The Centers for Disease Control and Prevention (CDC) has reached a critical juncture where it may need to be effectively “ended” and restructured. Recently, I shared this viewpoint on social media, sparking considerable debate. As a public health professional involved in local health efforts during the pandemic, I have heavily relied on the CDC's science and guidance since the outset. My interest in epidemiology was even sparked by their Principles of Epidemiology course before I obtained my Master of Public Health (MPH) degree.

Public health is inherently political, a fact evident both in the United States and globally. Effective public health initiatives demand substantial resources, typically provided by nations with the financial capacity for large-scale projects. Consequently, health departments are often led by government-appointed officials who select others to manage various public health functions. In the U.S., the President appoints a Secretary of Health, who is confirmed by the Senate, who then selects the CDC Director, overseeing daily operations. This chain of command means that the CDC’s mission and values can shift dramatically with each new administration.

We are witnessing this phenomenon currently. A President criticized for his response to the COVID-19 crisis suggested reducing testing, prompting the CDC to recommend that asymptomatic individuals who were in contact with confirmed cases should not be tested. This decision was met with backlash from public health experts.

South Korea's rapid containment of the virus stemmed from extensive testing across the nation. When individuals tested positive, their contacts were also tested and quarantined, continuing this process until the infection chain was broken. They were able to resume activities like baseball, while we have faced ongoing challenges.

Many states and localities are implementing contact tracing as part of their COVID-19 strategies, having utilized this method for other diseases such as tuberculosis and sexually transmitted infections. It can be effective, but the political climate complicates its implementation, especially when some leaders express skepticism about public health measures. The new CDC guidance is complicating these efforts.

I've heard from colleagues that some partners, such as law enforcement or management in large government facilities, are reluctant to test contacts of confirmed cases due to the CDC's latest recommendations. They prefer to allocate funds elsewhere, often citing the CDC to justify their decisions.

A few months ago, I would have unequivocally trusted the CDC's expertise. However, my experiences have led me to question this trust. I've observed many colleagues leave the CDC, frustrated by decisions influenced by political appointees or directives from the White House aimed at aligning with administration goals.

One colleague likened the situation to the film Hunt for Red October, where approvals must come from a “Party Officer.” The reality is there are numerous political influences at play.

So, what are the next steps?

Removing politics from public health seems nearly impossible, as decisions in this realm impact everyone, necessitating accountability for how public funds are utilized. Unlike privatized services like waste collection, public health cannot be treated the same way.

This piece lacks the nuanced dialogue required for a significant transformation in the U.S. public health landscape, yet it is essential. We need leaders in public health and policy to engage in these conversations, as the credibility of our foremost health agency is being undermined by political maneuvering.

I propose two potential directions:

1. An Academic Approach with Political Oversight

One possibility is to reframe the CDC as a major institute for public health education, where professionals globally can learn from experienced experts. Instead of a traditional Director, the CDC could be led by a Dean accountable to a Board appointed by the President, serving terms longer than presidential administrations. Senate approval would be required for appointments, with removal only possible through a two-thirds House vote. This structure could prevent politically motivated dismissals based on personal grievances or fleeting political pressures.

While this model retains political involvement, it introduces checks and balances. The Board and Dean would face scrutiny every two years, ensuring accountability. If public health outcomes falter, Congress could require explanations and consider changes.

Throughout this process, the various CDC centers would continue their work without interruption, benefiting from rigorous peer review before recommendations are published to minimize expert disagreement post-factum.

2. A Cooperative Privatization Model

Reflecting on my childhood in Mexico, a strike by trash collectors led to a private company offering reliable waste collection services, demonstrating the potential for competition to enhance service quality. If we apply this idea to public health, we risk allowing business interests to interfere with the operations of a central public health authority, as we have seen with political influence.

However, if the CDC is not effectively managing the pandemic, alternative solutions must be explored. We need accountability and results from those entrusted with public health. Currently, if vaccines are ineffective, we simply fulfill contractual obligations with pharmaceutical companies. It would be preferable to demand effective solutions and withhold payment for ineffective ones.

If the CDC begins to offer recommendations swayed by political pressures rather than solid science, it would be beneficial to implement a system ensuring rigorous scrutiny akin to customer feedback mechanisms for other products and services.

I Don't Claim to Have All the Answers

I acknowledge that I do not possess all the solutions. Yet, it is clear that political influence on science—especially public health—has been magnified during this pandemic, a reality that has become apparent to many. This was not unexpected for me, as I have long recognized the necessity of considering political factors in public health decisions.

We must initiate these discussions urgently, without waiting for the outcome of upcoming elections. Political pressures from all sides can affect the CDC, which is detrimental. The agency requires greater independence, allowing it to base recommendations on the best available science and data. The path to achieving this may vary, but it is essential to prioritize public health before more lives are compromised.

Thank you for your attention.

René F. Najera, MPH, DrPH, is a public health expert and epidemiologist who enjoys photography, athletics, and family life. He works at a local health department in Virginia and teaches at a prominent public health school. The views expressed in this article are solely those of Dr. Najera and do not represent those of his employers or affiliations.