‘We Haven’t Invested in Public Health’: Trump CDC Leader Speaks

(Bloomberg) -- The U.S. Centers for Disease Control and Prevention needs to change its structure and culture, said Robert Redfield, the director of the agency during the Trump administration. 

Redfield spoke to Bloomberg News for more than an hour last month, discussing his time running the CDC and how he thinks it should change. He was often criticized as too deferential to then-president Donald Trump as the U.S. struggled with consistent messaging during the first year of the pandemic. Now retired from government, he says running the agency was a privilege but that it needs substantial changes to prepare for the future — including deploying more people around the U.S. and the globe, modernizing its data operations and abandoning a slow-moving culture. 

The conversation has been condensed and edited for clarity. For more on the the CDC during the pandemic, and the growing push for changes at the agency, click here.

You had some remarks recently where you said that it’s the wrong idea to think about the U.S. as has having a public health system. I wonder if you might be willing to expand on that.

Redfield: I prepared my whole life for the opportunity to be the CDC director. I’ve mentioned this publicly: One of my six children almost died from cocaine [mixed with] fentanyl. The first briefing I asked for CDC to give me was on the opioid deaths.

I got a wonderful briefing. And afterwards I asked the simple question: When was the data through? And they said through March 2015. And I said, but it’s April 2018. And they said, director, you don't understand the complexity of collecting data from the states, getting it curated and making sure it’s accurate.

I said — and I think some people were offended — when I became CDC director, I was excited about making an impact on the human condition in our nation. I didn’t realize I was becoming a medical historian.

We don’t have real-time data. Truthfully Covid is the closest thing we’ve ever had to it.

What needs to be done to change that?

One of the first things I did was go to Congress and ask for data monetization for the nation. Now I was thinking in terms of $25 to $50 billion. My own hospital system spent over $2 billion modernizing their data. When we had the measles outbreak when I was CDC director, I was getting some health departments sending me information by fax machine. That still happens.

We have really not invested in public health. We’ve never given the American public the public health system that it needs, more importantly that it deserves.

 Is there something you would have done differently to change the agency?

What I was hoping to do at CDC was to bring on board an extra couple of thousand people. Rather than have everybody at CDC, I was hoping to put 50 to 100 people in each state that would augment the state and city health departments. In particular to make sure that the data system was fully operational, real-time integrated — rather than relying on overburdened, understaffed public health systems to somehow take on the burden of whatever reporting we wanted to do.

 Is that what the CDC should be doing?

I had 23,000 people that worked with me — like 15,000 of them middle managers. (Note: The CDC directly employs about 10,000 people, but also works with contractors.) Every time I had an outbreak somewhere, I had to ask the volunteers. I should have people pre-deployed all over the United States. I wanted them pre-deployed all over the world. We had offices and our people in over 60 different countries, but none of them had a comprehensive capacity. I argued that it was time for us to develop a regional CDC, initially six to 12 CDC offices strategically placed around the world that had full capacity, similar to what the defense department has done.

Why hasn’t that happened?

The problem is people see global health as kind of like a cherry on top of a cupcake, right? They don’t, they don’t see it as the cupcake.

I say this cautiously, but I say it intentionally: The coronavirus pandemic is the lesser pandemic; the great pandemic is coming. And you would think we would be awakened to the potential for a new pathogen to be highly disruptive for our nation.

I live outside of New York and still remember when everything shut down.

I was never in favor of shutting things down. I was in favor of taking a pause and learning how to maintain important services like schools and hospitals in a safe and responsible way. There’s some children who will never get back on their education platform.

You said the Covid-19 pandemic is about as close to real-time data as we’ve ever had in public health. Is that being built in a sustainable way?

I don’t think there’s been a sustainable investment. It used to bother me when I was CDC, I was quite embarrassed that everybody quotes Johns Hopkins or Bloomberg. Why aren’t they quoting CDC? Well, because Johns Hopkins to Bloomberg’s data was more up-to-date.

The system that we have right now is so dependent on 70 different jurisdictions feeding stuff in. And there’s a problem with the culture in Atlanta. They’re very uncomfortable with data that hasn’t been, what they call, curated.

What’s does “curated” mean?

Validating primary data sources. And then double checking, triple checking, primary data sources. It’s a process that takes weeks and months. Why do we have to wait until the New England Journal of Medicine publishes? The culture has shifted into an academic perspective on public health.

With vaccines, did you feel like you had good information on the early part of the rollout?

I was very disappointed when [Ron] Klain, chief of staff for Biden, got up the first day and said what a mess he was handed on vaccines and that they were going do a million a day. It was all political rhetoric.

Because they’d met that pace when they took office, yes?

Yeah. It just bothered me that after all that hard work that we all did, that we couldn’t come together and just say, “Hey, we want to thank you for the way you handed us the football. Now we’re gonna take it higher.”

Does the CDC need to be restructured?

There’s an enormous opportunity for restructuring. I had multiple different institutes. They all were sort of independent, they control their own money. When I tried to move some of that money, if they didn’t like it, they made phone calls to Washington. Then I spent my time writing letters.

Secondly, the 23,000 people in the agency, I don’t need 60% of them in Atlanta. I needed them throughout the world and the United States. If I had a team of a hundred people that were detailed to each of the 10 regional health units in the United States, or into different states, it also would allow more people to be part of the public health mission for the U.S. government, because you, you know, you could live in any state in the country.

There’s real structural overhaul that the agency needs. I don’t think it’s should happen in an hour. I think it needs to be thought through. I think you’ll probably take a couple of years of argument and debate to see how to do it. And then probably another three to five years to implement.

Thank you for speaking with me.

I have great pride and respect for CDC. It’s a great agency. It was a privilege of a lifetime to lead.

©2021 Bloomberg L.P.