US disease-fighting agency struggles as it seeks to avoid Trump’s ire

During a recent telephone interview with the Financial Times, Robert Redfield, the director of the US Centers for Disease Control and Prevention took an unscheduled break to answer a call from the White House.

“That was higher up my command chain, I had to take that,” Dr Redfield said. “When you ask the question ‘is the CDC out of the loop?’, you have direct evidence it’s not true.”

Dr Redfield was referring to accusations that America’s storied disease-fighting agency, which has taken the lead during every previous outbreak since its inception in 1946, has been sidelined and undermined by Donald Trump’s administration during the country’s response to coronavirus.

The agency has also come under attack for bungling the launch of an early test for coronavirus, and for its ageing, creaking data systems, which have made it difficult to track the spread of the disease. Some public health experts say the reputation of the organisation and its 11,000 employees is at an all-time low.

“It’s a tragic downgrading in professional regard for what was the world’s top organisation of its kind,” said Barry Bloom, professor of public health at the Harvard TH Chan School of Public Health. “It was once the blueprint for every other CDC around the world.”

Earlier this month the CDC, which has shied away from making public interventions, broke cover to warn that the US was “not out of the woods” with regards to coronavirus following an upswing in cases in several southern and western US states that have quickly reopened their economies.

The agency warned the public against attending large gatherings such as the protests that have swept the US following George Floyd’s death, or the political rallies that Mr Trump’s campaign has planned, the first of which took place on Saturday in Tulsa, Oklahoma.

Dr Redfield delivered the warning on a call with reporters on June 12, marking the first time the agency had given a press briefing since March 9, when the outbreak was still in its infancy in the US.

“The CDC went for 13 weeks without giving a press briefing — that’s unprecedented during a public health crisis, let alone one of this magnitude,” said a former high-ranking official at the agency.

The absence of the CDC from the public stage underscores the dilemma facing the agency, which has tried to guide the public through the crisis without provoking the ire of Mr Trump, who has repeatedly attacked or undermined government scientists with whom he disagrees.

When the CDC released its long-awaited guidelines on reopening the economy — which were watered down following objections from the White House — it did so by quietly publishing them on its website over a weekend in late May.

“The CDC produces lots of good guidance on how to come out of lockdown, but the big problem is it is not allowed to publicise [it] in any way,” said Pierre Rollin, a former CDC official who worked on the Ebola outbreak.

He added: “And where is Robert Redfield? He is absent. He got the message early on that he should not say anything or raise any concerns. I know it could cost him his job, but sometimes you have to decide between your position and your duty.”

Relations between the White House and the CDC became strained in late February when one of the agency’s top scientists, Nancy Messonnier, warned that the administration was preparing for a potential pandemic, and that the virus would soon start circulating within the US.

“It was exactly the right thing to say, and at exactly the right time,” said Thomas Frieden, who led the CDC during the Obama administration between 2009 and early 2017.

Dr Messonnier’s warning angered the president, who at that time was downplaying the impact of the virus. He was so infuriated by her intervention that he threatened to have her fired, according to a person briefed on the discussions.

Dr Messonnier, one of the top infectious diseases scientists in the country and once the de facto leader of the US response to coronavirus, has since lost her clout. She is now focused on ensuring that enough Americans receive a flu vaccine before this winter, when many experts expect flu season and a second wave of the virus to put hospitals under strain.

“Nancy continues to play a critical role,” said Dr Redfield, adding that she was also working on ensuring that the US was prepared for the rollout of a coronavirus vaccine if one is found.

The agency and the White House also appeared to be at odds over the benefits of wearing face masks, which have been proven to reduce the spread of the virus. On April 3 the CDC recommended that people wear cloth face coverings in public, but the president undermined the announcement by insisting it was a voluntary recommendation, and one which he would not be following.

“To me the epitome of this was the press conference where Redfield said everyone should wear a mask — and then the president said he’s not going to,” said Dr Frieden.

Donald Trump, appearing without a face mask, discusses vaccine development in May at the White House Donald Trump, appearing without a face mask, discusses vaccine development in May at the White House © AFP via Getty Images

While some of the CDC’s failings can be explained by its fraught relationship with the White House, it has also made a series of unforced errors that have damaged its credibility.

The agency had to suspend the national rollout of a test for the virus in April after the kits it distributed to the state and local labs were found to be contaminated and faulty.

“Contrary to the narrative of the media, it is an excellent test,” said Dr Redfield, although he conceded that there was a manufacturing “glitch . . . that took us about three weeks to figure out”.

Some former CDC officials said the bungled rollout was symptomatic of one of the agency’s biggest weaknesses. While it has some excellent scientists, it operates more like an academic institution than a public health agency. So while the prototype test it developed was of high quality, the agency failed when it came to scaling it up and distributing it for wider adoption.

“The failures have been on both sides, the White House and the agency,” said one former senior public health official who worked in the Obama administration.

He added: “The challenge with brilliant scientists is they are not necessarily the best managers. The CDC testing failure fiasco set back America terribly and it does indeed reside with the director. That was science without consideration of policy, process or operations.”

The CDC has also come under fire for its inadequate data systems, which rely on a patchwork of unintegrated spreadsheets that make it hard to monitor the progression of coronavirus. In particular, Deborah Birx, the White House coronavirus response co-ordinator, has expressed frustration at delayed or inaccurate data from the CDC.

Dr Redfield acknowledged the failings, but insisted that there was no tension between himself and Dr Birx. “I’ve worked with Dr Birx and that whole issue was not really a disagreement,” he said. “I’ve articulated from the beginning that we need to modernise our data systems and bring them into the 21st century.”

He said he realised that the CDC’s systems were inadequate upon becoming director in March 2018, when Mr Trump’s first pick was forced to resign over an alleged conflict of interest. Although he said the CDC had made some progress, such as developing a better system for monitoring opioid overdose deaths, he accepted more needed to be done.

“It’s an old system that there’s been limited investment in. This outbreak really shows that we need [a new] data system. For us, data is fundamental. It’s the whole foundation of the CDC.”

Data is not the only area of the CDC that has suffered from under-investment, according to Dr Redfield, who recently called for a doubling or tripling of the agency’s budget. The agency has a discretionary budget of about $7.8bn. Its funding fell by roughly 10 per cent in real terms between 2010 and 2019, according to Trust for America’s Health, which performs research into US public health policy.

“If the investment doesn’t happen . . . then unfortunately this too will pass and all my successors will eventually be in the same situation where they will be underprepared for the challenges,” said Dr Redfield.

However, he made no apology for keeping the agency out of the public eye. “We’re very engaged in every single major meeting that’s happening in the White House with a seat at the table,” he said. “But it may not necessarily be on the nightly news.”