Georgia Today: How The CDC Was Set Up To Fail During Pandemic
This episode of Georgia Today takes an inside look at how the Centers for Disease Control and Prevention lost public trust amid an international health crisis — and how the repercussions of the organization’s unraveling could have long-lasting effects beyond the course of the COVID-19 pandemic.
Host Steve Fennessy talks with Pulitzer Prize-winning journalists Patricia Callahan and James Bandler about their reporting for ProPublica.
RELATED: 'Inside the Fall of the CDC'
Steve Fennessy: This is Georgia Today; I'm Steve Fennessy. It's Friday, Nov. 20th, 2020.
Newscast: China has identified the cause of the mysterious pneumonia outbreak in Wuhan City, and it's from the same family that caused the deadly SARS epidemic 17 years ago. It's a new type of coronavirus.
Steve Fennessy: It's been one year since scientists in China identified the first documented case of the novel coronavirus. And since then, at least 50 million people worldwide have tested positive for the virus, with close to 1.4 million fatalities. One out of six of those deaths have occurred here in the United States. Last month, ProPublica, the nonprofit investigative news site, published a story under the headline “Inside the Fall of the CDC” that tracked, in exhaustive detail, the agency's missteps, as well as its usually fruitless efforts to withstand an unprecedented level of political interference. Today, two of the stories’ authors, James Bandler and Patricia Callahan, both Pulitzer Prize winners, join me to discuss what they learned about the agency and how it might regain its reputation.
James and Patricia, thanks for joining us today. Before we get into what all of the emails and all the interviews revealed about the CDC's response to the pandemic, I think it's important to sort of establish what the climate was like in the months and years leading up to the pandemic, what it was like at the CDC in terms of its funding, in terms of the work it was doing. We've been reading that we'd steadily disinvested in public health over the years.
Patricia Callahan: There had been this sort of quiet gutting of public health since the Great Recession, and that was felt acutely at state and local health departments, where there were about 26,000 fewer employees at state and local health departments since 2009. So in a very short period of time there was just a huge drop in the number of folks on the ground at state, municipal, and county health departments, which the CDC regularly relies on in an outbreak.
And so we were going into this crisis of a century in a weakened state. And I also would say that the CDC's global presence was suffering, too. There had been this big infusion of hundreds of millions of dollars at the time of the Ebola epidemic in 2014. And that allowed the CDC to increase its presence in as many as 65 countries. But a big chunk of those funds ran out in 2019 and the CDC had to cut over 300 posts overseas. So at the same time that you're seeing this contraction at state and local public health departments, the CDC globally is starting off in a somewhat diminished state from where it had been at one point.
Steve Fennessy: So the CDC is on a weaker footing and specifically it's at a weaker footing too and in China as your story sort of unfolds. Can you talk a little bit about sort of what the situation is when it comes to disease detectives from the CDC who are stationed in China? Was there a reduction in those numbers, too?
James Bandler: So there was a reduction. The impact of that was not really clear to us whether that actually had an effect. But what really we were struck by was that the U.S. really helped the Chinese build their own CDC. We helped train the scientists. We were really good partners for this because there was always a belief that the next big infectious epidemic could come out of China.
And there were very close ties between the senior scientists. In fact, the CDC Director, Robert Redfield, was on very good terms with George Gao, who was the director of China’s CDC. And a few days after the U.S. first got wind of — that something was brewing, an infectious respiratory disease in China. Redfield got on the phone with Gao. And Gao is usually a very chatty guy. But in these sort of subsequent conversations, he started clamming up. And many of Renfield's questions were going unanswered. And this became an issue of concern inside the government.
Patricia Callahan: And I would also add that, you know, part of the frustration inside the White House that we heard about was that the U.S. had made decades of investments, both financial with expertise and with people in China.
And that had big repercussions from folks in the White House who are very frustrated that it was time to sort of cash in on those relationships and those investments. And yet the lines were going silent and we weren't getting the kind of information that the CDC would normally expect given the longstanding relationships there.
Steve Fennessy: So we have the CDC going into the outbreak amid all these budget cuts, we have a pandemic that's emerging in an authoritarian state, and we have Robert Redfield, who's relatively new to the position of director of the CDC and and was not, in fact, President Trump's first choice to head that agency. What was his reputation coming in?
James Bandler: So Redfield was a serious AIDS scientist, and had been in public health for his entire career. His temperament was gentle, soft, deferential. The Trump administration needed a brawler.
And what it got as, you know, one senior health official told us, was like the nicest grandfather you could imagine. And I think another weakness of Dr. Redfield was he was not a great communicator. He tended to mumble. He tended to close his eyes.
Robert Redfield: If I got too preoccupied by the critics right now, it would be paralytic. I’ve considered it an honor and a privilege to be given a chance to be in the arena. And yes, yes, we fail. We're in it doing the best we can and we're trying to make the best judgments we can. And I'm sure there's going to be plenty of time in three, four, or five years for people to go back and do postmortems. But I wish now we would come together and recognize and see the possible: that we can beat this pandemic.
Steve Fennessy: I'm recalling one of the early comments from a CDC official, Dr. Nancy Messonnier, who is the head of immunization and respiratory illnesses at the CDC. And her comments — this is back in February — really elicited a strong reaction from President Trump's administration. Can you talk a little bit about the effect that her comments had?
Patricia Callahan: You know, it was — essentially, she was asked by the media team to add kind of a personal touch, which I think makes public health leaders generally a little more relatable. So she talked about talking to her family, about preparing for a substantial disruption in their lives.
Dr. Nancy Messonnier: I had a conversation with my family over breakfast this morning, and I told my children that while I didn't think that they were at risk right now, we as a family need to be preparing for a significant disruption of our lives.
Patricia Callahan: And what's interesting is, talking to folks within the CDC, they did not see that media briefing as being this watershed moment, you know, or really any huge deal. It's just sort of what they normally did. You don't just spring something on the public. You kind of lay the groundwork and prepare them for something that might be coming. But for whatever reason, her briefing spooks the market. And the stock market fell and President Trump was very angry and the next day appointed Vice President Pence to be the head of the Coronavirus Task Force.
Donald Trump: I'm going to be putting our Vice President, Mike Pence, in charge. And Mike will be working with the professionals and doctors and everybody else that's working….
Mike Pence: I look forward, Mr. President, to serving in this role of bringing together all the members of the Corona Task Force that you've established, HHS, CDC, DHS, the Department of Transportation and State.
Patricia Callahan: And it was clear that this was kind of the president's stage and not the CDC’s. And I think that's where it helps to, like, just remind people of how it worked in the past and that the CDC would always have a person who was kind of the communicator in chief about things. That, you know, went out the door.
Steve Fennessy: Yeah.
Patricia Callahan: You know, and so then you find the CDC is just watching the president as he's countermanding science. You know, you get the sense of folks within the CDC watching this wall of screens as the president is theorizing about injecting disinfectant as a treatment.
Donald Trump: And then I see the disinfectant knocks it out in a minute, one minute. And is there a way we can do something like that?
Patricia Callahan: You can imagine how dumbfounded they were. It must have felt like the Earth had just fallen off its axis for them that that's what their lives had come to.
Steve Fennessy: In talking to CDC employees and those who are close to the agency, were there one or two examples of interference by the Trump administration that really stood out as being egregious in their eyes?
Patricia Callahan: Yeah, I would say that one example was the guidance for reopening schools. The CDC had prepared a very detailed, nitty-gritty documents for school administrators on when and how to reopen schools safely and what are all the things they should consider. And a department within Health and Human Services that's devoted to mental health chastised CDC scientists saying they were being overly negative and, you know, essentially accused them of being scolds, that we're going to keep schools closed, that they were far too preachy about their advice for school administrators.
And that particular arm of HHS wrote its own guidance that it was opposite in tone. And it was called “The Importance of Reopening America's Schools this Fall.” And people at the CDC told us that they saw that as propaganda and they literally used the word “propaganda” repeatedly. Everyone we talked to said, “That's just propaganda.” And yet that document “The Importance of Reopening America's Schools this Fall,” — at the top of their CDC Guidance for Schools page, it was that document that our — my own school administrator was quoting, you know, in the discussion with parents about whether to reopen schools. It was “Well, the CDC says we have to reopen, it's like the most important thing we could possibly do.” And citing that particular document, you know, that that the CDC's own scientists saw as propaganda. And after, you know, questions from Congress, they've since taken that document down.
Steve Fennessy: Right.
Patricia Callahan: But they didn't do it until after our story ran. Congress and other people also — I will say we're not the only journalists that wrote about that — and Congress started asking questions and then finally that came down.
Steve Fennessy: One of the things that struck me the most was, sort of, the mandate from — or at least the strong urging from the White House about closing the southern border and using the pandemic as sort of the reasoning for that and how that was received.
James Bandler: Yeah, I think that there wasn't science at the time supporting the idea that COVID was being spread by migrants, but there was strong pressure from the White House to use the CDC's powers to restrict immigration and then to also use it to separate children from their families. And the head of this division in charge of this, Dr. Martin Cetron, refused to be a part of those discussions and that part of signing that order. There wasn't, in his mind, a public health reason to do that, according to people we talked to close to him. So, you know, that was one of the more sort of painful moments. He just — he just refused to do it in an act of — small act of civil disobedience.
Patricia Callahan: Now, Dr. Redfield did wind up signing it.
James Bandler: Yes, Dr. Redfield did it.
Patricia Callahan: So while he — he may have stood up for it, the director wound up making it happen. It's worth noting that that meant that for the first time since the enactment of the Refugee Act of 1980, that people who came to the border saying they feared persecution or torture in their homeland were turned away with no chance at all to plead their case for asylum. You know, and that has been a foundational thing in our country.
Steve Fennessy: Just ahead: What will it take for the CDC to rebuild the public's trust? This is Georgia Today.
Steve Fennessy: This is Georgia Today; I'm Steve Fennessy. I'm speaking with ProPublica senior reporters Patricia Callahan and James Bandler. I'm curious to know sort of what your approach was in reporting the story, because you spoke to, it appears to be, dozens of people, reviewed hundreds and hundreds of emails. What were you trying to accomplish going into this and what were some of the things that surprised you the most?
James Bandler: So our assignment was very open-ended. And I just want to talk a little bit about our team. In addition to Trish and me, there were two other reporters, Sebastian Rotella and Kirsten Berg. And the four of us — none of us had covered the CDC before. We hadn't covered public health. So we were really starting both with sources and knowledge at square one. And we started our project by looking backwards at how the CDC had covered past epidemics and outbreaks. And I think we came to the table having done a lot of reading. So I think people — I think people generally appreciate that.
Patricia Callahan: And as we got into it, I think we realized — and we had a phenomenal editor, Tracy Weber, who kept asking us the question of like, “What does it feel like to be in the midst of this situation where you've prepared your whole life for this moment, right? Every ounce of training you have ever had, as you know, led up to this critical moment in history. And at the same time, you're being thwarted, openly thwarted by people within your own administration. What does that feel like?” And I think the more interesting things that we wrestled with in our reporting and in our interviews was the notion of, like, what would it have been like to stand up and to say “no” in this situation?
And there was just a deep anguish that we heard from not just scientists, but at all levels of the CDC, we heard from employees there who just were deeply troubled by what was unfolding. And these are veterans who had gone through many prior outbreaks before, right? So these are folks who had been on the front lines of Ebola and Zika and the H1N1 flu pandemic. You know, these — this was not their first rodeo by any means, but the degree of interference and the degree of hostility to both scientific expertise and also just government. You know, just the notion that they would be accused of being sort of seditious or “deep state” bureaucrats.
You know, what we heard from folks was the sense of helplessness and to a certain degree of just deep anger, both at Washington and also their own leaders’ inability to defend them and to convey to the public what the dangers of this pandemic were and how people could protect themselves.
Steve Fennessy: And when you say their leader, you're referring specifically to Dr. Redfield, right?
Patricia Callahan: Not just Dr. Redfield, even senior career CDC leaders. So these are not the political appointees — even the career leaders were unable to stop the interference from the Trump administration and to make sure that the American public was getting the scientific truth about what was going on in the pandemic and how the public should protect itself from getting sick and dying — to the degree that some people wept in interviews.
Steve Fennessy: Wow.
Patricia Callahan: It was a deep, deep anguish that we heard from people.
Steve Fennessy: Wow.
James Bandler: I mean, one of the most amazing things was a veteran who — who worked with local health departments. And he told these health departments to ignore the CDC's own guidance. And it got to the point where he just felt like he had to get out of the agency. And he was like, you've come to this point when the CDC comes out with a recommendation and folks are going to ask, “Is that really the truth? Or are you told to say that?” And I mean, that was one of the most shocking things to us.
Patricia Callahan: And I would also add that we even heard that from career CDC scientists who said, you know, “When I see my agency put out guidance for the public,” the first thing that they would do is go to colleagues who they knew were involved and ask the question, “Is this what we really think or is this what we're being forced to say?” And that to me was shocking. If they don't trust their own agency's advice and they're questioning it, how the heck is the public supposed to know what to do?
Steve Fennessy: Generally speaking, what kind of power does the CDC have to, in practical terms, affect my behavior? Can they close schools and churches? They can't do that, right? What can they do?
James Bandler: The CDC has few statutory powers. They can do medical exams for immigrants and refugees. They have the power of quarantine for folks coming from abroad and in between states. But they don't have a lot of hard powers. And most of their power is influence and is sort of the platform of the CDC. And in the past, when the CDC spoke, people listened.
Steve Fennessy: Right.
James Bandler: It's that power that's been diminished. And that's probably the most damaging thing. The trust we have in this agency, you know, that's been the most damaging legacy of this pandemic.
Steve Fennessy: One of the phrases in your story — it's a quote from a scientist, he refers to a bankruptcy of trust. What does he mean by that?
James Bandler: That was something we came across in an oral history that was given by Dr. Martin Cetron, the man we talked about before, who was the agency's veteran Director of Global Migration and Quarantine. And — and he coined that phrase years ago for what can happen when people lose confidence in government and institutions and when denial about a disease and lies can start spreading faster than the disease. And — and he'd seen this bankruptcy of trust in other outbreaks. He saw it in Ebola in Liberia in 2014. So he understood and worried about a time when there was not just a breakdown in sort of technical expertise, but also a breakdown in faith in these institutions like the CDC. And he had talked about it extensively and we found, you know, in addition to his oral histories of talks he'd given about this as well.
Dr. Martin Cetron: And all of this successful control of a virus like this, a global pandemic requires, a full bank account of trust in all of these institutions in all these ways and an alignment of messaging. And that there's a bankruptcy of trust can be really tough.
Steve Fennessy: In the course of your reporting and talking to CDC officials, did they have any insight into how the agency regains and rebuilds that trust?
James Bandler: I think the sense — the first thing you have to do is acknowledge your mistakes and how you fell down. And to restore trust there has to be a full sort of almost a truth and reconciliation commission on what mistakes were made and how they could be avoided again. And I think that's going to be critical to rebuilding.
Patricia Callahan: One thing I would also add is that we did talk to some veterans who worried that this isn't just a rebuilding that's going to happen over the next month. They worried that it could take a generation or longer to regain that trust, that it's not — trust is not easily won back. And one person said, you know, most of us who saw this could be retired or dead by the time that's fully fixed.
Steve Fennessy: Our thanks to ProPublica senior reporters Patricia Callahan and James Bandler. This week, the U.S. saw its COVID-19 death toll rise to more than a quarter of a million people. During its first agency-led briefing in months, the CDC advised yesterday that Americans should not travel for the Thanksgiving holidays for fear of spreading the virus further.
I'm Steve Fennessy. This is Georgia Today, a production of Georgia Public Broadcasting. You can subscribe to our show anywhere you get podcasts. Please leave us a rating in review at Apple Podcasts. Have a story idea? Connect with us at GeorgiaToday@GPB.org. Our producers are Sean Powers and Pria Mahadevan. Our intern is Eva Rothenberg. We'll see you next week.
Transcript by Eva Rothenberg