Three former directors of the Centers for Disease Control and Prevention (CDC) shared their thoughts on the world’s loss of credibility toward public health professionals and what needs to be done to restore faith in science as part of the Yale Institute for Global Health Conversation Series. Dr. Jeff Koplan, director from 1998 – 2002; Dr. Julie Gerberding, director from 2002-2009, and Dr. Tom Frieden, director from 2009 – 2017, joined Saad Omer, director of the Yale Institute for Global Health, on March 16 for an open to the public Zoom and Facebook live event attended by nearly 300 guests.
Omer started the discussion by noting how the COVID-19 pandemic has catapulted the CDC to the center of attention with daily news stories and everyday conversations among the general public. “We will reflect on the work of the CDC, including how the agency can evolve to keep pace with health challenges in the U.S. and around the world and what it means to have the microscope of the public on their decisions,” Omer said and then asked the panelists to share their biggest challenge they had to face during their tenure as CDC director.
Koplan, Senior Strategic Advisor for the Child Health and Mortality Prevention Surveillance Network and the Principal Investigator for the International Association of National Public Health Institutes at Emory University, reminded the audience of the Anthrax attacks in the early 2000s. “Anthrax was the first time an attack of that scope had been unleashed in the U.S. It was a traumatic event to the country and not only were we dealing with a lethal microbe, but we had human intelligence behind that microbe which made it different from naturally occurring events,” Koplan shared. He said that experience taught the world “we can never be too prepared.”
Gerberding, Executive Vice President and Chief Patient Officer at Merck and soon to be the chief executive officer of the Foundation for the National Institutes of Health, said her challenge was not only dealing with infectious disease emergencies but balancing those imperatives with other health threats that plague people on an ongoing basis. “I started at the CDC during an HIV pandemic and the beginning of an obesity crisis in this country that continue to be global health threats – we couldn’t neglect long-standing issues and just address a current emergency.” Observing the CDC during the current pandemic reminded Gerberding that what people hear and see on the news does not tell the whole story of what is going on across our entire public health system. “There is data being gathered, guidance being given, documents created to address specific needs on many levels, and we all should remain mindful that all this continues to take place during a public health emergency.”
Frieden, former commissioner of the New York City Health Department and President and CEO of Resolve to Save Lives, added “It’s easy to criticize, but very important to realize the constraints the public health sector works within.” He said his scariest moment as CDC director was the Ebola outbreak in Lagos. “I knew if Ebola got out of control in Lagos, it would have been all over Africa potentially for years and shutting health systems. We had to coordinate all staff to stop what would have been a huge disaster,” said Frieden. “We made mistakes but made the best decisions we could with the information we had, and we learned that communication is essential during a public health crisis. You need to tell people what you know when you know it, what you don’t know and offer practical advice on how they can protect themselves and their community.”
When asked about the political influence on CDC work and decisions the panelists agreed that CDC can provide the science but needs more authority to help drive policy. “The best times in public health have been when we’ve had robust local, municipal, and state health departments working with federal partners,” said Koplan. “We’ve seen an unfortunate drop in respect for scientific institutions….we need to inform and encourage engagement of elected officials and have them as partners to regain trust and have the ability to control an outbreak of any kind.”
Gerberding said a much greater degree of harmonization and integration of all networks and data systems is necessary to unify policy and decisions. “Our data systems are about as integrated as children’s sandboxes.”
She went on to offer the idea of a national public health system and “not a network of 3000 plus independent entities that cooperate but not necessarily in an efficient or timely manner.”
The lack of trust in the CDC by the public during the pandemic was of definite concern to all three guests, who agreed that open dialogue and more streamlined communications directly from the CDC to the public may be beneficial. “Let’s reflect on what’s happened over the past five years – there has been an inappropriate interference of CDC science in past the administration,” said Frieden.
“The CDC needs to speak regularly to people directly, trust is built a teaspoon at a time and lost buckets at a time.”
A former New York city department of health epidemiologist posed a question to Frieden on how to rebuild the public health workforce. “Yes, public health workers have left the job and there is no doubt we need funding to sustain salaries and programs, but it’s also true that public health is seeing good interest at universities,” said Frieden. “This can be a time for a public health renaissance and diversity in the field. This is a wonderful career with an opportunity to make a difference and improve, protect and even save millions of lives.”
Several questions came from the audience asking about vaccine equity and collaborations with other countries moving forward to help ensure more people are reached faster during the next global crisis. “There is value in having a working relationship with every geopolitical entity around the globe because you don’t know where [diseases] are going to start and where they are going to end up,” advised Koplan. “We stand to lose more than stand to gain if we don’t find ways to work together.”
Gerberding agreed and added, “I don’t think it’s an easy solution, if it were easy, we would have solved this problem years ago. What we observed in the pandemic are well-intentioned statements and commitments that fall by the wayside when the urgency of national demand takes precedent. I’m very familiar with the scarcity of both the human and technical resources it takes to manufacture vaccines. We need much stronger commitments through governmental alliances. I would like to think that one of the lessons we’ve learned is that we are only as safe as the world is safe.”
For the full YIGH Conversation Series event on March 16, visit https://youtu.be/mD09OrCa5eE.
The Yale Institute for Global Health Conversation Series provides a forum with some of today’s pivotal decision-makers in the world of global health and the COVID-19 pandemic. Representing diverse areas of expertise, speakers will address the latest in research, public policy, cutting-edge programs, and more. The series is co-sponsored by The George Herbert Walker, Jr. Lecture Fund at the MacMillan Center at Yale.