TThe US Centers for Disease Control and Prevention (CDC) was not prepared for COVID-19. More than two years later, it still is. The CDC’s response to COVID-19 has been widely criticized for being slow, confusing, and often ineffective.
Now, the agency is taking a long hard look at itself. On August 17, CDC Director Dr. Rochelle Wallensky proposed sweeping changes to how the agency communicates with Americans and disseminates data — two of its most important roles as the nation’s leading public health agency.
“I don’t think moving tiles on an organization chart will fix the problem,” she tells TIME of the changes, which she’s already starting to implement. “What we are talking about is changing the culture. We are talking about data timing, data transmission, policy guidance. Reorganization is difficult, but I think this is harder than that.”
The renovation has been months in the pipeline. In April, just over a year after taking over, Walinsky called for an agency-wide review of the Centers for Disease Control and Prevention. While previous directors have ordered such reviews to assess the Centers for Disease Control and Prevention’s operations, this particular analysis has been particularly urgent because of the pandemic and low confidence in the CDC, after the Trump administration ignored the agency, ignored its advice, and at times contradicted its own. her directions. Walensky asked for honest feedback from about 200 employees, academics, and other outside experts.
Walensky says the review, which has yet to be announced, was factual but not surprising. “To be honest, we are responsible for some very dramatic and general errors, from testing to data to communications,” she said in a video message addressed to CDC staff, which was seen by Time magazine.
Here’s what Walinsky says went wrong — and how she plans to improve the CDC.
The need for more agile data
The CDC was “developed on the basis of an academic infrastructure,” Walinsky says. Until the novel coronavirus pushed the agency into the spotlight, the CDC’s target audience was mostly public health experts and other academics, and the main method of communication was through periodic publication of scientific papers. “In these pandemic moments, we have found ourselves having to speak to a wider audience,” Walinsky says. “We didn’t have to convince the scientific public – we had to convince the American people.”
Americans wanted accurate and timely information on how to deal with the new virus. But since the start of the pandemic, the CDC’s advice has often seemed confusing and contradictory — particularly about how the virus spreads. Who should wear masksWhat are the most effective types of face coverings? The agency has also been slow to produce critical information about the extent of SARS-CoV-2 infection. “Not all of us liked the headlines, especially when we knew all the good work was going on,” Walensky says of the media coverage of CDC’s mistakes. “So how do we tackle the challenge of what people say about us?”
Walensky says she is now paying the CDC to collect and analyze data in a simpler way, in order to more quickly turn that information into actionable advice. During COVID-19, researchers began to rely more on preprint servers, which published scientific studies on COVID-19 before results were reviewed and vetted by experts (the gold standard for validating results). She says, “The peer review process generally improves papers, but also if you’re trying to take public health action with actionable data, you don’t need to adjust peer review before you do.” [the results] general.”
She and her team are discussing ways to disseminate data that may be relevant to the public earlier — not to replace the peer review process, but to complement it, so that both public health and health experts can see the evidence on which the agency is based on its recommendations. They consider, for example, uploading data to a prepress server or publishing separate technical reports to distinguish early data from a peer-reviewed end product.
Currently, the agency’s advice is only official once it’s published in a CDC publication, MMWR, which requires a long and relatively foolproof peer review process. Walinsky says that during public health emergencies, such data should be made more quickly available. “I called the magazine editors and said, ‘I know we have a paper under review, but the public needs to know, and I’m going to break that ban,'” she says.
It happened last July, when data from an indoor gathering in Barnstable, Massachusetts, showed that vaccinated people had contracted the infection after mask policies were relaxed; As a result of the findings, the CDC re-recommend the wearing of masks in large public environments prior to the study Posted in MMWR. In another case, CDC scientists had data about the effectiveness of vaccines under review MMWRBut she revealed the information before it was published at a public meeting of vaccine experts held by the US Food and Drug Administration.
“We can’t be free from data,” she says. ‘But there must be something between drip every I and cross all T. “
Better and clearer messages
The key to making such data more accessible is to use clear, jargon-free language to convey it. In her video message to staff, she stressed that producing “plain and easy-to-understand language material for the American people” would become a priority, along with making sure scholars develop talking points and frequently asked questions.
They’re already starting to put this into practice, she says, referring to the Centers for Disease Control and Prevention Review of isolation recommendations on August 11. Compared to previous guidelines, the new version is more written for the public and addresses people’s practical concerns, such as when to start counting days of isolation and which precautions to take at home, she says.
In her view, the cultural change that Walenksy hopes to implement boils down to one question she urges all CDC employees to consider: Does the data they analyze, the study they conduct, or the advice they generate, address the need for public health? “We really need to talk about public health measures, not just public health publications,” she says.
You admit that this won’t happen overnight. But now that other viral diseases – including monkeypox even poliomyelitis—You joined COVID-19, the stakes are high for the CDC to catch up quickly. Agency contact receive cash of public health experts, clinicians and the general public for repeating some of the same mistakes of COVID-19 in dealing with the monkeypox outbreak. Data on monkeypox cases is still very slow. “To this day, we have race and ethnicity data on less than 50% of monkeypox cases,” she says. “We are still working on getting complete case report forms and we are still working on getting immunization data.” monkeypox test It was also not widely available for several months — delays reminiscent of the early days of COVID-19 — because the agency’s testing protocols were too long and ineffective to combat a rapidly spreading virus. But, Walinsky says, “within a week of the first case, we were reaching out to commercial laboratories to rapidly expand testing capacity.”
The changes you implement won’t be immediately visible to the public, but she is confident that they will eventually lead to clearer communication and faster data on emerging outbreaks. “People are not going to wake up after Labor Day and think, ‘Everything is different,'” she says. “We have a lot of work to do to get there.”
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