. We’re talking about data timeliness, data communication, and policy guidance. Reorganization is hard, but I think it’s even harder.”

The renovation has been going on for many months. In April, just over a year after taking office, Walensky called for an agency-wide review of the CDC. While previous directors have ordered such reviews to assess CDC performance, this particular analysis is particularly urgent because of the pandemic and low confidence in the CDC, after the Trump Administration eliminated quit the agency, ignore their advice, and sometimes contradict their instructions. Walensky asked for honest feedback from nearly 200 employees, academics, and other outside experts.

Walensky says the review, which has yet to be made public, is serious but not surprising. “Honestly, we are responsible for some pretty serious and fairly public mistakes, from testing to data to communication,” she said in a video message to CDC staff, which TIME watched.

Here’s what Walensky said was wrong – and how she intends to improve the CDC.

Need faster data

Walensky said that the CDC “was built on top of the academy infrastructure. Until COVID-19 brought the agency into the spotlight, CDC’s target audience was primarily public health professionals and academics, and its primary mode of communication was through publishing. periodicals of scientific articles. “In these pandemic moments, we find ourselves talking to a wider audience,” says Walensky. “We don’t have to convince the scientific audience — we have to convince the American people.”

Americans want accurate, timely information on how to deal with the new virus. But since the pandemic began, the CDC’s advice has seemed confusing and often contradictory – especially about how the virus is spread. Who should wear a mask?, and which masks are most effective. The agency has also been slow to release important information about the spread of SARS-CoV-2. “We all don’t like headlines, especially when we know all the good things are going on,” Walensky said of the media coverage of missteps. CDC mistake. “So how do we tackle the challenge of what people are saying about us?”

Walensky said she is now pushing the CDC to collect and analyze the data in a more streamlined way, to quickly turn that information into practical advice. During COVID-19, researchers began to rely more heavily on preprint servers, which published scientific studies on COVID-19 before the results were reviewed and vetted by experts (Standard Standard). yellow to confirm the result). “The peer review process often makes for better paperwork, but there are also cases where if you are trying to take public health action with actionable data, you don’t need to think about it,” she said. peer review before you make it [the results] public.”

She and her team are discussing how to make data available to the public sooner — not to replace the peer review process, but to supplement it, so that both the public and experts The health care provider can see evidence of that organ. based on its recommendations. For example, they are considering uploading data to a preprint server or publishing separate technical reports to differentiate the original data from the final peer-reviewed product.

For now, the agency’s advice is only official after it’s published in a CDC publication, MMWR, which requires a relatively lengthy and involved peer review process. During a public health emergency, such data needs to be made available more quickly, Walensky said. “I called the magazine editors and said, ‘I know we have an article under review, but the public needs to know, and I’m going to lift this embargo,’ she said.

That happened last July, when data from an indoor gathering in Barnstable, Mass., showed that vaccinated people became infected after mask policies were relaxed; As a result of the findings, CDC reinstated its recommendation to wear masks in large public settings prior to the study. published year MMWR. In another case, CDC scientists had data on the effectiveness of the vaccine under review for MMWRbut released the information before publication during a public meeting of vaccine experts convened by the US Food and Drug Administration.

“We can’t be lax with the data,” she said. “But there needs to be something between dotting each I and overcome all BILLION. “

Better, clearer messages

The key to making that data more accessible is to use clear, jargon-free language to convey it. In her video message to staff, she stressed that producing “simple, understandable material for the American people” would be a top priority, along with ensuring scientists develop their own theories. scores and frequently asked questions.

They’re already starting to put this into practice, she said, pointing to the CDC’s Amendment of the 11 August isolation recommendations. Compared to previous guidance, the new version is written more for the general public and addresses people’s practical concerns, such as when to start counting quarantine days and what precautions to take. present in the house, she said.

From her perspective, cultural change Walenksy hopes to address a question she is urging all CDC staff to consider: whether the data they’re analyzing, the research they’re doing, or The advice they’re creating, will address a public health need? “We really need to talk about public health action, and not just public health publications,” she said.

That won’t happen overnight, she admitted. But now other viral diseases — including monkey pox and even polio—Having entered COVID-19, the stakes are high for CDC to catch up quickly. The agency continues receive criticism from public health experts, physicians and the public for repeating some of the same mistakes from COVID-19 in handling the monkeypox outbreak. Data on smallpox cases in monkeys is still too slow. “To this day, we have data on race and ethnicity for less than 50% of cases of monkeypox,” she said. “We are still working to get complete case reporting forms and are still working to get data on immunizations.” Test for smallpox in monkeys were also not widely available for months — a delay reminiscent of the early days of COVID-19 — because the agency’s experimental protocols were too long and ineffective against a contagious virus. spread quickly. However, Walensky said, “within a week of the first case, we contacted commercial labs to rapidly expand testing capacity.”

The changes she is making will not be immediately apparent to the public, but she is confident they will eventually lead to clearer communication and faster data on new outbreaks. floating. “People aren’t going to wake up after Labor Day thinking, things have changed,” she said. “We still have a lot of work to do to get there.”

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