A window into what changes at the CDC might look like

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The Centers for Disease Control and Prevention leadership recently announced the agency will undergo an overhaul to address the causes of repeated missteps during the pandemic. For how that might actually look, Federal News Network’s Eric White spoke to Julie Swann on the Federal Drive with Tom Temin.  Swann is a professor of industrial and systems engineering at N.C. State. She’s done much research in this area, including on behalf of CDC itself.

Interview transcript:

Julie Swann: There is, at this point, still not full details on exactly what’s going to happen. The CDC director has stated that a plan will be submitted. There are some things that we know: We know that the reporting structure is going to change for the laboratory group at CDC. And now that we’ll be reporting directly to the director’s office, there are some changes coming in the communications side of the CDC. There are also some other changes that are not necessarily the structure so much as the incentives and permissions, such as how data is released to the public and how papers, or in this case, prepense are released to the public.

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Eric White: And I imagine, you know, this is all from looking within after the COVID-19 response that is still ongoing. So we got to just lay that out there. But what during the pandemic, do you think set this kind of restructuring up? What were some things that you and your colleagues saw that you said, you know, maybe there could be a little bit more updating there?

Julie Swann: Well, there are a number of things that people have identified as being problematic. One problem was the initial lab tests for coronavirus, and the way that that was rolled out. The exclusive lab tests from the federal government, it was difficult to use, and there were some errors. So that may be one reason why the laboratory structure is changing a little bit. One of the other big complaints about the CDC during the pandemic has related to communication: communication about what to do, how long to isolate, how to think about different aspects of prevention and mask usage and those kinds of things that can be seen partly in the changing of how communications will be done. Another challenge has certainly been data and obtaining data required reporting from the states in several cases, which does not happen in all diseases, and in all cases until certain conditions have been met. And then making that data available to the public. And that can be addressed, at least partly with some of the changes that are coming with respect to data and publications. One of the other changes to see is that the CDC is creating an equity office, this can help them make sure that the workforce is representative of the U.S. population and is communicating information appropriately to different groups. With having this focus on equity really central in that director’s role, it can also help make sure that we’re addressing equity and disparities in access and outcomes across public health emergencies, as well as other areas of the CDC.

Eric White: So we can kind of just go through all of those briefly when it comes to public health. What are the key aspects of good clear communication that you’re trying to release to the public when you are looked at as the wise old man when it comes to infectious diseases?

Julie Swann: One of the real challenges during a public health emergency is that you don’t have the full information at the beginning of the event. And really even what the scientists know may be changing over time as there’s more information about the disease or even as a disease changes itself. So certainly, we want communication to be clear and actionable. It can also be helpful to communicate the uncertainty, the things that you’re sure about, the things that you’re not sure about. And sometimes even the reasons for doing something. So the communication around masks might fall into that a little bit given some of the different things that have happened over time. In some cases, that communication can also lay out whether that particular advice or guidance is driven primarily by the science or whether it’s also driven by the cascading effects of particular actions or behaviors within communities.

Eric White: And mistakes and wrong choices, I guess or wrong advice just gets amplified, especially in today’s environment. And we saw definitely a lot of that. What can you say about maybe how this improved communication effort might step back some of those mistaken ideas that were first thrown out in the beginning of the pandemic and, you know, lost CDC some credibility?

Julie Swann: Well, there’s a lot that we still don’t know about exactly how the CDC will restructure and improve communication. What is clear during this public health emergency is that communication from government agencies and on important topics like public health has been hit with a lot of misinformation and disinformation. Things have been spreading through social media that are not true or have a kernel of truth, but have other things that are not true. This represents a huge challenge for our governmental agencies. I think that restructuring communication is one part of this. But I think that we’re going to have to work on this issue for many years to come and really figure out the best ways to deal with the miscommunication and disinformation and misinformation that can occur during social media and ways that people are engaging in media.

Eric White: One way to do that would be to showcase some of the facts and data that you have to back up some of those plans. What can you tell me about data access and where the CDC could improve in making sure that the state and local government health agencies also have access to the important data?

Julie Swann: It may be surprising to people to know that the CDC does not necessarily receive data from the states, even in this recent monkey pox outbreak. Initially, there was no requirement that the states had to report that information to the CDC. That did occur after the public health emergency was declared. But making sure that the CDC can get the full information that we need for protecting our society is one important piece of that data. And so the CDC is working with HHS to request that kind of authority under various kinds of conditions. The second piece is sharing of data. And one of the things that happened during this pandemic is that we saw a number of media organizations that were able to pull together data and share things in a public way. That is, unlike things that we have seen before. And you know, really with the the new data sources that are available, this becomes more and more impossible over time. So the CDC, along with other federal agencies, certainly needs to look at modernizing data and thinking about the the wide set of data sources that might be available to fully inform what is presented to the public, as well as how this data is stratified. One of the other missteps that we saw during the pandemic is that initially, race ethnicity was voluntary reporting by states, for example. And when data started being reported about vaccine administration, we saw that there were initial disparities in who was receiving or taking vaccine from the states that were reporting that. Having that information then allows us to know how we are doing and how we need to address it. That stratification by race, ethnicity, by age distribution, by geography, from state down to county can help both public health organizations, their partners, and even the community to make sure that we are protecting society to the extent possible.

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Eric White: Ideally, what do you and your colleagues think that the CDC can do to improve its mission and how that it goes about ensuring that people have the information they need, and all the right people have the right data and information?

Julie Swann: Our public health system is really complex, we have a lot of decentralized decision makers, from different federal agencies, to state agencies, local agencies, hospital providers, and other kinds of partners throughout the space. So you know, it’s a really complex system. I think restructuring is important, focusing on the things that are most impactful in thinking about ways to incentivize the participants in this decentralized system in a way that aligns the entire organization and the entire public health system. So data is one example. There is an emphasis on publishing with papers. And that’s really important to make sure that we’re getting CDC reviewed material that’s out there. But being able to get that out faster, as prepense, or even have the data released as soon as it is accurate, can be helpful in protecting the public. So making sure that not only the structure of the organization, as well as the communication, and even the incentives because we all know that people behave according to what they’re measured.

Tom Temin: Julie swan is professor of engineering at N.C. State, and she specializes in health and humanitarian research. She spoke with Federal News Network’s Eric White.

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