In a time of intense scrutiny and growing distrust of the CDC, the Yale Institute for Global Health invited three former CDC directors to address how to shore up confidence in the government agency. 

As part of the Institute’s Global Health Conversation Series, YIGH hosted former CDC directors Jeff Koplan, who served from 1998-2002; Julie Gerberding, who served from 2002-2009; and Tom Frieden, who served from 2009-2017, on a public Zoom and Facebook live attended by nearly 300 virtual audience members. The inaugural director of the Yale Institute of Global Health Saad Omer moderated the discussion and fielded questions from the audience. 

Although Omer directed each audience question to all three panelists and allowed them each to respond, common themes emerged among each former director’s responses.

Koplan emphasized the importance of partnership and relations in public health. He touched on both the CDC’s relationships with legislators and the public’s relationship with scientific institutions. 

Koplan stressed the importance of “engagement among elected officials at the local, state, and federal levels” so that the CDC could “have them as partners moving ahead.” Underscoring the importance of these officials, Koplan asserted that elected officials have had enthusiasm and appreciation for what the CDC has accomplished in past decades. Furthermore, he recognized that some elected officials in the House and Senate have played important roles in public health policies alongside the CDC and expressed optimism about rekindling that partnership. 

In his responses, Koplan also warned of the dangers of the public’s intense scrutiny of the government agency in light of the pandemic. He expressed that the current lack of public confidence in the CDC could stunt the development and improvement of the agency. 

“One of the problems we are dealing with right now is an unfortunate drop in respect for science in general, for scientific institutions, for the people that work in them, [which] is disastrous for the well-being of our country,” Koplan asserted.  “That’s not where growth is.”

U.S. News conducted a survey in May 2020 and again in October 2020 and found that trust in the CDC had dropped 10 percent in just months. 

Frieden echoed many of Koplan’s concerns and highlighted the importance of using science to inform public health policies. 

“It’s not just a question of science,” Frieden told the audience. “It’s a question of science and policy.”

Frieden asserted that the Trump administration’s involvement in CDC matters was “inappropriate” and blurred the lines between science and political interest. He cited the incident in which Trump administration staff posted documents on the CDC website downplaying the effects of the pandemic. 

Frieden also acknowledged the importance of allowing science to inform policy, but he stressed that the CDC does not make the policies.

“When you say follow the science, the science will lead you so far, but the science ends where a community makes a decision,” Frieden said.

Frieden said the onus is on legislators to accept science and create policies that will benefit communities, so the relationship between lawmakers and the CDC is one that needs to be fortified for the greater interest of the country. 

While Frieden and Koplan focused on returning to previous principles of the CDC, Gerberding urged internal change to sustain the perpetuation of the CDC’s mission. She conceded that restructuring can remedy inefficiencies and bring in different kinds of talent, but ultimately foundational changes are the answer to improving government scientific institutions such as the CDC.

“We have to have a much greater degree of harmonization, [including] integration of our data systems, which currently are about as integrated as a children’s sandbox,” Gerberding said. 

Gerberding cited the difficulty of obtaining hospitalization data at the onset of the pandemic due to a lack of centralized data to illustrate the importance of data integration. Before the emergency health declaration, the CDC did not have the authority to require health systems across the nation to report COVID-19 hospitalizations and deaths. Consolidating data from nearly 700 health systems across the country posed a serious challenge to the CDC, and Gerberding cited this as support for a national public health system. 

The lack of data integration caused confusion about death and hospitalization numbers in the first weeks of the pandemic, which opened the CDC to become the subject of many conspiracy theories. Social media posts claimed that the CDC was adding deaths to the national count in order to incite panic amongst the public; however, a lag in reporting and data collection contributed to the unusual and inconsistent numbers. 

Towards the end of the discussion, Omer cited a Feb. 8, 2020 survey conducted by Yale on attitudes toward the pandemic. The survey asked participants who they would like to hear pandemic-related information from. Overwhelmingly, participants stated they wanted to hear from the director of the CDC. Omer asked the former directors what could be done to restore this pre-pandemic level of faith and trust in the CDC.

“The CDC needs to speak regularly to people directly,” Frieden said. “Trust is built a teaspoon at a time and lost buckets at a time.”

Gerberding echoed this sentiment and emphasized that information to the public should come directly from the scientists “so it doesn’t look like something has come down from the mountain and is being disseminated into the valley.”

In response, Koplan again affirmed the importance of collaboration between municipal, state and federal institutions. Moreover, Koplan advocated for the modernization of the agency. He said that individuals who possess novel skills in data analytics must be recruited along with experts in technology and social media in order to effectively reach the public. However, Koplan stressed that these changes would only be possible with consistent and predictable funding, something heavily lacking at the CDC currently. 

“The job of public health can be frustrating, underpaid, tiring,” Omer conceded in closing. “But it is never, ever meaningless.”

The headquarters of the Center for Disease Control and Prevention is located in Atlanta, Georgia.