After two years of responding lethargically, failing to reveal key data, and issuing muddled messages, the U.S. Centers for Disease Control and Prevention (CDC) has proven it is fundamentally incapable of leading the nation through a fast-moving pandemic. In his recent book, The Premonition, Michael Lewis pejoratively refers to the CDC as “Center for Disease Observation and Reporting.” While this was meant as an appropriate criticism of the CDC’s passive operating posture and inability to “control” COVID-19, Lewis was actually too kind. The CDC’s performance in “observation and reporting” has been dismal.
The CDC, founded in 1946 as the Center for Communicable Diseases, boasts a rich history of achievements. Beginning with malaria, the CDC has played central roles in the identification, mitigation, or eradication of diseases such as smallpox, Ebola, polio, and HIV/AIDS. Common to many once-successful organizations, however, it has failed to modernize, adapt, and evolve to sustain a position of relevance, let alone leadership. Nothing short of a complete transformation is necessary.
Where to start?
While there are scores of changes necessary to transform the CDC’s pandemic response capability, three of them are more critical than the others: its ability to capture and aggregate data, its role in conducting research, and its use of sound behavioral science principles.
Capturing and aggregating data. The CDC relies largely on antiquated state, county, and municipal public health agencies to collect data on infectious disease cases, hospitalizations, and deaths. These public health agencies in many cases collect the data manually, aggregate it, and then send it to the CDC, where it is aggregated again. In some cases, the local public health agencies still use facsimile machines. As such, these data are at best incomplete, inaccurate, and untimely. Why go through so many layers of manual data collection and aggregation when we have the infrastructure to collect all these data—almost instantaneously—straight from the sources?
The United States has spent tens of billions of dollars over more than a decade to automate data capture and aggregation across most aspects of the nation’s health system. Electronic health records (EHRs) now exist in nearly every hospital, physician’s office, clinical laboratory, community health center, and retail pharmacy in the country. All of these entities are capable of capturing and transmitting relevant COVID-19 data on cases, hospitalizations, and deaths multiple times a day.
Many of the EHRs are linked through regional Health Information Exchanges (HIEs). During 2020, we tapped into all of these entities’ information systems during Operation Warp Speed to distribute vaccines and track vaccinations. Moreover, we used outside firms to create an integrated management system to track critical medical supply inventory from factory to warehouse to hospital and to tap into claims data from health insurers to identify and prioritize for vaccination those most vulnerable to COVID-19.
The U.S. medical supply, health insurance, and care delivery systems, supported by regional health information exchanges and advanced analytics firms, have the infrastructure, capacity, and capability required to capture, transmit, and evaluate nearly all relevant pandemic-related data in real-time. The CDC simply needs to coordinate an effort to aggregate it.
Democratizing pandemic research. Once the relevant data described above are aggregated, they should simultaneously be put into the public domain for use by public health entities, political leaders, businesses, and others. America’s schools of public health and academic medical centers have thousands of highly trained epidemiologists, data scientists, and researchers eager to derive key insights into what has been happening throughout the pandemic. Imagine what they could have done had they been fed relevant data on a daily basis.
For example, in June 2021, the Cleveland Clinic published a compelling COVID-19 study of the protection afforded by natural immunity based on its 50,000 employees’ data. The CDC did not release its own findings on this critical information until seven months later in January of 2022. The CDC’s role should not be to conduct its own research during a pandemic, rather it should promote, sponsor, and then evaluate research from all over the country and synthesize it for policy purposes.
Enhancing behavioral science capabilities. Mitigating the spread and clinical impact of a virus such as COVID-19 is all about modifying human behaviors: successfully donning a mask, maintaining social distance, isolating, and getting vaccinated. Behavioral scientists at many of our universities, consumer goods companies, and social media platforms study health-related human behaviors and have established well-known principles such as status-quo bias, loss aversion, and saliency that, when used effectively, are highly impactful. If we really wish to “follow the science,” then behavioral science should play a much more prominent role in the CDC’s overall pandemic response and communications arsenal.
Embedding these changes into the CDC will require a critical evaluation of its leadership, mindsets, and culture. The current organization favors working with the nation’s public health community to the exclusion of the more nimble, capable private sector. As well, it believes its source of power and influence is in hoarding critical data and publishing its own research rather than enabling others to have immediate access to such data and conducting their own research. As we proved during Operation Warp Speed, if the government enables success, America’s private sector will deliver it. The time is right for the CDC to adopt this principle.