The journal's editors also expressed shock at the inability of the once well-respected US Centers for Disease Control and Prevention (CDC) to cope with the public health crisis set in motion by the virus – a crisis that continues to spiral out of control, even as the Trump administration urges states to “reopen” their economies.
Following is the full text of The Lancet's May 16 editorial, one entitled “Reviving the US CDC.”
The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80,684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of two months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.
The US Centers for Disease Control and Prevention (CDC), the flagship agency for the nation's public health, has seen its role minimised and become an ineffective and nominal adviser in the response to contain the spread of the coronavirus. The strained relationship between the CDC and the federal government was further laid bare when, according to The Washington Post, Deborah Birx, the head of the US COVID-19 Task Force and a former director of the CDC's Global HIV/AIDS Division, cast doubt on the CDC's COVID-19 mortality and case data by reportedly saying: “There is nothing from the CDC that I can trust.” This is an unhelpful statement, but also a shocking indictment of an agency that was once regarded as the gold standard for global disease detection and control. How did an agency that was the first point of contact for many national health authorities facing a public health threat become so ill-prepared to protect the public's health?
In the decades following its founding in 1946, the CDC became a national pillar of public health and globally respected. It trained cadres of applied epidemiologists to be deployed in the USA and abroad. CDC scientists have helped to discover new viruses and develop accurate tests for them. CDC support was instrumental in helping WHO to eradicate smallpox. However, funding to the CDC for a long time has been subject to conservative politics that have increasingly eroded the agency's ability to mount effective, evidence-based public health responses. In the 1980s, the Reagan administration resisted providing the sufficient budget that the CDC needed to fight the HIV/AIDS crisis. The George W Bush administration put restrictions on global and domestic HIV prevention and reproductive health programming.
The Trump administration further chipped away at the CDC's capacity to combat infectious diseases. CDC staff in China were cut back with the last remaining CDC officer recalled home from the China CDC in July, 2019, leaving an intelligence vacuum when COVID-19 began to emerge. In a press conference on February 25, Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, warned US citizens to prepare for major disruptions to movement and everyday life. Messonnier subsequently no longer appeared at White House briefings on COVID-19. More recently, the Trump administration has questioned guidelines that the CDC has provided. These actions have undermined the CDC's leadership and its work during the COVID-19 pandemic.
There is no doubt that the CDC has made mistakes, especially on testing in the early stages of the pandemic. The agency was so convinced that it had contained the virus that it retained control of all diagnostic testing for severe acute respiratory syndrome coronavirus 2, but this was followed by the admission on February 12 that the CDC had developed faulty test kits. The USA is still nowhere near able to provide the basic surveillance or laboratory testing infrastructure needed to combat the COVID-19 pandemic.
But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets – vaccines, new medicines, or a hope that the virus will simply disappear. But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today's complicated effort.
The Trump administration's further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic. Americans must put a president in the White House come January, 2021, who will understand that public health should not be guided by partisan politics.
Related Off-site Links:
The Lancet Medical Journal Calls on Americans to Vote Trump Out for "Incoherent" COVID-19 Response – Julia Conley (Salon May 17, 2020).
Replace Trump and Bolster the CDC, a Leading Medical Journal Urges – Bill Chappell (NPR News, May 15, 2020).
How Do You Stay Safe Now That States Are Reopening? An Expert Explains How to Assess Risk When Reconnecting With Friends and Family – Ryan Malosh (The Conversation, May 18, 2020).
Masks Help Stop the Spread of Coronavirus – The Science Is Simple – Jeremy Howard (The Conversation, May 14, 2020).
See also the previous Wild Reed posts:
• Hope and Beauty in the Midst of the Global Coronavirus Pandemic
• A Prayer in Times of a Pandemic
• An Infectious Disease Specialist Weighs-in on Covid-19
• Marianne Williamson: In the Midst of This “Heartbreaking” Pandemic, It's Okay to Be Heartbroken
• The Calm Before the Storm
• In the Midst of Crisis, Learning Resistance and Vision-Seeking from the Indigenous and African-American Experience
• The Crisis Is Not About the Virus
• Examining the Link Between Destruction of Biodiversity and Emerging Infectious Diseases
• Marianne Williamson: “This Is a Time of Transformation”
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