Transcripts For CSPAN CDC Director Discusses Preparing For The Next Pandemic 20220906

Really focus in on cdcs preparedness and at road ahead. Im julie gerberding, and i serve as the ceo of the foundation for the National Institutes of health. I am cochairing with my colleague former congresswoman , susan brooks, this csi commission on strengthening Americas Health security. I also served as the cdc director from 2002 to 2009. So so you can imagine that this topic is near to my heart. Im delighted to be hosting dr. Wilensky here today. Shes been the cdc director since 2020 one, but i bet it feels longer than that. Before her tenure in government, she was the chief of Infectious Diseases at the massachusetts general hospital, a professor at harvard and has an amazing track record of contributing not only to the events in the covid pandemic there, but also a long history of contributions to ctor from 2002 to 2009. So you can imagine this topic is pretty near to my heart. Im delighted to be hosting dr walensky here today. Shes been the cdc director since 2021 but i bet it feels a bit longer than that before her tenure and government, she was the chief of Infectious Diseases at the massachusetts general hospital, a professor at harvard and has an amazing track record of contributing not only to the events in the covid pandemic there, but also a long history of contributions to combating he is cochairing here on the future of cdc and cdc repaired nest, welcome tom, thank you very much for joining us. I think it would be fair to say that we are at a Pivotal Moment in the cdcs future. On one hand, i know, and i think that anyone knows whos watching closely recognizes that the cdc has to had a tremendous impact on the course of the pandemic and has done a spectacular job in many dimensions. They are showing signs of strength. Scientific rigor has been challenged. Education competency has been challenged. And political assaults have intensified. It has been a tough time. When i was a cdc director, we faced similar challenges. But what was similar then, from my point of view, the context in which these challenges were adjudicated was much different. They were operating in exceptional environment. And other major issues beside the pandemic. We have a citizenry that is frightened. Sometimes confused. And is not able to tolerate the kind of ambiguity and uncertainty that a chronic pandemic has created for them. So its really eroded the trust in all of the institutions and clearly cdc is no exception i think we want and believe that cdc remains the Gold Standard od investments so that the agency can really move ahead and not have the crisis fretting that weve experienced in the past. So maybe like tap at your two cents before we get into the heat of the discussion. You been watching it from the same place ive been watching a, from afar. Thank you, julie. Great to be with you. Thank you for all that youve been doing. I absolutely agree that this is a pivotal time for Public Health hit america and particularly cdc. Its a time where we should strengthen the cc work to secure its own future and for the country. We all know how important is to do this in a bipartisan way, and that we will only make progress if we have the support of the administration and congress. Emily also know how important this commission, and in this working group are working on similar issues and eager to learn more from you today and to hear about your plans for the future. We have a lot of ground to cover this afternoon, so we want to get right into it and make this an informal interaction with you and we are really eager to do that. We also have a small group of experts on our commission who are here with us today, who with that, let me turn back to you to get us going. Sitting here realizing that a lot of people dont really understand what cdc is and what it really includes. The focus right now has been on the urgent Emergency Preparedness part of the cdcs responsibility, but actually, it has a very important and much broader agenda. Maybe you can start us off at the fundamentals. What is the cdc and what is its mission . Again, a pleasure to be with all of you. Its a Public Health agency in public help means caring for everybody. That is what we do. We protect the health, security and safety of all that come from domestic threats or from or from abroad. We are an agency with 12,000, 13,000 people, and i think that those people are our biggest assets, and they have been incredible. As you know, cdc became the work that we do there has not really recognized what we can do beyond the pandemic. I can tell you that she repelled all of the officer to alex hoff master led a team on outbreak investigation of amyloidosis, which im certain many people have not heard of when it started to strike in numerous disparate states and it is generally endemic in a world away and he found the source of his team found the source. We had 63 foodborne outbreaks in 2021 that most people didnt hear about, but that we were charged with addressing. Weve deployed 400 people to five Different Countries to address marburg hemorrhagic fever in uganda and cbcs polio cdcs polio effort in afghanistan and pakistan. And you know, numerous covid outbreaks around the world. So theres theres so and then of course that many of the infectious threats, but the non infectious threats are a really key component of what we do. As we think about covid 19. We think about it as an infectious threat. But the people who were most impacted by covid 19 had in fact many noninfectious comorbidities. So as we think about mental health, environmental health, opioid crises and then of course chronic conditions, chronic Heart Disease and obesity. So we do have a wide vast menu of things that we are tackling in the news, youre going to hear about covid and monkeypox and polio. But what we do every day, our subject matter expertise does every day is what leverage is leverages our ability to do that. And in fact, we know so much about monkey pox because we have decades of work going on within the cdc about monkey pox specifically. Now when i see dr bester here in the audience. Dr rich besser lead our center for Emergency Preparedness and response. When i was at the cdc and we went deep on preparedness in terms of planning and exercising and investing and so forth. But i think looking back on it, we thought of it as a Health Crisis and we approached it as a Health Crisis. We concentrated on the medical and the Public Health dimensions of it. We didnt think so much about the economic crisis and we didnt think so much about the social consequences and in equities that were part of what were experiencing right now in the context of this pandemic, what that really says to me is its a whole of government responsibility. And so i guess part of the issue is how does cdc fit into this much broader governmental context and how do you negotiate your unique role and yet at the same time participate in the intraagency process. Yeah. That i think has been something that i have to learn quickly and is so key because we will say we lead with science and we do lead with science but as we make policies we cant ignore the fact that these are interagency policies. So how does our School Guidance intersect with the plans of department of education. How does our Infection Control and prevention guidance intersect with what labor is doing . Department of labor is doing . How does the Eviction Moratorium intersect with the housing and urban development. And so almost every decision that we have made in the context of a pandemic in the of the pan in the in in our guidance in our Decision Making has brought and has broad interagency collaboration important policy intersections that we have to take into account as were making these you know these guidances and recommendations. Yeah. So rochelle, just picking up on what you said a little earlier about your deployments overseas. Ive heard you say before that when an Infectious Disease crisis hits many parts of the world, the first call people make is to cdc you want to say any more about your International Work that youre doing . Yeah. I think that actually people recognize cdc for its domestic work. But i think i had my first opportunity to go abroad and weve had a lot of campaigning domestically. So i havent been able to go as broad as much as i would have liked. But i had my first opportunity to go abroad and it has been and ive been doing outreach to our 60 country directors. We have a presence in 60 countries. And truly meetings dont start in many of these countries without minister of health meetings dont start unless cbc is at the table to provide that cdc is at the table to provide that advice. When when theres a minister of health who is giving advice to a government, they want cdc at their side to give that technical support. We do an incredible amount of work in the training of the Public Health leaders, the epidemiologists, the laboratory ins the disease detectives in these International Sites in uganda. I got to see you know a staff of 160 that were called to do a leptospirosis outbreak investigation. So i think that the here in the United States its underappreciated how important it is. Our domestic our International Footprint and of course you know we now know that no one is safe until everyone is safe. Right . And so i do an International Threat very much is one that could, you know from a Global Health security standpoint be a domestic threat. And i am particularly proud of the incredible work that we do internationally. I try and stay in touch with our International Offices to our to make sure that they know headquarters is with them. And rochelle, you noted a minute ago that people may not know about the International Work. Are there other things about cdc misperceptions or things that you see every day that the American Public may not see things that youre particularly excited about . You know i think i think the science of the agency is really its just incredible and and there have been when i started and i started really learning and and mind you i am an before i got here i was an avid consumer of cdc like i knew more than the average person about the cdc and yet when i got to the cdc and i started really doing a tour of all the divisions and and centers and the work that they were doing that it was a bit of a kid in a candy store. We do that here . Vital statistics and an Environmental Justice and you know cardiovascular disease i of course knew about but the deep subject matter expertise that you know when there was this first case of monkey pox i could talk to somebody whos literally spent decades of her career working in monkeypox. I was the first person to say, gosh i dont know if theyre ever gonna find where this came from. And sure enough they did so that is the incredible work of the people every single day. And mind you we will never know their names. I gave you their names but they are not doing it for credit. Theyre not doing it for recognition. Theyre doing it because they believe in protecting our health and safety and security. So can we keep going in that direction around the work that cdc is doing for epidemic preparedness and response. Pandemic preparedness and response. Obviously in this pandemic many things have been happening and when things dont work they may be called out but theyre not always called out when things are working. And so can you say a little bit more about the things that at cdc. Even when youre looking at your reform agenda and what i think d just acknowledge that in the last 19 months, we have delivered 600 million vaccines to americans. Thats kind of extraordinary, with the vaccine safety and Effectiveness Program profile that has been rigorously studied from moms, babies and infants. That in a of itself is something is underappreciated. What it took to vaccinate, we can call it 75 of america. So, so, that i think is something we should acknowledge in terms of the work that were doing and have been doing. There have been numerous things when i came when i started as an as a admire of cbc from the outside. Cdc from the outside. I could also say that these were challenges that i perceived as the outside, our signs needed to move faster. Cdc had been long criticized for our science not moving fast enough. So how can we get things out faster . Our clearance process out faster. That was something i addressed early on equity. Clearly a challenge in the pandemic. And this was something that i know all of cdc actually believed in but we have this moment to do more for Health Equity and and actually it was one of the things that worked to boost them around most of the agency when i got there was to talk about equity to mobilize around social determinants of health around a core strategy for equity around addressing Diversity Inclusion within the agency and outside of it. Data. Im a data geek. So data has always been important to me. We launched the center for forecasting and outbreak analytics which was really important to think about innovation. Data sources. How we can project how we can forecast how we can work with our partners, what do they need in terms of forecasting. And im really excited about this new this new center also in data. You know i dont know that everybody recognized in in as an Infectious Disease doc when you report something to the cdc it was a handwritten form that you send and say this patient has measles that this patient has tuberculosis in covid it was a million a day. We were getting reports to the tune of a million a day and some of them were literally coming in by fax machine thats not a data system. And so we really went from case reporting of 187 places to 15,000 Healthcare Facilities that were now reporting data electronically. So weve really scaled up our data systems and then maybe one final because really mentioned communications and that is i started and we had a Communications Director position that had been opened and vacant for four years. We posted christ we posted it twice, we just had that higher. Kevin griffin, im really excited is now with us, but thats been challenging, theres no question. You are mentioning this data systems problem, but a lot of people dont really understand what your authorities are from the state and local level, i think its really worth emphasizing that you get data by being a good partner, but you dont really have the authority to require it. Dir. Walensky thank you, so there are two major challenges, i would say, with data right now. When is the pipe stone connect. Data coming in from one county does not connect to its own state, doesnt connect to the cdc. It doesnt match the pipes from a different state. If one jurisdiction was to send data to us, we cant send a similar jurisdiction back to see how they are doing comparatively. Thats problem number one. Problem number two is, even if all the pipes connect it, theres nothing falling through it. So, having come in in the middle of the pandemic when we had the Public Health emergency, many of those systems started coming in because, through the Public Health emergency got through the authority for the data to come in. But you are exactly right, we do not have the capacity to compel data to come in. We get it voluntarily, we did not get it from monkeypox, we are just now able to get vaccine data from jurisdictions from 64 legal teams working on data use agreements each time so that we can get these data and they are now just starting to flow. We cant make real live nimble decision when three months after a first case we are first starting to see data. So, its both of those issues. We can work on the systems issue, we need the authorities issue and we need the partnership. Because i really do want to say is what im not interested in is mandating data from jurisdictions. Im interested in a bidirectional highway where if data was to come in, we have a responsibility to get it back in a way thats helpful to the jurisdictions as well. I think thats tough because, as you said, the pipes dont match up, and just linking one Institution Health care institutions data to their local Public Health department is a huge challenge, let alone trying to construct the system for the entire country. But the idea of a data, and public houses, i think an idea dir. Walensky we are actively working on it. Its really important and you need congressional help. That that leads us to the topic of the reform agenda. I think many people are familiar with the basic framework of the reform agenda. Maybe you could just highlight what youve already done, because i know that you did not wait around for time to pass. You got started right away. Dir. Walensky we did a lot of work on the data side, we did a lot of work on the equity equity side and weve done a lot of work on the Community Side communication side. Weve done a lot of work on the laboratory side. Laboratory has been a challenge. Weve read that in the news. One of the first things that we did when i came in was to do this and try to understand, but also have our Advisory Committee and the director reconvene. One of our first workgroups is on lab. Also, a lot of work on Quality Assurance and lab, our laboratory science, our director sat down. So, we needed to have a replacement, but also being in that role, which im delighted about, and really do a lot of work on Quality Insurance Quality Assurance. Importantly, and this really will get to the core Public Health capability. We need to raise our core Public Health capabilities. Laboratory has to be one of them. They have been in layers of hierarchy within the agency and not necessarily at the top, rising to the top. So, laboratory is really important, really key. From a laboratory standpoint standpoint i will say, we developed Infectious Disease laboratory and no test believe the agency now without review. So that is something that is now in place. In terms of the core Public Health infrastructure, laboratory, data and workforce. And what i really leave is, i certainly would have imagined in 2022, in addition to covid, i would deal with a National Monkeypox challenge. If you could have predicted what i think it really does say is we need a nimble workforce that knows how to deal with Public Health challenges, whatever they may be because we dont know what tomorrows hour. So, we have a workforce, a Laboratory System and a data system that is really strong and really elevated our core capabilities. Then whatever the subject matter that is the challenge, we will be prepared to tackle it. Its a lot to do at cdc, and looking at it from a Headquarters Point of view, but i think our commission and many of us believe that is the broader systems issue in just the cdc, and that our state and local health departments, which are so critical to the front line, have the same challenge. They need data, they need confidence workforce, they need resources and a lot of other things. And we could say the same things about our schools and Public Health. These are generally among the poorest funded and resourced components of most universities, and yet, arguably they are the front line of creating Better Health protection for everyone, but we dont treat them like they are valuable treasures and resources. So, in your reform of the cdc, how are you thinking about the responsibility and the advocacy for the rest of the system . Dir. Walensky i think this is really key. I was really energized for the Public Health threat there were 200 other areas of Public Health, departments of Public Health that either filed suit or were motivated and were working in that direction also. I have since also heard that States Department of health are looking at a review of what went well, what didnt go so well the last year and a half. But to your point about workforce, i think that the Walmart Foundation did a review and estimated that our Public Health workforce is about 80,000. Which is truly extraordinary. When you think of the work that we have to do, these are folks that often left Public Health. We have a lot of folks who are retiring, people who retired and stuck it through the pandemic and really wanted to do their best, but also folks who are realizing this has been a hard job, a divisive job. Many of them threatens, so people have left. With the good news is is that the Public Health schools, the applications are up. Med schools applications are up. People are interested in leaning into this moment. I am an hiv researcher because of when i trained. That is what i wanted to do. So, i think that there is this is a time where we can energize people towards his field, but we do need the infrastructure, we do need the support from congress, from a Bipartisan Congress to say that these are valued, revered positions because you are helping others. Thank you for that. In terms of the workforce, youve mentioned this before, talk about this very eye important of workforce and responding to these positions in front of it. What is that look like to cdc . Ab people dont know how challenging it is to have people divert from their day jobs and be deployed overseas for in a bowler crisis. In the field in the United States, what would it take to get that workforce where it needs to be and how do we do that . Dir. Walensky that is a really important point. 12,000 people in the cdc i dont think many people know, during most of our pandemic response, we had 2500 who were deployed to our response. So thats like 25 of the agency at any given time that was working in our response. That means two things, one, that they had to agree to be deployed. Two, whatever work they were doing didnt stop the foodborne outbreaks. Nothing else stopped because they were deployed in the response. So, what we have to do as an agency is make sure that there is a role for everybody in our agency and their response. I call them unsung hero calls that i just call people who maybe havent been seen or heard from the work they are doing, but somebody booked all the flights for people that deployed. Up all night booking flights. That person was deployed. So we need all level of expertise. So, we have that at cdc, but we dont have everybody trained in order to do that every single day, and we dont have and incentive structure and the agency that says, you are celebrated because you deployed. And that is actually a lot of the work that i think we need to do, to set up an incentive structure to be able to say, extra something for deploying, whatever it is, factors towards promotion, whatever those may be because right now feels like you are abandoning your homework if you agree to work deployed. Thats a challenge. There is a difference between deployment and and bedding. So deployment is a crisis, and sent some people there to help deal with the problem, the other complementary model is embedding, where people are permanently detailed to serve in the Public Health department at a local level or state level or international vetting. And there have been several reports and commentaries from the cdc recently that have called for much more in bedding move the workforce closer to the front lines of Public Health. Is that part of the reform you envisioned . Dir. Walensky i think it will take resources, people and mechanisms by which we do it, but i do completely agree, and they are not mutually exclusive, to be clear. I do agree that by working in a state or local department of Public Health, you understand the local challenges. You understand how some decision that may come from the cdc result in some big challenge that happened locally and that is so much of what we need to do and eyes spend this as part of our review of partnership. That means being a good partner and listening. Again, the bidirectionality here. We are only as good as our effector and we could only help them as much as they could provide information. The first monkeypox case was not found by somebody at cdc, it was found by somebody in a local jurisdiction, it was a local department of Public Health that came in. So we really have amazing partners here. I admire your candor and your courage as you take this on. Just even being able to step forward and saying, we didnt do everything right and we have a responsibility to do it, takes the rise of leadership, confidence and courage. What i also know firsthand that its very difficult to do, and im sure that you are already experiencing some bumps in the road. How do you get help . Who are you going to turn to do to help carry this banner forward, and how can the commission help you . Dir. Walensky thank you for that. I will say i have had a lot of support to do this. For the time that im in this position, my job is to better Public Health in the country. I think we saw some challenges over the last two and a half years, and my job is to get it to a better place. Some of those challenges you know, cdc was not set up for a pandemic. It wasnt necessarily set up for an infectious threat that would touch 330 million americans, literally. We think 95 of us have gotten covid already. And of course globally, right. One of the things we need to do, having learned this lesson hard, what are the things we need to do . Ive had a lot of individual support, the agency wants to be in a good place, they want us to be in a better place. Bipartisan congressional support. There are a lot of things that i could do within the agency in ways that this review could shed a light on things we could improve upon or ways that we could change. Incentive structures that could be set up so things are at her. There are many things that have made it so that we cant and data authorities are among them, as you talked about. Human resource authorities. We dont have the capacity, we are not permitted to hire the way fema does, to draw and resources the way fema does. Contractual authorities. Even in a pandemic, how quickly so we have to complete the contract . It will take three months. What if we needed a contract in new york city to combat polio education . Do we really need to wait three months for that contract . And then paperwork, reduction act, how can we get data faster and do studies faster before the Public Health emergency is declared . There are numerous areas that would, from a bipartisan standpoint, would really allow us to be more nimble. I will do all the work i can from inside the agency, and after a little bit of grace in time, we are making these changes. Some of these challenges did not happen overnight. Changes will happen overnight either. But also to say that there are a lot of different ways as i look at the bigger structure outside of cdc on the level, we could be more nimble. Is how i know youve been thinking a lot about this, when you look at all of these reports that have already been disseminated. He must feel like you are getting a lot of advice. Dir. Walensky what are the things you are most in first interested in focusing on . I think maybe you could say more about your interest in changing culture to try to align with what americas expectations for cdc or your expectations. It would be great to hear a little bit more about that. The other thing that i think is important, weve heard lawmakers from capitol hill some of them have said we really need more accountability. You said the same thing in your talk about reform. Maybe you can say it little bit about what you are thinking about accountability. What does that mean in this case, and how do you do that . Dir. Walensky when i think about the incentive structures, we have traditionally been an academiclike agency. We have talked to Public Health officials, weve talked to scientists in my commander people. Over the last two and a half years weve learned we needed to talk to the american people. So we need to be action oriented, and our science needs to be action oriented. So if one would be promoted for a publication or for the obligation productivity, how do we promote people for their Public Health action . How do we promote people not because that publication mated to the new england journal, but because the publication lead to something on the ground that changed practice . Even if it was in some western journal. Aligning the incentives so that we now communicate with the American Public and things that are not esoteric and needy, but so that the American Public can understand, and aligning action towards deployment, towards embedding, towards other things that lead to in fact, sometimes when we implement, we have to implement differently in different places. How do you learn that what you implement in frontier america will be different than what you implement in innercity america. You do that by deploying to those areas to see whats culturally sensitive. One of the challenges i think that is inclusive and one of these local Public Health efforts in the communication challenges is the fact that we are working in a society that doesnt have high Scientific Literacy and certainly doesnt have high health literacy, and we dont need to recap all of the issues around social media, misinformation, disinformation, but that is the root cause of many of the challenges you are facing, and getting the uptake of the guidance and the recommendations and then layered into that is the political divide that sometimes amplifies that. Is that part of your communication plan . Dir. Walensky two weeks ago we released updated covid19 guidance, one was a full guidance. If you look at that and put it sidebyside from what we did in february of 2021, they look different. They intentionally looked different, they are talking to different audiences. Much of what had been in many of our guidance documents was what about this and what about that, which we kept being asked. But we could take that out and not all of those need to be in a guidance document. You can find your questions and say, what if i went here this weekend . We dont have to in bed that in the guidance. So weve been doing a lot of that. From a communication standpoint it has been interesting. We had the literacy challenge you noted. We also had the challenge that we are making decisions in a perfect time, sometimes within perfect data, controversy is always great on the news, and is if we had a piece of guidance that had 12 really important areas of guidance, and i really pretty uniform agreement, one of the 12 we didnt have all the data and we had to land on a certain place, thats the one and you could get smart people who have respect on the pros and cons. I couldve fought on either side of those pros and cons because we didnt have enough data. But thats the one that is and then of course people are confused, and that makes sense to be confused. So how do you create a communication space where we can admit, we didnt have all the information, we needed to make a decision because not making a decision is a decision in it of itself, and this is where we lean for all these pros and cons. Its really tough. Really tough. We are going to ask our audience to have a chance to come to the microphone and a couple minutes, so think of your questions and there will be one live mic here in the room. You asked before, what are some of the things that stand out as part of the challenge, and it seems from the outside, just want to check in with you, that the budget of cdc is a very difficult thing to run. There are lines that are directed from congress . Page after page after page and my understanding is that you cannot moving money from one line to the next. So when you had a large, unexpected crisis, you dont have a large sum of money to deploy for that crisis, is that true still, and what would it take to change that . Yes, it is exactly true and it really is a challenge. Early in covid, when it became clear that we needed contact tracers. Contact tracers are in our sei clinics but we have a line budget item for those in mobilizing them to do, and this is what im talking about with the Core Infrastructure. We need an investment in Core Infrastructure. We need lots of that budget to be on the people, labs and data so that those are all there, with the line items because i believe in the line items. Its not that i dont want to have every single one of those line items exist, they are critically important, but they locked a sit in a way that does not allow us to be nimble. So, the words i use our disease, agnostic resources so that today, when we have a monkeypox challenge, we can borrow from covid of yesterday, if we need to, and thats really the permission and layers that we need to do in order to get and be nimble for that is paralyzing in our ability to move forward. I think every cdc director who ever looked at the cdc budget knows exactly where you are talking about, it is completely inflexible and you have no authority to move money from one budget to another, may be a smidgen, but nothing that can support. I wrote this down, disease agnostic. This will be something we want to make sure we include in our report, for sure. Thank you. Thank you so much, dr. Walensky, for being with us. Im carl hoffman i run a Global Health nonprofit called psi, used to be in the state department. Let me just say at the outset, i think everyone here admires you, im not sure how many of us envy you because the job is really difficult for all the reasons that youve been talking about here. Let me take you back to your comments about the cdc and the very impressive overseas work. Icon as an american, of course im a beneficiary of what the cdc does domestically, and now i work and have worked in my previous life and interacted with cdc overseas and it found out to be a very rewarding as well, but its a complicated ticket of players and agencies just speaking about the u. S. Government overseas in terms of u. S. Global health. Can you say a word about how the cdc and u. S. Aid in the state department and other agency, dod for that matter, how you look at that as a collective, how you see your role in that, the agencys role in that collective u. S. Government response overseas. Dir. Walensky its a great question and im glad i can answer it because i do have a much better sense. We speak with one voice. I see the cdcs role there as critically important at the table, the forefront, but much of that is technical expertise. Teaching to its the old term , you want to make sure that you are providing the technical support, but also fostering towards independence. So, thats a lot of what we do based on our infrastructure, the teaching, and, as you say, in some countries ive seen aware this region of the country was doing covid vaccinations its being done by a, this one was being done by cdc. Other places we are all doing the entire country, but we are looking at different areas, but Laboratory Systems are not just the same. Workforce, Laboratory Systems, setting up Emergency Operation systems. Our training programs, the epidemiology and Laboratory Training is teaching the next generation and country. That is a very parallel role to what we are doing here. But really with one u. S. Voice and country. Formally with cdc. Dr. Walensky, i cant imagine what it was like coming into the cdc, running the cdc in the midst of a pandemic, you listed the separation you made as racism is a Public Health crisis and the Ripple Effect with health departments. When i look at what you laid out last week, you mentioned in the Health Equity office, and im wondering what some of your thoughts are about what needs to change at cdc so that cdc is an agency that meets the needs of all americans and that not only will the next pandemic not have this impact based on race, and the everyday issues that people face will not have such a disparate impact by race. Dir. Walensky this is clearly something, my work at hiv, is something i was passionate about. It really was mobilizing at a time when morale was really low when i started saying we will do something around Health Equity, everybody was on board. What happen was our Different Centers and divisions came together and talked about everything they were doing and Health Equity. It was one of those places where we could break down silos and look at the intersection of all of the important work that was being done. So this office will raise that. It will be an office that reports to the director. We really do want to raise up our key core capabilities. We talked about the lab in workforce and data, but also our policy, communications that equity is a really important one. Weve talked a lot about promoting a workforce that is as diverse as the communities we serve. Weve talked about Core Infrastructure and core capabilities. Also, one of the things i did early on was charge the agency with proposal. Everybody perform a proposal and i really did not want to document the problem anymore. Wherever you look theres an equity problem. We knew with monkeypox vaccination, we never saw the data but we knew it would be an equity problem. We have to document the problem but in addition, lets look at how we can implement solutions. I charge every Single Center and division with putting forward proposals of how they could address equity. Folic acid and travel nations. Everybody came forward and it was really mobilizing and they have a year to work on those proposals. We should be starting to see some of those, not all will work, but some will work in different parts of the country. Thats a lot of mobilizing work that we are doing, and im hoping we will set an example for other health departments. You have been talking a lot about workforce, and we havent really touched on the Commission Core. Could you say word about the commissioned corps and what you might imagine the future role of the core of the cdc might be . The core has been key, it has been from a deployment standpoint, most of the folks are satan, you cant pick it because we are deploying it towards our own key emissions. Much of the core lies with what the core does, the assistant secretary of health and the secretarys office, but i do believe one that is key in critically important. Other areas i want to mention, bolstering up our program. Bolstering looking out loan repayment. Our americorps for Public Health program. So then we have this opportunity with 3. 9 billion in workforce resources to the states. I think we need to invest in our Public Health workforce at the Commission Core level, but also in many different areas. Thank you im senior associate here at csis. For the first 40 minutes of the 45 minutes of your discussion we were talking about Public Health, but we didnt talk about the public at all. I was glad to hear you talk towards the end about the hard lessons at the cdc learned about Public Communications during the pandemic. Recently when tony fauci announces retirement we were all reminded in the early days of the aids epidemic, one of the breakthroughs that happened was when tony fauci and others, wasnt just tony fauci, again listening to aids activists and listening to what they were saying about the design of Clinical Trials and how Community Trials could be conducted and we could get data faster and things could really change. So, i wonder, with that in mind, could you talk a little bit about what you are thinking about how to bring their Community Place more directly into the work that the cdc does. Because thats one of the ways you will be able to really address the equity issues you were just talking about. But im just curious to know if there are advisory groups and if there are ways you could build on those kinds of models to bring those voices more directly into your work . Dir. Walensky thats a terrific question. It was in those moments that tony inspired me early on in my career. I will tell you anecdotally that i had the great privilege of being on a white house called very early in the monkeypox pandemic outbreak. Where one of the advocate said, could you imagine if we were in a white house call within a week of an outbreak that was affecting our community in 1981. And i have a phone call with Community Folks every week for exactly the reason as you note. But i think one of the things thats really important here is ensuring the community is part of our workforce. It gets back to as diverse as the community is that we serve. How we know what will work in dalton, georges Vaccine Center if we dont know with the Community Needs and that Vaccine Center. So we really do need and we need to listen, theres no question that we need to listen, but we need to recruit people in health it all of these areas. Thats what weve been doing globally. Thats what we do on the ground globally. And then i think we need to rely on community and also on our local jurisdictions to understand and recognize one of the things thats been interesting as we put Forward Guidance is to be able to articulate if somebody has a challenge with the guidance. Our guidance has to be applicable in manhattan and american samoa, and cherokee nation, and alaska. So, as we think about all the areas that are guidance applies to, we need to understand what the communities in those areas need. As we talked about wastewater surveillance or even our covid19 community levels, we needed to recognize that we couldnt use wastewater surveillance because there is no surveillance in alaska. So what is it our communities need on the ground . We have to listen to that. Public health cant work from above, it has to work from the bottom up. I really understand and agree with your premise that science needs to happen faster and good science takes time. We all understand that. But the processing of science and the communication of science is something that can be sped up. But i think most of us still believe that the cdc is it science. What goes on in the lab and what goes on across the entire agency in the different domains of Public Health. How is that signs faring while we are all focused on Infectious Disease and outbreaks . Are we doing ok and the other domains . Dir. Walensky i think we are. I firmly believe in the process. Almost everything got better because it went through the peer review process. And things that i hadnt considered were addressed through that process. The statistics got better through the peer review process. So that is still happening and it is still happening and i dont want to discount that because so much critical scientist happening at the cdc. They cant be mutually exclusive. But if i looked back to july 24, that was the day that i saw the data, it was a friday afternoon in massachusetts, and it was very clear that people who are vaccinated were transmitting delta. That changed. We looked at the data on friday afternoon, we cooperated it with data coming out of the gate over the weekend, we saw another outbreak happening at a correctional facility, we had three different places where we were seeing this and we needed to change the guidance before any paperwork got out. And thats what i mean. We need to make those data public so that when we change our guidance, people recognize this is the science around it and we wont waste peer review. We have two people at the microphone, can each of you ask your question and we will try to summarize. Good to see you. I think one of the surprising and positive up shots of what weve gone through in the pandemic is the realization that the Health Care System now sees itself a little better outside the four wall. Sees itself perhaps is having a Public Health mandate. Im wondering if youre thinking about reforms in the cdc, beyond making these necessary data interconnections, which are so critical, what are other ways that you are thinking about connecting more of that bridge that is Still Critical between formal health care and formal Public Health . We want the second question because we want to make sure we get to both of them. Center for forecasting. I wonder if you could talk a little bit about changes you are considering to the way out brake response structure that cdc and speaking about the graduated response framework where it had a response and as it rises in that scope, more and more the agency becomes involved. Are there any changes you foresee there . Dir. Walensky to your question, its good to see you again. We are looking at this, while we need some partnership between people who understand emergency response, which it is of itself is a specialty, and people understand the specific outbreak or the specific pathogen, and that partnership has an historically necessarily happen, so we are raising our response, the level of response within the og, and to the ups of the director and we are working on this now, so we are actively working on this, but we do need more training in responsive and how to be part of a response in different layers of the response in vaccine effectiveness, and how one would manage, or world starter deployed to a response. We are working on that and thinking about the structure we need to have as we move forward. That is actively happening. With regard to health care, i think you are right. One of the things i really worked hard to do when i was chief at mass general was to say that our clinic is run by the state. Why dont we talk to them very much . We need to have more fluid communication with our state labs, so we do need to foster these connections, i do think the pandemic has given this opportunity, even from a vaccine standpoint or even a case standpoint, if we had laboratory case reporting at cdc but did not have comorbidity data that lies in the hospital, how could we look at how comorbidity how could we examine that if we have vaccine data that lied with the states. A comorbidity your hospitalization rains, we cannot connected to. One of the things we are actively working on and im working with rnc right now is to say, once we get our price connected, and we are working really hard, well they connect with the ethics of the world so that we can make sure all of those systems connect . And their mechanisms by which that can help happen and i think health care is motivated by. Thank you for that. Before i turn it over to you to close it out, i do want to thank you for you being here and for your leadership and Incredible Service under really challenging circumstances. I want to thank steve morrison, whos the leader of our whole commission and he is genius at putting these things together, but also our commissioners who are here as members of the workgroup. My cochair who is preparing for her daughters wedding, so she has a very legitimate reason. In our production crew. Thank you so much for your role, and for the team that has been managing this. Quakes really appreciate you doing this and being here and open to this kind of form. What i heard today were many of the very important changes that you are planning to make around data, culture, accountability, workforce and maybe some of the unsung capabilities at cdc which are strong and need to be supported. I think you also helped us understand the kind of things that will be important in the ecosystem that surround cdc, for you to make the kinds of changes that you want to make. As this commission, as this Larger Community of Public Health, we want to be very supportive of what youre planning and engage in the process of change in the time ahead. I also think its important, since were are talking about cdc, take a moment to thank the workforce of cdc, who i think has been out work for two and a half years without a break, working weekends and nights and often at some personal health risks. So we want to thank cdc for all its done since this pandemic are going and come back to thank you for leaving it in a very challenging time, so that you very much. [applause] [captions Copyright National cable satellite corp. 2022] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. 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