These 9 lessons can help new CDC director to lead and succeed

You will be leading the front-line agency for protecting America’s health when we are likely to face a new pandemic of H5N1, and multiple other severe threats, including outbreaks of tuberculosis in the U.S. and of Ebola in Uganda. If you are successful, millions of lives might be saved. The CDC has an extremely smart and dedicated staff, and they have learned some important lessons from the recent COVID-19 pandemic. We have also learned some lessons from the worst pandemic the world has ever seen: smallpox, a disease that in the last century alone killed more than 300 million people around the world. These lessons were first articulated by Bill Foege, a former CDC director who oversaw the implementation of the strategy that led to the eradication of smallpox. These nine lessons were expanded by a team working with Foege. Learning these following lessons can be the difference between life and death for millions:

1. Base your programs on the best science available. Ongoing and up-to-date research is necessary to know the magnitude and distribution of the problem, to understand the causes, to know what works to prevent it and how to deliver those things that work effectively and efficiently.

2. Know the truth, share the truth and use the truth. The CDC learns the truth through disease surveillance and monitoring. Surveillance requires partners around the world. The CDC needs to communicate to the American people and needs to be transparent, accurate and trusted. Our communications with the public are crucial and must be timely. The Morbidity and Mortality Weekly Report is an invaluable tool for this.

3. Coalitions and partnerships are essential. The challenges facing us are too big for any one agency to solve them alone. We need to work closely with partners who trust us, at state, local levels and tribal levels; in the private and public sectors; and with countries around the world. What happens over there, affects us here. The World Health Organization facilitates working with 202 countries around the world, and it is truly indispensable. Communication with respect and understanding can also overcome what initially appear to be insurmountable differences among potential partners. Your Congressional colleague, Jay Dickey, and I started out with diametrically opposed views but arrived at a shared goal that helped to mobilize bipartisan support for public health research.

4. Avoid certainty. We need to keep an open mind because if we are certain, we stop being open to new knowledge. We need to keep asking questions and learning from the science. Our scientific base changes as we learn new things and our guidelines, programs and recommendations must keep up.

5. Build in evaluation and continuous improvement. We need to keep evaluating the results of our programs and policies because, inevitably, we will make mistakes and need to improve what we do to get better results. Evaluation can also help to make the CDC more efficient and cut waste.

6. Respect the culture. Public health is not a high-paying job and most of the people who work in public health come to serve, not to get rich. Public health also has a responsibility for everyone, not just for the patients that come to our office or hospital. The U.S. has multiple cultures and multiple constituencies but to understand and serve them all is difficult. The CDC will be stronger if it works closely with all of the various communities across the country. This is true for collecting information on the prevalence and spread of disease and injuries, and for crafting the messages that are most likely to reach and help protect those populations at risk.

7. Seek strong leadership and management. Good science is necessary for designing the best strategies but strong leadership and management — at every level — are needed for implementing those policies. Most of the staff at the CDC are dedicated and experienced leaders in their field. Your leadership and attention to the staff can keep them from getting demoralized and leaving.

8. Mobilize political will. Public health in the U.S. is essentially a single payer system, where the payer is the government. Public health personnel need to work with politicians to get stuff done, and politicians need to work with public health to understand the problem and to know what to do. It is not “either/or.” The best public health policies are developed when scientists work with politicians. Your experience and knowledge of how both camps work makes you uniquely qualified and can prove invaluable.

Credit: Mark Rosenberg/contributed

Credit: Mark Rosenberg/contributed

9. The best policies move us closer to global health equity. Public health has a responsibility to protect those least able to protect themselves, and to do this we must make sure that everyone has access to the tools and benefits of public health. For many diseases and public health problems, it is often hardest to prevent or eliminate the problem in those with the least access to health care and accurate information. Epidemics that have been cured in wealthier populations often smolder and spread among those least well off. For this reason, equitable access to treatment and prevention is not just a liberal value, it is a necessary part of protecting the health of all.

Much of the responsibility for protecting the country’s health will rest with you and your team. Your challenges ahead will be difficult and following these lessons is not easy. They take time, deliberate efforts and a committed staff. But you will have a tremendous store of experience, a very dedicated staff and the foremost public health agency in the world to support you. I urge you to embrace these lessons as you take on this critical role and ensure that the CDC remains a beacon of science, truth and global health leadership.

Mark Rosenberg was assistant U.S. Surgeon General and the founding director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. He is president emeritus of the Task Force for Global Health.

Credit: Arvin Temkar/AJC

Credit: Arvin Temkar/AJC

Credit: AP

Credit: AP