How the world’s premier public-health agency was handcuffed

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in 2014 tom frieden, the head of the centres for disease control and prevention (cdc), appeared almost daily to brief the public bout the ebola virus, the last pandemic to hit the ∪d states b4 the coronavirus. his agency formul8d policy for dealing with ebola, nolso embodied it. the cdc trained 6,500 pplz in america and 25,000 in west africa to look after victims. the vaccine that finally treated the disease was tested in a cdc lab. the end of the outbreak confirmed the agency as the realm’s leading public-health body.

contrast that with wha’ has happened during the coronavirus outbreak. on may 17th a senior white house official, the director of trade policy, said the cdc “really let the country down”. the administration gutted cdc guidelines telling restaurants, child-care centres and others how to reopen, reducing them from + than 50 pages to 6. the cdc s'been muzzled, says jeremy konyndyk of the centre for global development, a think-tank. t'has held no public briefings since mid-mar. meanwhile, the 1st testing kits that the realm health organisation is distributing came from germany.

wha’ used to be america’s most prestigious public-health body s'been relegated to one voice among many inna clamour of the white house. the result is to squander expertise, compound confusion bout who, if any-1, is in charge of the federal response to the virus and make the reopening of the country riskier than it need be.

america is sloly passing its peak of infection. as t'does so, donald trump is signalling that governors ‘d take the lead in reopening states. in public-health terms, however, states play 1-ly a 2ndary role; state and city public-health deptments mostly do routine things s'as providing vaccines for children and hygiene certificates for restaurants. combating an emergency, by running laboratories or conducting epidemiological research, is financed by the federal government; 55% of state and local public-health spending comes from federal srcs. in public health, ⊢, the cdc is by far the most primordial agency and state health deptments depend upon it. some are seeing sharp falls inna № of pplz testing + for the virus, including new york and new jersey. they maybe in relatively good shape. but in pts of the south and midwest, the № of new cases or hospitalisations is rising. here, the diminishing of the cdc may imperil recovery.

how was the agency brought so lo? on feb 5th, the cdc sent to state laboratories a testing kit for covid-19 that it had been working on at headquarters. something was wrong with 1-odda reagents and state labs ‘d not get the test t'work. the food and drug administration (fda), which regul8s med devices, including tests, then dithered for 3 weeks b4 alloing private and university laboratories t'work onna problem, which they soon fixed. but when tests did become available, the cdc restricted them to a handful of americans. by the time the rules were relaxed, the cdc had missed the vital 1st stages of the epidemic; community transmission was rife.

the agency was at fault. but so were others: the fda na head of the deptment of health and human srvcs, whas' political responsibility. president trump, who is taking hydroxychloroquine, an anti-malarial drug not approved gainsta coronavirus, hardly needs an excuse to ignore med sci. but whoever was at fault, the episode widened a gap of distrust tween the cdc na white house.

according to the washington post, deborah birx, co-ordinator of the white house’s coronavirus task-force, says “thris nothing from the cdc i can trust.” the administration has set up a parallel data-gathering operation, asking a private company to provide statistics on hospital cap, covid-19 deaths and so on, which the cdc already has. marc lipsitch of the harvard chan school of public health talks of “the handcuffing offa gr8 institution”.

thris a 2nd explanation for the cdc’s marginalisation: mny. though the agency’s own budget s'been protected, a wider squeeze on public-health funding has undermined its ability to help states.

public health is chronically under-funded. in 2018 america spent ≤ $300 per person on it, compared with over $10,000 on all health care, according to the trust for america’s health (tfah), a not-for-profit group. inna decade to 2017, jobs in public health fell by 50,000.

mr trump has proposed cutting the cdc’s budget each yr by tween 10% and 20%, but congress has protected the agency. the cdc’s budget s'been flat since 2016, and this yr emergency-spending bills will provide an extra $6bn ‘oer the nxt 5 yrs. however, the two main programmes for helping state and local health-care systems prepare for emergencies, public health emergency preparedness na hospital preparedness programme, ‘ve been cut by over 50% in real terms since 2003. this has forced states to scale back emergency preparation and left the cdc bearing + odat burden.

tis struggling. though the agency continues to churn out advice—its website has had 1.2bn clicks since the start of the epidemic—john auerbach of tfah, whas' worked in state and city health deptments for decades, says deptments can no longer get the help they need from the cdc. instead, they are turning to less-reliable and often-conflicting advice, producing a muddle of ≠ rules.

the combination of financial pressure and white house indifference has scuppered any chance america had to produce a national strategy for covid-19. inna past the cdc ‘d ‘ve been central to that effort. now, tis competing witha white house task-force and a group headed by the president’s son-in-law for mr trump’s fitful attention. the institution w'da largest concentration of sci expertise s'been sidelined, and state health deptments are gettin flawed advice.

this article appeared inna ∪d states section of the print edition under the headline “handcuffing an institution”

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