Share This Podcast

The CDC is the nation–perhaps the world’s–most preeminent public health agency. But it’s taken quite the beating throughout this pandemic. From flawed tests to unclear guidance to political tampering, the agency’s mistakes continue to mount. How did this happen, and how do we make sure it doesn’t happen again? Abdul talks about how public health mistakes happen and speaks with Dr. Tom Frieden, former CDC Director under President Obama about the past, present, and future of the once-storied agency.

Transcript

Dr. Abdul El-Sayed: Omicron continues to set daily case records, though the peak looks to be in sight. Federal public health officials testified before Congress, reminding us how politics has interfered with the pandemic response every step of the way. And in a blow to worker safety and COVID containment, the Supreme Court blocked the Biden administration’s vax or test requirement for large employers. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. I want to tell you about the first time I stepped foot into the CDC campus in Atlanta, Georgia. I was the newly-minted city health official out of Detroit. I got to tour the campus, a dream for a public health nerd like me. I got to see the Emergency Command Center where the agency oversaw the Ebola response, Director Frieden’s office, who we’ll talk to you later today. Then I visited the CDC’s Museum of Public Health. I lingered a little longer to see the displays on all the CDC’s amazing public health wins. During my meetings with CDC officials, I learned about the institution’s storied history, its unique structure with only one political appointee, the Director. For a public health nerd, it was the equivalent of visiting the Smithsonian, the Louvre and the Pentagon all at the same time. Here we’re serious people doing serious work to keep us all safe. Even before my visit, I believed deeply in the work of the CDC. After all, no one gets into public health to be rich or famous, you get into it out of a profound care for people and a belief in the science you know can protect them. And I felt safer knowing that they had my back and all of ours. The CDC was founded in 1946 as the Communicable Disease Center with a simple mission: to stop the spread of malaria. By 1947, its remit had expanded to stop the spread of all communicable diseases—think smallpox or polio or tuberculosis, diseases that you rarely hear about today in America or so much of the rest of the world, for that matter, because in large part of the CDC’s heroics. Of course, any institution derived from the U.S. government is not without its blemishes and the CDC has been behind some dark moments in our history. When the United States Public Health Service came under CDC control, the agency failed to end the Tuskegee syphilis experiment, in which scientists allowed Black men in Alabama to go without treatment for syphilis, simply to track the long-term consequences of the disease. Today, the CDC has evolved, rather than the Communicable Disease Center, DDC now stands for Centers for Disease Control and Prevention. It’s not an exaggeration to say that it has played a pivotal role in everything from ending smallpox to leading the fight against teen smoking, expanding the work of public health beyond communicable diseases. It is THE public health agency on which nearly every other high-income county’s public health agencies are modeled. So when I heard about this new coronavirus that emerged out of Wuhan, China, in late 2019, I knew that the CDC was going to be all over it. I just knew that this pandemic, whatever it had in store for us, was no match for the CDC. Sure, we had a president whose only preparation for this was telling fake employees that they were fired in a fake business on the ironically named “Reality TV” and I’d heard the rumblings about how the CDC director he’d appointed wasn’t up to the task. But I believed in the rest of the institution. And then came March of 2020:

[news clip] Contamination at the CDC delayed the testing process for COVID-19 at the start of the pandemic. The CDC appeared to violate its own manufacturing protocol.

Dr. Abdul El-Sayed: Right out the gate there were mistakes made by CDC scientists, coupled with restrictions on other tests that delayed getting tests out quickly. And then there was this:

[news clip] A change from the Trump administration that takes effect today requires hospitals to stop sending their coronavirus data to the CDC and instead send it to the administration.

Dr. Abdul El-Sayed: The Trump administration began tampering with the CDC. They took one of the agency’s most important functions—collecting, analyzing and tracking public health data—away from it. I misjudged the impact one incompetent, mendacious president could have on the DCS’s work. So when President Biden was elected, I breathed a sigh of relief. The Biden administration brought new leadership where new leadership was desperately needed, yet the agency still seemed to find itself time and again mishandling some of the most basic things about the pandemic and in turn, confusing an already anxious public. In May of last year, for example, the CDC made this announcement:.

[news clip] Tonight, the new face of the pandemic is now one without a mask. The CDC’s ground-shifting change impacting the 117 million fully-vaccinated Americans who will no longer need to physically distance or wear a mask.

Dr. Abdul El-Sayed: But we already knew that SARS-CoV-2 was capable of profound mutation. What if we had a new variant that could evade our vaccine-mediated immunity? Would people put their masks back on after they’d been told by the CDC that they could take them off? Low and behold, a few months later, a new variant, Delta, emerged out of India.

[news clip] A U-turn from the CDC. Less than two months after giving vaccinated people the green light to get rid of their masks, the agency’s director now has this urgent message: put them back on in indoor public spaces.

Dr. Abdul El-Sayed: Now, months later, we face yet another wave of this pandemic, and the CDC rushed out a change in guidelines.

[news clip] New guidance shortening the recommended isolation time for those with COVID who are no longer experiencing symptoms: five days. That’s half of what it was.

Dr. Abdul El-Sayed: The CDC reduced the recommended isolation time for vaccinated and boosted people from 10 days to 5 days without even requiring a negative test. The timing was suspect. The change came right after CEOs of major corporations complained about the limitations the previous guidelines placed on staffing. Don’t get me wrong, staffing concerns are legitimate, they just haven’t been in the purview of the CDC, which stands for Centers for Disease Control and Prevention, until now. What’s more, they didn’t even release supporting evidence to justify a five-day isolation without negative testing. All of these— missteps, poor communication and political interference—have served to cut the credibility and trust in the agency at the time when Americans need it most. Needless to say, I’ve been profoundly disappointed by CDC throughout this pandemic. I say all this not because I’ve lost any of my reverence for the institution. I say it because I believe in the CDC, and I believe it can and must be better. The issues at the agency are bigger than one president and one director. Rather, I think it’s a problem with the disjunct nature of our public health system, the way that CDC has been politicized, and the lack of investment we’ve made in public health more generally. Our failure to invest in public health generally, and the CDC specifically, has left it in edifice of what it once was. It’s failed to keep up with the times. Gone are the days when a public health agency could just command respect simply for being. Instead, understanding how to message in a world of nearly unlimited information is key. The political pushback of this moment is something few of us could have imagined. And yet CDC hasn’t been agile enough to adapt. And finally, there’s just public health 101: when you release new guidelines, have the evidence ready to justify it. When you produce new testing, make sure you get it right. And it’s not just the messaging, it’s the blocking and tackling. I wanted to talk to someone who understands the CDC from a unique vantage point as its former director. Dr. Tom Frieden was appointed CDC Director in 2009 by President Obama. He led the agency throughout the administration. I invited him to tell us more about CDC, its past, present and future. More with Dr. Tom Frieden after this break.

[ad break]

Dr. Abdul El-Sayed:  All right. Perfect, let’s get started. Can you introduce yourself for the tape?

Dr. Tom Frieden: I’m Dr. Tom Frieden, President and Chief Executive of Resolve to Save Lives. Also former Director of the U.S. Centers for Disease Control, and the New York City Health Department.

Dr. Abdul El-Sayed, narrating: Dr. Tom Frieden ran the CDC from 2009 to 2017. Before that, he was New York City’s health commissioner. Now he runs a nonprofit public health organization called Resolve to Save Lives. He joined me to help make sense of the CDC’s actions during the pandemic and think through what could be done to make it better.

Dr. Abdul El-Sayed: Well, thank you so much for joining us today, Dr. Frieden. I wanted to check in with you as I can think of no one better to help us to understand the history, the present, and the future, of an agency that is absolutely critical to the public’s health, both in this country and abroad, and that’s the Centers for Disease Control and Prevention, of which you were the Director. And I wanted to just jump in here, can you tell us a little bit about the history of the CDC and its role in the development of public health as we know it?

Dr. Tom Frieden: Fundamentally, CDC’s mission is to work 24-7 to protect Americans from threats, whether those threats are infectious or otherwise, from the US or anywhere in the world, natural or manmade. The CDC grew out of the Office of Malaria in War Areas, which had an office in the south following World War Two. There were a few really visionary people early on. One of them was Joseph Mountin. Joseph Mountin not only founded the CDC, he also started the very famous Framingham Heart study, which have told us so much about how to prevent heart attacks and strokes. And Mountin made a very astute observation. He said that everyone who works at CDC should have spent at least a year or two as a county health officer in the U.S.—long enough, he wrote, for them to have proposed a budget and gotten it through the local council. He really had an understanding of the need to have an integrated system: county, city, state, federal. Then you have the CDC gradually adding units as the role of public health evolves. Public health at one point of time included sanitation—that spun off to other agencies. But public health increasingly addressed not just the infectious diseases but also injuries, violence, heart attacks, strokes. And sometimes we hear pushback from that. “Hey, CDC, you should stick to just infectious diseases.” But if it does that, it risks not addressing the major health problems of this country. And the CDC has had a lot of success, including in tobacco control and cholesterol reduction and other areas. Fundamentally, we go back to that bottom line: the CDC’s mission is to work 24-7 to protect Americans from threats, whatever those threats may be.

Dr. Abdul El-Sayed: Mmm. I really appreciate that framing and the development of some of the history of the CDC and how it’s taking on the evolving set of health threats that people face. And that point about getting your budget through county or city council is near and dear to my heart as a former city health official. I want to ask you, you know, under the hood, when the CDC is running at full tilt, can you walk us through some of the things that are going on in various parts of the agency, the various departments inside or centers inside the Centers for Disease Control and Prevention and what are they doing, how are they operating? What, what are the kinds of outcomes that they’re trying to avoid?

Dr. Tom Frieden: The CDC has about a dozen different centers. It’s the “Centers” for Disease Control and Prevention, and each of them has a different set of priorities, a different way of working. They’re combined as one organization but they do function differently with different priorities. It ranges from, for example, the Immunization Center, which does a wide range of programs, including through what’s called the Vaccines for Children Fund, providing about half of all the childhood vaccinations in the United States, to doing cutting edge research on how do we diagnose vaccine-preventable diseases, how do we support state and local health departments? One of the very important roles of the CDC is to support state, city and local health departments, and tribal nation health departments as well within the contours of the United States. And what I found and pointed out when I was director is that about two thirds of all of the dollars that the CDC spends aren’t spent on Atlanta. They’re spent sending money out to state and local entities to strengthen public health throughout the country. Other centers may have a role in creating guidelines. So, for example, the Injury Center created guidelines for opiate treatment and trying to address the overuse of opiates for the care of patients having pain. There’s a combination of supporting state and local entities, doing cutting-edge epidemiology, doing a cutting-edge laboratory work in a wide range of areas, whether it’s fungal disease or cholesterol, lipid metabolism, environmental poisonings, or other areas. The Environmental Health Unit also has a wide range of functions, including checking on disasters and creating registries of people who may have been affected.

Dr. Abdul El-Sayed: I appreciate that. And that’s really helpful context because it really is a huge agency, and I think folks don’t really appreciate that it’s not like the other pieces of the work stop in the middle of a major pandemic. You know, heart disease doesn’t stop. Strokes don’t stop. Cancers don’t stop. Air pollution doesn’t stop. All of these things to keep going. And you forget that it is a large agency that’s tasked with a number of outcomes. Now the pandemic, of course, is the major focus given the emergent and urgent nature of what we’re dealing with. Take us inside the mind of CDC Director. You’ve held the job for eight years. What are the various challenges that you’re managing at any given moment, and what are they that aren’t entirely obvious to the rest of us, as decisions get made?

Dr. Tom Frieden: Well, first, you have to recognize that it is a very large agency: more than 10,000 regular employees, about another 10,000 contractors. There’s a lot going on. And at any one time, there’s likely to be something that’s urgent. During my nearly eight years as director, our emergency operations center was activated more than 90% of the time. In the background, you’ve got the last mile of the polio eradication program going and CDC is a core partner along with Rotary International, the World Health Organization, UNICEF, and the Bill and Melinda Gates Foundation in getting over the finish line there. So that’s always going on and so important. Just take a step back for a minute. When that initiative was launched in 1980s, a 1,000 children a day were getting polio, and we’re now down to single digits. But we’re not over the finish line and it could come roaring back if we don’t do a better job. So there are a range of issues happening. But when an emergency happens, the CDC activates its emergency operations center and then staff leave their regular posts and they come either physically or figuratively to the EOC—Emergency Operations Center. And that’s the nerve center for CDC, and it has, it operates under what’s called an incident management system. This is something that all of government really learn from firefighting, where you have a modular system so you can expand it if there’s a problem. There’s a clinical unit coming up with clinical advice. There’s an epidemiologic unit looking at the epidemiology. There’s a laboratory unit assessing laboratory tests. There’s a state support unit. There’s a global health unit. There are different modules within the incident management system, and then there is an incident commander or incident manager, and the role of the CDC Director is really to learn from and support that incident command system.

Dr. Abdul El-Sayed: That’s really helpful to understand. And now you’ve got to imagine this has been the major public health incident that has occupied the world’s collective mind over the past two years and counting, and the impact that that has on the CDC and CDC officials and employees—I can’t even imagine what that’s been like. And so as you think about your time at CDC and what folks may be facing right now in the midst of this pandemic, how has it stretched the CDC’s usual operations and what signs of potential wear and tear have you seen, both you know, prior to the pandemic and then certainly two years and counting in?

Dr. Tom Frieden: When I was CDC Director, when I became CDC Director, I worked for CDC for 12 years before. I have been New York City Health Commissioner for eight years. I had been running public health programs for 15-plus years. I had been managing the H1N1 pandemic from New York City as New York City health commissioner and so I was pretty well set up to be ready and able to manage what was being dealt to us. But even with all of that background, and even working around the clock, I was overwhelmed as I came in to the CDC. There was so much going on. You have essentially near infinite requests from, on the one hand, the media, on the other hand, Washington—including HHS, the White House, Capitol Hill, the Senate and House. And your challenge is always to stay up to date with the science and then to be able to sift that about what’s important and then to communicate that clearly. And communication has been a challenge for CDC over the past year. I’m optimistic that it will get better, but it hasn’t gone as well as it should. And that’s unfortunate because the CDC literally wrote the book on how to communicate in a health emergency. They’re called the principles—or CERC Principles. And they essentially involve be first, be right, be credible, be empathetic, give people practical, proven things to do to protect themselves, their families and their communities. And I’m hopeful that CDC will increasingly get back to those principles. The challenge that they’re dealing with now is that we are such a divided society. Senator Moynihan used to say, You are entitled to your own opinion, but not to your own facts. And I feel that we’ve kind of lost that. People feel entitled to their own facts now. And facts are stubborn things, as people who end up in an intensive care unit after not getting vaccinated find out. And we don’t want that to happen. We don’t want anyone to get sick when it’s preventable. There is a fundamental challenge here, which is that public health is defined as the efforts of society organized to protect itself, and if in a society, we lose some of that sense that we really are one society, that the only enemy here is a microbe, we lose the ability to save lives.

Dr. Abdul El-Sayed: I really appreciate your point about the way that this pandemic has been politicized, and the role that politics has played in shaping so much of what has been a disjunct response. And we saw that pretty acutely in the context of the CDC during the Trump administration, when there was very clear political tampering with the CDC. How do you feel like that has affected the CDC’s morale, the CDC’s credibility as we’ve gone forth in this pandemic?

Dr. Tom Frieden: To be perfectly frank, I think both morale and credibility have taken a hit. CDC employees are not deaf to the fact that there are vociferous criticisms from both the left and the right. And some of those criticisms are valid. The CDC made a mistake in releasing a faulty test in February of 2020, and they just last month issued a report in the scientific literature outlining how it happened, what happened, and how they’re going to try to reduce the likelihood that anything like that happens again. They also have not optimally communicated some of the new recommendations that they’re making. And some of the recommendations that they made middle last year are questionable. So I think the CDC has some ground to make up, and the two things go together. The more they are able to bring people together, increase morale, increase cohesiveness. the better work they’ll do. The better work they’ll do, the more they will regain and earn the trust of the public. The more they do that, the better morale will be. So I think you can go from a vicious cycle to a virtuous cycle, and I’m optimistic they’ll do that. Just recently, Dr. Walensky and two of the subject matter experts held a press briefing. That’s the first such press briefing there has been, I think, during this administration and probably since they were kind of shut down in the prior administration. And in that press briefing, there was a commitment to doing briefings like that regularly. That’s very encouraging because it means that the CDC is getting back to where it needs to be, which is out there explaining science to the public, telling people what we know when we learn it, what we don’t know, and what we’re trying to do to find it out, what we’re recommending and why, what’s the scientific basis, and answering the tough and valid questions that reporters have.

Dr. Abdul El-Sayed: You know, you know this better than I do, that work in government public health where you are forward-facing to the public, it is probably two parts public health science and one part public communication. And if you get the public communication wrong, it doesn’t matter how right you are on the science because it’s not going to be well understood/ and you detailed a couple of these, but there have been a couple of real clear missteps around, you know, choices around removing masking after vaccinations, even as we knew that viral evolution still threatened us, you know, the recent release of the new guidelines without really good justification that the agency could point to, and I want to ask you, you know, this has become even more complicated in the context where internet communication is the modus operandi, in part because of the pandemic, but in part just because it’s 2022, that makes public communication that much more complex and complicated because you’re constantly, you’re constantly communicating into a far more saturated media environment. What were your experiences with this sort of new mode of public communication in a politicized moment? And what would your recommendation be to Dr. Walensky and others in this moment about how we ought to pivot to meet those recommendations that you had: to be first, to be right, to be empathic?

Dr. Tom Frieden: The most similar I can relate to is the height of the Ebola 2014-2016 outbreak, which happened to coincide with the midterm elections in the US. So August, September, October of 2014 was a very stressful time. I was holding daily news briefings and I didn’t feel ready. I remember saying to staff at some point, I feel like you’re kind of throwing me overboard and I’m having to learn to swim every time because the facts on the ground were changing so quickly. And there were things that I said that were wrong, and there were things that we did that we wish we had done better. It’s very difficult to get things perfect in an emergency, and part of responding to an emergency is recognizing when things don’t go well that you admit that you made a mistake. Part of dealing well with an emergency is recognizing what’s really an emergency, because sometimes it’s just a 24-7 news cycle, feed the beast, the media needs to hear something, and sometimes you really do have to get a message out. And in the fishbowl of Washington, D.C., it can be very difficult to distinguish between those two situations. So I think sometimes you really do have to go out there and say, based on what we know now, this is what’s happening and this is what we recommend. Other times you may say, Wow, this is a tempest in a teapot. There’s all this controversy but what’s really important is this, and that’s what we’re going to focus on. That’s a challenge. I do think that journalists can be allies, you know, for public health. Ultimately, they want to tell the accurate story, and that’s what a public health wants as well.

Dr. Abdul El-Sayed: That’s helpful, and I really appreciate that perspective, right, the differentiation between signal and noise. And, you know, I can imagine this pandemic has just turned up the noise so high that recognizing signal from the noise becomes that much more difficult. I want to switch tack a little bit and just zero in on the most recent recommendations around reducing the isolation protocols for vaccinated and boosted individuals from 10 days to 5 days. And it feels like in some respects that was in part motivated by workforce concerns, and it seems not in keeping with a lot of the precedent on which the CDC has operated in the past. Can you comment a little bit about that decision and the way it was rolled out, and then whether or not it was consistent with the remit of the CDC? And if so, why? And if not, why not?

Dr. Tom Frieden: All recommendations are a balance of different factors, including the impact on society. I thought actually that CDC’s guidance was well done. It was quick and we needed quick guidance. They saw what was going to happen with Omicron like a tidal wave sweeping across the country, and they saw that it was going to be very difficult to maintain the kind of isolation protocols that we had had. And the real problem, I think, was first there was, in my view, a lack of clarity about the initial release. The follow-up release made it clear that if you have a contact who is vulnerable—elderly or immunosuppressed—10 days. Period. And for other people, be very clear, it doesn’t mean five days and get out of jail free. It means five days and then you have to wear a mask at all times when you’re out of the home. That means you can’t go to a restaurant. That means you can’t take off your mask outside of the home. But it allows many activities to continue. And with tens—just think about this—there may be two, three, maybe two million infections a day. Two million infections a day, 10 days, that’s 20 million people not being able to leave their house. Really? That, I don’t think is inappropriate at all to consider the societal implications of your recommendations. In fact, I think it would be inappropriate not to consider those recommendations. The real problem with that guidance was that they just posted it with no explanation. They didn’t provide the rationale, they didn’t provide the scientific basis, they didn’t clarify the details of what it meant. And what that meant was that for the next two days, every pundit in the world got to take potshots at them and define the terms of the story. And if they had released it, they could have said upfront, Listen, there are a couple of things in these guidelines that seem counterintuitive, let us tell you why we made those calls. You may think it’s counterintuitive that we’re saying it’s best practice to get a test at the end of five days of quarantine but not saying that for isolation. Well, this is why we said that. And there’s actually a pretty good rationale for why you said that. You might think it’s counterintuitive that we’re not saying that everyone should test at five days. And yes, there are some people who think you should. Here are the reasons why we think it’s reasonable not to require that. I think those are quite defensible calls, but what’s not defensible is not having made that call openly, had a press briefing, explained the rationale, answered media questions about it. And because of that, it didn’t go well. In some ways, I feel that the CDC did the right thing on the merits, but the wrong thing on the communication, and they essentially seized defeat from the jaws of victory. This was a, this could have been a good news story in that CDC is looking at the science, anticipating in advance what’s going to happen, moving very quickly—the CDC is usually criticized for moving too slowly—moving very quickly to adjust its guidance in a way that is balancing protection of health with keeping our society moving. It’s a reasonable call. And the real problem was not having explained it clearly.

Dr. Abdul El-Sayed: Yeah, and I hear you on that, Dr. Frieden. I guess my only pushback would be that, you know, both you and I spent a lot of time in science communication, and one of the precepts that we often hammer is that science is not an outcome, it’s a process. And our responsibility, right, in being trustworthy as scientists and science communicators is that we show our work. And in some respects in not showing the work, the whole precept of science-based reasoning in some respect goes out the window. And it’s not to say that they didn’t use science, obviously, in their decision making, but it’s that when you can’t show the process, it undermines trust in the institutions of science. Because in some respect, when we say trust the science, what we’re really saying is trust scientists and trust scientific institutions. But the corollary of that is that scientists and scientific institutions ought to be very good at leveraging science and demonstrating their process. And so, you know, I think, you know, in some respect, the communication is the work, and so it was really quite frustrating. But I certainly hear you on the broader point that you made. I want to just ask you, you know, as we think about next steps here, the CDC is going to come out of this pandemic, you know, quite battered in terms of credibility, in terms of morale. What are the kinds of things that the agency needs to to do, or more importantly, maybe society needs to do, to build the kind of CDC that we deserve, that folks who, you know, who do really amazing important work at the CDC, deserve? What are the changes that are to come out of this pandemic era?

Dr. Tom Frieden: Well, one thing is we need consistent funding for the CDC. The CDC is woefully underfunded, and many of the problems we’re seeing are a reflection of that. We have people who have been working for two or three years now and going into their third year on the pandemic, and they have day jobs that are languishing. CDC needs to be able to respond robustly to everyday emergencies and to 100-year floods, and that means more funding and more flexible funding. One of the big challenges, as CDC Director, is that the budget is broken into more than a 150 different lines, and you have zero flexibility to move money between lines, and zero—not zero, but close to no cross-cutting money for urgent needs. In fact, as New York City Health Commissioner, I had 20 times as much flexible funds as I did at CDC Comm—as CDC director. So that is something that really needs to change, with the addition of cross-cutting funds for urgent requirements. The other thing that really has to change is the better alignment of federal, state, city and county health departments. And I think there’s a way to do that. And that’s why I started with Joseph Mountin saying everyone should have been a county health commissioner for a year or two. I think there should be thousands and thousands of CDC staff embedded in state, city and local health departments, and they should spend two to five years there and then they should rotate to Atlanta. And ideally at some point some of them rotate back out to leadership positions in state and local governments. Currently, there’s too much of an abyss between CDC and states and frankly, between many states and many cities, and many states and many counties. We’re not aligned in public health. That’s not something that you can snap your fingers and change overnight. That’s going to require many years of effort. I started that in my time at CDC with a program called PHAP, The Public Health Associates Program, where we put several hundred people for two years in state in local health departments, working on the front lines, knowing that they would become the face of public health in the future—people who actually knew what it was to get something done on the front lines, and therefore when they’re back in Atlanta, they’re listening when there are problems, they’re writing recommendations that can be implemented, they’re writing grant guidelines that are sensible. That kind of alignment among the different parts of the public health enterprise is extremely important.

Dr. Abdul El-Sayed: I appreciate that. And then, you know, as you think about the political interference that we saw during the Trump administration, how do we solve that? There have been recommendations perhaps to make the CDC Director either a term appointment—so rather than being at-will appointed by the president, they serve a term, something similar to, you know, for example, the Chair of the Fed. Or, you know, to appoint a commission who then appoints the director. How do you feel about those ideas, and what do you think might be the opportunities and potential costs of that?

Dr. Tom Frieden: I’m afraid that the cure may be worse than the disease, that these recommendations, including the recommendation that the CDC Director be Senate confirmed—which is not currently—could really make things worse. Senate confirmation takes a long time, and it makes something political that shouldn’t be political. So that would be a bad idea. Having a term appointment sounds great. The UK does it with their chief medical officers. But you know, if a president comes in and they don’t agree with the CDC Director, that’s not good for CDC. That’s not good for the public. The fact is that the president has a lot of say about what happens in federal agencies. I think there was a line crossed in the Trump administration when it came to trying to edit the MMWR, the CDC weekly publication. That had never been done before. And I don’t have a solution for how to immunize the CDC against politics, because policy issues are always going to be important for public health decisions. It’s really partisanship that we need to try to avoid infecting the CDC. I was proud when I was at CDC that I had good relations with both sides of the aisle, governments—governors that were both Republicans and Democrats. We didn’t always agree on everything with either Republicans or Democrats. The CDC’s role should be always to stand up for what is going to protect Americans best. Go back to that fundamental mission of working 24-7 to protect Americans from threats, whether man made or natural, whether infectious or otherwise, whether from this country or anywhere in the world.

Dr. Abdul El-Sayed: Well, that’s a great place to end it there. Dr. Frieden, we really appreciate you taking the time to join us today to talk to us a little bit more about the work of the CDC, about what it’s like to lead the CDC, and about how we can address some of the challenges that we’ve seen manifest in the context of this pandemic. I really appreciate your hopeful outlook and the service that you’ve rendered, and I hope that we can continue the conversation again soon. OK?

Dr. Tom Frieden: Thank you very much. It’s been a pleasure speaking with you.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Omicron is wreaking havoc across society: school closures, flight cancelations, un-stocked grocery shelves because of massive worker illness. But there might be light at the end of this tunnel. If you look at COVID case rates across Europe, where the pandemic has been about two to four weeks ahead of us, the graphs look like an upside down V. And cases are still on their way down. I’ve learned enough from this virus not to make any real predictions, but that could spell the tip of the V for us in the U.S. as well. It’s important to remember, though, that when it comes to COVID, the U.S. is not a singular place. The top of the peak reflects the largest cities in the U.S., which have always been hit first by any new variant. Things in the Midwest and South usually lag, suggesting that for listeners in communities like these, it could be several more weeks of pain. This week, federal public health officials, including CDC Director Walensky, Dr. Fauci, and acting FDA Commissioner Janet Woodcock, testified before Congress. Two things came out of those hearings that I want to break down here. This was Dr. Fauci and Senator Roger Marshall, who insinuated that somehow Dr. Fauci was hiding his financial interests:

[clip of Dr. Fauci] You’re so misinformed, it’s extraordinary. All you have to do is ask me.

[clip of Senator Roger Marshall] Why am I, why am I misinformed? This is a huge issue. Wouldn’t you agree with me that, that you have a, you see things before members of Congress would see them, so that there’s an air of appearance that, that maybe some shenanigans are going on? You know, I don’t think that’s—I assume that that’s not the case. I assume it’s not the case.

[clip of Dr. Fauci] What are you talking about? [to self] What a moron.

Dr. Abdul El-Sayed: What a moron, indeed. All federal employees, including Marshall, are required to disclose any and all financial interests. They’re a matter of public record. But the interchange, alongside a particularly acerbic one with Rand Paul, highlights just how much right-wing ideologues in Congress have used this pandemic for political gain. In the middle of a massive COVID surge, these Congress-people use their few minutes of fame to pull information out of context, misquote public officials, and make absurd insinuations, so that they could play to the base back home—who, by the way, are the most likely to be hospitalized or die of COVID because of this anti-science fear and hate mongering. It’s the height of cynicism. There was another moment that made headlines. This was acting FDA Commissioner Janet Woodcock:

[clip of Janet Woodcock] Most people are going to get COVID.

Dr. Abdul El-Sayed: First, I’ve been scouring the internet for any empirical COVID modeling to back that up. I’ve found none. But even if it were true, this is exactly how not to break hard news to people: off the cuff in a congressional hearing. Because even if it were true, telling people that they’re going to get COVID anyway decimates any incentive they have to protect themselves. And one of the most important things we can do, even if the majority of people were going to get COVID, is not to get it at the same time! Meaning we should all protect ourselves now. But Woodcock’s off the cuff prediction implies that we should all just give up on trying. It’s the height of poor science communication. And if that’s bad science communication, this next story is just complete disregard for it. On Thursday, the Supreme Court ruled against the Biden administration’s vax-or-test requirement for employers with more than 100 employees. Their reasoning, and I quote, “although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly.” But what should be plainly obvious to all of us, even if it isn’t to a bunch of out-of-touch judges who go to work in robes, is that as a condition of your employment, your employer can make you be in a particular place with particular people for an extended period of time, and being among unvaccinated people for a long period of time increases the probability that you get COVID at work. In the end, this vaccine mandate is entirely about reducing your risk of COVID at work, meaning regulating, quote unquote “occupational dangers.”

That’s it for today. On your way out, can you please rate and review our show. It really does help to get the show to a new audience. If you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected drip. We’ve got our logo mugs and T-shirts. Our Science Always Wins T-shirts, sweatshirts, and dad caps, and our Safe and Effective teas.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivier Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.