Operating via Zoom from her home office in Newton, Mass., Rochelle Walensky is facing down a challenge that would sound herculean for even the most hardened players in the federal bureaucracy: resuscitating the CDC.
Her challenge is especially tough because as director of the Centers for Disease Control and Prevention, Walensky is a political outsider and finds herself playing second fiddle to Anthony Fauci, the face of the U.S. pandemic response who has advised presidents for decades. And there’s this: The White House has not hesitated to undercut Walensky’s scientific expertise, and the agency’s scientific process.
Walensky came in with a bold plan to resurrect the once-revered public health agency, aiming to breathe new life into a CDC sidelined by the Trump administration in the middle of once-in-a-generation pandemic.
“This top-tier agency, world renowned, hasn’t really been appreciated over the last four years and really markedly over the last year,” she told the Journal of the American Medical Association. “So I have to fix that.”
After nine months on the job, that plan has faltered, discouraging longtime CDC advocates.
“It’s been disappointing: A lot more was expected in terms of centralizing messaging and policies, and turning things over to government agencies and the leaders of those agencies,” said Glen Nowak, a University of Georgia professor who spent 14 years at the CDC, including six as its head of media relations.
Even the CDC’s staunchest supporters acknowledge that the agency has experienced numerous setbacks since Biden took office. The debate over who to blame, though, is still raging. Some have pinned recent stumbles on the agency and its politically inexperienced director Walensky, while others say that the White House’s own actions have made the CDC’s full revival impossible.
The continued tension radiating between Pennsylvania Avenue and the CDC’s Atlanta headquarters highlights the storied public health agency’s precarious standing in Washington. And it calls into question whether Walensky’s political inexperience has prevented her from following through on the sweeping promises she made before taking office — or whether the White House has actively prevented her from doing so.
“There’s always internal debate, and politics has always played a role,” said Georges Benjamin, the president of the American Public Health Association. “But have they made some rookie mistakes? You bet.”
A CDC spokesperson declined to make Walensky available for an interview.
Walensky, 52, has a sparkling resume as a physician-researcher: Two decades on the faculty of Harvard Medical School. Author of countless papers about HIV/AIDS. Service on numerous government advisory committees. In 2017, she became chief of infectious diseases at Massachusetts General Hospital.
But Walensky has never worked in government, and she has never managed an organization approaching the scale of the CDC and its 10,000-plus employees.
While few challenge Walensky’s academic and scientific qualifications to serve as the country’s top infectious diseases official, some argue that her lack of experience in government and relationships with Biden’s inner circle poses an obstacle to her at the CDC, especially at such a pivotal moment for the agency.
“There was an old adage when I first started working in pandemic planning: You don’t want to be meeting someone for the first time during a pandemic,” said Sonja Rasmussen, a University of Florida medical school professor and 20-year veteran of CDC and its pandemic-preparedness efforts. “That’s the situation that she’s in. Ideally, you’d have met these people — so they know you, they trust you.”
While Walensky is a relative newcomer, Biden has known his other pandemic-response aides for at least a decade: chief of staff Ron Klain has worked for Biden since 2009. The president has known scientific adviser David Kessler at least since the 1990s, when Biden was a senator and Kessler was Food and Drug Administration commissioner. And Biden has worked with Surgeon General Vivek Murthy since at least 2009, when President Obama first nominated him for the same role.
“Somebody coming in as a new CDC director is clearly going to be behind in terms of name recognition and awareness,” Nowak said. “And also, behind somewhat in terms of being up to speed” on the pandemic response.
Perhaps the starkest contrast is with Fauci. Beyond his official role as director of the National Institute of Allergy and Infectious Diseases, he has been the country’s de facto public health spokesman for nearly four decades. Accordingly, much of the country is more familiar with Fauci in his public-facing role than in his day job as the director of a $6.5 billion research institute.
His presence as a cable-news mainstay and White House whisperer has posed an unexpected challenge to Walensky’s struggle for credibility, according to many academics and officials in the field of public health.
“[Fauci is] a good communicator, a smart scientist who knows his way around government, and he’s had to answer tough questions,” said Benjamin. “Dr. Walensky is pretty good. But she’s going to get better over time. This isn’t the last hot seat she’s going to be in.”
Fauci himself has been a fierce advocate for Walensky. But he, too, has acknowledged there is room for growth.
“Give her a little time,” he told the New York Times in June. “By the end of one year, everybody’s going to be raving about her. I guarantee it.”
W
aensky has made several unforced errors, as has the CDC more broadly.
At one point, Walensky drew criticism for stating, unequivocally, that “vaccinated people cannot transmit the virus” — an assertion that turned out to be incorrect.
The agency drew criticism, too, for its 180-degree turn on mask guidance in May, when it essentially declared that all vaccinated Americans could remove their masks indoors.
In hindsight, many epidemiologists blame the summer’s devastating Delta variant surge, and the ensuing wave of deaths, on the CDC’s mask-guidance reversal.
Walensky has also failed to follow through on a number of the pledges she made when she took office: In particular, she has not resumed the regular briefings with lower-ranking scientists that she promised before taking office. The Trump administration largely canceled those briefings in early 2020 after Nancy Messonnier, the deputy CDC director, warned that Covid-19 would soon upend everyday life.
Compounding the issues, also, are long-running complaints that the agency is understaffed, and the June loss of a long-tenured agency leader: Anne Schuchat, the longtime principal deputy director who served 30-plus years at the agency.
Still, the stumbles have been noticed beyond the world of public health. A May column in the Boston Globe, Walensky’s hometown paper (which shares the same owner as STAT), proclaimed: “Rochelle Walensky has a credibility problem.”
But Biden and his White House have done plenty to undermine Walensky’s authority.
As a candidate, Biden pledged to “follow the science” and “listen to the doctors,” suggesting repeatedly that squabbles between the White House and public health agencies would disappear the day he took office.
But last February, hours after Walensky suggested during a press briefing that schools could safely reopen before all teachers were vaccinated, Jen Psaki, the White House press secretary, dismissed the remarks, arguing that she had spoken “in her personal capacity.”
From an administration that had campaigned on restoring the credibility of public health agencies and government, it was a stunning rebuke of a brand-new CDC director who’d given a straightforward response to a straightforward question.
Some experts cast Psaki’s remarks as a one-off. Others, however, say that it foreshadowed a larger controversy that unfolded in the subsequent months: the White House’s push for booster shots.
The August announcement, that all American adults would soon be eligible for booster shots, rankled many scientists who had expected Biden to make good on his pledge of letting the scientific and regulatory processes play out without White House interference. Instead, the Biden administration appeared to assume that the FDA would authorize booster shots, and then that the CDC would recommend their use, universally and without reservation.
“There’s a method this goes through, and presupposing the way the decision-making process is going to end up makes people wonder if you’re following the science or doing things for political reasons,” said Rasmussen.
The White House’s booster stance eventually boxed Walensky into an uncomfortable position. In September, a CDC advisory committee recommended that Pfizer boosters be given to a dramatically smaller population than the White House had promised.
In effect, Walensky had to choose between ruling against the White House or ruling against the advisory board.
She sided with the White House, a move that Fauci called “courageous.” It was only the second known instance of a CDC director defying those advisers.
The CDC, of course, is no stranger to political pressure. Its Atlanta location only makes matters worse: Unlike the FDA and NIH, its peer institutions based in Washington suburbs, its leadership and staff can’t simply drive to the White House or Capitol for meetings.
And to be sure, the CDC’s current challenges pale in comparison to those it experienced during the Trump administration, and under the leadership of its previous director, the HIV/AIDS researcher Robert Redfield.
Redfield, too, largely ran the agency from his Baltimore-area home instead of its Atlanta headquarters, and had few prior relationships with high-level Trump administration aides. By the end of 2020, he was almost fully sidelined from the federal government’s pandemic response. (Redfield did, however, know Fauci before assuming the role of CDC director. Redfield co-authored research with Fauci as early as 1986.)
And while Redfield was dinged for not conducting public briefings or TV interviews, Walensky is the opposite: She is a cable news mainstay and, with Fauci and Murthy, conducts press briefings with the White House’s coronavirus response team more than once a week. And when on camera, she is comfortable and confident, a stark contrast from Redfield.
Even Walensky, though, has admitted at times that her efforts haven’t been enough.
“I am really struggling,” she told the Wall Street Journal in August, “with how to communicate to people who are worried about politics, and I just want them to continue to be at their family’s dinner table.”
https://www.statnews.com/2021/11/08/rochelle-walensky-cdc-faltering/
