12.10.20 — During the pandemic and under the Trump administration, the CDC’s reputation has been stained and its scientific and medical authority has been undermined. While it remains, as it is frequently referred to, “a national treasure” and “the gold standard” worldwide for epidemiology and disease control, it’s effectiveness has been diminished by the public’s perception that it has become highly politicized. Some blame rightly belongs to the agency itself for its release in February of a hurried and botched COVID testing kit. And Director Redfield’s public statements and testimony too often sounded more like a political appointee trying to keep his job than like a respected researcher relentlessly driving his agency to discover and convey the truth. The number of times policies and recommendations were pronounced, withdrawn, and then re-released then in conformance to what the president was saying, was both dizzying and disappointing.
But by far the most damage has been inflicted by the White House and the Department of Health and Human Services (HHS) where the agency resides. Functionaries from both of these entities, for example, have reached into the CDC’s website and left politically motivated documents that appeared to be CDC-generated guidance when they most assuredly were not. And the entire Smithfield report episode where reasoned and reasonable directives were rewritten to become mere suggestions, challenged the public’s trust in the CDC’s integrity. [ 1 ]
All of which is not to in any way disparage the thousands of CDC employees who continue to work day-in and day-out for our health and protection, many of whom have been discouraged and dismayed by the public bruising their agency has endured. [ 2 ]
The question here is just one of reputation, not competence, and how the CDC’s reputation can be restored.
Here are four suggestions:
1. Make the CDC an Independent Federal Agency
There are 66 U.S. federal agencies that are “independent,” i.e., they are neither part of the Executive Office of the President nor are they housed within one of the 15 cabinet departments. [ 3 ] Examples include the Federal Reserve Board, the National Transportation Safety Board (NTSB), and the Nuclear Regulatory Commission (NRC). The independence these agencies enjoy provides them a measure of insulation from the president and Congress. This discourages the president from dictating monetary policy to the Fed (Trump’s public outbursts aside), the Department of Transportation from weighing in on NTSB investigations, or the Department of Energy from influencing nuclear safety measures.
The CDC should be designated an independent agency.
As far as I know, no agency of the federal government has ever been re-classified as independent and it’s easy to imagine the Department of Health and Human Services (HHS) fighting hammer and tongs to retain control of the CDC. And while a case could be made that health policy as it resides at HHS is inherently political (or at least that it has been made so, for issues like healthcare coverage, abortion funding, etc.) and therefore should be controlled by the administration, there really is no objective argument that can be made to politicize the control and prevention of diseases. Thus, again, the CDC should by all rights be independent.
Being viewed as independent, and even just being described as independent, should help the public see the agency in a more positive light.
2. Appoint the Director from an Independently-Generated Shortlist, Stagger the Director’s Term, and make all Deputies, etc. Career Appointees
The Director of the CDC, who does not require Senate confirmation, is appointed by the Secretary of Health and Human Services, with the White House making the actual selection. So in addition to the agency gaining some measure of independence, what could be done to give the CDC director some remove from politics?
The Institute of Medicine (IOM), a nonprofit chartered by Congress but operating outside of government, could be designated to provide the Secretary a shortlist of highly qualified candidates to be the CDC director, and the Secretary in turn could be required to choose from among those candidates. The IOM says its “foundational goal is to be the most reliable source for credible scientific and policy advice on matters concerning human health,” [ 4 ] which would certainly make it a compelling choice for this task.
As currently defined, the director’s position is a “Noncareer Appointment,” meaning it expires coincident with the president’s term. To further insulate the director, the director’s term of service could be changed to some prime number of years, meaning that after the first such appointment, if every director served full terms, it would be infrequent that a president’s term and a director’s began in the same year. For example if each director served seven-year terms, it would be 28 years before a president’s and a director’s terms began in the same year.
Of the roughly 10,000 CDC employees, there are just 24 positions (other than the director) that are filled by appointment. Each of these may be filled in a variety of ways (e.g., Limited Term Appointment, Emergency Appointment, Presidential Appointment –with or without Senate approval–, etc.) These should all be re-designated Career Appointments. [ 5 ]
A career appointment begins once an employee has completed three years of permanent substantially continuous creditable service in the competitive service. [ 6 ]
In the competitive service, individuals must go through a competitive hiring process (i.e., competitive examining) before being appointed which is open to all applicants. This process may consist of a written test, an evaluation of the individual’s education and experience, and/or an evaluation of other attributes necessary for successful performance in the position to be filled. [ 7 ]
Career Appointments then would guard against a president tapping someone to undermine the agency or seeking to politicize it from the inside.
A Different Perspective
These first two recommendations aim to give the CDC more independence by taking it out of the political realm. Nicholas Florko at STAT argues that the way to ensure the CDC has more independence, or at least sharper elbows, is to actually give it more political power. In the interest of a full discussion, you should read his article here. [ 8 ]
3. Let the CDC Announce the US Re-engagement with International Organizations and Programs
When a new administration decides once again to support and work in conjunction with international organizations like the World Health Organization (WHO) and programs like COVAX, this will be a major about-face from recent U.S. policy and it would be expected that the president would make the announcement and take credit for this sensible re-engagement.
Instead, the President Biden should allow the CDC to make these announcements. The world will surely understand that the CDC would not be undertaking a role with foreign policy implications without the president’s approval. What matters though is that the CDC is the public face of these announcements, letting the agency benefit from the halo effect of these positive and restorative moves. And, frankly, any president who allows the CDC to do this will no doubt have more than enough opportunities to take credit for any number of other sensible policy reversals.
4. Create an Entity that can Promote the CDC to the Public
As the diagram below shows, the CDC has a fairly comprehensive support system designed to finance its operations and expand it’s scientific programs. This includes direct appropriations from Congress, programs supported by the CDC Foundation that supplement and complement CDC’s own work, and even an entity whose sole purpose is the lobby Congress on the CDD’s behalf. [ 9 ] What it lacks is an organization focused on generating public support. [ 10 ]
Let Congress Know
Members of Congress are exquisitely attentive when their constituents and the public in general express support for an idea, a bill, or a federal agency. It was true years ago when I worked on the Hill and remains so today. Staff keep tallies of calls, letters, emails, and even visits by topic, and many times that interest is later reflected in Members’ votes. But for this to work, someone needs to organize the contact-your-representatives campaigns, selecting dates, crafting messages, reporting results, etc.
Tell the CDC’s Stories
There are hundreds of stories of CDC’s work, and successes, that have never been fully told to the general public in a way that makes them accessible and understandable. Many of these stories are both fascinating and dramatic. A new CDC-promotion entity could support the work of medical writers, cable series producers, and more in crafting, distributing, and promoting these stories. For years Berton Roueché wrote for The New Yorker under the heading Annals of Medicine as well as in a number of books, including The Disease Detectives, capturing the suspense, diligence, and remarkably informed intuition of epidemiologists and other medical professionals. Writing like this not only engages readers but, ultimately, validates the work of the doctors. This is what the CDC needs today.
Even images can be compelling. Look for example, at the photograph of the CDC Emergency Operations Center above. It conveys everything that NASA’s Mission Control does –intensity, expertise, focus, high-tech monitoring– and yet, this is an image of the CDC that very few Americans have probably ever seen. How might their perceptions of the CDC change seeing this?
Promote a Support Environment
We know from psychology experiments and even our own day-to-day observations that social pressure can cause people to change their beliefs. That pressure can be fairly overt; e.g., when everyone around you says “X” is true even when it clearly isn’t, a surprising number of us will eventually relent and say that, yes, “X” is true. But that pressure can also be exercised in a more subtle fashion; e.g., when you see people expressing support through means like wearing branded clothing, your mind will tend to overestimate the extent and depth of that support and push you to form a positive opinion of that brand. The new CDC-promotion entity should work to create an environment of perceived support through a variety of means like social media, working with the Postal Commission to issue a CDC stamp, etc., and, yes, even selling t-shirts.
But while creating public support for the CDC is a laudable goal, an even more important goal of this entity is creating public trust. That way when the CDC says, for example, wear a mask or get a flu shot, everyone willingly complies because they have come to believe that the CDC is highly competent and has their best interests at heart.
What the Trump administration has done to diminish the CDC will take a long time to repair. Even if all four of these suggestions were implemented tomorrow, rebuilding trust in the agency will be a gradual process, taking years of sustained effort. But we know it can be done. After all, Martha Stewart is back on television, Tylenol is back in medicine cabinets, and Volkswagen sales have never been higher. CDC’s reputation, too, can be re-burnished to once again reflect its many achievements.
[ 1 ]
“CDC director’s office ordered softening of Covid safety protocols.”
[ 2 ]
“CDC’s credibility is eroded by internal blunders and external attacks as coronavirus vaccine campaigns loom.” September 28, 2020. Lena H. Sun and Joel Achenbach.
[ 3 ]
“List of independent federal agencies.”
[ 4 ] National Academy of Medicine
[ 6 ]
[ 7 ]
[ 8 ]
“The CDC has always been an apolitical island. That’s left it defenseless against Trump.” STAT. July 13, 2020. Nicholas Florko.
[ 9 ]
Federal agencies are themselves prohibited from lobbying Congress.
“Lobbying Congress with Appropriated Funds: Restrictions on Federal Agencies and Officials.”
[ 10 ]
42 U.S. Code § 280e–11 — Establishment and duties of Foundation.