“The COVID-19 pandemic
continues to worsen in the USA with 1·3 million cases and an estimated death
toll of 80 684 as of May 12. States that were initially the hardest hit, such
as New York and New Jersey, have decelerated the rate of infections and deaths after
the implementation of 2 months of lockdown. However, the emergence of new
outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May,
and Iowa, which did not enact any restrictions on movement or commerce, has
prompted pointed new questions about the inconsistent and incoherent national
response to the COVID-19 crisis.
“The US Centers for
Disease Control and Prevention (CDC), the flagship agency for the nation's
public health, has seen its role minimised and become an ineffective and
nominal adviser in the response to contain the spread of the virus. The
strained relationship between the CDC and the federal government was further
laid bare when, according to The Washington Post, Deborah Birx, the
head of the US COVID-19 Task Force and a former director of the CDC's Global
HIV/AIDS Division, cast doubt on the CDC's COVID-19 mortality and case data by
reportedly saying: ‘There is nothing from the CDC that
I can trust’.
“This is an unhelpful
statement, but also a shocking indictment of an agency that was once regarded
as the gold standard for global disease detection and control. How did an
agency that was the first point of contact for many national health authorities
facing a public health threat become so ill-prepared to protect the public's
health?
“In the decades
following its founding in 1946, the CDC became a national pillar of public
health and globally respected. It trained cadres of applied epidemiologists to
be deployed in the USA and abroad. CDC scientists have helped to discover new
viruses and develop accurate tests for them. CDC support was instrumental in
helping WHO to eradicate smallpox. However, funding to the CDC for a long time
has been subject to conservative politics that have increasingly eroded the
agency's ability to mount effective, evidence-based public health responses. In
the 1980s, the Reagan administration resisted providing the sufficient budget
that the CDC needed to fight the HIV/AIDS crisis. The George W Bush
administration put restrictions on global and domestic HIV prevention and
reproductive health programming.
“The Trump
administration further chipped away at the CDC's capacity to combat infectious
diseases. CDC staff in China were cut back with the last remaining CDC officer
recalled home from the China CDC in July, 2019,
leaving an intelligence vacuum when COVID-19 began to emerge. In a press
conference on Feb 25, Nancy Messonnier, director of the CDC's National Center
for Immunization and Respiratory Diseases, warned US citizens to prepare for
major disruptions to movement and everyday life. Messonnier subsequently no
longer appeared at White House briefings on COVID-19. More recently, the Trump administration
has questioned guidelines that the CDC has provided. These actions have
undermined the CDC's leadership and its work during the COVID-19 pandemic.
“There is no doubt that
the CDC has made mistakes, especially on testing in the early stages of the
pandemic. The agency was so convinced that it had contained the virus that it
retained control of all diagnostic testing for severe acute respiratory
syndrome coronavirus 2, but this was followed by the admission on Feb 12 that
the CDC had developed faulty test kits. The
USA is still nowhere near able to provide the basic surveillance or laboratory
testing infrastructure needed to combat the COVID-19 pandemic.
“But punishing the
agency by marginalising and hobbling it is not the solution. The Administration
is obsessed with magic bullets—vaccines, new medicines, or a hope that the
virus will simply disappear. But only a steadfast reliance on basic public
health principles, like test, trace, and isolate, will see the emergency
brought to an end, and this requires an effective national public health
agency. The CDC needs a director who can provide leadership without the threat
of being silenced and who has the technical capacity to lead today's
complicated effort.
“The Trump
administration's further erosion of the CDC will harm global cooperation in
science and public health, as it is trying to do by defunding WHO. A strong CDC
is needed to respond to public health threats, both domestic and international,
and to help prevent the next inevitable pandemic. Americans must put a
president in the White House come January, 2021, who will understand that
public health should not be guided by partisan politics” (The Lancet).
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