Adefiant Robert Redfield teed off on other former directors of the Centers for Disease Control and Prevention on Tuesday, lambasting the other onetime agency leaders for publicly criticizing his, and the Trump administration’s, response to the Covid-19 pandemic.
“The one thing I’ve gained from three years in the Trump administration is every time that I go through an airport now, I trigger the metal detector because of all the shrapnel that’s in my back,” he said. “It was disappointing that some of my CDC director colleagues felt the necessity to publicly criticize me in the news.”
Redfield, an experienced but controversial HIV researcher, served as CDC director from 2018 until President Trump’s term expired in early 2021. While he played a leading role encouraging social distancing and mask use during the early stages of the Covid-19 pandemic, he also weathered heavy criticism as the Trump administration’s careening response became increasingly politicized.
He argued, however, that the criticism served only to deepen distrust even as the agency was already in crisis. As result, he said, his first call to current director Rochelle Walensky included a pledge to never publicly criticize her.
Speaking at an event hosted by Harvard’s T.H. Chan School of Public Health and moderated by STAT Executive Editor Rick Berke, Redfield also hinted at his frustration with another major player in the Trump administration’s Covid-19 response: Anthony Fauci, the celebrated infectious diseases researcher who became the de facto head of pandemic messaging in early 2020.
The Biden administration’s broader decision to run the pandemic response from the White House and not the CDC, Redfield said, only served to disempower Walensky, as did Fauci’s formal elevation to the role of senior medical adviser for pandemic response.
“The CDC director ought to be driving the train,” Redfield said. “I have a lot of respect for Tony Fauci, but my own view is that should be the CDC director. … We ought to let the CDC director be the CDC director and lead the nation’s public health response.”
The panel took place as the agency has formally begun to evaluate its own strengths and weaknesses. The Washington Post reported Monday that Walensky recently told CDC staff that she enlisted a longtime federal health official to “step back and strategically position” the agency for the future, via a monthlong review.
“It’s very healthy to ask for outside help,” said Bill Foege, the CDC director from 1977 to 1983. “I don’t know if this is going to be enough. I think there are a number of things that should be looked at. … Asking the question: ‘What are the skills, what is the knowledge we need, what is the technology, what’s the science that CDC needs to stay at the cutting edge?’”
In light of the CDC’s ongoing self-examination, Redfield and his colleagues had plenty of suggestions for how the agency can restore its credibility among the American public.
Most notably, Redfield suggested that CDC directors should serve fixed terms of seven or 10 years, creating a degree of independence and alleviating the perception, if not the reality, that agency directors are beholden to the presidents who appointed them. The same structure, Redfield noted, is already in use throughout the federal government, including for the director of the FBI.
Already, Congress has moved to alter public perception of the CDC director, including language in one pending bill that would require the Senate to confirm future directors before they assume office. Currently, the position does not require confirmation.
Other directors, however, were split on the question of whether the position should be Senate-confirmable. Tom Frieden, the CDC director during the Obama administration, has argued that making the position Senate-confirmable would politicize the role from the outset, and might effectively lead lawmakers to undermine the nation’s top public health official before they’ve even taken office.
Julie Gerberding, who served as CDC director during the administration of George W. Bush, also said she opposed making the position Senate-confirmable. Bill Roper, who served four years under George H.W. Bush and Bill Clinton, said he supported the move, and Foege, who served under Jimmy Carter and Ronald Reagan, said he wasn’t sure.
All the former directors, though, conceded that attempts to wall off public health from politics are misguided.
“That is never going to happen,” Roper said. “That is frankly, in my view, a naive notion. We need science, the best of science, to guide the decisions that are made by political leaders to implement effective public health programs.”
They agreed, also, on another public health truism: That the agency, and other government programs focused on public health, are severely under-resourced.
Redfield, in particular, doubled down on his calls for a substantial investment in modernizing the agency’s data collection efforts, recalling an instance when he requested a briefing on the country’s drug overdose crisis and his advisers presented him with data three years out of date.
And while Congress has been generous to the agency during the pandemic, Gerberding warned that the CDC would benefit more from stable, longer-term increases as opposed to sudden cash infusions during times of crisis.
“Those are one-time dollars, and you can’t hire people on them or really build and expand the capacity of the system over time,” she said. “Those monies go away as soon as the crisis is over. So we’re left at the starting point again, where we really don’t have any capacity to improve both our biopreparedness.”
She continued: “We’re basically operating a CDC and a public health system right now that’s funded, on a per-capita basis, less than what it was in the 1950s, in real dollars. And that just doesn’t make any sense.”
Gerberding, however, also cautioned her colleagues not to leave the public with too dark an impression about the current state of the storied public health agency.
“I also don’t want to have our viewers left with the impression that everything is broken at the CDC,” Gerberding said. “There is incredible science going on there, there is incredible evidence of ongoing capacities in outbreak investigations, chronic diseases, environmental health, birth defects. We have to be careful that we don’t paint the entire agency with a black brush.”