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The Centers for Disease Control and Prevention has a new director, Dr. Mandy Cohen. Her predecessor, Dr. Rochelle Walensky, acknowledged CDC was “responsible for some pretty dramatic, pretty public mistakes—from testing, to data, to communications,” during the COVID-19 pandemic. Unfortunately, nothing indicates that Dr. Cohen has diagnosed the cause, much less prescribed a cure, for what ails the agency.
Dr. Cohen proposes restoring trust in the CDC by improving communications and “bringing the best evidence” to the public. This misses the fundamental problem.
A new study we wrote for the Paragon Health Institute and the Competitive Enterprise Institute reviewed the history, organization, and pandemic performance of the CDC. It identified the source of CDC’s pandemic failures as mission creep, abetted by the lack of congressional authorization for the agency. The CDC has grown into a large, diffuse agency with priorities that are far afield from its core mission of preventing and controlling communicable disease outbreaks. This lack of focus left the agency unprepared for the pandemic and distracted it from an effective response.
Congress normally exercises its spending power through a two-step process of authorization and appropriation. According to the Congressional Research Service, authorization measures “establish, continue, or modify an agency, program, or activity…[and] set forth the duties and functions of an agency or program, its organizational structure, and [its] responsibilities.” Appropriations measures then provide funding.
Unlike other significant agencies, Congress has never authorized the CDC. No single enabling statute defines the agency’s goals, powers, and structure. It was created by executive action in 1946 as the Communicable Disease Center and has since expanded in the executive branch largely through unauthorized congressional appropriations.
The lack of direct congressional authorization, aggressive efforts by the CDC’s early directors to expand the agency’s purview and the willingness of executive branch officials to delegate authority to CDC, led to a rapid and haphazard expansion of the agency’s responsibilities beyond its original purpose.
CDC priorities now include “the climate crisis,” “reducing racial disparities in public health,” “social determinants of health,” and the “growing crises of domestic, sexual, and gun violence.” Just a small fraction of CDC resources is devoted to communicable disease threats.
CDC’s disparate centers and programs are disconnected from each other and from state and local authorities, and duplicate programs in other agencies including, but not limited to, various institutes within the National Institutes of Health, the FDA, and the Substance Abuse and Mental Health Services Administration (SAMHSA). Some CDC priorities are barely health issues at all and have long been addressed by social service and law enforcement agencies. These redundancies are unnecessary, costly, and divert the CDC from its primary purpose.
Former CDC director Robert Redfield and former Assistant Secretary for Health Brett Giroir both testified that the CDC’s lack of focus on infectious disease outbreaks was a cause of its poor pandemic performance. Ironically, CDC’s review of its pandemic performance boasted that in April 2021—when CDC should have been concentrating on promoting vaccines—Dr. Walensky “declared racism as a serious public health threat” and established processes “to integrate health equity into the fabric of the agency.”
Unless CDC is refocused on its core mission, it will be unprepared to act effectively in future pandemics. But we cannot rely on CDC to reform itself—bureaucracies rarely do. Twenty years ago, following its disorganized response to anthrax attacks, CDC attempted a reorganization that had to be abandoned in the face of institutional resistance. And CDC’s pandemic review misdiagnosed the roots of its failures, claiming its shortcomings were in communications and due to underfunding.
Instead of reflexively increasing funding, Congress should comprehensively authorize CDC for the first time and reaffirm the agency’s core mission. Congress must delineate agency responsibilities and cut back on areas where CDC does not have expertise and duplicates other authorized agencies’ programs. It should transfer off-mission priorities—such as chronic disease prevention, environmental issues and violence prevention—to agencies where they can be, or already are, better addressed.
Dr. Cohen is right that the CDC has lost the trust of the American public. The only way to restore that trust and to ensure the country is ready for the next pandemic is for Congress to refocus the agency on its core mission: combating communicable diseases.
Drew Keyes is senior policy analyst at Paragon.