House committee drills down on CDC future, actions in COVID-19 pandemic

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Physicians, public health experts, and lawmakers are determining how the lessons of the COVID-19 pandemic will affect the future of the U.S. Centers for Disease Control and Prevention.

On June 7, the U.S. House of Representatives’ Energy & Commerce Subcommittee on Oversight & Investigations held the hearing “Looking Back Before Moving Forward: Assessing CDC's Failures in Fulfilling its Mission.” Discussion covered topics ranging from school closures to vaccine effects to sharing data and what it means.

COVID-19 affected the physical health of Americans and the economic health of the nation.

It was “an immense challenge for public health agencies, health care providers, every level of government, and the American people,” said Committee Chairman Rep. Morgan Griffith, R-Virginia. The agency also has many hardworking doctors and public health experts who want to keep Americans safe, Griffith said.

“One of my biggest frustrations, however, with the CDC is that when you look at all of the talent, all of the scientific knowledge, technical resources, and immense funding we have put into the agency, the end product is somehow less than the sum of its parts,” Griffith said. “It's reasonable for the American people to expect CDC to use the best available science when preparing guidance and recommendations.”

Since then, CDC Director Rochelle P. Walensky, MD, MPH, suggested a major “overhaul or ‘reset’” called the Moving Forward Initiative. The committee noted CDC has conducted the plan “largely in secret, with little opportunity for public or Congressional output,” according to the hearing memo.

Walensky did not testify, but other hearing witnesses shared their observations about problems that emerged during the pandemic and ideas about what should happen in the future.

Since 2007, the U.S. Government Accounting Office has made 155 recommendations to the U.S. Department of Health and Human Services, which oversees the CDC. As of April 2023, 91 of those remained unimplemented, said Mary Denigan-Macauley, PhD, Director of Public Health, U.S. Government Accountability Office.

COVID-19 is not the only example in which “persistent deficiencies” hurt HHS and CDC’s roles in leadership. HHS efforts have fallen short in five key areas, with examples, Denigan-Macauley said:

• Clear roles and responsibilities were not defined, and those affected response efforts.
• Complete and consistent data. Since 2006, HHS has made little progress implementing a nationwide, interoperable network to collect data to aid responses.
• Clear and consistent communication was unclear during critical incidents, including the H1N1 influenza response.
• Transparency and accountability. CDC COVID-19 testing guidelines changed with little explanation of the scientific rationale.
• Key partners’ capabilities and limitations. The HHS Administration for Strategic Preparedness and Response had limited capacity since at least September 2019.

Tracy Beth Hoeg, MD, PhD, an epidemiologist at the University of California-San Francisco, said she was senior author of a study published in CDC’s journal MMWR on COVID-19 transmission in schools. She and her coauthors expected the findings to inspire CDC to recommend swift reopening of schools due to limited transmission of COVID-19 in classrooms.

Instead, the agency “doubled down” on keeping schools closed and maintaining at least six feet between students and teachers. That kept up to 90% of students in the United States out of full-time school or in-person learning into 2021, Hoeg said.

CDC also downplayed urgency about post-vaccination myocarditis signal in young people, and MMWR had publication bias and errors that have eroded its credibility, Hoeg said.

“Whatever our political beliefs, we should all be deeply concerned about a national public health agency that chooses to publish, promote and develop guidelines around politically favorable policies instead of producing and/or utilizing the highest quality data or admitting uncertainty,” Hoeg said.

American Public Health Association Executive Director Georges C. Benjamin, MD, MACP, said Congress should support CDC’s efforts to improve, along with:

• Data collection and information technology modernization
• Workforce capacity
• A public health workforce loan repayment program
• Public health infrastructure, programs, and infrastructure

COVID-19 is one of numerous factors that have lowered life expectancy by almost three years in the United States.

“The federal leadership to address these health challenges is not the responsibility of CDC alone, but the agency is an important part of the collaboration of governmental and nongovernmental entities tasked with developing a comprehensive approach,” Benjamin said. “We need a strong and well-resourced CDC to adequately protect the public’s health from the many challenges we face today.”

Charity Dean, MD, MPH & TM, also was a hearing witness. Lawmakers peppered the panel with questions, and there were accusations that one party or the other were attempting to politicize health decisions.

“While I appreciate the witnesses for being here and look forward to their testimony, if Republicans were really interested in conducting oversight of the CDC, they would have invited the CDC to be here today,” Committee Ranking Member Rep. Frank Pallone Jr., D-New Jersey, said in his opening statement. “That clearly was not their goal. Republicans just wanted another venue to continue their attack against the CDC.”

Walensky has announced she will step down from the post as of June 30. The White House has not formally named a new director, but news reports say President Joe Biden will tap Mandy Cohen, MD, MPH, an internal medicine physician, for the post.