J. Stephen Morrison and Tom Inglesby. "Building the CDC the Country Needs." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, January 12, 2023. Accessed December 21, 2023.

The CSIS Commission on Strengthening America’s Health Security’s bipartisan working group on the CDC recommends a package of reforms to strengthen CDC’s performance in preventing and responding to dangerous outbreaks and drive a significant reset within the agency.

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Executive Summary

Today, the U.S. Centers for Disease Control and Prevention (CDC) has entered a moment of peril. CDC, a long-heralded national public health asset, has suffered a sharp decline in popular trust and confidence, a signal of widespread concern over its performance in preventing and responding to dangerous outbreaks, at home and abroad. The United States needs a strong, effective, and more accountable national public health agency to protect the health of all Americans and ensure the stability of the broader world. It is an urgent matter of U.S. national security.

The CSIS Commission on Strengthening America’s Health Security launched its working group on the CDC in August 2022 to conduct a rapid review of critical CDC capabilities related to epidemic preparedness and response. Throughout, the effort has been bipartisan, in recognition that a significant reset of CDC requires building consensus on actionable recommendations across branches of government and across party lines.

The power to shape CDC’s future rests in part on CDC leadership, which is pursuing internal reforms under the banner of “Moving Forward.” But realism is in order. The power to make major changes lies largely outside of CDC itself—at the White House, with the Secretary of the U.S. Department of Health and Human Services (HHS), and among key Senate and House leaders, of both parties. That is where the future of CDC will be decided.

CDC’s chronic challenges must be acknowledged and systematically addressed—in its culture, data management, budget structure, talent base, communications, partnerships with state and local authorities, weak Washington presence, and global health security mission.

We know what needs to be done. This CSIS report enumerates the essential, concrete, near-term steps that will return CDC to a pathway of high performance: clarifying and better integrating CDC’s core domestic and global missions; enhancing CDC’s leadership and transparency by bolstering its communications and federal engagement capacities; creating a much stronger competency in Washington; and bolstering its operational and surge capabilities through updated frontline engagement, workforce development, data analysis, and budget flexibility. Across all reforms, greater attention to equity and accountability will be essential.

These measures can deliver results. If, however, they are not enacted, CDC will likely see further erosion of its standing and capacities, U.S. global leadership will falter, and Americans will remain unnecessarily vulnerable to dangerous biological threats. Such an outcome is antithetical to U.S. national interests.

When the space shuttle Challenger crashed in 1986 and Hurricane Katrina struck in 2005, the White House and leaders in Congress of both parties responded and successfully reinvented the National Aeronautics and Space Administration (NASA) and the Federal Emergency Management Agency (FEMA), respectively. The same is possible for CDC if leaders across the U.S. government commit to work together to drive a reset strategy through to its conclusion.

This report is a product of the CSIS Commission on Strengthening America’s Health Security, generously supported by the Bill & Melinda Gates Foundation.

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