CDC Director’s Nomination Is an Opportunity to Reconstitute the CDC

A window has opened to repair the U.S. Centers for Disease Control and Prevention (CDC), reconstitute it to meet new realities, and regain essential bipartisan trust and confidence among the American people. Success requires Congress to take up its responsibilities in earnest, press for key select changes at CDC, and insist that CDC be able to perform its essential duties in line with current law.

President Donald Trump’s nomination of the highly qualified former Deputy Surgeon General Dr. Erica Schwartz to become the next director of the CDC, joined by three strong deputies, is cause for guarded hope. Indeed, there may be a path forward to repair and reconstitute this deeply wounded, vitally important U.S. national public health agency dedicated to protecting Americans from dangerous biological threats, at home and abroad. That is not to deny the need for caution, however, given the turbulence that continues to roil the agency, as well as the uncertainty regarding Dr. Schwartz’s nomination path and whether she will be adequately empowered to lead CDC out of this period of crisis.

In January 2023, after CDC’s performance and reputation had declined in the wake of the Covid-19 pandemic, CSIS published concrete recommendations for reform aimed at strengthening the CDC’s capabilities and restoring public trust. That work enjoyed strong bipartisan support and the endorsement of both the public health and national security communities. Several early CDC reforms did move forward: changes in the culture from academic research to service in informing and strengthening CDC’s public partners at the state, tribal, local, and territorial (STLT) levels; faster, more easily understood communications; intensified outreach to populations served and Congress; accelerated data modernization with better technology and greater private sector engagement; and strengthened operations and field responses.

That progress notwithstanding, CDC has experienced punishing, unprecedented turmoil in the past 18 months, including the absence of leadership, the firing or departure of a quarter of its staff, the discontinuation of major databases, and severe challenges to its programs and budget, including measures to rescind appropriated funds.

Dr. Schwartz’s confirmation hearing offers an opportunity for the Senate to understand her mandate from President Trump, to hear her priorities, and to learn how she will tackle the outstanding challenges facing the agency. It is also an opportunity for the Senate to reassert its critical oversight and accountability responsibilities. Below are three recommendations to guide those deliberations and to raise the odds of success for Dr. Schwartz’s tenure.

1. Commit to a Rapid Assessment of Needs and Capabilities.

Dr. Schwartz and her team should commit to select, essential steps early in her tenure that will chart the initial path forward. There needs to be a swift, 60-day forensic study of what capabilities still exist at CDC, in terms of programs, budgets, and personnel, and what has been lost. It needs to include steps to re-establish a clear chain of command at CDC. That study needs to be matched with a parallel assessment of what the chief STLT customers of CDC most urgently need from CDC to protect their constituents. That assessment will need to be quickly translated into concise recommendations to Congress on what investments are most essential in the 2027 budget cycle to stabilize the agency and renew the essential support it provides to its partners. Several core capabilities are at risk, including early warning signals that local jurisdictions rely on, provided through wastewater and traveler-based genomic surveillance programs that were established with supplemental Covid-19 funding and have never been integrated into established budget lines. The assessment should speak to how CDC can address “Make America Healthy Again” priorities, such as nutrition, chronic diseases, and microplastics, that enjoy considerable support among the American people.

2. Restore the Credibility of the Vaccine Enterprise.

Dr. Erica Schwartz must be fully empowered—and fiercely protected—to lead the urgent work of restoring the CDC’s Advisory Committee on Immunization Practices to a credible, evidence-based body. That means affirming to the public that the CDC director has impartial control over national vaccine guidance. Such a restoration of trust will demand both patience from the public and insistence from Congress, physicians, and parents that the process be transparent, rigorous, and free of ideological capture. The damage done to public trust in the past year has been profound. A clear majority of Americans now question whether the federal vaccine recommendations reflect the best science rather than a political agenda. Recent efforts at the CDC, U.S. Food and Drug Administration, and elsewhere to suppress peer-reviewed studies affirming vaccine effectiveness only deepen that skepticism. Restoring faith requires more than rhetoric—it requires a return to the independent, data-driven standards that once made the U.S. immunization program the global gold standard.

3. Expedite an Ambitious Plan for Reform.

Dr. Schwartz and her team should produce, within 180 days of confirmation, a detailed, updated vision that speaks to the medium- to long-term challenges that CDC must meet in order to protect the country from biological threats, to adapt to new realities, to meet its statutory responsibilities, and to set a new compact with the American people. They should move rapidly into implementation. The highest priorities should include the following.

Replenish and Restructure Staffing

Restocking the grossly depleted senior talent base at the CDC with the next generation should be a top priority. It should be done in the spirit of continuing to shift the CDC’s culture away from an over-indexing on academic research to a culture of high-quality service and operations to advise and strengthen public health partners across the United States. To that end, there should be a requirement that entry-level CDC talent are embedded for an extended period in STLT offices. Overseas, CDC country offices—much like CDC investments in domestic partners—should build data monitoring capabilities, laboratories, and skilled health workforces in partner governments in order to contain foreign outbreaks and keep them from spreading to the United States.

Launch a Listening Tour

The CDC leadership should launch a listening tour across the country to learn what is on the minds of the American public, understand how the CDC can better address skepticism and serve their needs, and build a far stronger rapport and allegiance with the offices of governors, mayors, and local officials who rely on CDC funding and services. The CDC would benefit from a new advisory council comprised of governors, mayors, and local and territorial government officials. Such a council could both guide the agency on how to best serve constituent jurisdictions and cement its members as strong champions.

Rationalize and Clarify the CDC’s Interagency Role

Interagency collaboration is critical to protecting the health of the American public, and the CDC should play an integral role in receiving information from and providing support to interagency partners. To optimize the CDC of the future, the agency should request feedback from STLT and interagency stakeholders, including the Department of Defense, Department of Homeland Security, Department of State, Department of Agriculture, Department of Energy, the Veterans Health Administration, and other elements within the U.S. Department of Health and Human Services on the support they are currently receiving from the CDC and their current and projected gaps which impact their ability to protect the U.S. population from biological threats. These departments and agencies should be converted to strong allies for the CDC rather than competitors in the political and budget-making process.

Upgrade Communications

The CDC should establish a new and highly effective voice that is able to explain—in clear, nonscientific language—the most serious health risks and potential responses to them to lawmakers, state and local partners, and the public. The CDC needs to modernize its communications capabilities, while pledging greater transparency and instituting regular external, objective feedback from the general public and key stakeholders on how well it is communicating. It needs to understand how its actions and products are seen and understood across the United States—far more deeply and comprehensively than it has in the past—and regularly update its communications strategy accordingly.

Modernize Biosurveillance Capabilities

The CDC plays a critical role in the defense of the nation from biological threats and should serve as the focal point for receiving, integrating, analyzing, and providing biosurveillance data in a way that meets the needs of the general public, STLT leaders, interagency partners, and global stakeholders. It should rapidly seek out and integrate private sector technology to leverage new innovations, as well as link to CDC country and regional offices charged with carrying forward the health security agenda laid out in the State Department’s America First Global Health Strategy. Success will rest on assiduously winning consent from states and other jurisdictions to share data on a protected basis, with the promise that CDC products and analytics will serve their decisionmaking needs. Success will also depend on incorporating technological advances that have come through research labs and the private sector into CDC science and data integration approaches, including through AI-based platforms.

Achieving comprehensive surveillance and early warning will also require maintaining the CDC’s more than 50 country offices and six regional offices, partnerships with 1,700 global labs, and flagship global networks trained through the Field Epidemiology Training Program. The CDC and other administration leadership will need to sort out the currently very messy relations between the State Department and CDC around how to fund CDC’s overseas work as the President’s Emergency Plan for AIDS Relief (PEPFAR) funds decline or are restructured into bilateral memoranda of understanding. It is vitally important for U.S. domestic health security to preserve the capacity for the CDC to operate overseas and to avoid ending all funding for CDC global programs as an unintended consequence of ending PEPFAR.

A Moment of Promise

A reconstituted CDC, if adequately supported by Congress and the administration, will look and act differently than in the past, as it strives to protect Americans effectively against biological threats at home and abroad, while regaining the confidence of Americans. It can have an amplified ethic of service to its partners in state, tribal, municipal, and territorial jurisdictions. It can regain control over the vaccine ecosystem. It can decentralize its staff presence and build strong bipartisan champions among governors, mayors, and other elected officials charged with protecting Americans. It can secure the CDC’s vital global role in providing that protection. It can embrace private sector technology, while restocking its ranks with a new, fresh generation of experts. And throughout these reforms, it can communicate better, focus on connecting with all Americans effectively, and be fiercely self-critical.

Hopefully, the Senate will advance Dr. Schwartz’s confirmation hearing as quickly as possible, with the strategy and priorities detailed in this analysis. These measures offer a credible formula for setting strong priorities for a revitalized CDC—on a bipartisan basis—that can succeed in its core mission to protect the health and safety of the American people.

Signatories

Stephen Morrison is senior vice president and director of the CSIS Global Health Policy Center.

Tom Inglesby is director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

Maj. General Paul Friedrichs (Ret.), U.S. Air Force, is a senior adviser with the CSIS Global Health Policy Center and adjunct professor of surgery at Uniformed Services University.

Michaela Simoneau is a fellow with the CSIS Global Health Policy Center.

Jerome Adams is a presidential fellow and executive director of Purdue’s Center for Community Health Enhancement and Learning (HEAL) at Purdue University and former United States Surgeon General.

Georges C. Benjamin is chief executive officer of the American Public Health Association.

Richard Burr is a former U.S. senator (R-NC), cochair of the CSIS Bipartisan Alliance for Global Health Security, and principal policy adviser and chair of the Health Policy Strategic Consulting Practice with DLA Piper.

Elizabeth (Beth) Cameron is a senior adviser with the CSIS Global Health Policy Center, senior adviser to the Brown Pandemic Center, and professor of the practice of health services, policy and practice, at the Brown University School of Public Health.

Stewart Simonson is a senior adviser with the CSIS Global Health Policy Center.

Rear Admiral Mitchell Wolfe (Ret.), U.S. Public Health Service, is a senior associate with the CSIS Global Health Policy Center and CEO and cofounder of Fairfield Bio.

This Commentary conveys a majority consensus of the signatories, who are participating in their individual capacity, not as representatives of their respective organizations. In becoming a signatory to the commentary, experts affirm their broad agreement with its findings and recommendations. Language included in this paper does not imply institutional endorsement by the organizations the experts represent.