Georgia Today: Why The CDC Has Been Sidelined During Pandemic

RELATED: ‘We ran the CDC. No president ever politicized its science the way Trump has.'

 

TRANSCRIPT: 

Maryn McKenna: The rest of the world thinks so well of the CDC — or did up until this point. I am confident that people behind the scenes are working very hard. But I think they feel frustrated and reputationally damaged, and as though — if they had been given free rein — this pandemic would have unfolded differently in the United States.

Steve Fennessy: This is Georgia Today. I'm Steve Fennessy. It's Friday, July 17th.

For more than 70 years, the Centers for Disease Control and Prevention in Atlanta has been the trusted expert around the world during times of outbreaks and widespread illnesses. But this year — during a global pandemic, the likes of which the world hasn't seen in a century — the agency has found itself largely on the sidelines: victims of its own missteps and a White House intent on controlling the messaging around COVID-19. This week, our guest is Maryn McKenna, an Atlanta based science journalist who in 2004 wrote "Beating Back the Devil," a book that chronicled months of unprecedented access to the CDC's famed Epidemic Intelligence Service. She also worked for 10 years at the Atlanta Journal Constitution, where she was the only American based journalist covering the CDC full time. Today, she writes for numerous magazines and teaches journalism at Emory.

She began by explaining why the CDC is in Atlanta and not say, in Washington, D.C.

McKenna: It's a pretty interesting story. In the early part of the 20th century, the South was really riven by mosquito-borne diseases, particularly malaria.

Archival Newscast: The same enemy who strikes in the dark, who obeys no rules of warfare, who hides where she can't be seen: the malaria carrying mosquito, the female anopheles mosquito.

McKenna: The CDC grew out of a malaria control agency that was part of the war effort in World War Two. They called it the Office of Malaria Control in War Areas.

Fennessy: And so, we have this agency that's tasked with, with eradicating this threat. And it, it works. And then...

McKenna: It does work.

Fennessy: The question becomes, what what do we do now?

McKenna: So, you get to the end of World War Two in 1945. And, through all the tasks it's been doing for the past couple of years, this group — the Office of Malaria Control in War Areas — has done a really good job. And has also amassed, while it's been doing that, a fleet of literal trucks and lab equipment and people, scientists of various kinds, that the government doesn't particularly want to let go of.

And so they go looking for a way to transform that wartime office into a peacetime agency. And then, after the war ended, there was a campaign to get it to stay in Atlanta. There's an apocryphal story that Robert Woodruff of Coca-Cola offered them their land next to Emory University for a very inexpensive price. And so, as it became a peacetime agency instead of a wartime one, it got to stay in Atlanta, instead of having to move up to D.C..

Archival Newscaster: Rocky Mountain spotted fever, ringworm, malaria, influenza: communicable diseases. Where do they come from and how do they spread. Many diseases...

Fennessy: The question is, "what to do next with this agency?" And there is a figure, Alex Langmuir, who has a great idea. What, what — so what was his idea?

McKenna: So the, the parents of the CDC are two government scientists. One is Joseph Mountain, member of the Surgeon General Corps, who had the idea at the end of World War Two to take this wartime office and make it a public health agency, which I believe is initially called the Communicable Disease Center.

Archival Newscaster: The Communicable Disease Center with its headquarters in Atlanta, Georgia, serves the nation in field investigation, prevention and control of communicable diseases.

McKenna: Mountain, the father of the CDC in some ways, realizes that in taking this insect control agency and turning it into a peacetime public health agency, he didn't really account for the fact that he acquired lots of people who were really good at combating disease threats on the ground once they were identified. But what he was missing was a core of people who would figure out how disease was spreading in order to be able to deploy the people who could block disease from spreading further. And the person who figured out how to solve that problem was an epidemiologist named Alexander Langmuir.

Archival Reporter: What were Alex Langmuir's early roots?

Archival Langmuir: I was born in Santa Monica, California, in 1910. The third of five children. I majored in physics at college.

Archival Reporter: Why physics?

McKenna: So this is Alexander Langmuir being interviewed in 1979 for a video series that was called “Leaders in American Medicine.” And Langmuir had the idea to create, within the CDC, this corps of young M.D.s and P.H.D.s who exist even today, who are called the Epidemic Intelligence Service, which is a title that has always enchanted me because it sounds so mid-century.

Archival Langmuir: Well, Dr. Mountain created this term because he was deeply concerned. He said, "what we need is an epidemic intelligence service." And although I don't think it's terribly well chosen phraseology, we weren't going to argue. And it stayed that ever since.

McKenna: They are the rapid reaction, disease detective force of the CDC.

Fennessy: And it's these doctors and scientists within the Epidemic Intelligence Service that are, that are represented often in movies and pop culture. That, that's, that — that seems to be one of the things that we sort of associate the CDC with, is this rapid response team. The team that goes out and and looks for certain, causes of Ebola and and other virulent diseases.

McKenna: Right. So if, I don't know how many people remember the movie Outbreak, which is a fictional movie with Dustin Hoffman, with — did it come out in the 90s? And it's about an Ebola-like disease. It's based on the book "The Hot Zone," which is about...

Fennessy: Oh, yes.

McKenna: A strain of Ebola named Reston, identified in monkeys in Reston, Virginia. People were very concerned it was going to jump to humans. In fact, it did not. So the people in — the scientists in "Outbreak," some of them are Epidemic Intelligence Service officers.

"Outbreak" clip: It spreads like flu. Impossible. Fine. Go to the hospital, check it out yourself. Go without a mask, you'll see more clearly. You've got 19 dead, you got hundreds more infected, and it's spreading like a brushfire. You gotta isolate the sick and I mean really...

McKenna: Many more people may remember "Contagion." Kate Winslet plays an epidemic Intelligence Service officer.

"Contagion" clip: I'm an Epidemic Intelligence Service officer. I'm here from Atlanta to find out what happened to Beth Imhoff.

McKenna: She is sent to the health department in Minnesota to explain to them what's going on with this strange disease spreading from Asia. And among public health people, that strand of narrative in the film is kind of an in-joke — because of all the public health agencies in the United States, the Minnesota Department of Health is one of the best equipped. Probably didn't need an EIS officer to be sent from Atlanta. But, but there she is and that's who she's representing.

Fennessy: So that brings up a good question as we get into discussing Coronavirus. And that is that — there is the CDC, of course, but throughout the country, there are literally thousands of health departments at the city level, at the county level, at the state level. And so when it comes to combating whether it be an outbreak of some sort — a contagion — what is sort of the protocol?

McKenna: This is a really good question, and it's, it's really complex. So we talked about Joseph Mountain, that — member of the Surgeon General Corps, who had the idea at the end of World War Two to take this wartime office and make it a public health agency. The way that Mountain got the rest of public health in the United States to agree to that was to promise two things: the first was that the CDC would exist to help the states conduct public health. Because public health is actually primarily a state-based function in the United States, so they would — they would always be on call to help the states.

The second thing that he promised was that, they would always have to be invited in: that the CDC would never come into a state to work on an outbreak or a chronic health problem unless the state public health agency or the state governor, the state — the state's political arm, invited them to come.

And so there have been other outbreaks through the years that I've covered as a journalist in which, you know, an outbreak has happened somewhere and the CDC will hold a press briefing for it and they'll say, "Well, we're hearing from state X that such and such is happening." And someone in the press corps will say, "Well, is the CDC on the ground yet?" And the CDC has to say, "Well, actually, no... the state has not yet ask us to come.".

But the reality is that, even though it has to, it's kind of held at arm's length by states in some way, the CDC is an inextricable part of public health in the United States — because it's a fountain of money for state and local health departments. A significant proportion of the money that the CDC gets in the federal budget every year just kind of flows through the agency and gets sent to state and local health departments through a variety of grant arrangements. So even if it doesn't have people on the ground there, it is, it is inextricably part of what's going on in the states.

Fennessy: And so, I'm thinking now about Coronavirus specifically. News comes out about that in December of 2019, out of China.

Modern Newscaster: China has identified the cause of a mysterious pneumonia outbreak in Wuhan city. And it's from the same family that caused the deadly SARS epidemic 17 years ago. It's a new type of coronavirus. The World Health...

Fennessy: When you first heard about that, that cluster of cases in China, what — what did you imagine would happen next in terms of the CDC's involvement?

McKenna: So I heard about what we're now calling COVID-19 on the day before New Year's Eve. There is a crowd sourced, very low tech list. A literal, an email list. Literally a listserv — very, like 1990s technology — called ChroMed that is run by a group of volunteers. It's based in Boston. It has nothing to do with the CDC except CDC sometimes send them things. And they are, I'm sure everyone in the CDC is an avid reader.

And they carried a report that they published a couple of minutes before midnight on the day before New Year's Eve, Dec. 30th, about a small cluster of pneumonia cases. And this made the hair on the back of my head stand up. 17 years ago, ChroMed was also the first to carry the first report of what came to be known as SARS, which was the first worldwide epidemic of Coronavirus.

And there, the bulletin that they ran in, I think February 2003 alerted the world that something might be coming. By the end of June, we had more than 8,000 cases of SARS in more than two dozen countries, 774 people died around the world, if I remember correctly. So in that first bulletin, on the 30th of December, it did not say coronavirus. It didn't say SARS. But there was something about pneumonia in China that made me think, "oh, I wonder if we know where this is going?"

It was a remarkably chilling moment. And to answer your question, what I thought would happen is that — the CDC would go running, you know, the way they always have run. Literally getting on planes in the middle of the night to go places, and that didn't happen.

Fennessy: Just ahead, how the novel coronavirus exposed deficiencies within the CDC and what happens when politics interferes with public health. This is Georgia Today... This is Georgia Today. In early March, Dr. Robert Redfield, the CDC director, hosted President Trump for a tour of CDC headquarters in Atlanta.

President Trump: Anybody right now and yesterday, anybody that needs a test, gets a test. They're there. They have the tests, and the tests are beautiful.

Fennessy: President Trump made it seem that there were plenty of tests available. But as we know now, and even knew then, there were not enough tests. Not near enough. Back to my conversation with Maryn McKenna.

There was an issue with Coronavirus tests coming out of the CDC that sort of delayed the amount of testing that could be done when scientists seemed to be agreeing that we need to be testing a lot, fast.

McKenna: Yeah, I think that's a fair criticism that can be made. And there have been persistent criticisms since then that the CDC — separate from the issue of how many tests we have in the country, which is, which is a procurement issue and which is not something that the CDC would be handling, that would be other aspects of the federal agencies.

Fennessy: Right.

McKenna: The question of, how the data from tests is being kept track of and is being collected and is being posted — that would be a CDC job. And it just does not seem that they are doing the kind of comprehensive work that they would have done in past outbreaks.

And it's quite odd to see that other entities have kind of rushed to fill that gap. The best known, probably highest regarded essentially dashboard of data for the pandemic for the United State and the whole world, is actually being run by the public health school at Johns Hopkins.

Fennessy: Right.

McKenna: The data, sort of, counting by state, of test data, was initially done by the magazine, The Atlantic. And now, there's a coronavirus tracker of cases that's being run by The New York Times. And when people want to know what the latest data is on the pandemic, they're going to those sources and not to the CDC.

Fennessy: And that's, that's surprising, isn't it?

McKenna: It's surprising and it's really troubling. And, you know, I think that, the thing that has been most remarkable to me is that the CDC was just absent for about three months. And I'm sure they were absent not because they...

Fennessy: They weren't on vacation, yeah.

McKenna: elected to be, but because they were told to be, right.

Fennessy: Right.

McKenna: You know, that they, their last — they dropped out for about three months of not having public health briefings. In our last big outbreak, which was the 2009 H1N1 swine flu, the CDC held a press briefing just about every day.

Press Briefing: Thank you. And thank you for coming here today or calling in for this update on H1N1 influenza and H1N1 influenza vaccine. Today's briefing will be conducted by Dr. Anne Schuchat. Dr. Schuchat is the director of CDC's National Center for Immunization and Respiratory Diseases. And I will turn the podium over to Dr. Schuchat.

McKenna: You know, you knew that at a certain time in the afternoon you had to dial a certain conference call number. And you and every other reporter in the planet would be listening to the CDC.

From something like the 9th of March until a couple of weeks ago, the CDC held no press briefings. And their director, Dr. Robert Redfield — although he was part of the Coronavirus Task Force for the White House — he was very seldom on the podium.

And I think it speaks to, you know, at one point I went back and I looked at the sort of the rogue's gallery of the past directors of the CDC going back to 1946. And Dr. Redfield is not an epidemiologist. And there are particular skills, and a particular sort of understanding of how disease spreads, and what you need to do to get out in front of it, including literally hitting the streets, that epidemiologists possess — particularly epidemiologists who came up through the CDC. And almost all of the past directors of the CDC, particularly in big outbreaks, had that training.

Dr. Tom Frieden, who now leads the think tank "Resolve to Save Lives" was the Obama administration's CDC director. He now is on — he's very frequently on Twitter, essentially being an unofficial mouthpiece for U.S. public health, saying things like "Since the CDC has been sidelined..."

Fennessy: Yeah.

McKenna: “And since the CDC has been silenced…”

Fennessy: Wow.

McKenna: “I am going to speak for them and say what they would be saying.” And it's really remarkable to see.

Fennessy: So traditionally, there seems to have been — if not exactly a firewall between the White House and the CDC — there has been some, some sort of sense of independence at least given them. But in recent months, with, with President Trump, we're seeing him taking the platform during a White House press briefings where he's saying Dr. Redfield was misquoted. And I got him right here to say that.

President Trump: A man who has done a very good job for us, Dr. Robert Redfield was totally misquoted in the media on a statement about the fall season and the virus.

Redfield: When I commented yesterday that there was a possibility of the fall winter — next fall and winter could be more difficult difficult, more complicated when we had two respiratory illnesses circulated at the same time — influenza and the Coronavirus-19. But I think it's really important to emphasize what I didn't say. I didn't say that this was going to be worse. I said it was going to be more complicated, more difficult.

Fennessy: There seems to be a lot more interference. Is that, is that a fair characterization?

McKenna: Yeah, I do think it's a fair characterization. Now, you know — that this is not to say that this is the only time that what the CDC doing, is doing, has been intensely politically sensitive. What is different about this outbreak is the political setting in which it's occurring. You would have to go back, I think, maybe to something like the Reagan administration. Reagan was president when HIV surfaced.

President Reagan: We will — I will — do all that God gives us the power to do to find a cure for AIDS. We'll not stop. We'll not rest, till we've sent AIDS the way of smallpox and polio.

McKenna: I think I read once that he did not actually say the words HIV or AIDS until his second term years.

Fennessy: It took years. It took years, yeah.

McKenna: Yeah. So I think you would have to go that far back to to find a White House that was as profoundly uninterested in the conduct of public health.

Fennessy: Right.

McKenna: I cannot think of another president who would have done what you've just described to the director of the CDC — which is not to say that they were not backchannel, telling the CDC to back off on things, or to make HIV less of a, you know, less of a priority or anyone or a number of things that they disagreed with politically. But it has never been this kind of direct personal challenge.

Fennessy: You've mentioned that you know a lot of people who work at the CDC. So what is their take on Dr. Redfield?

McKenna: I think there's enormous frustration. They go there because they wanted to make a difference in the world. They, they go there because they believe that what they do is something that pretty much no one else in the world does as well as they do.

And we actually know how the rest of the world thinks about the CDC, because — there are public health agencies, ministry of health agencies all over the world who have named themselves CDC in homage, even though the acronym CDC means nothing in their language.

Fennessy: Wow.

McKenna: The main public health agency in the People's Republic of China is the China CDC. In Nigeria, it's the Nigeria CDC. That's because the rest of the world thinks so well of the CDC... or did up until this point.

Fennessy: I mean, this is a once in a century, I hope, pandemic. And, and one would think that this is something that the CDC scientists have been preparing for — for their careers — and, and to see them sidelined feels, it feel sad.

McKenna: It does. I mean, quite aside from the impact on the health of the rest of us, the CDC, at this point is, I think of them, the scientists at the CDC, as being in a position very similar to the athletes who didn't get to go to the Olympics this year.

Fennessy: Yeah.

McKenna: Something like this is what the CDC exists for. And they didn't get to do it.

Fennessy: Where do you see this in three months, and six months, in a year? Where are we going to be?

McKenna: I believe Dr. Fauci said we could have a 100,000 cases a day if we don't turn this around soon. So if we've got what's essentially an uncontrolled disease in the United States, and we've got this crazy internal politicized fight over whether we're going to do the things that will control the disease — because they've been, somehow been construed as not public health measures, but political statements...

Fennessy: Like wearing a mask.

McKenna: Like wearing a mask. In a recent congressional hearing, Dr. Robert Redfield, the director of the CDC, admitted that the agency's messaging campaign to get everyone to wear masks hasn't resonated with everyone.

Redfield: We're going to continue to try to figure out how to get more and more people to embrace it. I was just remarking, when I will go home in the Baltimore area — I don't see anybody without a mask. But a lot of times when I walk through Washington, D.C., I see a lot of people without a mask. So there's different cultural approach to it. But we think it's an important public health message and we're going to continue to stress it. I think it's going to be key.

McKenna: We are really in trouble. And I have to say, as somebody who has spent her career immersed in the history and the rollout of, you know, the history of infectious diseases and the rollout of the ones that I have lived through as a journalist, I — I honestly never thought I would see this. And I, I'm very nervous when I look ahead as to where this is going to go, and what we're going to have to do to tamp it down. I really am not sure what we're going to do. I would like to be able to say that, you know, six months from now, we'll all be able to go out to a restaurant again and I'll be able to teach my students face to face again. But, like, I just...

Fennessy: It's almost like we're pinning all of our hopes on a vaccine. And until then, whatever mitigation efforts you want to take, you're free to take. But, you know, don't feel compelled to take them.

McKenna: Well, we are — I think we are pinning our hopes on a vaccine. And that is, on the one hand, reasonable because a vaccine is the only thing that will prevent this. But it's also pretty far fetched.

You know, the fastest that a vaccine has ever been produced from scratch is four years. That was for the mumps vaccine, I believe. Yeah, we get… we get influenza vaccines freshly every year — always barely in time — but that's because the flu vaccine isn't created from scratch every year. The flu vaccine is more like an old fashioned tape deck where you take cassettes in and out. But the the actual physical thing, the tape deck doesn't change. It's as though...

Fennessy: Right.

McKenna: Now we have to rebuild the whole tape deck from scratch now. And it's possible that the first vaccine that we get: first, we won't have that many doses of it. And second, it may not be that good. A federal official said that the — might have been the director of the FDA said that, they will accept a vaccine as good enough if it protects 50% of the time. So you could be taking that vaccine, if people agree to take the vaccine, and it will be a coin toss whether you were protected or not.

Fennessy: Right.

McKenna: That is not a lot of confidence on which to restart life as we used to know it. So until we get, it's not just till we get a vaccine — it may be till we get better vaccines, and that could be another couple of years. So, you know, are... When people talk about a new normal, this — our new normal is that life as we knew it is not coming back for a while.

Fennessy: My thanks to journalist Maryn McKenna. On July 14th, after Maryn and I spoke the White House further marginalize the CDC by ordering that Coronavirus data from hospitals would now bypass the CDC altogether and go directly to Department of Health and Human Services. In the pages of The Washington Post, four former directors of the CDC wrote, "We are seeing the terrible effect of undermining the CDC play out in our population. Willful disregard for public health guidelines is, unsurprisingly, leading to a sharp rise in infections and deaths."

I'm Steve Fennessy. This is Georgia Today, a production of Georgia Public Broadcasting. Our producer is Shawn Powers. Thanks for listening.