Challenges Facing the Centers for Disease Control and Prevention (CDC)

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The U.S. Centers for Disease Control and Prevention (CDC) has long been regarded as a premier public health agency, often seen as the “gold standard” by health professionals around the world. It has built a high reputation through decades of disease control successes – from helping eradicate smallpox to leading responses to Ebola and Zika. However, recent years have tested the CDC like never before. The COVID-19 pandemic in particular exposed and intensified a range of challenges – from eroding public trust and funding shortfalls to political interference, communication breakdowns, and operational weaknesses. These issues, combined with the unprecedented scale of the pandemic, left many Americans questioning the CDC’s effectiveness.

In mid-2022, barely half of Americans felt public health officials at the CDC were doing an excellent or good job handling the pandemic – a steep drop from 79% at the pandemic’s outset. Experts noted that from faulty COVID-19 test kits and weak data systems to confusing health messages, the CDC “could not meet the moment” during COVID-19, even repeating some past mistakes during the 2022 monkeypox outbreak.

Public Trust: An Eroding Foundation

Public trust is essential for any health agency’s effectiveness, and for decades the CDC enjoyed a strong reservoir of goodwill. The agency’s competence and leadership in public health led many around the world to view it with high esteem. Unfortunately, public confidence in the CDC has declined sharply in recent years. Surveys show that trust in the CDC dropped during the COVID-19 crisis and has remained low. For example, a Pew Research Center poll found that by mid-2022 only about half of Americans rated CDC officials’ pandemic response as excellent or good – down from 79% in March 2020. More recent tracking polls continue to reflect this downward trend, with trust in CDC recommendations hovering around the 60% range in 2023. This erosion of trust has been especially pronounced along partisan lines: Americans’ views of the CDC became strongly split, with significantly fewer Republicans than Democrats expressing confidence in the agency. In fact, political polarization during the pandemic meant that many people came to trust individual figures or commentators over the CDC’s experts for health guidance.

Why has trust fallen? Several factors contributed. Perceived missteps in the pandemic response dealt a heavy blow to credibility. In early 2020, the CDC struggled with a botched rollout of COVID-19 test kits and issued shifting guidance (such as reversals on mask recommendations), which created public confusion. These communication inconsistencies made some Americans question the CDC’s competence or suspect political motives. Indeed, political interference (discussed more below) visibly compromised the CDC’s messaging at times, undermining the public’s faith that the agency was speaking plainly and truthfully. Additionally, a flood of misinformation on social media and stark partisan rhetoric led many to doubt official health advice.

Historical injustices have also cast a long shadow on trust, especially in marginalized communities. The CDC itself oversaw the infamous Tuskegee syphilis study (1932–1972), in which Black participants were misled and denied treatment. This ethical atrocity sowed generations of mistrust toward public health authorities in African American communities. Likewise, a 1976 CDC-led mass vaccination campaign for swine flu backfired when the vaccine was linked (albeit rarely) to Guillain-Barré syndrome, becoming a “major setback for public trust in vaccines.” While these events are decades past, their memory, combined with more recent controversies, contributes to skepticism among some groups.

Rebuilding Public Trust through Transparency and Engagement

Re-establishing trust is arguably the CDC’s most urgent task, since public cooperation is crucial in any health emergency. Transparency is key. CDC leaders acknowledge that the agency must be more open about its data, decisions, and uncertainties to earn back confidence. Newly appointed CDC Director Mandy Cohen, for instance, has emphasized that making the agency more transparent is essential for rebuilding public trust. This means “showing its work” – sharing data and scientific reasoning with the public in a timely, accessible way. A positive step in this direction has been the overhaul of CDC’s COVID-19 data trackers (e.g. for wastewater monitoring) to make them easier to interpret. However, much more needs to be done. Experts suggest the CDC should regularly communicate what it knows and what it doesn’t know during crises, rather than appearing to issue pronouncements from behind closed doors. Being candid about evolving situations can help the public understand changes in guidance as new evidence emerges.

Another strategy for restoring trust is active community engagement. The CDC can partner with local health departments, community leaders, and healthcare providers to relay information through trusted channels. Notably, people tend to trust their own doctors and local health professionals more than distant federal agencies. Leveraging these local messengers – by equipping doctors, nurses, and community health workers with clear CDC-vetted information – can improve credibility and reach. The agency is also encouraged to build long-term relationships with community organizations, faith groups, and advocacy groups before the next crisis hits. Such inclusive engagement, as public health scholars point out, ensures that health messages are heard and believed, especially in underserved or skeptical communities.

Importantly, the CDC must demonstrate that it puts science over politics. Admitting past mistakes and implementing visible changes (such as external reviews of guidance for bias or political influence) can signal a renewed commitment to scientific integrity. In 2022, CDC leadership took the rare step of initiating an internal review of the agency’s pandemic response, openly acknowledging failures and promising reforms. Following through on these reforms – for example, by sharing scientific findings faster and making public communication clearer – will be critical to winning back trust. Over time, consistent, clear, and apolitical performance can rebuild the CDC’s reputation as a reliable guardian of public health.

Funding Constraints: Doing More with Less

Another fundamental challenge facing the CDC is chronic funding constraints and the ups-and-downs of support for public health. The CDC’s responsibilities have expanded over the decades to encompass not only infectious diseases but also issues like chronic disease prevention, injury control, and health equity. Yet its budget and resources often lag behind its mission. In fiscal year 2021, the CDC’s budget was about $13 billion – an amount that must support not only CDC’s own programs but also extensive grants to state and local health departments. A large portion of CDC funds pass through to frontline public health agencies across the country, meaning the CDC itself operates with a relatively modest core budget given its vast remit.

Historically, public health funding in the U.S. has followed a “boom-and-bust” cycle, surging during crises and contracting afterward. During the COVID-19 pandemic, Congress poured tens of billions into state and local health departments via the CDC to support vaccination campaigns, contact tracing, data systems, and more. But officials warned that once the emergency ebbed, those temporary funds could dry up – continuing a decades-long pattern of underinvestment between emergencies. Indeed, as of 2023–2024, many pandemic-era funding streams have expired, and state governments are slashing public health budgets that had been temporarily bolstered. Public health leaders caution that if budgets fall back to pre-pandemic levels, the nation could be left “unprepared for a health crisis” once again.

The consequences of underfunding have been evident in the CDC’s workforce and infrastructure. The nation’s governmental public health workforce has shrunk dramatically over the past decade – nearly 80,000 jobs were lost in state and local health agencies from 2010 to 2021. This has left critical gaps in epidemiology, lab expertise, and community outreach. The CDC relies on those state and local partners to execute programs, yet many local health departments operate with skeletal staffing and outdated equipment. Data systems in public health are notoriously antiquated (some still rely on faxes and manual spreadsheets) because modernization efforts have been repeatedly deferred for budgetary reasons. Prior to COVID-19, funding for public health emergency preparedness had been steadily in decline, leaving stockpiles, labs, and surge staff under-resourced. This “bare-bones” baseline hampered the early pandemic response, as overwhelmed health departments struggled to scale up testing and contact tracing with limited staff and tools.

Strengthening the Budget and Investing in Public Health Infrastructure

Tackling the CDC’s funding challenge requires sustained investment and structural funding reform. Public health experts argue that the country must stop the boom-bust cycle and commit to steady financing of core public health functions. One proposal is to establish a more resilient funding mechanism for the CDC and health departments – for example, a mandatory public health fund or trust (somewhat akin to how Social Security or highways are funded) that provides reliable dollars each year, rather than depending entirely on annual discretionary appropriations. Former CDC Director Tom Frieden has testified in favor of a new funding structure so that critical programs aren’t pitted against each other for scarce dollars year after year. Consistent funding would allow the CDC and states to maintain readiness (e.g. keep epidemiologists on staff, labs updated, stockpiles rotated) even when no crisis is in the headlines.

In the near term, the CDC is allocating recent one-time funds to where they’re needed most. For instance, through grants like the Public Health Infrastructure and Data Systems initiative, the CDC is helping states hire staff and upgrade technology. These efforts aim to patch some of the holes revealed by COVID-19. But lasting improvement will require political will to prioritize public health funding at federal, state, and local levels. Studies convened by public health organizations have estimated that billions in new annual funding are needed to adequately prepare for future outbreaks and health challenges. Such investments would pay off by preventing costly emergencies and saving lives long-term.

Better funding isn’t just about more money – it’s about smart allocation. The CDC and Congress can work to ensure funds are directed to modernizing labs, data infrastructure, and workforce development. For example, upgrading laboratory capacity and genomic sequencing technology at the CDC and state labs can speed up identification of new variants or pathogens. Investing in the public health workforce (through loan repayment programs, competitive salaries, and training grants) can help attract the next generation of epidemiologists, data scientists, and communication specialists that the CDC needs. The COVID-19 experience showed that having surge capacity – people and tools that can be mobilized quickly – is invaluable. Funding policies could formalize a reserve corps of public health responders, similar to the National Guard for health emergencies.

Funding public health is a policy choice. The pandemic, as devastating as it was, at least demonstrated the consequences of neglect and the value of preparedness. It has been a wake-up call that “we can’t be in this place again” of scrambling to catch up in a crisis. Adequate and sustained funding, paired with accountability for how funds are used, is one of the foundational steps toward a stronger CDC and a safer nation.

Political Influences: Navigating a Highly Charged Environment

The CDC is intended to be a science-driven agency, but it does not operate in a political vacuum. It is part of the Department of Health and Human Services, reports to the Executive Branch, and its Director is a presidential appointee. Over the years, political influences have sometimes clashed with the CDC’s public health mission. This challenge became starkly apparent during the COVID-19 pandemic, when unprecedented levels of political interference hampered the CDC’s work.

Under the Trump administration, the CDC’s scientists and officials faced repeated intrusion into their domain. In early 2020, after a CDC expert warned openly that COVID-19 could severely disrupt American life, the White House moved to tighten control of the CDC’s communications. Top officials required that all media statements be cleared by the administration, effectively muzzling the CDC for critical weeks. Political appointees at HHS went so far as to demand edits to the CDC’s scientific reports – such as the Morbidity and Mortality Weekly Reports (MMWR) – when findings didn’t align with the administration’s optimistic messages. Emails revealed that HHS communications aides pressured CDC leaders to water down reports they feared “undermine President Donald Trump’s message,” even attempting to retroactively change CDC publications. While CDC staff pushed back on some changes, they increasingly had to accommodate political reviews of scientific documents. In short, the pandemic response saw the CDC’s scientific integrity compromised by political goals – a reality later documented in a Congressional investigation. A 2022 House subcommittee report detailed how “President Trump and his top aides repeatedly attacked CDC scientists, compromised the agency’s public health guidance, and suppressed scientific reports” in an effort to downplay the virus, which “harmed the nation’s ability to respond effectively.”

Political pressure on the CDC is not entirely new. Previous administrations have also been accused of filtering CDC communications on sensitive topics. For example, in 2017 there were reports that certain terms (like “evidence-based” or “fetus”) were discouraged in CDC budget documents under political direction. And during the early AIDS crisis in the 1980s, the CDC’s recommendations (such as promoting condom use or needle exchanges) sometimes ran into ideological opposition, limiting federal support for those measures. State and local politics play a role too: during COVID-19, different governors took vastly different approaches, with some openly contradicting CDC guidelines on masks or business closures, often influenced by partisan leanings. All of this creates an environment in which the CDC’s experts must navigate science and public policy amid political currents.

Safeguarding Scientific Integrity and Independence

To address political influence, many observers call for strengthening the CDC’s independence in how it communicates and makes decisions. One proposal is to give the CDC Director a fixed term (for example, five years) and require Senate confirmation, similar to other high-profile public health roles or agencies like the FBI or Federal Reserve. This could insulate the position from immediate political whims and lend the Director more clout to resist interference. In fact, discussions have been underway to make the CDC directorship a Senate-confirmed post in the future, which could mark a step toward accountability balanced with independence.

Another important measure is to erect clear firewalls between science and politics. The CDC has policies on paper affirming its scientific integrity, but these may need bolstering and formal enforcement. For instance, ensuring that health advisories and publications (like the MMWR) are free from political vetting is crucial. Legislation or internal HHS rules could explicitly prohibit political appointees from altering scientific content. During the Biden administration, efforts were made to let the CDC hold its own briefings again and speak more freely – a reversal from the prior practice of routing everything through the White House. Maintaining that norm going forward will be important regardless of who is in power.

Some experts have suggested more radical structural ideas, such as making the CDC an independent agency outside of HHS (similar to how the Social Security Administration operates) so that it has a degree of separation from the political chain of command. However, even without restructuring, transparency can be a powerful disinfectant for undue influence. If the CDC clearly communicates its guidance and the evidence behind it in real time, it becomes harder for political actors to secretly manipulate messages. In the COVID-19 aftermath, committees recommended “safeguarding scientific integrity” as part of rebuilding trust – this might include external audits of CDC actions during emergencies, and reporting to Congress if political interference is attempted.

It’s worth acknowledging that the CDC alone can’t fix politicization in public health. As Director Walensky noted, a coordinated effort is needed: businesses, schools, and government at all levels have roles in supporting public health. When the CDC provides clear national guidance, it’s most effective if state and local partners align their messaging rather than contradicting it. Building bipartisan support for public health – treating it as a nonpartisan issue like national defense – would go a long way in reducing harmful political tug-of-war. That is a tall order in today’s polarized climate, but aiming for unity in the face of health threats (where leaders agree to let CDC experts lead the messaging) would help ensure science-based advice isn’t drowned out by politics in the next crisis.

Communication Challenges: Messaging in a Fast-Moving Crisis

The COVID-19 pandemic highlighted how crucial effective communication is to public health – and how difficult it can be for the CDC to get messaging right. The CDC has a reputation as a highly technical agency, one whose communications often take the form of dense guidance documents or scientific reports. In an emergency that demanded clear and rapid public guidance, this approach faltered. CDC communications during COVID-19 were widely criticized as confusing, slow, and sometimes contradictory. Guidance about masking, for example, changed as evidence evolved – from initial advisories against public mask use in early 2020 (to preserve supply for healthcare workers) to later urging universal masking – but the rationale for the shifts was not effectively conveyed, leaving many people perplexed or skeptical. Similarly, updates on quarantines, testing, and school precautions often came later than the public wanted, and in a form (lengthy web pages) that was hard to digest. Even CDC officials admitted that their COVID guidelines were “confusing and overwhelming” for the public.

Several factors contribute to these communication struggles. One is the CDC’s organizational culture, which has traditionally prized careful science over quick messaging. CDC scientists usually take time to ensure data is absolutely solid and guidelines are meticulously vetted. While rigor is good, in a fast-moving outbreak it led to delayed or overly cautious public communications. As Dr. Walensky put it, historically the CDC was known for “making sure every I is dotted, every T is crossed” before speaking, but “we don’t have that luxury in this pandemic”, where waiting for perfect data means being “too late”. Another factor is that the CDC did not have dedicated crisis communications experts leading the charge. Messages were often crafted by medical professionals, resulting in language that wasn’t always accessible. And in the age of social media, the CDC’s communications were slow to cut through: nuanced explanations posted on a website were easily drowned out by misinforming tweets or soundbites that spread faster.

The CDC’s inability to quickly track and share data also hurt communication. For instance, delays in gathering case and hospitalization data (due to system issues and state reporting lags) meant the CDC was sometimes “weeks behind” in recognizing trends. This made their guidance reactive and seemingly out-of-step with what people were experiencing on the ground. In an information vacuum, speculation and rumors filled the gap. All of this fed a narrative that the CDC’s messaging was muddled. By late 2021, even as the CDC tried to refine its statements, public patience had waned; criticism mounted that the agency’s advice on issues like isolation periods or booster shots was poorly communicated and inadequately justified.

Enhancing Public Communication and Messaging

Improving communication is one of the central parts of the CDC’s post-pandemic reform agenda. To reach the public more effectively, the CDC is looking at several changes. First, professionalize the communications function: this means bringing in or elevating experts in risk communication, marketing, and plain-language writing. Public health scholars note that clear and authoritative communication is perhaps the most important responsibility during emergencies, yet the CDC historically has not emphasized communications training. The agency would benefit from staff who specialize in crafting messages that are both scientifically accurate and easily understood by non-experts. During the COVID response, the CDC eventually started holding more regular press briefings (after a period of silence), which helped put a human face on the agency. Continuing frequent, transparent briefings led by CDC’s leaders or designated communicators can ensure consistent messaging.

Another improvement is to streamline the clearance process for urgent communications. In the heat of an outbreak, waiting days or weeks for every guidance document to be approved by multiple layers is not feasible. The CDC has acknowledged this and is working to simplify internal review so that updates can be issued faster. Along with speed, clarity is crucial: guidance should be concise and avoid unnecessary jargon. For example, instead of burying key recommendations in a 10-page PDF, the CDC might release a one-page summary or infographic with the main points, supplemented by details online for those who want them.

Meeting people where they are is also part of the solution. The CDC needs to proactively engage on social media and other modern platforms to disseminate information. In recent years, misinformation about vaccines and COVID-19 spread rapidly on Facebook, Twitter, and YouTube, whereas official information sometimes felt absent or late. By having a stronger social media presence – e.g. quick myth-busting posts, short explainer videos, partnerships with influencers or community figures – the CDC can insert credible information into the feeds where people are getting their news. This also ties into inclusive engagement: tailoring messages for different communities and languages. During the monkeypox outbreak, for instance, advocates noted the importance of messaging specifically for LGBTQ communities at risk. The CDC eventually did targeted outreach, but starting such tailored communications earlier could improve effectiveness.

Internally, the CDC’s reorganization is aiming to ensure that communication experts are at the table for major decisions. Rather than science and communication operating in separate silos, the agency wants its scientific experts and communicators to work hand-in-hand so that when a policy is decided, a clear message is crafted alongside it. This helps avoid confusion like what occurred when complex isolation guidelines were announced without a plain-language explanation ready. Going forward, the mantra for CDC communications is to be first, be right, be credible – a saying in public health – which means getting accurate information out fast, and doing so in a way that maintains trust.

Operational Limitations: Structural and Data Hurdles

Beyond the headline-grabbing issues of funding and politics, the CDC also grapples with less visible operational limitations. These include bureaucratic processes, outdated data systems, and constraints on its authority that collectively hinder nimble action. One glaring issue brought to light during COVID-19 was the fragmented data infrastructure in U.S. public health. The CDC was unable to get timely data on cases, hospitalizations, deaths, and vaccinations in part because it relies almost entirely on voluntary reporting from states and healthcare facilities. Unlike some countries, the U.S. does not have a centralized electronic health reporting system for public health; instead, each state (and even each hospital or lab) might have its own system. CDC has no general legal authority to require states or hospitals to share data on diseases. This meant that during the pandemic, the CDC often had to negotiate data-sharing agreements or use ad-hoc methods to compile national statistics. The result was delays, inconsistency, and sometimes blind spots in understanding the outbreak’s spread.

Linked to this is the CDC’s outdated technology and lab capacity. The infamous early COVID test kit failure was partly an operational problem: a contamination in CDC’s central lab led to unusable tests being sent out. It took weeks to identify and fix the issue, during which the virus spread undetected in communities. This pointed to shortcomings in quality control and surge capacity at the CDC’s labs. Additionally, the CDC’s disease surveillance systems (for tracking things like influenza, outbreaks, etc.) have been built in piecemeal fashion over years, often using old software. Integrating new data sources (like COVID testing data from pharmacies or genomic sequencing results from university labs) was a challenge. Officials in 2020 sometimes had to turn to faxed reports or manual entry spreadsheets because systems couldn’t talk to each other.

Bureaucracy is another limitation. The CDC’s decision-making process can be deliberative and slow, as it must coordinate with multiple stakeholders – other federal agencies, state health departments, etc. In an emergency, this coordination is vital but can also bog things down if roles aren’t clear. For example, confusion arose early in the pandemic between the CDC and the FDA over testing approvals, and between the CDC and FEMA over who was managing certain data streams, causing duplication and delay. Internally, the CDC’s structure of many centers and offices can lead to siloed efforts, where one center (say, on immunization) may not seamlessly share data with another (on respiratory diseases). Former directors have noted that the CDC must modernize not just its tech, but also its culture of internal coordination.

The CDC’s jurisdictional limits also constrain its operational reach. The U.S. federal system gives states primary public health authority. The CDC cannot simply dispatch teams to take over a local outbreak unless invited, nor can it enforce uniform measures across states. During COVID-19, this contributed to a patchwork response. While the CDC issued guidance, some states ignored it, and the agency had little recourse. This fragmentation is a structural reality, but it is certainly a hurdle when trying to execute a swift national response to a pandemic.

Modernizing Data, Systems, and Response Capabilities

Addressing operational limitations is a heavy lift, but the pandemic has galvanized efforts to modernize the CDC’s capabilities. One major initiative already underway is the Data Modernization Initiative, which aims to overhaul public health data systems. A key part of this is pursuing stronger data authority – essentially, updating laws to empower CDC to require critical data from states and health facilities during emergencies. Even without absolute authority, the CDC can work on incentivizing states to report data and share information by providing funding, technical support, and feedback loops. The goal is a more connected system (“the pipes have to connect,” as Walensky said) where each state’s data can flow into a national pool in real-time. Congress allocated hundreds of millions of dollars to start this process, helping states upgrade their reporting systems and hiring data analysts. This includes moving toward interoperable electronic case reporting, so that when a doctor diagnoses a reportable disease, it automatically and securely updates local and federal databases without manual steps.

Technological advancements are also being embraced. The CDC is exploring use of cloud computing, automated analytics, and even artificial intelligence to enhance how it detects and responds to health threats. For example, AI could help analyze vast amounts of data (social media trends, anonymized electronic health records, wastewater virus levels, etc.) to spot early signs of an outbreak. However, to leverage such tools, the CDC needs skilled personnel. Strengthening the workforce with more data scientists, programmers, and informaticians is part of the plan. Public health agencies have realized they are competing with tech companies for talent in data and IT, so they must offer opportunities to work on meaningful projects with modern tools.

On the laboratory side, investments in laboratory safety and capacity are continuing. The CDC has been building new state-of-the-art labs (like the recently constructed Building 21 at its Atlanta campus, which houses emergency operations and advanced lab spaces) to ensure it can handle dangerous pathogens safely and develop diagnostics quickly. After some high-profile lab incidents (such as a 2014 accidental contamination of flu strains), procedures were tightened. The lesson from COVID-19 is that the CDC also should have redundancies – for instance, working closely with academic and commercial labs as partners, so the burden of test development and production isn’t solely on the CDC. In fact, after the initial test kit stumble, the FDA opened up avenues for university and private labs to create tests, which greatly expanded capacity. Formalizing these partnerships in advance (through agreements or emergency plans) can make responses more agile.

To cut through bureaucracy, the CDC’s ongoing reorganization (the “Moving Forward” initiative launched in 2022) is trying to create a nimbler structure. This includes streamlining management layers and empowering a central response team that can swing into action during a crisis without getting tangled in red tape. The agency is also working more closely with other federal bodies like the Biomedical Advanced Research and Development Authority (BARDA) and FEMA, so that each knows its role in emergencies. Clearly defining how the CDC coordinates with these entities (for example, CDC handles guidance and epidemiology while FEMA handles logistics) will help operational clarity.

Because the CDC cannot change the federalist system, it is focusing on building stronger partnerships with state, tribal, and local health authorities. The idea is to cultivate a network of trust and coordination before the next crisis. This could mean joint training exercises, data-sharing agreements, and including state health officials in CDC planning. If the CDC can act as a convener and supporter of a 50-state coalition in an emergency, the response will likely be more unified. As public health law expert Lawrence Gostin noted, even though the CDC can’t force states’ hands, it has the “moral and normative authority” to lead – and it should use that by forging coalitions and speaking for the nation when a health threat looms.

Pandemic Response and Readiness: Learning from COVID-19

All of the above challenges came into play during the COVID-19 pandemic – the ultimate stress test for the CDC. The agency’s pandemic response had some successes (for instance, developing vaccines was primarily an NIH and industry effort, but the CDC helped roll them out nationwide, and initiatives like deploying “disease detectives” to hot spots did save lives). However, the failures and gaps were more apparent to the public. From the outside, it looked like the CDC was “struggling to develop a diagnostic test, issue guidance, and share best practices”, despite being expected to lead the U.S. response. This starkly highlighted the challenges we have detailed: insufficient preparation, confusing messaging, external interference, and data hurdles.

The CDC is now engaged in deep self-assessment and external review to derive lessons from COVID-19. One clear lesson is the need for speed and agility. By the CDC’s own admission, it needs to “share scientific findings faster and make communications easier to understand” as part of any future outbreak response. The traditional playbook of publishing in journals and updating guidance at a measured pace must be augmented by real-time updates and press conferences when dealing with an emergent pathogen. Another lesson is the importance of surveillance. Early on, the U.S. was essentially flying blind when community transmission began, due in part to the testing debacle and a lack of sentinel surveillance systems. For the future, CDC is expanding programs like wastewater monitoring (which can detect virus spread independent of clinical testing) and genomic surveillance to catch variants. These efforts were scaled up during COVID-19 and will remain in place as part of an early warning system.

Coordination is another lesson. The pandemic saw instances of fragmented authority – for example, disputes between federal agencies or between federal and state entities about who should do what. To address this, the federal government has developed plans to clarify roles in health emergencies (the American Pandemic Preparedness Plan and other frameworks outline that the CDC leads on public health measures while other agencies take on their respective parts). Strengthening the chain-of-command and communication channels in crisis response will help the CDC operate more effectively when the next pandemic hits.

On a policy level, many have called for an independent “9/11-type commission” to thoroughly investigate the COVID-19 response, including the CDC’s performance. Such a commission could make formal recommendations to Congress and the Administration on how to reform the nation’s public health system. While this is still being debated, it reflects a recognition that systemic changes (not just tweaks) may be needed to be truly prepared. Some proposals include updating public health laws, increasing CDC’s authority in emergencies, and investing in research on pandemic prediction and prevention.

Preparing for Future Health Threats

Every crisis is also an opportunity to improve. The CDC’s experience with COVID-19 and other outbreaks provides a roadmap for what to fix going forward. Key opportunities for improvement include:

• Policy Reforms: Modernize the legal framework for public health emergencies. For instance, establish clear triggers for CDC emergency powers, or create statutes that facilitate data sharing and coordination during a declared health emergency. Reducing the influence of politics might involve protocols that guarantee scientific reports are released unaltered, and setting expectations that CDC’s guidance is the baseline standard for states.
• Technological Advancements: Complete the overhaul of data systems. The aim is a real-time public health information highway that links healthcare providers, laboratories, state health departments, and the CDC. Embracing new tech such as AI and advanced analytics can help detect outbreaks sooner and target interventions more precisely. Upgrading laboratory tech (for rapid pathogen sequencing and diagnostics) is also crucial. These investments would make responses not only faster but smarter.
• Workforce and Training: As highlighted, a renewed workforce is needed. The CDC can partner with universities to train more epidemiologists and public health practitioners, perhaps expanding programs like the Epidemic Intelligence Service (EIS, the CDC’s “disease detectives” training program). Cross-training personnel in communication and data skills can create more versatile teams. Also, maintaining a roster of surge staff (who can be called upon during crises) will ensure capacity when regular staff are overstretched.
• Strategic Shifts: Culturally, the CDC is aiming to become more action-oriented and less academically insular. Walensky’s mantra that the CDC should make decisions even if evidence isn’t 100% complete (because waiting for perfection means missing the moment) is a strategic shift in mindset. Drilling this into the agency through training and leadership examples will help it act decisively when early action can save lives. Another strategic focus is on equity – making sure responses reach all populations (racial minorities, rural areas, etc.) effectively. COVID-19 revealed disparities in outcomes; the CDC is now prioritizing community partnerships to better serve vulnerable groups in future responses.
• Public Engagement and Education: In peacetime (between crises), the CDC has an opportunity to educate the public about its role and about health preparedness. Increasing the general public’s health literacy and familiarity with CDC guidance (for example, flu prevention campaigns each year that also build trust in vaccines and CDC recommendations) can pay dividends when a new threat emerges. An informed public is more likely to cooperate with guidance and less likely to fall prey to misinformation.