Changes at CDC: Potential impacts on public health

[00:00:17]

ELENA RENKEN: Hello, everyone, and welcome to SciLine’s media briefing on changes at the Centers for Disease Control and Prevention, or CDC, and potential impacts on public health. As measles and avian flu outbreaks continue, we’ll get into the details of the role that the CDC plays in U.S. public health infrastructure, how prepared the country is for disease outbreaks, and communicating about public health issues. My name is Elena Renken, and I’m SciLine’s manager of journalism projects and multimedia. If you’re unfamiliar with SciLine, a little background. We’re a philanthropically funded, editorially independent non-profit based at the American Association for the Advancement of Science, and everything we do is free. Our mission is to make it easier for reporters like you to use scientific evidence and expertise to strengthen your reporting. Whether you’re covering a topic that clearly involves science like new measles cases, or a story from an entirely different beat, like a new local bill, scientific research can strengthen your reporting with evidence and context. You can see all our resources on sciline.org, including our toolkit for covering major issues of 2025. And whenever you need a scientific expert to answer your specific questions before your story’s deadline, you can click the blue “I need an expert” button on our website and we’ll look for a source with the right background who’s available to talk with you. A couple of notes before we begin. I’m joined here by three experts who have researched the CDC and public health in the U.S. I’ll let each of them introduce themselves, their topics of research, and their connections to the CDC. Dr. Keller, would you go ahead?

[00:02:01]

ANN KELLER: Yes, thank you so much. I’m really delighted to be here. My name is Ann Keller. I’m a Professor of Health Politics at the UC Berkeley School of Public Health. My Ph.D. is in political science, and for the length of my career dating back to the 1990s, I’ve studied expertise in public decision making, particularly in federal agencies and particularly in areas of contested policy making.

[00:02:25]

ELENA RENKEN: Thank you. And Dr. Resnick, would you introduce yourself next?

[00:02:29]

BETH RESNICK: Yes, thank you. Thanks so much for inviting me here today. I am Beth Resnick. I am a practice professor in the Johns Hopkins Bloomberg School of Public Health in the department of health policy and management. I am also a principal investigator in the Consortium for Workforce Research in Public Health, which is CWRPH, which is based out of the University of Minnesota. We were, the consortium works with the CDC. We are funded by them, and we also do lots of work with state and local health departments that are funded through the public health infrastructure grants from the CDC.

[00:03:06]

ELENA RENKEN: Great. Thank you. And Dr. Nuzzo, would you introduce yourself as well?

[00:03:10]

JENNIFER NUZZO: Sure. Hello, everyone. It’s a real pleasure to join this conversation. I’m Jennifer Nuzzo. I’m founding director of the Pandemic Center at the Brown University School of Public Health. I’m also a professor of epidemiology at Brown. I have no funding from the CDC, though was recently appointed to the Advisory Committee for the Director of CDC for a term that, if the ACD still exists, will start in July.

[00:03:37]

ELENA RENKEN: Thank you all for being here. I’ll ask each of our panelists a couple of questions before we start taking questions from the audience. Journalists, you can submit those questions at any time. Just click the Q&A icon at the bottom of your Zoom screen. And please note if you’d like your question directed to any specific speaker. We’ll be posting a recording of this briefing on our website later today, and a transcript will be added in the next few days. I’ll go ahead and dive in. Ann, what challenges does the CDC face in responding to infectious disease outbreaks?

[00:04:11]

ANN KELLER: That’s a big one. There’s a lot of challenges responding to disease, particularly to infectious disease outbreaks. And I think just to start, I would say that typically we’re used to hearing from public health on issues where there’s really settled science. So when, we knew before the surgeon general started to say that smoking was bad for your health, there was literally decades of research showing that smoking was bad for health. Another example is thinking about wearing seat belts. There was just a treasure trove of information saying that people who were seat belted in cars did better during car crashes. So we can think of any number of examples where public health advises us from sort of a stable evidence base that is oftentimes decades long in the making. A novel infectious disease comes to town, and you have professionals who are trying to develop guidance on what they know is a partial, patchy, error-prone evidence base that might be only weeks old and is rapidly changing. It’s not a domain for the faint of heart. It’s incredibly difficult to try to make, to try to write good guidance in that, under those circumstances. And if you fold in sort of partisanship and politics and divisiveness over what people think we should do, it makes that domain even that much harder.

[00:05:37]

ELENA RENKEN: Good to know. Thank you. And what does research show about the value of transparency in CDC communications about infectious disease?

[00:05:46]

ANN KELLER: Well, let me sort of build out, one of the things that I think is, so I did a lot of research on how the media and journalists responded to CDC public health guidance during COVID, in particular under the Biden administration. And the reason why I looked at the Biden administration is that CDC wasn’t writing its own guidance during the Trump administration, so the first year of COVID. In fact, many journalists were able to expose this. We learned this because journalists were able to find out that political appointees were writing things that they were then, that then were being published as if they were coming out of the CDC. So, I want to, well, I can talk about that case. Why is it interesting? How was the Trump administration able to do that? But for the moment, I want to talk about what it was like for CDC to try to write good guidance under the Biden administration, when the Biden administration was sort of letting the organization function as intended. And one of the things that was really, that happens is that if the organization puts out guidance and then something happens, a new variant comes along and the organization has to update its guidance, it’s often criticized as sort of acting too quickly. If the organization takes a long time, not a long time, if it takes some amount of time to try to validate the information that it has, the data that it has before it issues guidance, it is often criticized for being slow and bureaucratic and not sharing with the public what it knows. Sometimes this even, even when organizations, sometimes when professional public health organizations are trying to validate information, they can be accused of cover-up.

I also found a case where the CDC issued guidance that was treated as very controversial. There were a number of experts, even well-placed experts in academic centers who were saying, We don’t like this guidance, we’re not happy with it. And if you look at the trajectory of what happened with that guidance over its lifetime, what you see is a number of independent public health jurisdictions across the United States, across Canada, in Europe, picked up the CDC’s guidance. And one of the things that’s really interesting about it is if you stopped paying attention when it first landed, you would get the impression that the CDC had written terrible guidance that the expert community hated. But if you kept, if you stayed tuned in, you would realize the guidance actually sort of became the professional standard. So the guidance sort of weathered expert criticism. But that didn’t mean that the CDC wasn’t sort of lambasted at the time for having failed, which I think is part of one of the things that can be really difficult about trying to perform in this environment. Even when you write what ends up being sort of professionally accepted guidance, you might still be treated, when you release that guidance, as if somehow you’ve messed up.

So that brings me to the transparency question. It actually I think is really important for journalists or for the public to understand that learning is a process and that learning might be messy. And particularly, I think when we think about the way that science works, the norm for science is that scientists challenge each other. If a scientist comes along and says, Hey, I have this new finding, I have this new way of thinking about this, the scientific community is supposed to react with skepticism. Prove it. We’re not sure we believe you. We’re not sure that you’ve done this with acceptable methodologies. We’re not sure we believe your data. That normal process should produce stronger science. The science that withstands criticism should be better. And I think that, what I think could happen, although I think there’s, with political actors getting involved, I think this can be very difficult. But I think that if the CDC could be very transparent about this process, if journalists covering the CDC could treat controversy and learning as normal instead of treating it as failure, then the public might be invited into a process of learning. And I sort of have what I call this learning in plain sight, where an organization might think it has a good answer and it releases guidance and says, I think this will put us on better footing going forward. And they receive criticism, but instead of treating that criticism as evidence that the system isn’t working, what if we treated it as, No, this is the system working. We need, we should have more confidence in guidance that has withstood criticism or learned from criticism or benefited from criticism than guidance that’s gone untested. I think, so when I think about transparency, I guess I could say two things. One, you know, is the president in the White House going to let the organization communicate with the public? That’s a really open question right now. It didn’t happen under the Trump administration. I think it happened under the Biden administration. And if the organization is allowed to communicate, is, can the organization feel confident that being transparent about the messy process of learning is going to be accepted as sort of normal.

Because it’s quite easy to, I think one of the things that we see happen is that sometimes the stories about what’s happening with writing guidance sort of treat scientists and public health professionals as if they’re omniscient. And if they don’t know everything, that somehow they’ve failed. So I think one of the things that I’m hoping about sort of future transparency is that journalists can sort of join the conversation in lifting up the idea that learning can be messy, it can be error prone, and that we should be, we should stay tuned in. So don’t just attend to the guidance at the moment of controversy, but follow it, what happens after the controversy? What happens once the guidance is implemented? And give an opportunity for the CDC, for the people that are speaking for the CDC, to explain what’s happening going forward. So I really think that at the end of the day, we sort of have to trust that the public will respond to transparency, and that we can do a bit better by shining a light on learning, instead of getting into this I think problematic conversation where we sort of expect omniscience, and then when we don’t get that we’re really frustrated.

[00:12:09]

ELENA RENKEN: And how do you expect recent changes to CDC communications to affect the public and information access?

[00:12:16]

ANN KELLER: Great. Well, there’s, I think there’s sort of two ways to answer that, and I think one of the things that I think is so, I’m a political scientist and I spend a lot of time studying how we set up federal agencies and how they are controlled by elected officials. And in the United States, we have very open and transparent federal agencies that are subject to a range of controls by Congress, by the current elected president, by the courts. So we very intentionally have an expert sort of federal, a set of expert federal agencies that are very much subject to electoral control. And what happened I think in the first in the Trump administration during the first year of COVID is that Trump just sort of cut off the CDC’s ability to communicate with the public. He did what I would call as a political scientist “replacement”, which is he gave political appointees who had no scientific training, no particular expertise in public health, the responsibility of writing what was released as if it was CDC written guidance. So it’s very, it turns out, and I think a lot of scientists were surprised by this, but political scientists aren’t. It’s very easy for a president within the norms of the Constitution to do this replacement thing, to have a political appointee take over what was normally under past presidents a function that was left to the civil servants, left to the experts. Trump did this. So we were not getting CDC written guidance, we were getting political appointee written guidance. What I think is happening now with the Trump administration trying to cut, severely cut CDC staff and potentially CDC budgets is something that will, is something that could, that can very meaningfully erode CDC’s ability to do its normal functions, to monitor what’s happening with infectious diseases, to collect data about them, to analyze that data, to provide the best information they can come up with, to put that information into the hands of communities and individuals so they know how to protect themselves during a pandemic. I think if we look at what Trump did with what I call replacement, he didn’t necessarily erode the core personnel or budget of the CDC during the first year of COVID. So when Biden came in, the CDC could function. What is I think a more open question right now is what the cuts that Trump is trying to make is whether or not a future president who wants this agency to function will have a very much reduced capacity CDC.

[00:14:57]

ELENA RENKEN: Thank you, Anne. And let’s move on to you, Beth. To start off, what role does the CDC play in U.S. public health systems and workforce?

[00:15:06]

BETH RESNICK: Yeah, thank you so much for this important question. I think we all always hear about in our own lives, right, do you have a support system, do you have mentors who’s helping you work through things, right? So the CDC is basically our nation’s support system for public health. It’s the leading public health agency. They provide critical personnel, technical support, data and analysis, research and guidance to not just health departments but for businesses, local decision makers, politicians, across our communities, and make an impact on all of us in our daily lives. So, there’s many things I think people probably are very familiar with in terms of outbreaks or the listeria outbreak we had, the measles or the avian flu, but there’s many other things that CDC is supporting that is protecting all of us on a daily basis. So, I’ll give you some examples, and maybe you know this but maybe you don’t: Center for Forecasting and Analytics, which enables infectious disease outbreak responses. The CDC’s Injury Prevention and Control Center includes suicide prevention, opioid overdose prevention, and surveillance activities, firearm injury and mortality prevention, for programs to address adverse childhood experiences, domestic violence, drowning prevention, and other programs that work to reduce injury and deaths in all of our local communities. There’s a tobacco prevention and control program, which helps states prevent youth vaping and saves lives by addressing tobacco control, one of our leading preventable causes of death. There is also the school health program that works to prevent HIV, sexually transmitted diseases, and unintended pregnancies among our youth, prevention research centers that conduct research to help communities prevent chronic diseases. I could go on and on. One more that’s important is occupational safety and health research and environmental health laboratory programs. I didn’t even get into all the environmental work that CDC provides. So as you can see, it’s a huge, huge support system and critical for not only all the communities in our nation, but across the world, it’s seen as the leader in all of these areas with programming and research and promoting prevention.

[00:17:31]

ELENA RENKEN: Thank you for the framing, that it’s a support system. That’s a good way to think of it. And how does the CDC interact with individual states and localities?

[00:17:40]

BETH RESNICK: So again, we have our support system, right? And here maybe you go to your parents or your family to help you, right? So the CDC is huge. It provides a bunch of funding. In addition to the funding, it also provides in cases of surge protection and things, they might actually give staff to local and state health departments that can actually help in that surge capacity. They also provide tools and guidance and technical assistance if needed, data analysis, research, guidance. It’s a huge support to our state and local systems. I mentioned about the public health infrastructure grant. That is money that is, was dedicated to state and local health departments specifically for increasing their capacity in the aftermath of the COVID pandemic to plug some of those holes and capacity issues that we saw come out in the challenges of responding to the pandemic. So those things are all critical, as well as technical assistance and training around some of these key workforce skill areas in terms of being able to interpret data. And the pieces are that we can do this proactively, so we don’t have to only react if something happens, but to be able to be monitoring these things on an ongoing basis. So, it’s critical to have these supports in place. It’s kind of when you don’t realize that something’s there, you might not recognize it, but if all of a sudden it was gone, we would be seeing many issues in terms of the ones that we’re even more aware of, the measles outbreaks, the avian flu, as well as the ongoing challenges that I just mentioned about suicide prevention, tobacco control, these other threats to our communities and all of us in our lives.

[00:19:25]

ELENA RENKEN: Absolutely. And so that successful prevention means we don’t hear much about it. One quick clarification. Could you tell me what you meant by surge protection situations?

[00:19:35]

BETH RESNICK: Absolutely. So if you, and it could be also a natural disaster or some kind of disease outbreak, CDC actually will oftentimes send some of their personnel to a specific state or locality to help provide response. And that, again, it can be really important to be able to provide those needed services to communities when they’re overwhelmed at the state and local levels.

[00:20:03]

ELENA RENKEN: Thank you. And to what degree is the U.S. public health workforce and spending meeting current needs, and what outcomes would you expect from the proposed cuts to the CDC?

[00:20:14]

BETH RESNICK: Yeah, so I think it’s important to take a step back on this question, and it’s a great one and I so appreciate you asking it. So even before the pandemic, state and local public health forces were already depleted. They were down 15 to 20 percent in the decade before. So again, public health tends to be on these cyclical funding. So a disaster happens and all of a sudden money is thrown at it, and then you forget and it goes away and then it becomes underfunded. So many of us might not remember about Ebola and Zika, right? So those were back in those days. So the funding came and then it went away. So they were already underfunded. So, the, trying to plug these types of holes, and this is what the public health infrastructure funding grant that I was mentioning is really critical to help rebuild the capacity in state and local health departments that were already underfunded. And then the COVID pandemic put huge stress and lots of employees left. There was a big exodus. So they were, they’re trying to now get back up to speed. So lack of workforce capacity matters. It could mean that we don’t have needed skillsets when we have a public health challenge, as well as these ongoing threats that I had already mentioned and unnecessary pain. And also I think a really important thing is much of what we do in public health is prevention, right? So again, it’s hard to necessarily know what that impact would be. But if you take that away, then we would have increased disease and most likely an additional burden on our already overburdened health care system, and increased costs in terms of health care costs as well as obviously the emotional and physical toll on all of us in terms of our own health and quality of life.

[00:21:58]

ELENA RENKEN: Thank you. Let’s now turn to you, Jennifer. How does U.S. preparedness against disease compare to that of other countries, and how has this changed in the recent past?

[00:22:09]

JENNIFER NUZZO: Yeah, thank you for this question. So, I come at this, just sort of disclosure where my facts are coming from, as one of the co-leads of the Global Health Security Index, which measures the capacities of 195 countries to be able to prepare for and respond to significant infectious disease emergencies, basically the things that have the potential to spread across borders. And we, prior to the COVID pandemic, we assessed countries’ readiness and we and we published our first report just basically a few months before COVID. And it wasn’t a surprise to me when we published that first report that the United States ranked towards the top, because on paper the United States has more capacities, has more resources, has fewer risks, inherent risks than other countries. We did not conclude that the United States was prepared; it just had more resources and was better prepared. But we found that no country had been fully prepared. Every country was missing something. And in an event, you never know what is going to be the capacity that will be the make or break for the response. But given that, knowing that no country was fully prepared, it didn’t set me up to expect that the United States would struggle as much as it did during the COVID-19 pandemic.

And in this instance, when we see the United States struggling, in many instances it was because, well, some of the capacities that should have been that were there at least notionally on paper, weren’t perhaps as functional as we thought. But in a lot of instances, it was just that we chose not to use what we had for a variety of reasons. There was a failure to mount a response that made best use of the resources that we had. The United States is also a federal country. And so when you measure a country and its preparedness at the national level, you have to ask whether that trickles down or extends to the local level where, as Beth described, the majority of the preparation and response really rests. And so clearly that’s a challenge in a country as large as ours that what may exist at the federal level may not necessarily extend into our communities. And you heard from Beth a lot of reasons why that may not be in terms of just less, the sustained erosion of public health workforce and a variety of other things over the years. That said, the U.S. is not the only federal country. There are other countries that have that same challenge. And so why did the United States really struggle as mightily as it did? And it truly did struggle mightily. I mean, even when we adjust for differences in countries’ surveillance capacities, you can’t just look at countries’ reported COVID cases or deaths because those are measured using the same capacities that you then want to say, are you prepared or not? You would want to see. But even when you would kind of account for that to the best of your abilities, even if you account for the fact that some countries were, had an older population and therefore higher built-in vulnerabilities and likelihood of death if that population became infected. And even when you account for that, the United States still experienced about eight times as many deaths as any other highly prepared country. So to me, that says we were just not prepared in the way that we needed to be, in part because we just did not make use of all of the resources that we had. And I think if you push me to say, Well, give me an example, I would really point, I think, to probably what was the original sin in the COVID-19 response, which was our inabilities to rapidly establish testing.

And that, testing challenges persisted throughout a lot of the pandemic. It was very hard to get tested for a long time. And then when the tests were available, you could go get tested, but you wouldn’t get your test results for maybe in some cases five days, which is, you know, pretty much the incubation period. It’s not great for mounting an effort to kind of interrupt transmission chains. So we really had some struggles that just other countries didn’t. I think a lot of them may be ascribed to leadership, but I think also some of it was probably ascribed to a lot of other built-in challenges. We have a highly vulnerable population in a lot of ways. We have a lot of our population living in congregate settings like nursing homes and prisons. We have a lot of built-in social vulnerabilities that just make it hard for some people to protect themselves, that make it harder to mount a response. That’s why it’s so critically important, we’re having debates right now about health equity. Health equity is about making sure we meet the needs of all communities, including communities that may need more resources than others. So, I have a lot of reasons to think that where we are today in the United States is actually a lot worse than where we were at the end of 2019 at the start of 2020. Because I do believe that were we to publish the index today, the United States of course would decrease quite a bit in part because we are seeing a systematic erosion of even those capacities that existed at the start of COVID-19 pandemic. And I think seeing lots of questions about the federal workforce, I have a lot of concerns about the public health workforce, not just in our federal agencies, but insomuch as changes at the federal level absolutely will have an outsized effect on the workforce that exists in our state and local communities. And if you ask me for the single most important thing for preparedness, it is an educated and experienced public health workforce.

[00:27:48]

ELENA RENKEN: Thank you for those details. This has come up a couple times, and I was wondering if you could briefly explain what those surveillance capacities look like on the ground.

[00:27:57]

JENNIFER NUZZO: Yeah, so surveillance capacities can mean a variety of things. I mean, at its core, it’s just a systematic collection of data that help you understand what’s going on and should inform your decisions about what to do about it. In the traditional parlance of public health, surveillance had typically mean you count cases of a disease. You have a defined, you have a definition of what counts as a disease, and then you go out and find everything that fits that definition and you count it and you total it, and you use the trends that you see in those data to understand what’s happening. Over the years, surveillance has changed and expanded. And so now it’s not just about counting cases of disease and diseases that are diagnosed. And usually diagnosis comes from a test of some kind, either performed in a laboratory most commonly or sometimes performed outside of a laboratory. But surveillance can mean a variety of different things. Surveillance, even now today, I’ll just give you some modern examples. We’re testing wastewater to understand what pathogens are in our environment. That may be coming from people, in a lot of cases they are, but they may also be coming from the environment. It helps us better monitor the pathogen environment and whether there are trends. We are using surveillance in other ways, too. There’s air quality surveillance systems that were put into place after September 11th out of concern that the United States might get attacked by a biological weapon. And there are in cities around the country sniffers that are constantly monitoring the air for said biological weapons. There’s also surveillance just monitoring kind of online trends to see what people are talking about online and whether they’re talking about reported illnesses, or whether there are reports of illnesses. So, surveillance can take many different forms. How specific that information is or how sensitive that information is will differ by the surveillance system. But ultimately, what we’re talking about when we talk about surveillance is the act of collecting information to help us understand what’s going on and to inform our decisions about what to do about it. And I would say, I think one thing that people need to understand is that in all cases, what we’re trying to do with all of these various different surveillance systems is to piece them together, understanding their strengths and their weaknesses and what kind of information they can tell us and what kind of information they are unable to tell us.

And we put that together and sort of triangulate our way to the truth. And this is why it’s so important to and educated public health workforce, because in that role of trying to figure out what’s going on, even if you have AI or advanced tools analyzing data, there’s always going to have to be some level of judgment applied to the data to decide, Hmm, something is going on that is unusual, something that is going on that is undesirable, something is going on that warrants a response and then to be able to take action as a result of that information and to activate the system to get your boss’s attention, to tell somebody that, I think something is happening that we need to pay more attention to, that we need to do more for. And so that’s why that workforce piece is just one of the examples of why that workforce piece is so absolutely critical. Because sometimes our surveillance systems tell us things that are confusing and hard to parse, and sometimes it turns out to be nothing. But having that educated and experienced person in the loop is really important to know when it’s something that requires action.

[00:31:24]

ELENA RENKEN: Thank you. And how do you expect proposed CDC cuts will affect vulnerability to U.S. diseases? And what infectious diseases are you most concerned about?

[00:31:35]

JENNIFER NUZZO: I mean, we’re already saying that these cuts are having an effect. And it’s not just the cuts. I mean, when we talk about cuts, we’re often talking about budget. It’s also about the chaos. And we are seeing the letting go of just whole categories of federal health personnel. That is, of course, having a detrimental effect, not just in our federal agencies, but also in the state and local communities that many of these individuals work. I don’t think people realize how much our communities rely on not just federal dollars and resources, but federal personnel who are working in our communities, supplementing the workforce of our communities in order to make the systems work that keep us safe. Just letting those people go just means now there are fewer people minding the shop in our communities. And that in and of itself is detrimental. But what is also detrimental is the chaos that we’re seeing, which is that nobody quite knows what’s coming next or how to interpret what is happening. And so you’re seeing a lot of paralysis that’s happening, a lot of concerns about whether functioning systems are going to be able to continue to function, whether there’s going to be funding or people to power those systems in the coming days. I’m hearing from health departments who are trying to prepay bills now because they don’t know if they’ll be able to cut checks in a month. I’m hearing about health departments wondering if even some of our bread and butter public health programs like studying the high burden diseases in our communities, if those systems are going to be able to function or if the federal resources both in terms of funding and personnel that power those systems will still be there where they are needed. So we are seeing already impacts of that. And, really, in the field of preparedness is really incompatible with this level of chaos, because what preparedness means is you take actions for some future benefit. You don’t know when you’re going to need it, but you have a pretty good hunch that you’re going to need it at some point so you take action, you plan for it in advance.

It’s not possible to do that when there are open questions about whether you’re going to be able to continue to sustain it. And remember, this is also happening on the backdrop of a public health workforce that has been systematically decimated over time. We started the COVID-19 pandemic with a dearth of personnel. There were not enough people in health departments working at the start of the COVID-19 pandemic. And that was in part because of budgetary declines due to the economic downturn of 2008 and just kind of a failure to kind of replenish the workforce. We saw how incredibly challenging that was. And we saw suddenly a scrambling and literally billions of dollars spent to try to hire temporary workers to kind of deploy to health departments and sort of backfill them for the kind of activities that were needed during the pandemic. Well, that’s not really a great way to build a workforce. And then once the federal money went away, you see an erosion of that capacity. That has been happening. You also have seen a real departure of public health personnel, not just due to funding declines, but also just due to exhaustion and frankly political blowback and just feeling attacked and vilified. So really, it’s, we were starting from a very weak place. And now what we’re seeing is I think a real kind of make or break moment, make or break moment for the workforce. And I always try to liken this to things that people better understand. And I think, imagine if we just had a major fire ripping through our city. And our first instinct, once we finally put the flames out, is to basically get rid of all of our fire departments. That is essentially what we’re seeing happening here.

[00:35:29]

ELENA RENKEN: Thank you all for sharing your expertise here. We’re now going to begin asking questions to all the scientists here with us. And I want to remind reporters on the line to submit your questions using the Q&A box found at the bottom of your Zoom screen. For our first question, I want to ask all of you about the news coverage you’re seeing on changes at the CDC. What are reporters doing well, and what could they be doing better?

[00:35:56]

ANN KELLER: I guess I can jump in. I mean, I definitely feel, a couple of things that I’ve seen that I’ve really liked is that one of the first things that the Trump administration did was to remove people who were on probationary status. So explaining what that means, because it sort of sounds like if you’re on probation, aren’t you in trouble? And shouldn’t we get, if we’re going to, if we think it’s good to cut down federal workers generically, which as an organization theorist, I would say that’s problematic at the start. I’ve never seen a single study about organizations that says indiscriminately firing people makes organizations more efficient or effective. But I think explanations of who get into this probationary category. It’s people who are newly hired, and it’s people who have just been promoted to a new position. And I want to just say something about people who are newly hired at the CDC. It’s an extraordinarily hard organization to be hired into because there’s so much quality and there’s such a history of sort of talent. So one of the things, the CDC has a program where it trains people in what it calls epidemic intelligence service. It’s a fellowship that really just pulls the cream of the crop who are coming out of graduate school into the organization. So if you’re removing people who are on this probationary status, you’re removing people who have recently been promoted, and you’re removing the recruitment of literally the most talented crop of people who have just finished graduate school who would be going into the CDC. So I think when journalists have been able to explain who’s actually being targeted, I think that’s been really helpful. And I think, I mean, on the point about does it make sense to just indiscriminately remove people from an organization? Maybe there’s a place where journalists could do a little bit better about that. Is that, if you did that to a private sector organization, you just said, We’re going to just cut a whole bunch of people. We’re not going to look at functions. We’re not going to look at what we like about the organization. We’re just going to cut the workforce. Would you believe that that was good management? So I feel like journalists could maybe better tackle the premise, right, that just removing people. And I guess just to build certainly on what the entire panel has said, if public health has been underfunded, then removing people isn’t making public health more efficient. it’s taking an already, it’s taking a system that’s already kind of functioning a bit underwater, and it’s bringing it to a breaking point. There’s no efficiency that’s going to come out of any of this.

[00:38:42]

JENNIFER NUZZO: Maybe just to add a few words. I think that covering the changes in the federal workforce has been impacted. I do see some of the decisions being revisited. So I think shining a light on what those decisions are and the impacts that they have is important. So kudos. And just for anyone on that beat, thank you and keep it up. I think if I had to just make a plea for going forward, I think making it real for everyday Americans and what it means for their lives. Because I think a lot of people who aren’t in the D.C. orbit or paying attention to the, these policies, hear it in the background and they’re like, Ah, federal jobs. I mean, companies let go of people all the time. But just really kind of doing the forensics of what that means for your communities. Because I think that’s where the issue became quite clear is that in cutting the federal workforce, this isn’t just affecting blue states. I mean, I think Republican states started to see, Oh, this affects us, too, as it turns out. There are actually a lot of federal workers in our states. I think some of the reporting that we saw on what the USAID cuts are meaning for American farmers, for instance. I just don’t think people understand how these programs touch their everyday lives.

And in the case of public health in particular, again, when the programs function well, people just don’t see them because their job is to avert the bad stuff from happening. So the extent to which we can understand how these programs are working in our communities and what they are doing on a day-to-day basis. I’ll just give a very clear example. I mean, again, the extent to which our state and local health programs, things that we rely on every day to keep our families healthy, to protect our families, to protect our tax dollars, are heavily supported in some way by federal programs. For better or for worse, they are. And I think people just don’t realize, they don’t, they think that cuts in Washington or cuts in Atlanta may not have any relevance to what’s happening in their communities. But talking about, tracing that to what is happening in our local communities and how our local communities depend on it, how it would be more costly to us and our local tax base were we not to have these resources, I think that is really, really important. And I say that just, not just for the programs, but also for some of the concepts. So for instance, we’re hearing this attack on sort of health equity as though it’s part of this larger political philosophical argument that we’re having in the country to talk about. This is, what we’re talking about when we’re talking about equity is making sure we are targeting, best targeting the very limited resources we have to make sure they are being aligned and matched with the communities where there is need, and not wasting them on communities for which there is a need. Just kind of making those concepts more real for people. And I continue to believe that were people to understand better how this functions, they would have a totally different view of what’s happening.

[00:42:00]

BETH RESNICK: So just to add on a couple things, thank you guys. Ann and Jennifer did such a great job. I just want to add two points. So, what Jennifer was just saying about the extent that it goes into communities, more than 80% of CDC’s domestic budget is actually going to support states and local communities. And some of that is direct supports and also, again, the things that I was talking about, your support system. So even if they’re not directly supporting them, it’s their work that is giving them the tools and skills and training. And as Jennifer said, and I can’t emphasize it more, is that the workforce was already depleted. So we’re already starting below. So now if you just, it’s like you kicked out their foundation there. The second thing I wanted to follow up on Dr. Keller’s point about the probationary employees. CDC is like, just to give you a sports analogy I guess, it’s like the penultimate job, right? So people really want it. It’s like if you were trying to get to the NFL, right? And now you’re cutting, it’s like you got rid of all your draft picks, your best and brightest. At Hopkins, it’s always our best and brightest that want to go to CDC or the Presidential Management Fellowship program. Those are your creme de la creme. So it’s like you just wiped out all your draft picks to reach, for the future of your team. So the loss there is, and if you wanted to look just financially at it, those are not the ones that are the most expensive employees, right? You’re actually getting rid of the ones that are the new ones that are at lower salary rates. So even from a budgetary perspective, it doesn’t make sense to get rid of the best and brightest, youngest people that would actually be costing you less than some of your other employees. So, thanks.

[00:43:44]

ELENA RENKEN: Thank you all. A first question here from the National Association of Black Journalists. In terms of communities of color, what aspects of public health are you most concerned about with these recent administration changes?

[00:44:05]

ANN KELLER: I guess I can jump in. I would say in terms of communities of color, this administration seems like anything that has health equity, that has the terms diversity in it, is being targeted. And so I think there’s a lot of concern about how that will impact communities of color. And I think, I mean, we’re seeing that play, you know, and that’s not just about sort of cuts, for example, to CDC or the workforce. I mean, that’s hitting academia. People are feeling like they’re, the normal funding or the practiced funding coming from NIH or NSF is now really turning away from the kinds of research that will help look at health equity, that will help us better understand how to address health equity. So all of those things are, they’re absolutely immediate concerns. And what I’ve been doing is I’ve been keeping an eye on what’s happening with the courts who are trying to, whether or not the courts are going to stop some of these changes to allow the research, the way that it’s evolved and developed, to continue. And I think if that doesn’t happen, I think that the next step is to wonder how states maybe can fill in the gaps, which occasionally when some issues at the federal level get very politicized, that we decide we’re not going to fund something that traditionally we funded, occasionally states try to step in and fill the gap during a particular administration. So, potentially that’s where that movement will happen. But I think we’re still sort of seeing how this works through the courts.

[00:46:03]

JENNIFER NUZZO: And maybe just, I completely agree with that, and just to add that some of the challenge I think that’s happening is because the direction from the White House has been very nonspecific. And I think what you’re also seeing is an attempt by scientists to interpret their very nonspecific guidance. And some of what is happening I think is happening just because nobody knows how to do it. And I just say that in part because that might mean we may over-interpret, that might mean that we are a bit indiscriminate and arbitrary, but it also speaks to opportunities for pushback. Just to say, I mean, one of the first EOs, executive orders came out and was basically a very short statement about ending woke gender ideology. Well, I can tell you as an epidemiologist, there’s no case definition for woke gender ideology. And when you ask a scientist to figure out what that means, you’re going to get a mishmash of responses, some of which may be what the spirit of that is, but some of it may be far broader than what is necessary. And so I do think that it is important to really question the rationale of some of the changes that we are seeing, in part because I do worry that some of it is happening due to just uncertainty and just in response to some of the nonspecific chaos.

[00:47:24]

BETH RESNICK: So, just to add one more thing, I think I’m going to be, I hope I’m stating the obvious, but I just wanted to have it here for the record that when services are cut and things are cut back, the people who get hurt the most are obviously the most vulnerable communities. And in addition to minority communities and low-income, also our rural communities too, who have less access to services in the first place. So again, I just, I hope I’m stating the obvious for everyone here, but I just wanted that to be on the record, that those communities are going to get hurt worse than other communities with more resources.

[00:48:03]

ELENA RENKEN: Thank you. And in our remaining 10 or so minutes, I’m hoping to get to several more reporter questions. The first I want to mention is a followup from Lexington, Kentucky, to Dr. Nuzzo’s remarks about firing all the firefighters. Can you tell us what infectious diseases you’re most concerned about at the moment?

[00:48:25]

JENNIFER NUZZO: I mean, do we have another hour? Because the list is growing, I’m going to say. So we have been, we started, just maybe a plug, a shameless blog. We started almost a month ago a tracking report because I was getting questions from journalists. And I remember one day where I had been living in worry about H5N1 and the journalist called me and I assumed they wanted to talk about H5N1. But, no, they wanted to talk about COVID. And I had to get my head back into the COVID data. The list of diseases that we are tracking because we are concerned has grown in a truly staggering way. Don’t ask me to pick my favorite. I mean, I like none of them. I am of course, worried about these ongoing measles outbreaks. You know, in 2019, the United States barely missed losing its measles elimination status. And even then, we didn’t have a death due to measles. And this year, we have had our first tragic death due to measles in a decade. We are seeing, you know, really a staggering accumulation of cases of measles. And we are more vulnerable to measles now than we were in 2019 when we almost lost our measles elimination status. I remain very worried about H5N1. I have seen nothing good about that virus, nothing that makes me at all not worried about it.

I’m worried about the farm workers who we know are being exposed, who are getting sick and in some cases hospitalized. And I’m also worried about the potential for that virus to change, mutate, recombine, and potentially cause a pandemic. There are lots of disease outbreaks happening abroad that we are very worried about for which CDC’s inability to interact with its international partners, including the WHO, has just limited our abilities to truly know what’s going on and to know what risk it poses to the United States. And just to give you a very specific example, some time ago there was a rumored outbreak of Ebola in DRC happening on the same day that the United States was closing an embassy in Kinshasa. And CDC at that moment was not initially allowed to call scientists in DRC or call the WHO to find out more about what’s going on. Now, some of that has since been resolved and, but only resolved once media attention was shined on the fact that they were unable to do that. But you can imagine we have that in the context of Mpox [inaudible 00:50:49] spreading throughout many, many countries. We have Marburg in Tanzania, we have Ebola in Uganda. The list of deadly and discouraging disease outbreaks continues to grow with this backdrop of an erosion of not just the response workforce, but also the insight workforce, the abilities understand and track and stay ahead of these things.

[00:51:17]

BETH RESNICK: So, just to add one more thing, and my husband’s a firefighter, so I appreciate this question. And it’s also, driving up to the fire, you might have the truck, but there’s no water in the pump, or your hose is bent or broken, is also sort of like that constant defunding of the public health system, little bits, pieces. So you might still have the truck, but you don’t have the other tools and things. But I think also, and this question I think emphasizes that we all put attention on, and of course, all of those things that Jennifer just said are going to keep us all up at night. But what about the everyday things, too? The big crises get the media attention and get everybody focused on that, but the everyday things, right? The mental and behavioral health issues, we all just talked about the chaos and the stress that all of this is causing in our communities, tobacco prevention, chronic disease, you know, all of these things that are ongoing issues that aren’t as attention grabbing as these big outbreaks. But I just want to highlight that those are also really, really important and the impact on our day-to-day and quality of life, not in the same way, but over the long term can be just as detrimental, if not more.

[00:52:34]

ELENA RENKEN: Thank you. And from NBC 5 Seattle, Can you elaborate on concerns about cuts amid bird flu and measles spreading?

[00:52:48]

JENNIFER NUZZO: So I think what we’ve said, and I’ll just repeat again, is the cuts that we’re talking about are people. And there was a very clear example of the USDA employees who are working on H5N1 who were cut. I know they’re trying to hire them back. Last I saw is that they may not be able to get them back. It’s been a little bit hard. I want to say, this is like even if somebody gets cut and then they get re-offered a job to come back, just think about what that means for the morale, what that means for someone’s ability to kind of put their all into the job, to take the necessary risks that an effective and proactive response to infectious diseases require. If you fear that if you stick your neck out in some way that may be required, that you will possibly get fired again. So, just to say that I am most worried about the workforce. EIS is not just a program that trains the next generation. EIS is a program that trains literally the best and the brightest, but trains them through experiential efforts, which means they are working in our communities. In many cases, they’re the ones who are doing the outbreak investigations.

They are the ones who are compiling the data, analyzing the data, making recommendations to the larger workforce. They’re often the ones that have skills that aren’t inherent in some of the workforce that exists in some of the communities. So, I’m most worried about the people. But I’m also worried about those that have been left behind. And if you talk to federal workers, they are spending a lot of their days just trying to manage and stay ahead of these incredibly chaotic and changing workforce, HR situation. So their bandwidth for focusing on the problems that we have is limited in part because they’re now trying to send in their five bullets, but also write the memo that they’ve been required to write justifying how to do their job were their job to be eliminated. So the asks of our federal workforce have increased at a time when their need, their subject matter need has also increased, but now they just have less ability to do it. We are doing less with less.

[00:55:09]

ELENA RENKEN: To confirm, Jennifer, when you mentioned EIS, that’s the Epidemic Intelligence Service?

[00:55:13]

JENNIFER NUZZO: Correct.

[00:55:14]

ELENA RENKEN: Thank you.

[00:55:14]

ANN KELLER: I wanted to see if I could just jump in. Of course I agree with everything that Jennifer is saying. I think one thing that really concerns me when I think about H5N1 is that because farmworkers are being exposed who are working with cows, with mammals, I guess also with birds, obviously with birds, one of the things that’s really critical about trying to monitor what’s going on is being able to get farm workers good information about their risks and exposure and what they can do to protect themselves. And in an environment where people who are who are here working and may not have legal documentation, I don’t think those people are showing up for information, right? I think putting the fear in the hearts of people who are trying to do this work is not a great situation to try to give them information they need to come forward if they have symptoms, to give them information about how to protect themselves in the workplace, or to give them critical information that this is a really good season to get flu vaccine so that there’s less likelihood that this virus can kind of mutate with seasonal influenza. And that, to me, is one of the really alarming things about trying to manage H5N1 in the particular climate we’re in.

[00:56:28]

ELENA RENKEN: Thank you. And I want to ask a combination of questions we’ve gotten from local newspapers, which respond to your comments that, a lot of report — about covering the ways the CDC is directly affecting people’s everyday lives and what those employees are doing on the ground in local areas. Can you point to any resources that reporters should be looking at to help find those stories and understand what’s happening in their areas?

[00:56:55]

BETH RESNICK: So, I think the National Association of County and City Health Officials, which the acronym is NACCHO, their website, they are the national association for all of the local health departments across the whole country. There’s also the Big Cities Health Coalition, and we can follow up with that information. They are for city health departments across the country, and I think you will find many examples of what those employees are doing on the ground from those organizations.

[00:57:32]

JENNIFER NUZZO: And I think those are great places to start. This is one of my great frustrations, is that the people who know the most are the ones who feel unable to speak. And that’s always a problem. I think it’s incredibly frustrating that we don’t let our public health officials speak more freely to the media. I partially think we’re in this problem because we haven’t done enough engagement between the people working in those jobs and those kind of public speaking opportunities. But now it’s of course quite difficult. And I do think there’s going to be some degree of trying to speak to people on background, anonymously, but also perhaps talk to some of their community partners who may be a little bit, they may have insights into what’s going on, but are not as directly imperiled by some of the funding-related decisions. So talking to, you know, healthcare organizations and some of the community-based organizations that work with communities, some of the patient advocacy groups and other responder organizations, I would attempt to do that. And also I think talking to city halls and governor’s offices to say, Listen, what does this mean for you?

[00:58:45]

ANN KELLER: Yeah, just to build on that, I think county supervisors sometimes are in a position, they’re elected officials, they can speak on the record and they understand a lot of where their federal resources are coming for at the county level.

[00:58:58]

ELENA RENKEN: Thank you. We have one final question today, which will give our experts here a chance to cover some essential takeaways. But first, I want to note that reporters, you’ll be getting a brief email survey after the briefing ends. And if you could take even 30 seconds to let us know if you found this briefing useful, it would really help us design our programming based on your needs. Now, for our last question today, in about 30 seconds, what is one key take-home message for reporters covering changes at the CDC?

[00:59:29]

BETH RESNICK: I think the focus on the budget cuts is what we keep hearing about, and that’s very transactional, and people say, Oh, we’re going to save money. But I think it’s really important to think about all of the things we’ve been discussing today, that in the long run, this is more expensive when we have to deal with the impact and the cost and the long-term effects of some of these cuts, and what that would mean in our healthcare burdens and costs for our society.

[00:59:59]

JENNIFER NUZZO: Hear, hear. I think that cost piece is really, really key. I mean, there’s a reason why these programs were developed. It is not only to save lives, but it is also to protect our economy. And I don’t think people realize that this isn’t just you buy a computer and now you have it and you’re fine. I mean, really what it takes to protect our community’s health and our economy are people. And so that is a recurring cost. A recurring cost amidst a backdrop of an increasing and recurring list of hazards that are affecting our community. So the needs for public health are only going to increase. It’s really remarkable what we’ve been able to achieve with very little, but I really fear that we have right now spiraling need and a resources that are eroding quite quickly.

[01:00:55]

ANN KELLER: And one thing I would, I echo everything that Beth and Jennifer are saying. And one thing that I think is there’s a potential now is to break into a stereotype. We have a stereotype that people, that bureaucrats are lazy or unproductive or in the bureaucracy because they’re not as competitive as people in the private sector. Otherwise, why wouldn’t they be in the private sector getting those higher paying jobs? And I think that that stereotype, it’s so inaccurate. I’ve never, I’ve been researching people who are in the federal workforce my entire career, and what I find is that what draws them into the federal workforce is the mission and the dedication. And one of the things that I think that we see, especially in public health, in routine times as well as during pandemics, is people who literally will put in 24/7 if there’s an emergency occurring. And if you’re driving those really dedicated people who are really motivated by meaning and mission out of work, that’s a really big problem. So I think this is an opportunity potentially to sort of try to break open that sort of long-standing stereotype of who is drawn into federal work and really try to tell stories about what the real accurate characterization of the federal workforce is like.

[01:02:21]

ELENA RENKEN: Thank you for those reminders. To our scientists here today, enormous thanks for packing so much expertise into this briefing at a time when understanding the U.S. public health landscape is so vital. And thanks to all the journalists on the line who took the time to be here to get deeper context and inform your coverage. I hope we’ll see you all at our next briefing. Thank you.