ROchelle Walensky, the outgoing director of the Centers for Disease Control and Prevention, will miss aspects of leading the nation’s largest public health agency when her term ends Friday. But testifying before Congress is probably not one of them.
Walensky ran against congressional committees 17 times during her 2½ years as head of the CDC, most recently in mid-June when she faced a quirk from Republicans on the House Committee on Oversight and Accountability.
Asked in an interview with STAT this week if she would miss such opportunities, Walensky said with obvious glee: “I am So will miss that part.
If testifying before Congress was a new experience for Walensky, so was much of her work. Although she has a master’s degree in public health, Walensky’s background when she took the CDC job was clinical medicine. An HIV specialist, she stepped down as chief of Massachusetts General Hospital’s infectious disease division to go to service.
She acknowledged that the learning curve was steep. But during her final days in the office, she seemed more interested in describing what the agency has been up to and where it’s going than dwelling on her feelings about putting it through a 29-month-long bruise.
The communication training which she received seems to have produced results; she’s clearly learned the crucial—if sometimes frustrating for journalists—technique of using a question to get to something she wants to talk about. Case in point: Yes, the congressional committee appearances were tough, but they gave her a chance to brag about the CDC’s work.
“We at CDC have never in our 76-year history had to deal with a pandemic of the magnitude, scale and scope that Covid has brought us. Here are some of the things we’ve learned along the way and what we’re doing to improve [on them]. And these are some of the things that were really extraordinary that we’ve done that no one has heard of,” Walensky said.
In an extended interview, Walensky spoke about the progress made in reforming the agency, part of the CDC Moving Forward revamp she launched last year.
There’s the new registry of CDC personnel that lists the different skills each has, a tool designed to make the agency better prepared to respond. For example, when the CDC had to deploy Hispanic lab technicians to a Marburg virus outbreak in Equatorial Guinea this spring, the candidate pool was clear.
There is a push to get CDC science out more quickly to shape policy and guidance for the public. Walensky said internal cleanup time for scientific papers has been cut in half, proudly noting that the impact factor of the CDC online journal Morbidity and Mortality Weekly Report has increased significantly. (A journal’s impact factor indicates how important it is to its field and how often its articles are cited elsewhere.)
“We have more work to do there, but we’re getting our science out faster,” she said.
And a major overhaul of the CDC’s massive website is underway, reviewing 200,000 web pages that sometimes contradict each other. The process includes streamlining content, but also archiving material that will still be available to the public, Walensky said.
She is clearly pleased with the progress her reform efforts have made, but she is also aware that this is a task she will not – she could not – complete. “I will humbly say this will take years to do,” she said.
Walensky seems unconcerned that her departure will jeopardize progress.
“So much of what I really wanted to do is set the visions, set the frame, set the inflection point, and kick the pedal to the metal,” she said. “What I want to say is that there has been an extraordinary amount of support, not only within the agency, but also outside the agency. At the administrative level, at the [Department of Health and Human Services] level…. I think there is momentum and a recognition that this work needs to be done.”
But some of what the agency needs to effect change is beyond its own powers to implement. Crucially, it lacks the power to require states, territories and tribes to share data. When it needs continued access to data, for example in the case of last summer’s mpox outbreak, it must negotiate numerous data use agreements with states, territories, tribes and local health authorities. Some allow CDC to share their data widely, others place restrictions on what can be made public. When all those agreements were signed in September, the CDC could see that the outbreak had peaked in early August.
“It’s our job to master these things before they become outbreaks or emergencies,” Walensky said.
To change that, congressional action is needed. Walensky believes there is a dual understanding of this need among legislators in Congress who understand health. But translating that to new authorities may not be feasible in the current climate.
“Maybe there isn’t a two-pronged path to get there right now. But we understand that we can’t be nimble if we can’t see what’s happening,” she said. “Congress will have to take a step forward.”
The CDC is also in dire need of workforce flexibility. The agency does not have the power to hire in emergencies the way an agency like FEMA — the Federal Emergency Management Agency — does.
“It’s true that tomorrow if we got the budgetary staff and data authorities we need to be an agile agency, we wouldn’t be where we need to be within the agency,” Walensky said. “That work is the work we do.
“It’s also true that if we’re the only ones doing that job, and we don’t get those authorities, we still won’t be able to be the nimble agency that’s expected of us.”
Asked to reflect on what she wishes she had known when she got started, Walensky said she and other players may be underestimating the extent to which deliberate disinformation would undermine efforts to keep the public safe during the pandemic.
“I think we all probably didn’t realize how many nefarious actors there would be to undermine that science evolves and science changes, and the virus evolves and the virus changes,” she said. “We could have said that louder. And that there were people who deliberately acted to undermine us has been a challenge.
Another thing Walensky learned is that during a health crisis there are many people at the table making decisions about the response. Some approach decision-making through the prism of what’s best for health; for others, the primary concern may be the continuity of education, the stability of the country’s transportation system, or the state of the economy. The fact that there is a push and pull of competing priorities is not well understood, she suggested.
Case in point: The CDC was hammered at the start of the Omicron wave on easing isolation and quarantine guidance. The evolved virus was much more contagious than the previous one, in part because it was able to evade some of the defense mechanisms of humans’ immune systems. Shortly after his appearance, huge numbers of people became ill or quarantined because they had been exposed to someone who was infected. There was a real risk that important social functions would come to a standstill. Supermarket shelves would become empty and hospitals would not have staff to provide care.
“We heard from hospitals that blood culture bottles weren’t being delivered, we heard from dialysis centers that they couldn’t get dialysate” – a solution used to remove impurities from blood – “we heard from pharmacies that their pharmacists couldn’t come, and their patients couldn’t pick up their insulin,” Walensky said.
Halving the amount of time it took exposed people to remain in quarantine was a compromise needed to keep the country functioning. She called it “doing as little harm as possible.”
It didn’t seem that way to the agency’s vocal critics. “Thanksgiving Christmas of 2021 was not my favorite time,” admitted Walensky.
When she leaves the CDC, Walensky finds herself in an unusual place. When she took the CDC job, she resigned from Mass General. She has nothing on the professional horizon. “My next chapter is very deliberately empty.”
“I’ve never been in this situation before and I don’t know how long it will last,” Walensky said, noting that she looks forward to spending time with her husband, sons and parents this summer. She plans to do some reading and hit the gym. She also plans to spend time thinking about what her next act should be. She has every confidence in one thing: it will be in the area of health/public health.
“I deeply believe in the mission,” said Walensky. “And part of the real question in my mind, and what I really want to spend some time thinking about and being mindful about is where is the most productive place from where I can do that?”