Walensky prepares to leave CDC — and Congress — after a bruising 29 months

Rochelle Walensky, the outgoing director of the Centers for Disease Control and Prevention, will miss aspects of leading the nation’s top public health agency when her term ends Friday. But testifying before Congress is not likely to be among them.

Walensky squared off against congressional committees 17 times during her 2½ years as head of the CDC, most recently in mid-June, when she faced a grilling from Republicans on the House Committee on Oversight and Accountability.

Asked in an interview with STAT this week if she would miss such opportunities, Walensky said, with evident glee: “I am so going to miss that part.”

If testifying before Congress was a new experience for Walensky, so was much of her job. Although she has a masters in public health, Walensky’s background when she took the CDC job was clinical medicine. An HIV specialist, she stepped down as chief of the division of infectious diseases at Massachusetts General Hospital to go to the agency.

She acknowledged the learning curve was steep. But in her final days in the office, she appeared more interested in describing what the agency has done and where it is heading than in dwelling on her feelings about having led it through a bruising 29 months.

The communications training she received seems to have delivered results; she has clearly learned the crucial — if sometimes frustrating for journalists — technique of using a question to pivot to something she wants to talk about. Case in point: Yes, the appearances before congressional committees were tough, but they gave her a chance to brag about the work of the CDC.

“We at CDC have never in our 76-year history had to tackle a pandemic of the size, scale, and scope that Covid delivered to us. These are some of the things that we learned along the way, and what we’re doing to improve [on them]. And these are some of the things that were really extraordinary that we did that nobody heard about,” Walensky said.

In a wide-ranging interview, Walensky spoke of the progress being made to reform the agency, part of the CDC Moving Forward renewal that she launched last year.

There is the new registry of CDC staff that lists the various skills each has, a tool designed to make the agency more ready to respond. When the CDC needed to deploy Spanish-speaking lab technicians to a Marburg virus outbreak in Equatorial Guinea this spring, for example, the candidate pool was evident.

There is the push to get CDC science out faster to help shape policy and guidance for the public. Walensky said that the internal clearance time for scientific articles has been halved, noting proudly that the impact factor of the CDC online journal Morbidity and Mortality Weekly Report has increased substantially. (A journal’s impact factor signals how important it is to its field and how often its articles are cited elsewhere.)

“We have more work to do there, but we are getting our science out faster,” she said.

And there’s a substantial overhaul underway of the CDC’s massive website, which involves a review of 200,000 web pages that sometimes contradict each other. The process involves streamlining the content, but also archiving material that will still be available to the public, Walensky said.

She is clearly pleased with the progress her reform efforts have produced, but cognizant, too, of the fact that this is a job she won’t — she couldn’t — see through to completion. “I will humbly say that this will take years to do,” she said.

Walensky doesn’t appear worried that her departure will compromise the progress.

“So much of what I really wanted to do is set the visions, set the framework, set the inflection point, and put the pedal to the metal,” she said. “What I will say is, there’s been an extraordinary amount of buy-in, not only within the agency, but outside the agency. At the administration level, at the [Department of Health and Human Services] level…. I think that there is momentum and a recognition that this work needs to be done.”

But some of what the agency needs to effect change is beyond its own powers to implement. Critically, it lacks the authority to require states, territories, and tribes to share data. When it needs ongoing access to data — in the case of last summer’s mpox outbreak, for example — it must negotiate scores of data-use agreements with states, territories, tribes, and local health authorities. Some allow CDC to share their data broadly, others place restrictions on what can be disclosed. When all those agreements were signed in September, CDC could see that the outbreak had peaked at the beginning of August.

“Our job is to be on top of these things before they turn into outbreaks or emergencies,” Walensky said.

Changing that will require congressional action. Walensky believes there is bipartisan understanding of this need among the lawmakers in Congress who understand health. But translating that into new authorities may not be feasible in the current climate.

“Maybe there’s not a bipartisan pathway to get there right now. But there’s an understanding that we can’t be nimble if we can’t see what’s happening,” she said. “Congress will need to step forward.”

The CDC also badly needs workforce flexibility. The agency does not have the authority to hire in emergencies the way an agency like FEMA — the Federal Emergency Management Agency — does.

“It is true that if tomorrow we were to get the budgetary workforce and data authorities that we would need to be a nimble agency, we would not yet be where we need to be within the agency,” Walensky said. “That work is the work that we are doing.

“It is also the case that if we are the only ones doing that work, and we don’t get those authorities, we will still not be able to be the nimble agency that’s expected from us.”

Asked to reflect on what she wished she had known going into the job, Walensky said she and other players perhaps underestimated the degree to which deliberate disinformation would erode efforts to keep the public safe during the pandemic.

“I think all of us probably didn’t appreciate how many nefarious actors would be out there trying to undermine the fact that science does evolve and science does change, and the virus does evolve, and the virus does change,” she said. “We could have been louder in saying that. And that there were people acting intentionally to undermine us has been a challenge.”

Another thing Walensky learned is that during a health crisis, there are lots of people at the table making response decisions. Some approach the decision-making through the prism of what’s best for health; for others the primary concern may be continuity of education, the stability of the nation’s transport system, or the state of the economy. The fact that there is this pull and push of competing priorities is not well understood, she suggested.

A case in point: The CDC was hammered for relaxing isolation and quarantine guidance at the start of the Omicron wave. The evolved virus was much more infectious than what came before, in part because it was able to evade some of the defenses people’s immune systems had been generating. Soon after its appearance, huge numbers of people were either sick, or quarantining themselves, because they had been exposed to someone who was infected. There was a real risk that key societal functions would grind to a halt. Grocery store shelves would empty and hospitals would lack the staff to deliver care.

“We heard from hospitals that blood culture bottles weren’t delivered, we heard from dialysis centers that they couldn’t get dialysate” — a solution used to clean impurities from blood — “we heard from pharmacies that their pharmacists couldn’t come in, and their patients couldn’t pick up their insulin,” Walensky said.

Halving the amount of time exposed people needed to be in quarantine was a compromise needed to keep the country functioning. She called it “doing the least amount of harm.”

It didn’t seem that way to the agency’s vocal critics. “Thanksgiving-Christmas of 2021 was not my favorite of times,” Walensky admitted.

As she leaves the CDC, Walensky finds herself in an unusual spot. When she took the CDC job, she resigned from Mass General. She has nothing on the professional horizon. “My next chapter is very intentionally blank.”

“I have never been in this situation, and I don’t know how long it will last,” Walensky said, noting she looks forward to spending time with her husband, sons, and parents this summer. She plans to do some reading and going to the gym. She also plans to devote time to pondering what her next act should be. One thing she feels confident of: It will be in the health/public health sphere.

“I deeply believe in the mission,” Walensky said. “And part of the real question in my mind, and that I really want to spend some time thinking through and being intentional about, is where is the most productive perch from which I can do that?”