For more than 70 years, the US Centers for Disease Control and Prevention (CDC) has earned a solid reputation as one of the world’s leading public health agencies—and with it, the trust of the American people. However, after the CDC’s uneven response to COVID-19, many people’s faith in the agency has been shattered.
The first step to regaining trust is admitting mistakes. Director of the CDC, Dr. Rochelle Walensky, who has been outspoken about the agency’s failures during the pandemic, has committed to a series of reforms in response to reviews of the agency’s missteps. But if our nation is to finally receive the public health system that has eluded us for so long, it is incumbent on CDC and the policymakers who fund and oversee the agency to make a renewed and sustained commitment to health equity.
The goal: A nation where every person — regardless of zip code, income, race, ethnicity, gender, disability, sexual orientation, or occupation — has a fair and just chance to not only survive, but to thrive. A new paper from the Robert Wood Johnson Foundation (RWJF), the organization we lead, explains why and how CDC should commit to that vision.
We are both proud to work with and for CDC. (Dr. Besser has worked at CDC for 13 years, including as acting director during the 2009 H1N1 pandemic and four years as chief of its Office of Emergency Response. Dr. Morita is a current member of CDC’s Director’s Advisory Committee.) Each of us is the agency’s epidemiologist. Served, investigating and responding to outbreaks and other public health emergencies. We believe strongly in CDC’s mission and deeply respect its more than 10,000 employees.
CDC has already taken important steps to prioritize health equity. Last year, Dr. Valensky correctly stated that discrimination against racial and ethnic groups is baked into our nation’s laws, policies, and institutions — a public health threat. Among the steps in the CDC’s reform plan is the creation of a new equity office within the agency. Last week, the CDC announced a new $3.2 billion investment in more than 100 health departments across all 50 states to help rebuild a devastated public health workforce. The funding builds on previous CDC grants to address COVID-19 health disparities and empower community health workers who build stronger relationships between CDC and trusted local voices.
These steps are welcome but more is needed. For example, RWJF’s paper recommends modernizing America’s public health data collection systems. Since the beginning of the pandemic, our public health system has failed to accurately identify the disproportionate impact of COVID-19 on people of color. This deficiency later helped drive the disproportionate impact of severe disease and death, leading to significantly lower life expectancy for black and Aboriginal people.
CDC can chart a new course by setting minimum standards for data collection and aggregation to empower state and local health departments not only to document health disparities but also to link those disparities to housing, employment, education, and other social determinants of health. Without addressing this inequity, the next pandemic is likely to play out like this, and emergencies — from poverty to chronic disease — will continue to affect the daily lives of many people.
Additional areas of focus may include this health equity perspective. The CDC’s declaration of racism as a public health threat should be more than a one-time announcement; Agency leaders should regularly use agency platforms to explain how racism—not ethnicity—creates persistent health disparities. CDC should build its own internal capacity to address racism by working to diversify its staff and leadership. And it must partner with trusted messengers from communities who can draw on their own lived experience to illuminate our path forward.
The greatest strength of public health is its people. Despite chronic underfunding, misinformation, and disinformation threats to their credibility and their personal safety, public health officials still managed to save hundreds of thousands of lives in the United States and millions around the world during the COVID-19 pandemic. . These officers deserve our praise and admiration.
From an organizational standpoint, CDC does not bear sole responsibility and cannot do it alone for all the ills in our current system. CDC has no standing authority to require states to share data, even during public health emergencies. Antiquated data systems prevent public health officials from collecting and reporting critical health information. Adequate, consistent and flexible funding for health institutions at all levels of government has long been denied.
In 2020, our entire nation suffered the consequences as political interference sidelined the CDC and other health leaders from the pandemic response at a time when they were most needed. Everyone in America — even people who no longer trust the agency — has a vested interest in addressing these shortcomings.
We strongly believe in our foundation’s recommendations to improve it because of our professional connections and personal relationships with the CDC. America’s need for a strong and well-functioning CDC confirms — rather than undermines — the pandemic’s devastating impact.
Thankfully, the hard work of restoring trust and reinventing its mission is already underway. With fresh thinking, sustainable funding, and a commitment to equity, CDC can regain lost trust while leading efforts to improve health and well-being for all.
Richard Besser MD is President and CEO of the Robert Wood Johnson Foundation and former Acting Director of the Centers for Disease Control and Prevention (CDC). Julie Morita MD is a member of CDC’s Advisory Committee to the Executive Vice President and Director of the Robert Wood Johnson Foundation.