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The CDC has done a poor job responding to COVID-19 and will make major changes to its operations, CDC Director Rochelle Walensky, MD, MPH, said Wednesday.

"For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations," Walensky said in a statement. "As a long-time admirer of this agency and a champion for public health, I want us all to do better and it starts with CDC leading the way. My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness. I look forward to working with the incredible people at CDC and our partners to realize the agency's fullest potential to benefit the health and well-being of all Americans."

"In April, I launched an effort to refine and modernize CDC structures, systems, and processes around developing and deploying our science and programs," Walensky said in an email to colleagues on Wednesday morning. "The goal was to learn how to pivot our long-standing practices and adapt to pandemics and other public health emergencies, then to apply those lessons across the organization."

"The effort included a review of key workflows, with a particular focus on how we swiftly move from science and program to policy, so that we can promptly operationalize guidance for the public," she continued. The review Walensky mentioned was conducted by James Macrae, MA, MPP, associate administrator of the Bureau of Primary Health Care at the Health Resources and Services Administration (HRSA).

Walensky and the CDC to the pandemic, and more recently for the agency's response to monkeypox.

"For CDC to be more effective, we must build on the lessons learned from COVID-19 to improve how we deliver our science and programs," Walensky continued, noting that this includes sharing scientific findings and data faster, as well as "translating science into practical, easy-to-understand policy."

To accomplish these goals, "there are some areas that will require a reorganization," she said. These include "creating a new, agency-wide-focused equity office in the Office of the Director, moving both OLSS [the Office of Laboratory Science and Safety] and OS [the Office of Science] back to the Office of the Director, and establishing a new, senior executive position for global health in the Office of the Director. In addition, I will continue to gather feedback from agency leadership to develop and submit a reorganization package later this year."

"We will work together to change systems, processes, governance, and the structure of CDC to build an agency that values and rewards public health action," Walensky wrote in the email. "None of these challenges happened overnight, and our work ahead for improvement will take time."

"I am leaning on every one of you to accomplish the hard work of transforming CDC for the better, and I look forward to our collective efforts to position our agency and the public health community for greatest success in the future," she concluded.

Georges Benjamin, MD, executive director of the American Public Health Association, applauded Walensky's initiative. "CDC is a great organization, but it has always functioned like a big academic health system and not an emergency response entity," he said in a phone interview. "And the world has changed a lot."

"There have been lots of reorganizations at the CDC to improve programming and efficiency," he continued. "But I think what makes this one different is that they're not just trying to move boxes around; they're fundamentally trying to deal with the culture, to deal with issues of more rapidly pulling data together and getting data out in a timely way, so people can make informed programmatic and policy decisions."

One result Benjamin said he hopes will come out of the review is a single point of entry for outside groups looking to speak to CDC officials. "All of our associations and groups -- we have to call around to two or three places to find the right person to talk to about something," he said. "A 'no wrong door' approach or single point of entry would be important."

In general, "I continue to argue that the federal government needs to think about how it responds to health emergencies and how it utilizes all its assets," he added. "CDC is a major part of the response to health emergencies, but you also have the ASPR [Administration for Strategic Preparedness and Response], you have the NSC [National Security Council], you've got HRSA, and you have NIH and the FDA, which have been playing a lot more active roles in these responses."

"Because of that, the government needs to think about how it creates a unitary response system, or the command system that clearly defines who's on first and who's on second," said Benjamin. "So if it's an infectious disease emergency, that falls within the CDC and the CDC has command of the response, and if it's some other kind of response, somebody else responds to that."

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