Three Action Steps for CDC to Start Rebuilding Trust
These steps will help the new director to rebuild trust in the beleaguered agency.
In an NPR interview last week, CDC Director Mandy Cohen emphasized the importance of trust in a democracy:
Trust is a critical foundation for a healthy society. Trust in institutions such as government or media or business has been eroding in recent years. This lack of trust has led to polarization, to division.
I agree with Cohen and want to propose three action steps to help with rebuilding trust in what was once the world’s leading public health agency:
First, CDC should produce an exhaustive pandemic response report. Among other essential topics, such as the agency’s own successes and failures, the report should explore why the United States’ Covid death toll was considerably higher than so-called peer nations and analyze the effectiveness of non-pharmaceutical interventions (NPIs) in the U.S. context. The public deserves answers as to whether masking, school closures, social distancing, travel restrictions, and business closures actually reduced transmission or morbidity and mortality. Questions posed by the Norfolk Group could be a good starting point for this report.
With members of Congress making hyperbolic claims about the efficacy of NPIs, a well-researched report could raise the quality of discourse at congressional hearings related to the pandemic response — and, potentially, help to inform a future 9/11-style commission on the subject.
Second, CDC needs to do a better job of acknowledging the Achilles’ heel of U.S. public health, which is widespread uninsurance and underinsurance among the population. It is extremely difficult to catch emerging infectious disease threats in a country where tens of millions of Americans and undocumented migrants — often individuals working in public-facing roles — have no or limited access to health care. People with mild respiratory symptoms will not honor guidance to report to doctors or hospitals for evaluation and diagnostic testing when the financial consequences are extreme. Moreover, poor population health resulting from the absence of universal health care increases the nation’s vulnerability to disease. I would like to see CDC task staff with evaluating how the agency can contribute to the achievement of universal health care, the absence of which Anthony Fauci said contributed to lower vaccine uptake in the U.S. than in Europe.
Because rhetoric surrounding universal health care is, to be frank, totally bonkers in America, CDC would have to be very careful to note that their work would be apolitical and agnostic as to the exact model (e.g. single-payer, managed competition, etc.). But it is clear that CDC’s core objectives can’t be achieved in a country where tens of millions are effectively excluded from the health care system. And it is difficult to expect Americans to trust public health guidance when their everyday interactions with the health system can be extremely negative.
Cohen’s background means she is exceptionally well-suited to understanding the importance of universal health care to pandemic preparedness and achieving broader public health goals:
As Secretary of North Carolina’s Department of Health and Human Services, Dr. Cohen developed innovative and nationally recognized programs that improved the health and lives of families across the state. Her leadership through the COVID-19 crisis drew bipartisan praise, as did her successful transformation of North Carolina’s Medicaid program and pivotal role in the bipartisan passage of Medicaid expansion. Before serving in North Carolina, Dr. Cohen held senior roles at the Centers for Medicare & Medicaid Services where she helped implement Affordable Care Act programs, including expanding insurance coverage and protections.
Third, CDC needs to evaluate its workforce and ensure that those in high-level positions at the agency are capable of inspiring public trust. For example, it was unsettling to learn that Andrew Cuomo’s former health commissioner — who defended New York’s early-pandemic nursing home policy and oversaw creation of a special testing program for Cuomo and his family — has been serving as Deputy Director of Global Health at CDC since January 2023. Cohen should investigate what led to this hiring decision and ensure that future hires align with the values and institutional culture that she hopes to build at a reformed agency.
By moving from words to action, CDC can rebuild public trust and more effectively defend the health and welfare of all Americans. There’s no time to waste.
