The disaster at the CDC, explained by its former boss

After the Trump administration laid off hundreds of health workers during the ongoing government shutdown, the Centers for Disease Control and Prevention has now lost one-third of its staff this year. States are forming public health alliances in direct opposition to the changes being made by Health Secretary Robert F. Kennedy Jr. Only half of Americans say they trust the CDC to deliver reliable information about vaccinations.

The consequences of the CDC’s gutting will be diffuse, given the agency’s many different functions, and they could take some time to materialize. Public health trends are measured in decades, not in months. 

But to get a sense of where the agency stands after the chaos of the past year, I went to somebody who knows the place inside and out. Dr. Tom Frieden, the president and CEO of Resolve to Save Lives, a nonprofit global health organization, was CDC director from 2009 to 2017 under President Barack Obama. Our conversation is below, edited for clarity and length.

Which specific CDC functions do you worry about the most? What hasn’t gotten enough attention?

You start with: We’re losing our basic ability to know what’s happening. That’s really dangerous. Flying blind is a really bad strategy, whether you’re piloting an airplane or trying to avoid cancer and infectious diseases. Our systems track what’s happening and see whether the programs that we want to implement to save lives are actually working or not, so that we can then either fix them or continue them. 

Then there are the specific actions that are being taken that are very damaging, such as dismantling the Office of Smoking and Health, which has led US efforts that have dramatically reduced smoking in the US and continue to track what’s happening in populations. The FDA tracks the product; the CDC tracks what happens in people and supports comprehensive action in communities and quit lines and hard-hitting ads. That’s all gone.

So, although I think much of what is said is laudable, what is done is the opposite of what is said.

As a reporter who cites the CDC’s survey data a lot, I’m concerned about the layoffs in that office. What are the potential consequences if that data isn’t available or reliable?

This is a really complicated survey. It’s really hard to do. I know that particularly well because when I was New York City health commissioner, we did the first-ever community-specific health and nutrition examination surveys.

It was massively difficult. It takes incredibly rigorous work to get comparable data and a representative sample and competent lab work. It’s like building battleships, kind of. And once you stop building them, it’s really hard to start again.

This is our most ground-level truth of what’s really happening. These surveys tell you how we’re really doing, and that may indicate what needs to be done differently. It’s also the way we know what’s happening with PFAS and how many people have exposure to these chemicals in our blood, and whether we’ll be able to reduce that with actions that this administration says they want to take.

What should people think about these state public health alliances or states issuing their own vaccination guidance? How do they decide which authority to listen to?

What’s the alternative? People have life-and-death decisions that still need to get made.

You have a CDC that has been basically taken over by ideologues. This has never happened before. You have political appointees running the agency, setting policy on social media, making statements that show that they have very little understanding of or respect for basic scientific method, evidence, and facts. 

A lot of people had already lost trust in the CDC. Now, more people are losing trust for very different reasons. How will the CDC ever regain trust — or is it becoming obsolete?

It starts with listening carefully to what people are hearing, what they believe, and addressing valid concerns because the Make America Healthy Again movement gains power by real concerns people have: What’s in my food? What’s in my water? Who is involved in making these recommendations? Those are perfectly valid questions. 

Unfortunately, with what’s being done is in the name of reducing conflict of interest, you’re seeing a big increase in conflict of interest. That’s really clear in the autism discussion. They want to make autism a compensable condition under the Vaccine Injury Compensation Fund. This is payday for trial lawyers while using the people who are dealing with autism and giving them false hope and false information about vaccines, which are repeatedly shown not to have been associated with autism. 

I think also public health needs to have tangible wins, things that it does that people can see and understand that this made their life better. This made my life healthier, safer. Our kids are about seven times less likely to smoke than they were a generation ago. Even with vaping, tobacco use is dramatically lower than it was a generation ago. The average lead level a generation or two ago would today result in urgent investigation. These are invisible wins. 

That’s not to say that either those problems are adequately addressed or there aren’t other serious problems. We haven’t dealt effectively with obesity. We haven’t dealt effectively with asthma. We haven’t dealt effectively among adults with hypertension, cardiovascular disease. We’ve had 10 or 15 years of stalled progress. I think past progress shows both what’s possible and what’s needed. But any mandates or requirements also need to be kept to an absolute minimum. 

I don’t see public health becoming obsolete because facts are stubborn things. Even if they’re denied and suppressed and misused and misquoted and cherry-picked, facts are still facts. The plain truth is that most people want to be healthy and safe, and what’s being done now is putting that very much at risk.