Now that the COVID-19 national public health emergency is over, it’s time to fix the CDC

The COVID-19 pandemic made one thing very clear: We need a new CDC – a CDC for the 21st century that’s part of local communities and held accountable for its actions.

The more than a million Americans who died of COVID-19 represent a failure across our institutions. We need to act now to prepare for the next pandemic, and the end of the immediate crisis and a leadership change at the Centers for Disease Control and Prevention make this the perfect time to consider a full overhaul.

Dramatic change is possible, but it starts with a more data-driven, solutions-oriented and outcomes-driven CDC. We need a new public health model that includes integrated data systems based on our health care delivery network and an annual report to Congress on the top five public health issues. Funding should be linked to improved outcomes to hold the CDC accountable for its mission. It's not about more money; it's about how each dollar is spent.

What compounded many health issues in America

The pandemic laid bare many health issues that were visible in America for decades but hadn’t generated an effective response: increasing obesity, heart disease and diabetes as well as the opioid epidemic and the failure of adult vaccination programs.

These were compounded by the insidious loss of rural health care access and the persistent struggles of the Indian Health Service programs.

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Rural Americans and tribal nations account for the largest population-based death rates from COVID-19, and many are still at risk. Americans older than 75 remain vulnerable to COVID-19 hospitalizations and death as vaccine protections wane, the virus spreads unchecked through communities and COVID-19 surveillance decreases.

At the same time, effective monoclonal antibodies are lost and there are few effective antivirals, increasing the susceptibility of vulnerable Americans.

But we can change this trajectory. We’ve done it before. I was part of the evolution within the CDC two decades ago that led to clear success with another pandemic – HIV/AIDS.

The Centers for Disease Control and Prevention headquarters in Atlanta, Ga.
The Centers for Disease Control and Prevention headquarters in Atlanta, Ga.

President’s Emergency Plan for AIDS Relief created in 2003

The CDC was initially paralyzed when AIDS emerged globally, its staff mired in academia, documenting diseases instead of forming programming for disease prevention and control.

Then the creation in 2003 of the President’s Emergency Plan for AIDS Relief propelled the CDC into the world of global public health program implementation.

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The CDC’s Division of Global HIV and TB formed at the same time, bringing together epidemiologists, laboratorians, behavior scientists and physicians.

It was transformative.

The division put boots on the ground: 77% of the new division’s staff were in the countries they served, not at headquarters. They focused on implementing effective solutions to scale and using continuous data to improve the HIV pandemic response. They worked with local governments and community groups and constantly adjusted programming to meet the needs of all people.

In short, they treated every new infection and death as a failure.

This is the CDC America needs at home but lost to the publication of weekly reports and manuscripts.

We need a CDC that partners with local communities

The CDC must transform itself into a body that acts and uses data for continuous programmatic improvement – and one that holds itself accountable for both preventing and controlling disease. We need a CDC that combats misinformation and disinformation with data-driven decision-making in partnership with local communities. One that lives and works at the local level and empowers and evolves with information.

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The new CDC must recognize that Americans need choices, and that it needs to help bring communities together rather than drive them apart. It should engage behavioral scientists to develop clear strategies to address vaccine hesitancy and prevent chronic disease. It must ensure its evidence-based guidance is practical and can be implemented on the ground.

A country as vast and as diverse as ours necessitates gathering granular data. So the CDC needs to work with all hospitals and clinics to use data collected in their electronic medical records.

We need to definitively diagnose by lab test each and every viral disease at all levels of care. We have the technology to do it. We just need to make it a priority.  People need to know so they can be empowered to protect their families and seek the right treatments.

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Then we need to create a national database that's publicly available and broken down by county or ZIP code. A simple rule change linking Medicare and Medicaid payments to definitive laboratory diagnoses would jumpstart the effort and better prepare us almost overnight for a new viral pandemic. All Americans would always know what viral respiratory diseases are circulating in their communities, and we would immediately know there is something new.

Imagine if we used real-time data to understand our opioid epidemic, mental health conditions, suicide attempts and childhood obesity and held ourselves, state and local governments, and the CDC accountable to improve the health of our nation, community by community.

Dr. Deborah L. Birx, a senior fellow at the George W. Bush Institute, is a former U.S. Global AIDS coordinator (2014-21) and a former White House Coronavirus Response coordinator (2020-21).
Dr. Deborah L. Birx, a senior fellow at the George W. Bush Institute, is a former U.S. Global AIDS coordinator (2014-21) and a former White House Coronavirus Response coordinator (2020-21).

It’s possible. We've done it around the globe in many countries – using data to chart outcomes and impact in real time, expanding the solutions that work and stopping those that don’t.

States and the federal government should sign cooperative agreements linking resources to local outcomes and embedding the CDC in the states. That would give federal public health workers a deep understanding of local issues and the performance of the state programs they're funding based on objective outcomes and impact.

This transformation of the CDC could save many more American lives.

Dr. Deborah L. Birx, a senior fellow at the George W. Bush Institute, is a former U.S. Global AIDS coordinator (2014-21) and a former White House Coronavirus Response coordinator (2020-21). 

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This article originally appeared on USA TODAY: COVID-19: Reform Centers for Disease Control and Prevention (CDC)