The Glue that Binds.

Alongside the FDA and NIH, the United States Centers for Disease Control and Prevention (CDC) serves as one of the foremost public health and health safety agencies in the United States. The CDC serves as part of the Department of Health and Human Services with the goal of protecting US individuals from harm and disease. (1) The CDC’s main goals include preparing the United States for emerging diseases by optimizing healthcare infrastructure and working with other nations to track disease flow. (2,3) The CDC is also responsible for responding to disease outbreaks; the organization played a pivotal role in the US COVID-19 response, facilitating contact tracing and vaccine distribution procedures while spreading public health information. (4)

The CDC itself is split into three levels: (5)

In the past decade, the CDC has been active in providing on-the-ground support in dealing with the Ebola and Zika virus outbreak while supporting the Michigan government in dealing with the Flint Water Contamination situation (for more information, read my article about how Policy Controls Health Outcomes). (6) The CDC has also played a role in developing a multinational health network, collaborating with other nations to respond to health threats. (7)

This is where our story begins. Early in July, President Biden appointed Dr. Mandy Cohen as director for the CDC. (8) Dr. Cohen is an internal medicine physician who served as Secretary at the NC Department of Health and Human Services as well as the Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid services. It’s safe to say she brings years of professional experience to the table.

Her appointment comes at a unique time for the CDC; during and after the COVID-19 pandemic, trust in the CDC and other long-standing American public health organizations have declined. (9)

This decline in trust is the result of many factors, including health politicization, structural and racial inequities in terms of healthcare outcomes and treatment, and conflicting recommendations over the course of the pandemic. (10, 11, 12) However, my focus in this article is to highlight how Dr. Cohen and other CDC administrators may restore America's trust in this enduring organization. I recently came across an NBC article titled “The new CDC director has a plan to fix the agency’s trust problem”, and I hope to dive into this topic in further detail. (13)

I will delve into Dr. Cohen's direct statements from the NBC article to explore various possible avenues for rebuilding trust in the CDC.

1. Transparency and Trust

This quote really sums up what changes Dr. Cohen hopes to implement moving forward. In 2021, during the peak of the COVID pandemic, the CDC held only 2 tele-briefings to communicate with American individuals. (14) As mortality rates skyrocketed, individuals were looking for a clear national plan to bring an end to the pandemic.

While many at the CDC thought they were doing their best with the limited data available, the public was not made of aware of newly released data and thus Americans were confused about misleading or contradictory messaging. In fact, former CDC director Tom Frieden himself called for more consistent messaging during the pandemic, especially regarding mask mandates and contact tracing policies. (15) While the CDC has provided new channels of communication with other federal health organizations, the CDC must ensure that new, updated information is provided to American individuals in a cohesive and understandable manner.

2. Bipartisan Relationships with Legislators

Below is a graph showing the expenditures of the CDC and NIH adjusted for inflation. (16)

CDC funding comes largely from Congressional appropriations; as the CDC’s spending rises, its power becomes more and more constrained by the legislation of Congress. Dr. Cohen is right in that Congressional legislators are perhaps the most important stakeholders for the CDC, however their faith is not just important in keeping the CDC operating in the years to come but also in coordinating messaging with the federal government and reducing public health politicization. Throughout the COVID pandemic, CDC news was subject to partisan agendas largely because no one, not even legislators, was aware of the empirical research behind new policy. By bringing legislators into the fold, CDC administrators can facilitate greater cooperation and joint messaging from the government and public health agencies.

I will quickly mention that working with government legislators and increasing CDC involvement in partisan politics are not without downsides. Legislators have a wide range of opinions on public health issues, influenced by political ideology, constituents, various media sources, and donor opinions. (17) While collaborating with Congressional legislators, CDC researchers must ensure that their research remains unbiased and devoid of political agenda.

3. Awareness

Public health (and science in general) suffers from a transparency problem; while COVID has pushed public health research and organizations like the CDC into the public conversation, how and why research is conducted remains difficult to understand. During the COVID pandemic, the CDC opted to hide public health research entirely, putting high-ranking and respected individuals such as Dr. Anthony Fauci into the limelight to promote and advocate for public health measures. Moving forward, the CDC Summary Report highlights the need to improve communication with the general public by tailoring information to different audiences; while providing more information is a step in the right direction, to truly improve trust, the CDC may have to incorporate communities and individuals into the decision making process, reducing the gap between the scientific and lay population. (18)

4. Messaging and Post-COVID Vaccine Rollout

Yes, I’ve already talked about messaging in Dr. Cohen’s previous statements. In this section, I hope to clarify the subject further. The main point is this: public health institutions put billions of dollars into COVID research and prevention, yet after the pandemic, many Americans were unimpressed by the work of the CDC and other key institutions. (19)

The reason is messaging. While the CDC was running hundreds of studies, at the national level CDC recommendations were at times incorrect or contradictory. (20) Regarding quarantine and mask mandate procedures, American individuals were privy only to CDC recommendations and could not see the changing data that resulted in policy change. Accuracy (as stated by Dr. Cohen), however, wasn’t the issue; CDC researchers thought they were correct until new data caused a paradigm and policy shift. Moving forward, the CDC must clarify why recommendations exist, how they are supposed to work, and why they must be followed in order to gain public approval.

5. Community Network

We are influenced by many individuals whom we perceive have authority, including government officials, religious leaders, subject experts, and social media influencers. In this statement, it seems that Dr. Cohen is calling for increased public health infrastructure that includes community individuals as stakeholders in the CDC decision-making process. Even at the best of times, building relationships with communities throughout the nation would seem to be an arduous task; with limited funds and public support, this task might be all but impossible. By working closely with high-profile individuals and organizations who have significant public trust, the CDC can reach more Americans, improving trust and reputation.

6. Resource Management

During the COVID pandemic, the most vocal opponents of the CDC have criticized the organization for withholding important data about COVID vaccine availability and hospitalizations. (21) This data, while not necessarily important to every American, ensures that CDC recommendations are seen as credible and improves public perception. With the CDC’s new Data Modernization Initiative, the organization aims to make public health more accessible and equitable by simplifying research data and providing researchers with the ability to make better decisions about community health. (22) This way, Dr. Cohen hopes to simplify CDC recommendations and back up all policies with empirical data to improve public reception and credibility.

We’ve taken a brief look at ways the CDC can improve public perception and increase trust.

Yet it is important to note that this decline of trust in the CDC during the COVID pandemic could have been prevented with prompt communication, publicly available data, and the formation of community networks to enhance transparency. These measures would have made CDC recommendations more effective, saving lives.

If the goal of public health is to analyze data and implement policies to save lives, trust in public health institutions is critical in achieving results. Ultimately, COVID-19 was a lesson in communication and transparency; by maintaining faith in critical public health organizations, we can help build a world of global cooperation, where we respond proactively and effectively to emerging health crises.