May 13, 2020 10:56AM

CDC Failures: Mission Sprawl Is One Problem

The Centers for Disease Control and Prevention (CDC) says that it “has a unique mission—to save lives by deploying effective, proven strategies to prevent, detect, and rapidly respond to disease outbreaks at their source.”

But the CDC was slow to recognize the size of the COVID-19 threat and it fumbled the ball in numerous ways. CDC Director Robert Redfield tweeted January 14 that “there is no confirmed person‐​to‐​person spread” of the illness, and on January 28 he emailed CDC colleagues that “the virus is not spreading in the U.S. at this time.”

A ProPublica analysis found, “Internal Emails Show How Chaos at the CDC Slowed the Early Response to Coronavirus.” The analysis concluded that “the CDC underestimated the threat from the virus and stumbled in communicating to local public health officials what should be done.” Meanwhile, an NPR investigation found that the CDC’s initiative to create an early warning system in selected cities was a flop.

This CDC brochure lauds the agency’s success at battling COVID-19. It says, “An important part of CDC’s role during a public health emergency is to develop a test and equip state and local public health labs with testing capacity.” The brochure does not mention that the CDC’s test failed and that federal actions delayed the deployment of private‐​sector tests.

The CDC and other federal health agencies told the public not to wear masks. The official line was: “CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19.” The U.S. Surgeon General was insistent about masks: “They are NOT effective in preventing general public from catching #Coronavirus.”

Why should we spend billions of dollars on health agencies that give us harmful advice?

Some pundits claim that budget cuts were the problem, but the table below suggests otherwise. The CDC workforce increased 12 percent between 2010 and 2019, based on data in CDC budget submissions here and here.

The largest employment increase was in “Global Health,” a group that monitors foreign outbreaks of infectious disease. The group’s employment jumped from 272 in 2010 to 1,263 in 2019. The CDC says the group “supports global efforts to detect epidemic threats earlier, respond more effectively, and prevent avoidable catastrophes.” The agency should have been ready.

CDC leaders may have been distracted because of mission‐​sprawl. The CDC’s 512‐​page budget submission for 2021 reveals a vast and disparate array of activities. What are occupational safety and injury prevention doing in the government’s infectious disease agency?

The CDC highlights its recent accomplishments on pages 18 to 23. How is CDC Director Redfield supposed to remain alert to emerging epidemics when he is also supposed to manage programs on tiny teeth, colon cancer, opioids, child abuse, diabetes, workers’ compensation, lead‐​based paints, mold in buildings, and lifting heavy objects on construction sites?

From the highlights:

“In 2019, CDC launched the Protect Tiny Teeth initiative in collaboration with partners. The initiative includes an oral health toolkit to raise awareness about the importance of oral health as part of prenatal care.”

“As part of the Combatting Opioid Overdose through Community‐​Level Intervention program, CDC expanded efforts to partner with public safety (e.g., law enforcement, first responders) by collaborating with the Office of National Drug Control Policy to fund 25 pilot projects.”

“Using CDC resources, the Forest County Potawatomi Community, a tribal nation in Wisconsin created a media campaign, in collaboration with the Tribe’s Executive Council, targeting the stigma associated with opioid use disorder within the Native American culture.”

“CDC’s Essential for Childhood program recipient states increased the percentage of Community‐​Based Child Abuse Prevention dollars invested in evidence‐​based programs from 24% to 52%.“

“CDC’s Colorectal Cancer Control Program grantees have partnered with over 760 health system clinics that serve over 1.2 million patients age‐​eligible for colorectal cancer screening.”

“As of December 2019, more than 1,500 organizations have received CDC‐​recognition for delivering CDC’s National Diabetes Prevention Program lifestyle change program…”

“CDC Project 3–3: Children with Asthma is working to identify factors associated with asthma exacerbation in children following the 2017 Hurricanes Harvey and Maria and aims to establish or improve programs to reduce asthma burden among children during and after hurricanes.”

“CDC published a web‐​based data visualization dashboard to explore 1.4 million workers’ compensation claims in Ohio, creating a causation‐​specific injury surveillance system using existing claims databases.”

“CDC’s Data Linkage Program facilitated evidence building which supported policy decisions for the U.S. Department of Housing and Urban Development (HUD). HUD’s 2018–2022 Strategic Plan cited findings from the NCHS-HUD linked data files to support the continued removal of lead‐​based paint hazards in HUD homes.”

“Using CDC resources, the CPWR‐​Center for Construction Research and Training, piloted and launched best​built​plans​.org to provide contractors and workers with practical tools, microgames, and information to prevent injuries from lifting and moving heavy materials while staying productive and profitable.”

“In 2019, the Coal Worker’s Health Surveillance Program provided 8,398 chest x‐​ray screening examinations and reviewed 2,758 spirometry test results from its mobile unit and 40 Spirometry Clinics in 11 states.”

“CDC released the Dampness and Mold Assessment Tool for both general buildings and schools to help employers identify and assess areas of dampness in buildings.”

In coming months, Congress should reassess the CDC’s budget and consider some of the agency’s failures during the COVID-19 crisis. Policymakers may want to take a pruning knife to the CDC and refocus it on the core mission of infectious disease and epidemics.

In general, less is more with federal agencies. Federal mission‐​sprawl often results in overlaps with state, local, and private activities, and it distracts federal leaders from their core responsibilities.

Dave Kemp assisted with research for this post.