Rochelle Walensky’s resolution for 2023: A better CDC

The moment Rochelle Walensky, the director of the U.S. Centers for Disease Control and Prevention, stood to greet me as I walked into a room on the third floor of Loews Hotel at 12th and Market, we burst into laughter. We both stand about 6 feet, and weren’t expecting to meet another tall lady.

Walensky was in town this month to give a keynote address at the annual Bloomberg American Health Summit. After we composed ourselves, we sat down to talk about what she’s learned from her first two years doing one of the hardest jobs on the planet.

Walensky took over the CDC in January 2021; in that month alone, more than 95,000 U.S. residents died of COVID-19.

Before then, Walensky had been in the trenches fighting COVID in Boston, where she was chief of infectious diseases at Massachusetts General Hospital. It was a hard job, but people were applauding hospital workers in the streets, so she felt appreciated. Transitioning to a political position was a challenge, she said. “When you leave the bedside and people are grateful for your effort, and then you come into a role where there is a politicization of public health, and everyone’s critical of your efforts … it’s just been a personal transition for me.”

Another transition: getting a handle on everything she is responsible for. We hear a lot about COVID, mpox (the virus formerly known as monkeypox), and the flu, but the roughly 11,000 employees of the agency track almost every condition you can think of, from heatstroke to obesity to opioid use disorder. They even track dog imports: After a rabid rescue dog from Azerbaijan was brought into our country in June 2021, the CDC issued a temporary suspension of dog imports from countries with high rabies risk. “I have a lot to worry about,” she told me.

“I have a lot to worry about.”

In addition to COVID (which still kills almost 500 people in the U.S. every day), here’s some of what’s keeping her up at night:

Colder months always bring more illness, but this year pediatricians are facing what they call a “tripledemic,” as COVID, RSV, and the flu strike all at once, leaving children’s hospitals overwhelmed and families in a state of panic. Since October, the CDC estimates that up to 27 million people have gotten the flu, 260,000 have been hospitalized for it, and 21,000 have died from it.

It’s not a surprise, Walensky told me — masks and social isolation because of COVID have enabled people to avoid other illnesses over the last two-plus years, rendering them less immune. What’s more, only 10% of kids ages 4 and under have received at least one dose of the COVID-19 vaccine, and less than half of all kids have gotten their annual flu shots. “In the backdrop of little immunity, and not robust vaccination rates the way we would like to see them, I knew we were at risk at some time for a potentially bad flu season,” she said.

» READ MORE: At St. Christopher’s Hospital for Children, children are waiting hours to be seen as they struggle to breathe.

One of the biggest health threats before COVID-19 was the rise in drug-resistant bacteria, which killed more than 1 million people worldwide in 2019. The last three years have only worsened the problem, Walensky said, as clinicians have continued to over-prescribe antibiotics to COVID patients — and, now, to the children flooding emergency rooms — which fuels drug resistance. “Antibiotic resistance and regaining the gains that we’ve lost is really important to me,” she said.

Since late September, Uganda has been dealing with an outbreak of Ebola, a horrific virus that kills roughly half the people it infects. Dozens have died, and schools have been forced to close early to stem the outbreak.

All travelers from Uganda to the U.S. have been routed to five airports, where they are screened for Ebola. Airports in three of those cities (New York, Washington, and Newark, N.J.) are within 150 miles of Philadelphia.

Ebola “has been a major area of focus over the last three months. Major area,” she told me.

Federal officials recently ended the emergency health declaration for mpox, but in the outbreak’s early days, this outcome was not a given. “Mpox was a huge concern as it was evolving and we didn’t know if we could get to the place where we are,” Walensky told me. “We need to sustain where we are and do more.”

What Walensky worries about the most, she told me, is the future. “In the big picture,” she said, “I always worry that I don’t know what to worry about tomorrow. Are we prepared?”

This is the question that’s driving Walensky as she sets out to reform the CDC so it is better prepared to handle the next public health threat.

It’s safe to say that, in 2019, CDC was not prepared for COVID-19. Under President Donald Trump, the White House meddled with the CDC’s COVID advice to protect the economy, but even when Walensky took over in 2021, there were many missteps. She acknowledged that she got heat “from both sides [saying we were] masking too little, masking too much.” (Guilty: I was among the critics of the agency’s decision to declare vaccinated people could remove their masks indoors in May 2021, prompting many unvaccinated people to do the same. I still believe that decision was premature and misguided, leaving us vulnerable when the delta and omicron variants began spreading in the United States in subsequent months.)

Going forward, Walensky told me there’s a lot she plans to do differently. She’s always said that the CDC is “going to follow the science.” That’s not enough, she told me. “In my mind, given my background, that has implied to me ‘and maybe we won’t know all of the science immediately.’ That was left unsaid but needed to be said.”

To that end, she is changing how the CDC communicates its science, to make those nuances more clear. That includes showing its work — with each policy recommendation, presenting the science that supports it, and emphasizing that as the science changes, so could the recommendation. “Our science has to be packaged differently,” Walensky said.

But “the science” is only as good as the data behind it, which gets to another major issue. The CDC cannot force states or local jurisdictions to share data, or to share it in a standardized format. So when there is a health threat, whatever data they get often come long after they need that information, in formats ranging from electronic files to fax reports. (Yes, faxes.) This makes it nearly impossible for the CDC to give good, timely advice on how to stay safe. The agency has launched a Data Modernization Initiative to try to address these issues, including a $200 million center that, like weather forecasters, can help predict the next outbreak of infectious disease.

Walensky also worries about the estimated shortage of 80,000 public health workers in the U.S., which puts everyone at risk. “When there is a public health threat, it’s not going to knock on CDC’s door,” she told me. “We’re going to get that information from some community where they notice something.” To get more boots on the ground, the CDC has distributed $3 billion to train new people in the field.

In the meantime, she will keep saying the same things over and over: Get your vaccines (COVID, flu, and others). Wear a mask on public transport (“I never stopped,” she told me), and consider masking in other public indoor settings to get through the latest viral surge.

Walensky knows the CDC has to do better. I just hope that these changes are enough — and happen fast enough — to leave us better prepared to face whatever is coming next.