番茄社区

In the time since she stepped down from her position in June 2023, former CDC Director Rochelle Walensky, MD, MPH, has largely stayed out of the limelight. 番茄社区 Washington Editor Joyce Frieden caught up with her in a phone interview Wednesday to find out what she has been up to lately, and what her reflections are on her time at the CDC.

The interview has been edited for length and clarity.

Hello, Dr. Walensky! Thanks for being with us today.

Walensky: Glad to be here.

Tell us about your life post-CDC. What have you been doing?

Walensky: Well, my family was in Boston, so I came back [from Atlanta, where CDC is headquartered] to Boston. And I really wanted to immerse myself in areas of academia that were different than ones that I had previously been engaged with. So I decided to do a fellowship at the [Harvard] law school, the business school, and the [Harvard John F.] Kennedy School.

It's hard to go to someplace new, someplace foreign, someplace where you don't know the scholarly work as well. But I started teaching a reading group at the Petrie-Flom Center, which is the bioethics center at the law school. I taught a reading group of about 12 students about how the law intersects with public health, and gave numerous examples of places where that intersection occurs and some of the challenges that are faced at that intersection.

Can you give an example of a challenge you discussed?

Walensky: Oh, there are plenty of examples -- one is the importation of dogs in this country. That is something that falls to the CDC, and there is a regulatory component that CDC is deeply engaged with, and there are certainly legal and policy implications towards that regulation.

Another one is, for example, what happened with vaccine authorizations and approvals -- all of that happened at the FDA, but the [CDC's] Advisory Committee on Immunization Practices (ACIP) generally speaks to the use of those vaccines. What were the implications for the recommendations ACIP had in the context of an emergency use authorization for the vaccine -- and in the context of the U.S. government owning that vaccine?

There were provider agreements that everybody who used government-owned vaccines needed to sign, so there were numerous layers that we really needed to navigate to understand how they could be used and who could use them. What happens under an authorized rather than an approved vaccine? What are the implications of trying to use them off-label? And on and on and on it goes.

Sounds really interesting! So what else are you doing now that the reading group has ended?

Walensky: I got a request from the [Harvard T.H. Chan] School of Public Health -- back to my roots! -- to do something similar, so now I'm teaching a seminar. It's a bigger class, engaging with students as to what public health practice looks like on the ground. We teach a lot of academics in the classroom, but what are the real-world implications of some of the things that we're teaching?

The seminar at the Chan School [is part of being] a . I also spend 2 days a week as a Hauser leader at the [Harvard] Kennedy School, and a lot of that is really talking to folks about public policy, and what it means and the importance of having really good people lean in and do government work.

Speaking of government work, do you think you would ever agree to work in government again?

Walensky: Well, I will say that it was the hardest thing I hope to ever have to do. But when someone calls you and says, "There are 4,000 people dying every single day, and we think you can help," the answer for me was, "How can I help?"

So as hard as it was and with everything that I learned, I would most definitely do it again because I believe in the duty to serve.

The next question people ask is, "What are you doing next?" And the answer is I don't know yet. I'm thinking about what kind of opportunities does the world have available to me, and thinking about what I want to do next.

How has it been being back in Boston? Are you getting to spend more time with your family?

Walensky: I am still traveling and speaking, but I have kids in college and what's been really fun for me is to be able to go to parents' weekends. That has been really fun.

Talk about your experience dealing with the COVID pandemic while you were at CDC. What accomplishments were you proud of, and on the other side, what would you have done differently?

Walensky: Let's just be clear that there were more than a million souls who perished due to the COVID-19 pandemic. So every time you think about something that you're proud of, you have to do it in the context of many, many lives lost, and the families who lost loved ones, and people who are still suffering with long COVID. So I don't want to dismiss any of that.

As to the things that I think that we did well, there are incredible anecdotes of work at CDC. We had a CDC employee who rappelled out of the helicopter to drop test kits onto cruise ships. We delivered over 700 million vaccines into arms in a 2.5-year period. That was an extraordinary effort and probably the largest vaccine rollout in history.

For the things we could have done better, there were a lot of ways in which the CDC did not act as nimbly as it could. The agency was at the time 76 years old and had never tackled a pandemic of the size, scale, and scope that COVID delivered. What were some of the things that we needed to learn from and do better, so we were better ready the next time? How could we deliver our data faster? How could we communicate better to the public now that everybody will keep coming to our website for information? So I think that there was a lot that we learned.

What were your challenges communicating to the public during that time, especially as the science kept changing?

Walensky: I've spent some time over the last couple months watching some of my own communication and trying to understand what I could personally learn. As we were rolling out booster vaccines in the fall of 2021, how did that go and what can I learn from that myself? I have spent quite a bit of time reflecting. I do think that there were several issues that were challenging there.

Among those challenges was the fact that not only was the science changing and updating, the virus was changing. People were very interested in [advice that was] stagnant: "Tell me what to do and then I want to be done. Because I don't want to continue to follow this." And yet, we had a responsibility to change things when information came in, and information was coming in quickly.

We also had forces that were actually actively working against us to send misinformation and disinformation out, and they were trying hard to undermine all of the messaging that we were sending out. And so it was a difficult environment in which to operate.

On the one hand, while people expected things to be stagnant, we had a responsibility to update. The other thing that was really tricky is some people very much wanted it simple -- "Tell me what to do and make it easy" -- while many other people wanted the nuance: "What should I do because I have an elderly mother living at home with me, and my daughter is on an immunosuppressive agent for Crohn's disease?" So it was about trying to please everyone with the information that they got, at the pace they got it, with the updates that were necessary. Oh, and by the way, it's got to meet the needs of families in New York City, and in Guam, and [in tribal lands], and in rural Wisconsin.

And what about masking in particular?

Walensky: People feel very strongly whatever side of the issue they're on. And one of the challenges that happens is -- and in fact, I've watched some of the footage -- I had people on [TV] say, "Why would people get vaccinated if they can't take off their mask?" I had that question asked to me numerous times. To me, the answer was, "Because you don't want to end up in the hospital. You didn't want to die."

Many people saw vaccination as a way to get rid of the mask, and with the Alpha variant, that was very much true. And then in the summer of 2021, when we had the Delta variant, it became no longer true -- our vaccines were waning for some of the people who got them early, and we now had a Delta variant that could now overcome our immunity. With regard to transmission, the virus changed, and therefore the policy had to change. And we were already in a place where people were not unified on what to do with masks. So a change in policy in that context was complicated.

I have spent a lot of time thinking through, "What if we didn't take masks off in that period from May of 2021 to July of 2021, when we put them back on?" You know, we could have been faulted easily for that. "Everybody knows these masks can come off, the science says these masks can come off, why would you not relax the policy?" I firmly believed and continue to believe in what I call "diastole," which is like, "Relax a little -- take them off and then put them back on when we need them." But America was not ready for that.

And what are your thoughts on the most recent controversy about reducing the isolation period for patients with COVID?

Walensky: Here's what I will say: I am certain that there are extraordinary forces that people don't understand -- that I don't understand -- that would push one to shorten it, and would push one to keep it on. And reasonable scientists could easily debate that topic, which implies that CDC was never going to win. And that's actually what happens when you're in these areas of tough gray. There are really good reasons to go in one direction and good reasons to go in another direction. And CDC has a responsibility to make that call.

Let's talk for a moment about another difficult area for the CDC, and that has to do with data collection. How can it be improved?

Walensky: There are two major challenges, I think, with data in this country. One is the data system, and CDC has been working very hard on data modernization, and there's a lot of progress that's been made. Many resources have come to CDC, and they're pushed out to states and local jurisdictions so data can travel on a common highway, so that when tests are being done at the rate of a million a day, some are not coming in by fax, some by Cloud, some by email, and some by cell, because that is not a way to run data in this country.

Is that what you were facing?

Walensky: Oh, yeah. That is the frailty of our public health data systems. Now, major work happened during the pandemic. But the resources that are needed to modernize our data systems in this country are not there. And I spent a lot of time in front of Congress talking about the resources that would be needed for us to have a modern data system.

The other challenge I do want to talk about is lack of authority. CDC does not have the authority to compel states to report data, and in the absence of those data coming in, we await either a public health emergency or for some mandate for those data to come in. And when that happens, you're behind the eight ball.

[For example], the public health emergency [declaration] for the mpox outbreak happened 3 days after the peak number of cases of mpox. So how is it that CDC has the responsibility to be nimble, and get all of the data, and know where things are, and jump on top of an outbreak, if we in fact don't even receive the data until after the outbreak has already peaked?

Finally, let's turn to another big issue at the agency: the reorganization that you announced. How did you feel about where it was when you left?

Walensky: The initiative -- it was more about more than just reorganizing, and one of the things that I did say was that the reorganization was "necessary but not sufficient." The reorganization was really to center the agency around its key work that it did -- its workforce and having a workforce that was ready to respond, and our laboratory, and our public health partners, and our data system. So a lot of that was really central. The reporting structure for the laboratory was pretty numerous layers deep, which I think probably contributed to one of the challenges with the lab early on before I was there.

What I did is I set the course not only for the reorganization, but also for a lot of that work and CDC Moving Forward, and I was really proud of that work. I knew that that was going to take years to happen; it was not going to be finished in my tenure. But we set the stage and I was really proud of that.

I don't know where things stand on that, since I'm not there now. But I do believe that when I left CDC, the senior leadership was really motivated to have that work continue.

Thanks very much for speaking with us today!

Walensky: You're welcome! Glad to do it.

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