Walensky denounces the underinvestment in public health

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

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

As one of the most visible faces in the world of American public health and frequently criticized for her agency’s response to the pandemic and other outbreaks, she now travels with armed security guards. But she does not shy away.


Now more than a year and a half into his tenure as 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 underpinned it and forces that continue to constrain the CDC’s capacity. be agile in the face of public health emergencies, such as monkeypox.

The final mixed message Walensky sends is from the White House. On Sunday, President Biden surprised many when he told Scott Pelley on CBS’s “60 Minutes” that the pandemic was over – much to the chagrin of clinicians and non-clinicians who are still feeling the effects of Covid on a daily basis. Walensky did not say whether or not she agreed with Biden’s assessment.


“I think there are a lot of different ways to think about ending a pandemic,” she said. Two years ago, her children stayed home after school and her family cleaned up groceries, she said. Now there are 600 million vaccines in the arms of Americans, as many are returning to workplaces and classrooms.

“I won’t let go of the 350 deaths we have every day,” she said, but noted that “it’s still well under 3,000 ‘deaths that were happening every day in January 2021.'” And so , I think we’re in a very different place,” she said. “And we can look at very different metrics when we think about how things will go. And then also, you don’t know what what the fall will bring in. We don’t know what the winter will bring.

For immunocompromised people – those awaiting or who have recently received a transplant, cancer patients undergoing chemotherapy, people with chronic autoimmune diseases, people who cannot be vaccinated, etc. – Covid remains a daily threat. Walensky acknowledged this and said perhaps one of the “good parts” of the pandemic is how it has made Americans more aware of the disproportionate risks and impacts certain groups face.

“Among the things we’ve done, we’ve put a health equity lead in every response,” she said. “And yet, this is difficult for a respiratory virus, in particular for Covid. And we can also talk about monkeypox, where we have immunocompromised people who are at risk of transmission, whatever the route.

Just as the CDC began to cut staff dedicated to the Covid response, monkeypox has become a public health threat in the United States. And the agency is still grappling with some of the same issues that slowed the Covid response, Walensky said. A major issue is infrastructure — the money that states and cities haven’t spent to bolster their public health departments, data systems, and other essential services.

“It has been waxing and waning, from disaster to disaster,” she said. “I can tell you that states don’t have money dedicated to monkeypox. Period.”

Despite the giant injections of cash that states and local jurisdictions have been able to keep afloat during the pandemic, it’s money that can’t be used to fight monkeypox. Some estimates indicate that the nation needs an additional 80,000 public health workers to meet the country’s diverse health needs; even if states get money to respond to health crises, they probably don’t have the right staff to handle things properly.

Walensky defended the CDC’s efforts to collect and disseminate key data on Covid and monkeypox, both on the scope of outbreaks and the progress of vaccination efforts. Even as the nation’s top public health agency, the CDC still lacks the power to force states to release data, she said. It took the federal agency more than six weeks to obtain Data Use Agreements – legal documents that authorize the CDC to collect and publish state figures – from all 50 states on monkeypox vaccination . It was “wasted time,” Walensky said.

More than half a billion dollars has been allocated at the federal level to modernize the imperfect patchwork of data systems used across the country, yet that money hasn’t made a dent so far to smooth out information bottlenecks or fill data gaps.

“If we are going to ask States to report to us, we owe it to them to give them back something that is useful to them: what is happening around them? she says. “What do other jurisdictions see? What is happening in their border states? All kinds of things so they have more information and more data. It must be a two-way highway. That, I completely understand.

Communication is an area that needs improvement, she acknowledged. It’s cited as a major area for improvement in a review Walensky commissioned earlier this year to determine what went wrong in the CDC’s Covid response and how the agency can do better. Many public health actors have called for a commission with subpoena power, similar to that launched after the 9/11 attacks, to document failures and prepare for future emergencies. Walensky said she doesn’t know if such a commission will be formed, but is focused on implementing the criticisms she’s heard informally and through the internal review.

“I strongly believe that we need to restore and regain trust,” she said.

Get your daily dose of health and medicine every weekday with the free STAT Morning Rounds newsletter. Register here.