‘Disaster to disaster’: Underinvestment in public health systems obstructs response to Covid, monkeypox, Walensky says

For the record, Rochelle Walensky, director of the Centers for Disease Control and Prevention, would take the job again. 

“I’m a clinician, a physician at heart,” she said Friday. “And when somebody calls you for help, you run.”

As one of the most visible faces in the world of American public health, and the frequent recipient of criticism for her agency’s response to the pandemic and other outbreaks, she now travels with armed security guards. But she isn’t shying away.

Now over a year and a half into her tenure as the head of the CDC, Walensky spoke to a group of reporters outside Boston about a review of the agency’s Covid response, the challenges that undergirded it, and what forces continue to restrict the CDC’s ability to be nimble in the face of public health emergencies, like monkeypox. 

The latest mixed messaging Walensky is fielding came from the White House. On Sunday, President Biden surprised many when he told Scott Pelley on CBS’ “60 Minutes” that the pandemic was over — much to the chagrin of clinicians and non-clinicians alike who still feel the impacts of Covid everyday. Walensky did not say whether she agreed or disagreed with Biden’s assessment. 

“I think that there are a lot of different ways to think about a pandemic being over,” she said. Two years ago, her children were staying home from school and her household wiped down groceries, she said. Now, there are 600 million vaccines in Americans’ arms, as many return to workplaces and classrooms. 

“I will not let go of the 350 deaths that we are having every single day,” she said, but noted that “it’s still way less than 3,000” deaths that were occurring each day in January 2021. “And so, I think we are in a very different place,” she said. “And we can look at very different metrics as we think about how things will be. And then also, we don’t know what the fall will bring. We don’t know what the winter will bring.”

For immunocompromised people — those awaiting or who recently received transplants, cancer patients undergoing chemotherapy, people with chronic autoimmune conditions, people who cannot be vaccinated, and more — Covid is still a daily threat. Walensky acknowledged as much, and said perhaps one “silver lining” of the pandemic is how it made Americans more aware of the disproportionate risks and impacts that some groups face. 

“Among the things that we’ve done is put a chief health equity officer in every response,” she said. “And yet this is challenging for a respiratory virus, especially for Covid. And we can talk about monkeypox, too, where we have immunocompromised people who are at risk for transmission, whatever the route.”

Just as the CDC began scaling down the number of staff devoted to Covid response, monkeypox emerged as a public health threat in the U.S. And the agency is still grappling with some of the same problems that slowed the response to Covid, Walensky said. A major issue is infrastructure — the money states and cities have not spent on beefing up their public health departments, data systems and other essential services. 

“It has been waxing and waning, disaster to disaster,” she said. “I can tell you, states do not have any money dedicated to monkeypox. Period.” 

Despite the giant infusions of cash that states and local jurisdictions got to stay afloat during the pandemic, that is money that cannot be used to address monkeypox. Some estimates say the nation needs 80,000 more public health workers to meet the country’s various health needs; even if states do get money to respond to health crises, they probably don’t have adequate staffing to run things properly. 

Walensky defended the CDC’s efforts to collect and disseminate key data about Covid and monkeypox, both the scope of the outbreaks and progress of vaccination efforts. Even as the country’s top public health agency, the CDC still does not have the authority to force states to release data, she said. It took more than six weeks for the federal agency to get data use agreements — legal documents that authorize the CDC to collect and publicize states’ numbers — from all 50 states on monkeypox vaccination. That was “time lost,” Walensky said.

Over half a billion dollars have been allocated on the federal level to modernize the flawed patchwork of data systems used across the country, and yet that money hasn’t made a dent so far in smoothing information bottlenecks or filling data gaps. 

“If we’re going to ask states to mandatorily report to us, we owe it to them to give back to them something that’s helpful to them: What’s going on around them?” she said. “What are other jurisdictions seeing? What’s happening on their border states? All sorts of things so that they are empowered with more information and more data. It’s got to be a bi-directional highway. That I totally get.” 

Communication is an area that needs improvement, she acknowledged. It’s cited as a major area for improvement in a review Walensky requested earlier this year to determine what went wrong in the CDC’s Covid response and how the agency can do better. Many in public health have called for a commission with subpoena power, similar to the one launched after the Sept. 11 attacks, in order to document the failures and prepare for future emergencies. Walensky said she does not know if such a commission will be formed but is focused on implementing the critiques she has heard informally and through the internal review.

“I very much believe that we have to restore and regain the trust,” she said. 

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