Come on, CDC, we need you - Science Magazine

PHOTO: CAMERON DAVIDSON

The US Centers for Disease Control and Prevention (CDC) has had a rough few weeks. At first, it was criticized for being too cautious about its mask guidance for vaccinated individuals. Then, when it abruptly changed its mask recommendation for those who had been vaccinated, it was criticized for acting suddenly and without clearly explaining the reason for the new guidance and what it meant for the unvaccinated. Meanwhile, author Michael Lewis released a bestseller about problems at the CDC that go back decades, with local and state public health officials fighting pandemics in the face of inaction and confusion from the agency. The CDC is in a difficult position: In the course of carrying out its appointed task of communicating science and promoting the best health practices, it can also appear to be making policy—and that is not supposed to be its job. But where do you draw the line between proffering advice and promulgating policy? Maybe the CDC and the administration need to step back and consider if there is a better way for the agency to protect public health.

According to its website, the CDC “conducts critical science and provides health information that protects our nation against expensive and dangerous health threats” (italics mine). The first part is easy to understand. CDC scientists conduct research and marshal scientific information for public release. Although the muzzling, contradicting, and rebuking of the CDC by the Trump administration made this part of the mission hard to see, there's no reason to think that the agency isn't performing this task well.

It's the second part of the mission where the agency has been getting tripped up. The public cares much less about the details of scientific studies than about the upshot. Do they need to wear a mask? Can they go back to work? Can they hug their grandchildren? To scientists, it makes perfect sense that the answer to these questions is “it depends, and there is still some risk.” But caveats are hard to sell to a public hungering for specific directions.

The CDC has been occupying a gray zone somewhere between the very different worlds of science and politics. Threading this needle requires serious chops in both communications and politics. Scientists get penalized—perhaps unfairly and unproductively—for reporting a finding that must be modified relatively quickly because of new results. The nature of science includes an unstated qualification that findings are subject to change. Political leaders, on the other hand, must often act on incomplete information. In the face of uncertainty, they are expected to make clearcut decisions. They get penalized if they get it wrong, but also if they fail to take action. So, is the CDC director a scientist or a political leader? If a scientist, then there are some pretty straightforward things to say. COVID-19 is a deadly disease caused by an airborne virus, so masks work. Period. The vaccines are expected to provide outstanding protection and slow viral transmission, though we won't know with absolute certainty until studies are done in humans. The vaccines perform extremely well against the variants that have emerged so far, but there could always be a new one that changes the game.

The politics—how to use the science to formulate public policy—are a trickier matter. Will seeing vaccinated people without masks cause unvaccinated people to let down their guard? Does the slight chance that vaccinated people might still spread the virus justify keeping mask mandates in place, especially to protect young children and immunocompromised adults who cannot get vaccinated or mount an immune response? Will explaining the nuances of the effectiveness of vaccines lead to more or less hesitancy?

It's time to think harder about the role of the CDC. If the agency is to continue its integrated mission, then it must be made very clear that it offers independent advice, not commands, and that the final word on public health policy comes from federal, state, and local political leaders. In this capacity, CDC must be given enough clout to hold its own among the forces in Washington, DC. As an alternative, the CDC could stand back and act strictly as a scientific research agency, but that would feel like a loss. Either way, we literally can't live without the CDC. We just need to sort out our expectations.

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Come on, CDC, we need you - Science Magazine
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