caption content and accuracy. visit ncicap.org] >> 3, 2, 1. >> if you have been following pandemic related news over the past few years in the u.s., and i'm guessing if you are here or watching, most of you have been, you will notice a focus on the u.s. centers for disease control and prevention or cdc. if you looked at the headlines, you will have seen criticism from a range of publication types over the agency's response to the covid-19 outbreak.

why the cdc botched its coronavirus testing from the m.i.t. technology review in march 2020. cdc's slow, cautious messaging seems out of staff -- out of step with the moment. cdc criticized for failing to communicate, promises to do better come on npr in 2022. cnn in february of that year, the u.s. still is in getting the covid-19 data right. in august of last year, even as the cdc director rochelle walensky announced findings from the moving forward initiative, the cdc admission of dysfunction misses the big problem from national review. a month ago, post-pandemic, cdc faces a uphill battle for new congress. agency plan for overhaul, as public trust has dropped.

over the course of the pandemic public confidence in public health agencies including cdc has dropped significantly, with trust in the cdc communication and guidance breaking down along party lines. in december 2020, 70 3% of people surveyed said they had a great deal or fair amount of trust in the cdc to provide reliable information about covid-19 vaccines. by april of 2022, that number had dropped 64%, with 89% of declared democrats saying they had confidence in the cdc and just 41% of republicans saying they felt the same way. a pew research center survey shows nearly half of people said that public health agencies, including the cdc, had done only a fair or poor job in responding to the pandemic. many respondents said they felt political pressures got in the way of good policy and

decision-making for public health. the agency we know as the center for disease control and prevention was launched in 1946 as the communicable disease centered and -- center. it was charged originally with controlling malaria transmission. over 80 years, the agency has grown significantly by almost any measure, the staff, the budget and geographic footprint to name a few indicators. its mission has expanded from a emphasis on vectorborne surveillance to encompass work on hiv, tuberculosis, influenza, maternal and child health, noncommunicable diseases and occupational health. today, in addition to its domestic work, it has an overseas presence with staff in offices assisting ministries of health and responding to outbreaks, strengthening health systems and laboratories and

training epidemiologists and health leaders. the agency's mission to prevent , prepare for and respond to disease outbreaks that do and could affect the u.s. population make it a critical core asset of u.s. national security. as the cdc's pandemic related challenges deepened over the past three years, how to rebuild the agency and restore that trust in public health and science has become important questions to consider and are the topic of today's discussion. welcome. i am a senior fellow with the global health policy center. it is my pleasure to moderate the discussion today centered around a new report issued by the csis commission on strengthening america's health security called building the cdc the country needs. this report argues a significant reset of the cdc is necessary and possible if building

carried out through building actionable recommendation across branches of government and across party lines. no small task. the csis commission is a bipartisan group of experts. it is cochaired by the former cdc director and current cd -- ceo of the foundation of the national institutions of health and by the former congresswoman from indiana susan brooks. in august, the commission launched a working group on the cdc to consider the following questions. what are the most important near-term steps that will drive a significant reset with cdc, within cdc, as the agency continues through a period of heightened pressure and scrutiny? what concrete messages could cdc and stakeholders take to improves -- improve performance and regain trust across political divides? what steps could the agencies take to be more flexible and

accountable and better equipped to respond to the uncertainties of emerging and evolving infectious disease? what kind of actions would be needed in organizations that oversee, fund or partner with the agency? the commissions working group was cochaired by steve morrison, director of mobile health policy at csis and joining me on stage, and by the director of the center for global health security at john hopkins university. they released a report endorsed by nearly 40 working group members, that contains a series of recommendations focused on clarifying the cdc's core and global missions, and enhancing congressional and executive dialogue on the future of cdc, and changing the way the cdc carries out operations to ensure timeliness and action orientation. in many ways, this report is a

capstone of the four year commission on strengthening america's health security. it had its last meeting decembe. as the commission winds down, the report also turns in many ways as a bridge to the work of a new bipartisan alliance of health security, which will be launched later next year. you will hear more about the bipartisan alliance in the months ahead. briefly, it will carry on months of the commissions work. it will integrate a focus on hiv, routine immunizations, antimicrobial resistance and other important topics in the years ahead. for today, we have a busy agenda. first we will hear from the commission cochair. they will offer their reflections and insights on the report. next we will turn to steve morrison and tom inglesby to discuss findings and recommendations. then we will have a roundtable discussion, bringing in the

president of the covid collaborative, the former director of the cdc and president and ceo of resolve to save lives joining us virtually from new york, and the chief medical officer for the state of alaska and president of the association of state and territorial health officials joining from alaska. and they are joining us virtually. we will have a hybrid of discussions and towards the end of the event, we will have time for westerns and comments from the in person audience today. julie, let me turn to you and invite you to offer thoughts on the report's findings and what you see as critical steps in the road ahead. thanks for joining us from europe. >> i thank my cochair susan and stephen and tom for incredible leadership in pulling this together with such robust input from so many wise people. it was a wise crowd who came

together, thoughtfully, and every effort was made to provide a balanced perspective. i really also want to thank the cdc, dr. walensky and the team who contributed a lot of time to go deep into the data and help the work group understand some of the nuances and subtleties of what was going on behind the scenes. and the on dissed -- honest and candid way, they laid out an appraisal of what they learned through their internal review of what is going on in the agency. i had several conversations with cdc leaders and we couldn't have had a balanced report if we didn't have the broad perspective. you laid out the big picture. we all see the need for a reset of the agency.

some of the reset has to be structural, some of it needs to be activities that only congress can really manage. that has to do with how the budget is structured. that has to do with how the budget structure is decided and modernization. we will be looking at how the cdc can take advantage of data science and the opportunity to build better data systems, more into-operable data systems and really complete the trajectory with the data modernization act. stepping away from the actual content of the report, which we will go into in more detail, i do really want to emphasize while there is opportunity here for evolution, modernization and performance improvement at the cdc, it has also done a lot of things well and we shouldn't lose sight of the fact that in the midst of the pandemic, there were many other public health activities going on. the cdc teams were employed all

over the u.s. and internationally to assist with response efforts. the cdc foundation engaged 3000 or more people to help the workforce shortages and so forth. there were lots of very positive things that happened and we need to make sure we don't throw the baby out with the bathwater when we look at the critical things that need to be fixed and appreciate and respect what our public health system has been able to accomplish for the past three years. it has been a daunting challenge. while we had our own out breaks to deal with, the scope and scale of the pandemic was orders of magnitude more complex. thank you for that. as i turn this over to susan, i want to thank her as my cochair for the wonderful experience for me to be able to work for her over these last couple years. >> susan brooks, as cochair of the commission, you have wrought

your perspective from serving in congress during the first stages of the pandemic as well as your perspective from serving on reviews and the perspective from indiana. what do you see as priority action for the cdc reset coming out of this report? >> thank you. i want to thank my cochair, julie. i have always been amazed not only by the depth of her insight and her knowledge about whether it was the cdc, the nih, anything to do with hhs, she has been a champion of public health, a champion really for all sectors of our health care system. as a lawyer and a member of congress, we rely on people like julie, people like doctor inglesby and all of those people

to inform us. my role in this commission has really been a reminder to all the experts that have been a part of putting this incredible, important report together. to remind everyone of the importance of educating elected officials at all levels of government, from local elected officials to state and federal, because all the incredible experience you bring is not most -- what most of us know. citizens take so much of this for granted until our country or our communities are presented with these incredible disasters like the pandemic. so i just finished my service, as well, on our governor from indiana, who had a public health commission to really look at the public health in the state of indiana. i must say that the work of this report, and i want to commend

tom and steve for the really aggressive steps they took to get this report done and the number of really incredible experts they brought together to the report. now, the goal is to get the report before members of congress, new members in particular, members that have been engaged in these issues because as jew he said, congress impacts public health. this will be very important and with the new congress, that we do this education, this report is a fabulous tool to help the cdc tell the story, to help all of the stakeholders around the cdc tell the story, explain what needs to be done and the reset that is very much needed. not only at the federal level but at the state and local level, as well. public health really needs a reset, as i have seen here at home in indiana as well as in the country, and i want to

commend csis and the leadership of steve and really, for bringing this together and getting this report going. congratulations and i look over to hearing from our experts today. it has been my honor to serve. this is one of the most important pieces of work i have done in congress and i'm proud to support it after i left and i will continue to. >> susan and julie, thank you for your leadership as cochairs of the commission and for supporting the work of this working group. steve and tom, congratulations on the release of the report last weekend the arrival of hard copies, for those of you who are in the room, to be able to look at the report in its final form. you write in one of the first chapters of the report that at present, cdc is not equipped to be highly effective and reliable within the u.s. government, at home and abroad, that americans

need and rely on for rapid disease detected in and containment. can i ask you to discuss the origins of the working group, the process of consultation and how you arrived at this conclusion? and the main recommendations? then tom, i will turn to you to say more about where you see the reforms and the proposals moving in the near future. >> thank you for taking on this role today and thanks to all of the members of the working group and the commission that are organizing this. it note of thanks -- a quick note of thanks to people who contributed to this effort and our activity today, michaela on our staff has really been exemplary in moving this forward at every step of the way and deserves special thanks.

our research associate, also very integral to our success. i want to second the note that julie made that cdc leadership was very generous and forthcoming with us, and that enriched the quality of all of this, all of the work that we did here. we are very attuned to what susan said in terms of trying to reach members of congress. we have a plan. we are itching out to those -- reaching out to those within our staff who are directing our congressional relations effort and others, and we will be aggressively doing that. to the question around the origin of this, the commission has been ongoing since 2018. at different moments during the course of the commission, we visited the issue of -- i think

when we met back in june, we had a commission meeting june 14 and we tabled the idea and said the storm clouds are forming. criticism is coming from multiple directions. this will not get better. it is important for us to take this on in the right spirit and with the right focus. i will say more about how we went about the business. too much was at stake. america cannot or do to have -- afford to have an agency that is not able to perform at the highest level to protect all americans. that is cdc's mission. that is at risk. it was in that spirit that we got consent within the commission to proceed in this way, and we launched at the end of august, it was an intense surge of effort. we have four full meetings, two

rounds of edits of the report you have today. this was somewhat record speed for such complicated enterprise, but we were able to drive it forward in hopes we would have something as the new year opened that could be a source of serious consideration within the administration, among state and local authorities and the broader constituency. we had a surge of activity with many private consultations, senior ranks of the white house and other executive ranch agencies, serving governors, former governors, leading members of the truck, obama and bush administrations, and many of those folks are acknowledged. we deliberately composed this working group as a highly diverse and broad group. we have several cdc former directors, heads of other public health agencies.

have those who served in senior additions in republican and democratic administrations. those who have authority at state and local public health levels. world public health, world industry. our operating premises are that this is a serious problem. the decline in performance and trust and confidence that catherine referenced, and action is needed to reverse course and reset. the current situation is a matter of national security. this is not something that is a side issue that we can afford to live with. it is antithetical to u.s. national interests, and it is not good news. if we wish to protect all americans reliably in this period. we will hear about data, communications and guidance, the

global mission, partnerships, including state and local authorities and the way in which the cdc itself operates within the executive branch and with external allies and partners. this is not an encyclopedic effort. it is focused on pandemic preparedness and response and it is intended to help start a reset. we proceeded with the view that we had to listen carefully, focus on what the core problems are and come up with concrete and actionable solutions that can attract support across the aisle. it had to be bipartisan in nature. the accountability, equity, speed and transparency, and better communication -- these mean different things to different audiences. we needed to be sensitive to that reality and listen carefully to what that meant. as we thought about what the concrete solutions are, this is

not an easy task we have taken on. it is politically charged, as we know. it is also many different complex issue sets that don't lend themselves to easy solutions. bipartisanship remains fundamental. it has been fundamental to the existence of cdc over the ages as well as other public health institutions and it will be essential to the solution as we go. we have said much of the solutions lie within cdc costs leadership choice, but much of it, the majority of the power around reaching solutions, lies outside of cdc and we need to focus on that and forging a combination around white house, secretary of hhs, sigg year -- senior figures in leadership and both parties. we make the reference that when

nasa stumbled badly in 1986 when challenger exploded, when fema stumbled into thousand five with the katrina debacle, there was a rally across party lines and institutions to devise solutions and come up with a multiyear plan and execute. these lessons are relevant today as we think about the path forward. we could not have gotten where we are today without tom inglesby. he brought a remarkable depth of knowledge, expertise, and a sensitivity to the nuance and complexity of these issues. i'm grateful for all you have brought to this. i think we would be at a different point were it not for you agreeing to join us in the way you have. so thank you. >> tom, you are back at johns hopkins at the center for global

health security but you completed service in the administration at health and human services and within the white house. i wanted to ask you to reflect on the recommendations in the report, drawing on your perspective. what are you optimistic about in terms of where change and reform can be carried out in the short to medium term? >> i want to say thank you to the csis team for inviting me into this process. i have great admiration for the work that you have been doing and it is a privilege to be part of this process. i want to echo what others have said, which is, i start with the greatest admiration for cdc's mission and people and we have to acknowledge what that organization has gone through and the pressure it has been under. we need to think about what we can do from the outside to strengthen this critical national and touche and.

-- institution. we undertook this study with the hope of being able to help in the reset effort that cdc initiated and we are hoping propel and provide momentum. a few words about the priorities that came out of this effort and what we recommended, and then we can think about the overall context. at the highest level, the recommendations break down into strengthening and clarifying, integrating the mission, making sure we are on the same page around the community, around its mission as opposed to other missions in government and out. improving accountability and strengthening operational accountability. when you think about the particulars, the first area around mission, even now after the country has gone through this searing experience, there

is still a lot of misperception around what cdc is charged to do and what it's sister agencies are responsible for. for example, there is policymaker and public misunderstanding about what the cdc should have been doing around contracting with the private sector, or around moving or distributing products around the country. we know other agencies had specific responsibilities to do that. when we think about strengthening the cdc's mission, keep in mind what its unique capabilities are and what we are asking it to do. we have to think about its critical role internationally. other agencies work internationally. they have been some ways many more processes in place that they should have for that work, and we need to make sure cdc has the staffing, hiring

capabilities, the processes, the cultural training afforded to other agencies that work overseas, and make sure that is available to cdc as it does its critical work. when embassies overseas get emergency calls about new outbreaks occurring in one country or another, the first call they make is the u.s. cdc and we need to make sure the u.s. cdc has the people in place, the assets, the tools they need to respond to those urgent calls. thinking more about, moving towards leadership and accountability, steve referenced the importance of this administration and future administrations and congress being on the same page. we called for a highest level dialogue about the future of cdc. the purpose of the recommendation is to recognize, as steve said, the power for much of the change that is needed in cdc rests in congress

and hhs leadership and the white house. if we want cdc to do big things going forward, to think about its mission and accelerate and strengthen operational capabilities, they will need help from power centers in washington. we have called for that dialogue. cdc is a critical participant but it can't do it alone. thinking about the experience of the last few years, one thing i think cdc has been criticized for is its guidance development process. one thing we talked about in the report is the importance of cdc being able to reach out to the private sector, state and local agencies as it moves quickly to develop guidance around emergencies. that is easier said than done. want cdc to move quickly but we are asking them to test feasibility and get input from outside the federal government.

it is important for us to recognize some of the things that happened during the pandemic around, for example, the economy or schools, we need to make sure the inputs around those decisions are also not just cdc's alone to make. cdc has extraordinary capability but they can't be responsible for all of the decisions that have impact across society in a setting like the pandemic. it is the federal governments to fix, how we think about guidance developing in crisis. rounding out recommendations, we called for a strengthening of cdc's presence in washington. cdc is in the lineup for reasons catherine described, but that puts it at a substantial disadvantage in terms of easy access to policymakers, interactions with federal agencies, that kind of collaborative work in the

federal government is going on every day. to has -- to have cdc two hours away by plane, it needs a substantial increase in the footprint in washington, the ability to interact and respond to all the congressional inquiries and requests and make sure congress is in the dull times with what it needs to know. we called for increased washington presence and strengthening cdc's partnerships outside the federal government. that means tighter relationships with state and local agencies. hopefully, tom wolf say more about that. that means embedding cdc experts in local organizations where they can do good, they can learn from each other at the local level and bring expertise back to the cdc and make it more of a living partnership between federal, state and local entities. we think cdc needs to make sure it is able to reward operational

excellence in the way it already rewards scientific excellence. cdc needs to recruit the best scientists in the country and maintain the reputation for scientific excellence, but it also needs to increase its ability to respond quickly and that requires different skill sets in addition to the best scientists. we need the best operators in the country working at cdc so they can respond immediately and get into the field in crisis. finally, the last two things i would say and then we will move onto other parts of the conversation, we recommended a real focus on increasing the ability for cdc to gather and organize data from around the country in crisis. we expect cdc to have moment to moment understanding of what is happening across the country and deliver that to policymakers and the public. we don't have, cdc does not have the authority to do that, does

not have the authority to get data from the rest of the country in that way so we need to change the authority around the relationship and that also comes with contracting authorities that are present in other agencies of government, but haven't been afforded to cdc. a transaction authority is one kind of authority that other agencies have had but cdc doesn't. we need to give them those tools if we want them to move as quickly as i think we all do. finally, back to the budget, the cdc's budget is in 13 different treasury accounts. it is 160 specific different lines. they don't have the flexibility to move things around in crisis. we have asked in this report for congress to consider a real change in the way they provide budget flexibility. director walensky has called for this wisely unapproved times

over the past year. -- a number of times over the past year. the final part is making sure cdc has the flexibility it needs at the start of a crisis. there is a fund created for that purpose, but that hasn't been provided resources for cdc to do the work. at the beginning of any crisis, cdc has to really struggle to get permission to spend money in ways they need to, to get out in the field. that is a quick wrap up of the different categories of recommendations we made and hopefully we can go into it in more detail. >> this is a big agenda for the round table discussion. budget, communications, data, state relationships, the health workforce. there are many different topics we can get into. we have a wonderful panel of experts who can help us get into these. i want to start with a question about data and the cdc-state

relationship. many of the recommendations center around ensuring the cdc has access to the most accurate, up-to-date data to guide forecasting and decision-making. the omnibus bill rises the cdc director to continue activities for forecasting of public health emergencies and outbreaks. it refers to improved collaboration among federal departments and it even directs the secretary of hhs to help state localities, territories and tribes that have leveraged public health data. and approved public health arrangements. it stops short of mandating states and localities provide data to cdc. we see a great deal of tension and variation in practice between states and the federal government when it comes to sharing the data. i want to start with you, tom.

you are the former director of the cdc, now in new york and you have been in new york in the past. bring that perspective from the agency and the regional perspective. does cdc need to reach out directly to states, governors and others, to initiate a better and improved relationship or dialogue about the use of data? the report recommends congressional executive dialogue. could this be, what could this accomplish? >> i think this is an important issue. it is not straightforward. when it comes to legal authority, you will have controversy and some misconceptions and maybe some politicization with the issue. you have already seen that with vaccine status, for example. that will have to be delicately addressed in this hyper-partisan

time we are living through. we are very -- have very sensible measures to share risks that they be multi-state. it may be difficult to establish. i would hope for more progress in this area and the doctor and i and other former cdc directors have talked about that. realistically, it is hard to imagine that getting through congress anytime soon. barring that, the broader issue beyond data, including data, is the public health enterprise, the connection of federal, state, city and local health departments. often, it is not well aligned. this is something that in my eight years as cdc director i tried to address. we made some progress but more progress has to be made. as i think about it, if you look at the broad scope of history,

it used to be until around 20 years ago, almost everyone in leadership positions at the cdc, especially on the administrative side, spent a few years, often five or 10 years but at least two years, working in a state, local or city health department for various reasons, that was discontinued. you now have people at cdc not having actually worked on the front lines for a prolonged time. that is important, because the result of that is sometimes a lack of speed and practicality. not because people aren't smart and dedicated, but because they don't have that multiyear experience of dealing with things at the local level. i was a commissioner in new york city for nearly eight years before becoming cdc director.

that gave me a unique vantage point. that is the case for really the range of public health programs. one of the most important things i think cdc could do is increase hiring of people who have spent a few years on the front lines at the state and local level, and greatly expand training programs the cdc has like a public health associate program, which could easily double, triple in size or more. over years. more and more of the leadership of cdc will have spent time at state and local levels and will have that shared vision. having thought about it a lot, i think that is extremely important. that bound the budget issues are probably the two most important issues to try to strengthen the cdc's functioning in this country. >> thank you. let me turn to you.

you are in alaska and have been working with the association of tribal and territorial health officials. when you think about the state and cdc relationship,, tom proposed increasing that and -- is that either an early career cdc offices at the state level arguing for greater financing for the health work force help create a more positive state-cdc relationship around the data it seems and what are some of the other areas of tension you have seen that could be resolved? >> thank you for the question and the opportunity to be here. thank you for including state and local government and territories in the process. we are the united states of america and we have a federation of states that come together to make our system.

i appreciated the report said the power to make changes lies outside the cdc. that is in its relationship to the states that have a lot of power on datasharing. those are limited as well as enabled by local governments and local decisions that are made. i appreciate the early recognition in being able to provide a state perspective. i have been honored to serve in this position throughout the pandemic and the relationship between state and federal has been a success and a challenge. i think most local and state public health officials have good relationships with cdc people and we want to do the same thing. we want to work well together and have good relationships. i see four major limitations. one is state laws. many times state laws prohibit us from sharing data. the second would be the use agreement highlighted in a report. i would say data governance.

the way data is used by federal agencies and placed back towards states needs to reflect on the ground what that looks like to make sure people see themselves within the data. i love the quote about, everyone wants to see the me within the we of data. we have a diverse state and country. what looks good in new york may not be useful in alaska. making sure we have valuable tools that allow us to get the data that is there, just like the weather forecast in new york isn't going to be health them alaska today -- helpful in alaska today, there are similarities implementations and we need -- and limitations and we need to take that into account. data entry, this gets called out. we hired national guard to enter one positive covid lab into the

data systems. our ability to share data wasn't a lack of will or interest, it was physically people entering them into different systems because the systems don't connect. back to the budgetary things that have been highlighted before, if we have limited and controlled budgetary line items for cdc, they create their own individual databases and states have to enter it into different databases. i might have someone who is covered positive and hiv positive and working through, and we are entering them into different systems. politics and public health are based on people and that relationship, i think susan called this out at the beginning, the comments about the way we make sure we are accountable and communicate and partner with local, state and federal authorities. i think that will help change state laws and increase the compatibility. just making sure we are doing

what we can to standardize, you mentioned the funding needed to create the infrastructure, i'm a practicing emergency medicine physician and i tell my colleague if you think hospital is bad, try state government. we need to think about health care partners as partners. what ways can we learn from our colleagues and partner with public health? building the workforce, i think to your question, what it be helpful to have more cdc members in states? yes. it would be helpful. it makes a world of difference when you were working with someone at cdc who understands the challenges and limitations you are going. as mentioned, we need funding sources to create a whole picture. it is great to see the report

call that out so i want to thank report for diving broadly into issues and coming up with concrete recommendations. >> thank you. you have highlighted the importance of data and standardization and modernization and the challenges that exist around legislative differences. it is not just a budget issue or a matter of political will. there are legal differences among the states and federal government that need to be overcome. i want to turn to you, you are with the covid collaborative, which was started during the pandemic to address and improve outreach and advocacy around the pandemic response. the report points to the reformer -- reform or overhaul of federal agencies like nasa and fema, nasa after the challenger and fema after katrina.

that is evidence that a reset or rebuild of a federal agency as possible. the report acknowledges those cases were higher recognition, acknowledge and -- acknowledgment of the problems, and we may require close communications with congress on the public and multiyear commitments to move those agendas forward. what would it take to launch an initiative of that scale for cdc? what would be the optimal timing for moving a rebuilding agenda forward? >> in terms of timing, there is no time like the president -- like the present. the issues are urgent and it is an issue of national security. i'm not sure those are the best examples. i don't know whether nasa is an example of successful culture

change or the posters -- child for how difficult culture change is. we have the apollo one disaster in 1967, less than 20 years later you had challenger, less than 20 years after that we lost columbia. this is hard work. it will take an enormous commitment on the part of cdc. it is getting to where we go, it is a two way street. the report points out, and folks of mentioned -- have mentioned, the majority of the power lies with congress in terms of the new authorities the cdc needs. the authority to collect data so we can mount a successful defense and target inequities. budget flexibilities, resources

to where they are needed most, hiring flexibility so cdc can attract the talented needs going forward. frankly, i don't think congress, especially republicans, are going to be eager to put new wine in what is perceived to be an old and broken bottle. i think it is up to the cdc to step up and first own the failures of its own making. everything from the about face on masking to the debacle over testing, to the inability to produce swift and clear guidance to the sometimes breathtaking lack of humility and transparency in the face of scientific uncertainty and a per nisha's virus. -- pernicious virus. we need to address those with

reforms. what we learned from nasa and fema is that cultural arm -- reform involves newport rarities , -- new priorities and people in the systems to support those. what the director said is, she offered a public me a call but -- mea culpa and initiated the internally led investigation to change the culture and reform the agency. that is great. if that results in nothing more than moving some boxes around on an organization chart or tinkering at the margins, it will be dead on arrival. by the same token, if congressional investigations are nothing more than a witchhunt, that is not going to make americans any safer, either. we need to fix the problem, not

the blame. i think that is the tone of this report, and the report calls on, as pointed out, a high level dialogue between the executive branch and congress. i think that is the path forward and i think the report can lay the foundation for that. >> you pointed to the potential for executive congressional dialogue and the importance of operational change or operational reform. julie and tom, i want to go back to you. you have direct experience in this relationship with washington. the report points to the challenges cdc, which is located in atlanta, has for undertaking these types of dialogues and making the case for its work. as the report recommends, cdc can deploy more policy related staff to represent its capacities and achievements and

interests. but should it relocate to washington in order to better make the case or have a new building or something like that? and how can, susan, i want to bring you into this. what more can cdc do in this relationship with congress to demonstrate it is up to the task of improving its performance and delivering results in a timely manner? tom, let's start with you and then julie and then susan. >> i think the likelihood of relocating and agency with thousands of employees and billions of dollars in buildings is zero. the necessity of strengthening its presence in washington is definitely there. as cdc director i calculated that i made over 250 trips to

d.c. from atlanta, basically to answer questions, testify and ask for more resources. that national center for health specific susan maryland, in the d.c. area and there is a washington office. but to be stronger -- it needs to be stronger. it is a structural week this that the cdc -- weakness that the cdc is not there. hhs and congress and advocacy groups are in the kind of force needed. there are a few ways to do that. bottom line is, you have to show up and you have to be there. hundreds of trips don't replace having high level staff there, getting to know people. when the director mentioned in the past quarter he has had

lunch with every single congressional staff member on one of the committees that authorized or funded it, that is one center but i haven't on that. no one at cdc has done that for the agency as a whole and that is the kind of thing that has made it. >> you can think about this on multiple levels. when i started as cdc director, the washington office was in the hump rebuilding and a decision was made without consultation that perhaps the cdc should be moved someplace else. so it was moved to co-locate with the headquarters, which is a few blocks away. but a few blocks away from the hump rebuilding, you might as well be on a remote island. for some time we were able to maintain a physical office on the humphrey building, and i was able to rub elbows with the secretary and other leaders.

that was critical. i could have lunch with them and interact at an hhs level ending age with my colleagues. that helped with a number of collaborations so when we were in response mode with whatever emergency was occurring at the time, i could operate just as easily. the operations center has been in atlanta and i was specifically there. your time was right. as a broader presence in washington, you need a strong leader, a deputy of the cdc to manage washington's presence in a strategic manner and develop the relationship with the whole of government, including the white house and congress. it is not possible to do that by flying people out occasionally from atlanta. the broader issues washington has is more than government. there are surroundsound opportunities that i'm sure the pandemic is part of that, i'm

sure dr. walensky has struggled to interact with the broader policy environment in d.c. and interact with the broader stakeholders and constituents, who have helped the cdc in many ways in the past. if you want to play, you have to be in the game and the game is not played in atlanta unless you are a fan of the baseball >> i think the structural issue is important. i think is a good opportunity to make the point that what we need in the government is the whole of government. and i think back to the incredible and intensive effort that cdc makes to exercise influence, a big part of that preparation and effort was coordinated by the white house, every cabinet participated.

cdc has very clear understanding of what its mission and role was in context of the operating plan , at that point in time. somehow through the years there has been a dissipation of that clarity. the mindset about what it would take, in order to manage the pandemic for more than just the public health perspective was diffuse, over the years. so that even the cdc performance have been optimized. there was still a great deal of lagging, and other areas. what to do about economic support for people. what to do at schools. having a whole of government, with cdc included in that conversation i think is one of the frameworks, for how we should think about how to defined the public health system in the context of public health emergency. another time we can talk about why that would also be important for a number of other public

health issues, as well. it shouldn't be hard to accomplish this. but it will take a realignment of the center of gravity and a lot of work on the part of the buildout of the washington office, so that it really can be more than just a small handful people. >> thank you. susan, let me turn to you. you mentioned earlier, the importance of educating congress about the public health and health security issues. we heard about the potential for increasing the washington presidents and cdc, in order to better engage for some of those congressional offices. gary emphasize the importance of bolstering an executive dialogue on the cdc. what d.c. as a potential for moving dialogue around cdc?

what will it take to really enable the agency to make its case? particularly, people who are new, who are learning for the first time? >> first of all, i want to completely agree with everything everyone has said. as a fairly recent former member of congress, the only reason i went to cdc one time was because i was at a speaker at another conference in georgia, and atlanta. that representative rogers had on the opioid crisis. i realize that here i was working on cdc related issues around pandemic repaired miss. i had never been invited. i did not know much about the cdc operation in atlanta. i was overwhelmed when i took the tour. i had had similar tours of other agencies.

of the nih, of aspirin barda. don't think you can understate the importance of actual site visits and understanding the magnitude of what government officials are trying to do, and these agencies, and having those types of visits are very important. i think we can never understate the importance of educating our staff. the what tom just talked about, relative to an agency that did a great job educating the staff, the staff, members of health and senate both are the ones that chili dig deep and have the time and are the ones you need to find, who are most interested in these issues. because they are the ones that really tf -- t up the agenda. so developing this relationships

with our staff are critically important. i will say. i completely agree. there needs to be a much stronger presence in washington dc by the cdc, rather than just the hearings that they appear before. yes, there are going to be hearings. i certainly hope they are not fetus witchhunts. they will be asked if the call questions about what we just went through, with respect to the pandemic. i think it was explained so well. all of the different positions that were taken and why they were taken. and why there appeared to be so much uncertainty and lack of readiness, when it take to -- when it came to the testing, the math. those are issues i think the american people want to know the answer to. they want to understand that her -- they want to understand better.

i think it is important that when meetings happen, that they are bipartisan. that members are identified who are really interested in these issues and help educate them, at the same time, democrats and republicans together. those were often the most effective site visits. it is incumbent on the images -- administration. so what julie was saying about cdc being in the mix of hhs, there is a lot of jockeying, within hhs which find its way to congress. i certainly saw that. you might have champions of different agencies or different agencies within hhs. those things often make their way, really grinding out those difficult pieces of legislation.

most importantly, those difficult items, with respect to their budget. i would often, quite frankly, leiser was a lawyer, medical profession owners -- professionals are growing. those who are not often look to medical professionals to give us that advice. certainly, starting with anyone who has been in public health who has been in the medical profession. i think those are the ones the members of congress should start with. we have a caucus on the republican side. there are a number of medical professionals on the democrat side. the georgia delegation has the best of interest to make sure cdc is strong and continues to have that presence. you are knocking to be thousands of folks from atlanta. i completely agree with tom. that allegation is currently important. those are my thoughts about how we can take this report and a

lot of great solutions and ideas , and put them before those members of congress in a bipartisan way, to put some of these recommendations into motion. >> thank you. susan has emphasized that all of the importance of education, and the potential for an enhanced dialogue between congress and the executive branch, but also raised the issue of communication. i want to turn to the issue of communication for moment. the last three years, we have seen an explosion of disinformation and misinformation about covid, about the pandemic, about cdc, about any number of issues. it has been amplified across social media and has served to undermine safe and trusted scientific methods and evidence-based guidance. addressing rumors and conspiracy

theories is not always just a matter of providing additional evidence and a scientific paper. it has to be acceptable and appealing, and the same way that the conspiracies and rumors might be. i want to turn to our panelists. but me start with you, if i could. i will ask for your reflection in terms of the capacities that are required, not just by cdc, but by a state and local health authority to address some of these information -- issues on disinformation and misinformation and make sure guidance is available to people, in a way that they can appreciate it. >> i appreciate that. i can't think of a topic that is more important. the end of the day we can come up with amazing science. we saw that with the vaccine. if someone doesn't trust it over to take it, it is not effective. if you don't trust the science

or data, you are not going to move forward. a couple of things i breakdown in communication, medication is built on trust. trust is accountability as well as your committee case and. this is a huge challenge from estate perspective. i think dialogue needs to continue to happen and finding ways to provide timely resource, rich information that make sense for the public, as well as having a dialogue in a state and local level with the cdc and say why did you make this decision. we don't understand this. that allows us to go back to her constituents and say this is why the decision was made in this is what you need to know about it and this is how you can do it. when it's just this is the way it shall be, it becomes hard to come indicate that. that is why the robust communication is happen. it allows a 28 -- a to wake medication.

-- a to wake medication. if you look at the data between health care providers, it could take years to get change in practice. how do you treat a heart attack? when you have something like a pandemic moving quickly, you you don't have really good systems to learn from what's happening to understand what vaccine resistant strains we are seeing in have any people are being hospitalized because of x, y, and z. we don't have that distant within our health care. we also don't have great ways to communicate with our health care providers. there's a lot of education that can access. that individual person relationship with your health care provider is fundamental, being able to understand and individuals person's health, and the choice to be to make on an

individual level. there's a lot we need to do to the relationship between health care, as well as public health. there is so much more work to do along those lines and making sure that communication is to way, both with the public, public see -- policymakers, large agencies and agency so we can understand the why and we can explain the limitations and weaknesses of the decision, so that those of us on the ground try to action that decision have it meaningful and make sense. i appreciate the focus on it. >> thank you. let me turn to. you are working very closely on the covid testing and treatment issues earlier, last year. and in 2022. i know the challenges of communicating about changing guidance.

in terms of thinking about what cdc needs to better to indicate with the public, where do you see the best opportunities for improving the agency's ability to carry that out? >> i think even in the course of the pandemic, that within cdc, there was a recognition that a lot of the communication efforts that go on within cdc were aimed at speaking to professionals to health care providers, to public health agencies. it underdeveloped a portion of the communication effort. cdc has begun to reassess the way it does large-scale communication. that is dependent to -- on the power outside of cdc. if you look at the team that ddc has, we expect it to be able to communicate to the public, to all of the technical community,

to congress, policymakers, to the credit sector. it is a huge responsibility. to throw in that critical area of challenge, misinformation and disinformation that is happening all the time, that is a substantial set of challenges. i do think cdc, to the extent that it has the assets in the contracting authorities, could really use private sectors and partnerships there. we have lots of communication technologies that are blossoming around the u.s. in the world that cdc can take advantage of. there were examples within the government about successes. for example, the testing world there was the example of the program that provided testing for the public, through the u.s. postal service. the driver of that program was, this is to be directed at the public, as simple and precise as

possible. i think it was commented on by wire magazine, the cool kids are back in government. it is possible for the government to be a sophisticated communicator. we need to make sure they have the right partners, people, and technicians to do that work. >> so it's not just medicating with professionals -- so it's not just communicating with professionals? >> it is an additional strategy. >> thank you. data, congressional dialogue, communications, addressing disinformation and misinformation, reforming operations, building staff in washington, this requires budget. a greater budget. tonya and you mentioned that budget is highly fragmented across multiple treasury accounts. there is little wiggle room for responding and pivoting, and the moment of crisis. gary, let me turn to you for a

second. the reports underscore the many challenges cdc has faced in the pivoting challenges. in the current context, how difficult do you think it will be to gain budgetary support for this proposed reset agenda that we have been talking about, that the agency itself is beginning to undertake? and do you see -- are there any cdc low hanging in terms of bipartisan consensus and secure funding in the new term? >> my guess is that it is going to be easier to get the budget flexibility then it will be to get more money. i think the argument for the budget flux ability is strong. i think there are cases within the agencies that have secured

those things like stability, the straitjacket that the cdc budget is. it constrained so much of what we needed for adequate peace time and wartime response, when were faced with the threat. i think that that is an area to push on. i also think that the data piece needs to continually be pushed on. one of the angles that you don't hear enough about is the equity issue. so many problems in this country. one is the persistent in equities. there's no way to address those inequities without adequate data about which communities are being most affected, which individuals are most vulnerable. then we can target our resources towards them.

you need to segregated data to do that. -- you need this aggregated data to do that. measures between the cdc, the administration, and the congress and those confidence building measures can start with things like budget flexibility. they can start with things like pushing on the data needs because i think that there is bipartisan support for directing inequities. i think there will be bipartisan support for meaningful services in a timely way to where they are needed most. that is the kind of process that i would engage in. i think it is getting more money , dramatically more money, goes back to what i said earlier. it will be depended upon congressional perception that the cdc had gone its own house in order and is deserving of

more money and can spend the money effectively. >> thank you. steve, i want to turn to you on this question. the report focuses on pandemic preparedness and response. but cdc has many other areas of work that are of great concern to the american public, long-term chronic diseases, environs of health, mental health, maternal and child health. it also has a significant global health presence we have not talked about yet. i want to talk about that for a moment. cdc has country offices and staff around the world. they play a critical role in programs and oversee training programs. there are staff serving in the world health organization and its regional entities. it's not necessarily straightforward with career paths within cdc. we talked a little bit about

some of the training around international relations and cultural competencies that other agencies have that may not be relevant for cdc, or haven't been so far. i wanted to ask you to reflect on this process of the recess that has been proposed here. what steps can be taken to better integrate and strengthen cdc's global and domestic health security agendas. what will it take from a budgetary perspective but also from an operational perspective to protect that global health action that cdc undertakes? that is so respected around the world. >> thank you, catherine. there's lots of knowledge among our other speakers on this. i would say cdc has performed very well in oversee missions

over many years. that work has been predominantly driven by the hiv program. when you add in those -- that funding and staffing. nearly a quarter cdc's budget, and roughly 2000 employees. it has become, and many missions, around the world. that presence has become an important element of u.s. foreign policy. it has been a training ground for generations of diplomatic leaders coming out of the cdc background. we have seen that in some of the sterling folks, some came through the regional hub. there is an emphasis on building up regional presence. we know that cdc is playing an

integral role in the youth crane response. -- on the ukraine response. it has been treated as a bit of an afterthought or an add on. it has not been thought as integral effort -- in terms of recruitment, integration, backend, the domestic and international immigrated in terms of funding. right now, that's our program. it is foundational. there are many other security functions that need to be provided in many countries were hiv is not a top priority. and what -- and whether that busing needs to be enlarged in that next. that is part of the challenge. i do believe, bringing across the value and the achievements and the performance to congress

and the american people will go a long way, and trying to build that. but there is not a good appreciation of that. i think we can do much better. some of that may involve what was referenced earlier by seizing another's, in terms of understanding by visiting. some of the transformative changes that happened involved bipartisan emissions going out to some of the key countries and seeing it at work. and having quite a dramatic transformative impact on attitudes and opinions. we may be in a time where we repeat a cycle with the global health security. thank you. >> thank you. so i want to give our speakers an opportunity to offer some final reflections. if there are one or two

questions from the floor, i would invite you to share those. i can ask our speakers to take those into account as they offer a final reflections. if not, i want to ask -- first i wanted think our speakers for joining us from near and far. and to ask each of you to reflect on one, or possibly two of the steps that you see as most promising in the next six to 12 months. that can make a difference in restoring and rebuilding trust in cdc and a core asset of security interest. let me start with our panelist. then we will go to the report officers and back to our cochairs.

i'm sorry? oh, ok. while were waiting for the system to reset, let me invite the audience. >> i have the first and maybe last reflection. i am going to start on a pessimistic note but end on an optimistic one. there is a view that we heard, in this some of our working groups, from some in the public health community that everything would be ok if the response had not been politicized. while there is some truth in that, i think it misses the mark. it obviously ignores the cdc's own, unforced errors, which undermine confidence in the

agency as much as political interference day. but more importantly, it ignores the fact that pandemic response and mitigation are inherently political. they involve major societal trade-offs between health and the economy, between in and remote learning, between individual freedom and collective responsibility. instead of pretending as if the answer is to do the impossible, namely insulate the cdc from political pressures, what we need to do is come together and better manage the inevitable political nature of the response to balance transparently the social educational economic impact. my optimism comes from the fact that we heard in our working group, some of us have

experienced as susan did in indiana, and in alaska, tom with maryland, we saw states coming together during the acute phase of the pandemic with ad hoc collaborations, fusion cells, bringing together scientists, public health officials, and elected office holders to manage the response together. i think what we need is to translate that into a federal stage. that is what the report is talking about in terms of its intensified engagement with congress, at this more robust, executive congressional dialogue. i have hope for the future. i think we ought to look at those models and let them out. because they succeeded with a bicycle -- bipartisan approach.

i think we should try the same thing at the federal level. >> what we really need to embrace, is the political dimension of the pandemic and really move that dialogue forward. do we have our online post back? >> were back. >> all right. tom, let me turn to you. one or two reflections. what are you most optimistic can be achieved in the next six to 12 months? >> first, i wanted to mention the report, highlighting the health defense operation approach. this is not going to happen in the next six to 12 months. but over time, this kind of approach can be accepted by both parties, both houses of congress, as core issues for our health defense.

this is a good idea. it has now been included in legislation that was introduced. those ideas sometimes take a few years to mature. i think this is essential. i think the ability of congress to be able to care resources to cdc, i think to give free to cdc without taking them from other entities would enable us to strengthen our help. -- our health. >> legislative processes at work. if she comes back. are you still there? >> yeah, i'm here. >> i thought we lost you. let me turn to you. your thoughts? >> i appreciate the report. it is very specific. one thing i would mention about

budget. i would think about health care and public health. i don't go into a shift and say can we take care of so many heart attacks because that is all the funding that i have to take care of. but i go to my day job and we only have so much funding to take care of 70 tv stations per there's only so much contract chasing -- tracing i can do. i think we need to think about the payment structures for health care and incentivize public health, as well as funding the academic and understanding the competitive. i think we did this as a nation back in the 1980's. i think we need to do the same thing with public health. it's not ok to not have the very basic data information because our economy, schools, security, are all dependent on that. has to be built into the way we address health care and public health at the same time. aches. >> thank you. >> susan brooks, let me turn to

you. >> ok, thank you. i think of the next six to 12 months, just reminding members of congress that the public health issue is national security. in trying to make sure that they understand, particularly the newer members, trying to mature they understand the intersection between national security, our military preparedness, which includes our national guard, men, women in our own neighborhoods that are going and serving our country. just making sure that they understand that it is all connected. and that the bio thoughts -- bio threats are really significant.

we have to be sure the public health has the resources they need to test and be far better prepared than we were during this pandemic. i think that is something that brings both parties together. if we can just continue to educate on what is needed, in a humbling way, because so many things did go wrong but so many things did go right. so many things that public health has done right in the past, we need to remind people what those are. and that with the right resources and with the right mission and clarity and types of things we are talking about, we can get back to that. but we have to be ready for tomorrow and what tomorrow brings. we don't know with that next disease is and how it might impact our neighbors and our communities. >> thank you. julie?

>> thank you. first of all, i agree with everything that has been said. i do hate to say it, but it's not over yet. while we all want to put this in the rearview mirror and think about how to learn from it go forward, we do need to have the humility that there is still ace -- there is still uncertainty about what is ahead of us. i agree with that. cdc needs to fix the things that are within our control to fix and work with the state levels to make sure there is clear understanding of what those priorities are. not just from the inside, but really reflecting, what can we do right now? to extend that into some of these other areas, to begin the process of expanding the workforce. because -- to build a strategy

for the d.c. presence, even if they don't have the resources to execute it -- execute entirely. when we have good news, we will have ways to communicate them and engage with the new congress. with that in mind, it is a critical opportunity. we need to have the house in order as we go into the conversations about the importance of what it needs to be so that we can assure that the opportunity to shake that reauthorization and to have it solve what we are talking about is i want to and with a very positive note, because there is a lot of incredible talent and capability at the cdc.

they can do miracles. >> our time has come to a close. i want to think the streaming, and the global health policy center staff for their efforts today, particularly michaela and hunter, who really managed it and kept going. i think you -- thank you, the audience, for joining us today, both online and here in person, these join me in thinking our panelists for joining us. to as far away as indiana, alaska, and europe. thank you, very much. [laughter] we are adjourned, thank you.