The policy shift happened quietly, but the message heard by many public health experts was loud and clear: The White House was sidelining the Centers for Disease Control and Prevention.
In a document recently posted with little fanfare to the Department of Health and Human Services’ website, the administration ordered hospitals to circumvent the CDC when reporting information about COVID-19 patients and instead go straight to the Washington-based HHS.
The administration said the change would streamline data collection. But overwhelmed hospitals struggled to quickly meet new reporting requirements, and CDC supporters viewed the move as damaging to the public health system.
“The way to make Americans safer is to build on, not bypass, our public health system,” said Dr. Tom Frieden, the former CDC director who’s now president and CEO of the nonprofit Resolve to Save Lives.
The Atlanta-based CDC was once a golden child, one of few health-related federal agencies over which Democrats and Republicans could agree. But now the nation’s premiere public health agency is being dragged into the political arena, an area its leaders spent decades diligently working to avoid. Some CDC supporters believe that could damage the agency’s reputation at a time when CDC is needed most.
“I think this was done for a political reason — to show displeasure from the current administration with the CDC in general,” said Colin Smith, a clinical assistant professor at Georgia State University’s School of Public Health and the immediate past president of the Georgia Public Health Association.
Agency employees have recently described a tightened pre-clearance process for releasing data or research. And nearly 350 public health groups and agencies this month wrote a letter asking the HHS secretary to support the CDC’s work and counter increasing resistance of health messages and threats to public health officials.
While vocalizing their support for CDC, some of Georgia’s top GOP elected officials this week defended the White House.
“I think a lot of the criticism that’s being leveled at the administration trying to cut them out is unwarranted,” said U.S. Rep. Buddy Carter, R-Pooler, a member of a House subcommittee with oversight of federal health care programs. “The CDC has played a visible and high profile role and will continue to do so.”
Making the case
Over the years, the CDC made many powerful allies in Washington and Atlanta.
Even as members of Congress tangled over cultural flashpoints like Obamacare and immigration enforcement while drafting government funding bills, they found money to steadily increase the CDC’s budget. It’s grown about 18% over the last seven fiscal years, from $5.8 billion in 2014 to $6.8 billion today.
Members of Georgia’s congressional delegation used their seniority on Capitol Hill’s most powerful committees to defend the agency and expand its footprint. They were aided by some of the most powerful members of the state’s business community, including Home Depot co-founder Bernie Marcus, who in 1999 helped create the lobbying group Corporate Friends of CDC after viewing deteriorating facilities on a tour of the agency.
Credit: ASSOCIATED PRESS
Credit: ASSOCIATED PRESS
Boosters built support by highlighting the agency’s successes battling malaria, Ebola and H1N1. David Ratcliffe, the retired head of Southern Company who currently co-chairs Corporate Friends of CDC, compared the agency’s work preventing the spread of infectious diseases to military readiness at the Pentagon.
The messaging resonated. Congress has rebuffed proposals by the Trump administration to slash the CDC’s budget over the last three years.
But many boosters and people inside the agency worry that early missteps by the CDC and increasingly critical statements by the president could erode political support for the agency among members of Congress who approve the agency’s annual funding, especially Republicans.
“We really should be very careful that we don’t destroy decades of work” to make the CDC a worldwide authority on disease prevention, said Dr. Louis W. Sullivan, president emeritus of the Morehouse School of Medicine who served as health secretary under President George H.W. Bush. “To do that for what seems to be political reasons – that is unforgivable.”
Changing role
During past public health crises, the CDC was at the center of public outreach efforts. That hasn’t been the case during COVID-19.
Regular media briefings slowed to a trickle. CDC Director Dr. Robert Redfield was less of a presence on the national stage as other members of the White House’s Coronavirus Task Force, and this spring he was pressured to walk back comments that the country could face a devastating second wave of COVID cases later this year.
More recently, the CDC delayed releasing guidelines for reopening schools after Trump criticized them for being “very tough” and “expensive.” And media reports have captured senior administration aides accusing the agency of “undermining” the president and mulling whether to frame the CDC as a scapegoat on the campaign trail.
Both the White House and the CDC disputed that there was a rift.
“The White House and CDC have been working together in partnership since the very beginning of this pandemic to carry out the President’s highest priority: the health and safety of the American public,” White House spokesman Judd Deere said in a written statement.
After public health officials strongly criticized the hospital reporting change, Redfield told reporters that his agency would continue to have access to the data. He said sending reports to HHS through a private contractor’s system would help to gather data more quickly.
A CDC spokesman said Friday the agency has “a seat at the table” and that the president “continues to be in full support of Dr. Redfield and recognizes the invaluable technical input from CDC and the thousands of dedicated public servants especially in this trying pandemic emergency.”
‘Doesn’t make sense’
But many working on the front lines don’t see the hospital data change as helpful and worry about its implications.
Hospitals are already stretched to the max, said Karen Hoffmann, immediate past president of the Association for Professionals in Infection Control and Epidemiology, and quickly figuring out a reporting system added an extra burden. Hospitals trust the CDC’s current system, she said.
“It is the system that everyone recognizes as being the best, the most accurate, the most reliable and the most accessible,” she said.
The change, she said, “just doesn’t make sense.”
Credit: Hyosub Shin
Credit: Hyosub Shin
Hospitals had only a few days to switch to the new system. And they had to figure it out at a time when they are dealing with a flood of coronavirus patients.
“We’re dealing with capacity issues to care for patients,” said Anna Adams, of the Georgia Hospital Association. “This is an added burden.” Adams said the state is working on a system to try to take over the new reporting requirement.
Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation, said the CDC has the expertise to analyze the data objectively and see how it correlates with actions the states are taking to combat COVID-19.
“You don’t want that information going to Washington where it can be influenced even more by politics,” said Besser, who co-wrote an op-ed in the Washington Post this week with Frieden and two other former CDC directors, Dr. David Satcher and Dr. Jeffrey Koplan, to raise concerns about attempts to undermine CDC.
Maintaining trust
Recent polling suggests the public is still behind the CDC. A June New York Times/Siena College survey found that 77% of Americans trusted the agency as a source of accurate information about the coronavirus.
Health experts said any effort to undermine the credibility of the CDC could hurt the public’s ability to feel comfortable about everything from the safety of school reopenings to vaccines.
“If the CDC is going to be effective it’s because it tells the truth and because people trust it and rely on it and act based on evidence that comes out of CDC,” said, Dr. Mark Rosenberg, president emeritus of the Atlanta-based Task Force for Global Health.
The agency is the go-to source for state and local public health officials because it has the top experts on diseases and a sophisticated, data-driven surveillance system that can spot public health problems as they emerge and track every health trend in the nation, said Dr. Georges Benjamin, executive director of the American Public Health Association.
David Ratcliffe, of Corporate Friends of CDC, said the CDC’s effectiveness is often hidden from the public because the agency is able to nip public health threats like salmonella outbreaks in the bud.
“There are so many things that go on in the country and in the world that nobody ever knows about because they get handled in a very expeditious fashion,” he said. “We tend to take for granted that capability.”
