Resuscitating CDC’s Reputation

Once again, we highlight the work of Dr. Peter Sandman, one of the country’s preeminent experts on the subject of risk communications.

In this piece, Dr. Sandman writes about what the CDC needs to do to regain public trust in talking about coronavirus, the tug-of-war between science and politics and the avoidance of hubris.

As is always the situation with Dr. Sandman’s writings, there are lessons here not just for the CDC but for any organization that seeks the public trust.

Dr. Sandman writes…

Maggie Fox to Peter M. Sandman and Jody Lanard, January 18, 2021:

I am writing a story on what CDC needs to do to regain public trust in talking about coronavirus. Would you all like to weigh in?

Peter M. Sandman and Jody Lanard to Maggie Fox, January 19, 2021:

The question you asked us is “what CDC needs to do to regain public trust in talking about coronavirus.”

We are talking here about one significant segment of the U.S. public. According to survey data, a very large segment of the public continues to trust CDC – not as much as their own doctors, but more than any other government agency. And a third segment (fervent antivaxxers, for example, and many people of color) never trusted CDC and will be very, very tough to win over.

But there is a crucial segment of the public that has lost trust in CDC directly as a result of COVID-19 events. This segment is crucial because it is attentive. It has been watching CDC for the past year, and what it has seen has aroused mistrust.

This attentive public is the “public” we’re talking about.

Regaining their trust is too ambitious a goal. We would reframe the task as earning a second chance – ameliorating distrust enough that people are willing to reconsider whether they see reasons to start trusting CDC once more.

To earn that second chance at regaining trust, we believe the CDC must first come clean about how it lost trust.

In particular, it must disavow the self-serving mantra that has insulated it from criticism, from self-criticism, and ultimately from a second chance: the mantra that CDC is a superb agency replete with world-class scientists who were thwarted by the monster in the White House from playing the role they had been preparing to play for decades, leading the battle against America’s worst public health crisis in a century.

There is some truth to that mantra. There are certainly instances where CDC’s world-class scientists were genuinely thwarted by the White House. Interestingly, most such instances are about CDC communications, not CDC science. The clearest example: After weeks of CDC compliant silence, on February 25 Dr. Nancy Messonnier gave an appropriately alarming press conference about the threat posed by COVID-19. President Trump was enraged. Thereafter, Dr. Messonnier and her colleagues spoke seldom and timidly. They were barred from the crucial role of media briefer that CDC typically performs so well in infectious disease outbreaks.

So yes, there is some truth to the mantra.

But most of CDC’s loss of trust has resulted from unforced errors. To earn a second chance, CDC must acknowledge these errors – which for the most part it has never done, at least never done vividly. It must apologize for them. It must diagnose why they occurred and propose a plan to prevent their recurrence. And it must ask the attentive public to look again, to give it a second chance to earn back their trust.

By far the most consequential of CDC’s COVID missteps was also the earliest. For crucial weeks in the spring of 2020, CDC failed to develop a usable test for the virus that causes COVID-19, leaving health departments with no way to track its spread. Worse, CDC had no Plan B to fall back on when its test development efforts failed, even though a very obvious Plan B was available: It could have licensed some other readily available test, such as the German test protocol distributed by the World Health Organization starting in mid-January 2020. And as far as we can determine, CDC never pressured the FDA to relax the rules that kept state and hospital labs from deploying their own tests, as many were begging to do.

CDC’s test was more sophisticated than the other available test protocols early on. Or at least it would have been more sophisticated if it had worked right – but it didn’t work right because of contamination. The simpler tests that much of the world deployed while CDC was still trying to fix its test worked reasonably well, especially compared with virtually no testing. But CDC didn’t want to settle for a simpler test, or anybody else’s test. It wanted its own test, complete with bells and whistles.

There wasn’t a whisper of political interference in all this. It was hubris, pure and simple. Political interference, in fact, was exactly what was needed – a politician to demand a simpler working test now and CDC’s bells and whistles be damned.

Several reporters have told this story, but it is a story CDC has yet to tell – a story CDC must tell over and over, with anguish and sorrow and embarrassment, if it is to earn a second look. Something like this:

Our lab work got sloppy. Our management got bureaucratic and ideological. We let the perfect be the enemy of the good enough. We lost the most fundamental understanding that guides any crisis management effort: In an emergency you can’t afford to dot every i and cross every t, and you succeed or fail based on your ability to decide wisely which corners you should cut and which you dare not cut.

Our test catastrophe wasn’t because of Trump. In fact, our biggest problem was just exactly the opposite of what everybody seems to think it was. We were too isolated from political decision-makers, stuck in Atlanta, some 600 miles from the White House. Decades ago somebody thought that sort of insulation would protect us from political interference. Instead, it isolated us. We had too few political appointees doing two-way communication between us and senior administration officials: telling us what the administration was thinking; telling the administration what we were doing, and why.

We were proud of our autonomy, resentful of any effort to boss us around. And it turned out we desperately needed bossing around on some issues. Or if not bossing around, at least dialogue, discussion, jostling out of our hermetic isolation. Yes, there are well-known examples of the administration tampering with our desire to put out certain information. But the worst decisions we have made during this pandemic we made alone.

Here are three more examples of some of those “worst decisions” that CDC needs to acknowledge, apologize for, and move beyond:

Masks.

Worried about exacerbating the shortage of surgical and N95 masks for healthcare workers, CDC joined in the false claim – which it knew or should have known was false – that masks were useless to ordinary people worried about catching or spreading the disease. And in April 2020, when CDC finally turned on a dime, lurching from “mask-wearing is foolish and antisocial” to “mask-wearing is essential and obligatory,” it pretended that the turnabout was a response to newly available data that the virus could be spread by people who weren’t sick. The “new data” CDC referenced in April merely reconfirmed what was famously reported in February: case clusters in Singapore and Germany launched by asymptomatic or presymptomatic cases.

The politicization of masks has had many causes, but early public health dishonesty was the beginning of this sorry tale. And CDC’s failure to apologize is the continuation of this sorry tale.

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