As it fights a pandemic, CDC wages a second battle to win back trust
“We’re following the science.” The line rolls regularly off the tongues of top US health officials — no one more so than US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky.
Science dictated last week’s guidance — widely criticized as confusing — advising fully vaccinated Americans that they could ditch the masks under most circumstances, Walensky said, citing studies showing the coronavirus vaccines not only provide better than 90% protection in real life, but also likely prevent vaccinated people from inadvertently infecting others.
But CDC is not following the science when it comes to talking to the public, communications experts say.
The agency, battered by the politically charged approach of the Trump administration, years of underfunding and disastrous mistakes made early in the pandemic, has failed to follow its own past research on how to communicate and clearly explain its decisions and guidance.
A lack of a coherent public communications strategy is in large part to blame, insiders and outsiders agree. But the CDC has also failed to adequately separate itself from politics and failed to own up to mistakes.
White House officials say they have, at times, grown frustrated as they attempt to navigate the CDC’s decisions from a political perspective without influencing them.
As a result, the nation’s premier public health agency is struggling to get Americans to follow guidance on how best to overcome the biggest catastrophe to hit the nation in a century: the coronavirus pandemic.
The polls reflect the public ambivalence. Only about half of Americans trust and believe in what the CDC is telling them, according to two recently released polls.
Even faced with a death count of more than 587,000, Americans cannot agree on whether and when to wear masks or get vaccinated.
Only 54% of Americans polled in February and March gave the CDC good or excellent job performance ratings. Another 45% gave the agency a poor or fair job rating, the poll of 1,300 adults conducted by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found.
A poll published by RAND in April found a 10% drop in confidence in the CDC between May and October of last year, even as trust in two other embattled federal agencies — the US Postal Service and the Federal Emergency Management Agency — grew.
Much of it is not the agency’s fault, noted Harvard’s Robert Blendon, who led the team that conducted this year’s poll.
“If you look at the poll results, people are filtering what comes out from the CDC on a day-to-day basis based on ‘my party,’ ” Blendon told CNN. “We have developed a partisan split in this country so badly that it affects how people interpret information about the pandemic.”
But that makes it even more imperative that the agency follow not only the science about the virus, but the science on how to communicate with people, Blendon said.
Communicating science
There’s a scientific approach to winning public trust and confidence, said Michael Pollard, a senior social scientist at RAND who helped lead last year’s survey. “The literature on trust suggests there are different buckets of things that can convey to people,” he said.
“One of those is competence and expertise.” There, the CDC is doing well, Pollard said.
“That’s the message they are using with the new masking guidelines. They’re, like, ‘we are following the science,’ which is good, but it’s not the whole story.”
One big mistake, Blendon and other experts agree, has been holding briefings under the auspices of the White House. That only serves to further paint the CDC — and other public health experts — with a political brush.
“If you want to be non-political, you never appear with political figures,” Blendon said. Yet several times a week, Walensky follows White House coronavirus adviser Andy Slavitt or White House Coronavirus Response Coordinator Jeff Zients in a brief and mostly scripted White House-sponsored Covid-19 briefing.
The CDC itself has in the past researched how to communicate during a pandemic, holding workshops and focus groups, and commissioning reports written by its own staffers. Knowing the risk of a pandemic at some point was 100%, the US Department of Health and Human Services sponsored tabetop exercises on communications and headlines under the George W. Bush administration.
In years past, the CDC held long, informative briefings with specialist staff who spent patient hours explaining to media the nuances of H1N1 swine flu, Ebola, Zika and other health emergencies.
The agency even held similar briefings at the start of the Covid-19 pandemic. But those ended dramatically in February 2020 when Dr. Nancy Messonnier, the trusted and respected director of the CDC’s National Center for Immunization and Respiratory Diseases, told the truth about the coming pandemic disaster.
“Disruptions to everyday life may be severe, but people might want to start thinking about that now,” she said, infuriating then-President Donald Trump.
Messonnier disappeared from public view for a year and coronavirus briefings moved to the White House, where public health officials such as former CDC Director Dr. Robert Redfield, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci and coronavirus response coordinator Dr. Deborah Birx were forced to stand by while Trump assured Americans the virus would “disappear” and mused about whether injecting substances such as bleach might be a good way to treat the virus.
White House briefings
Messonnier and the Atlanta briefings reappeared briefly when Biden took office, but were quickly replaced by a different version of White House-led events, dominated by political reporters rather than the health and science specialists who usually attended CDC news conferences.
Now, Messonnier has left CDC.
“It really does seem like the CDC has become highly politicized,” Pollard said.
“Presenting briefings from the White House keeps the political aspect of this in play.”
Former CDC director Dr. Tom Frieden doesn’t agree that it’s a mistake for the White House to take the lead on coronavirus briefings.
“It’s been very clear the Biden administration made stopping Covid their priority,” Frieden told CNN.
“It shows that it’s a whole-of-government response. I don’t think issues are being politicized.”
Frieden thinks some of the criticism has been unfair. “It’s easy to criticize. I think everyone’s piling on the CDC. You say ‘masks work’ — that’s somehow political. It’s hard to balance science with what people hear. It’s a tightrope you’re walking.”
Risk communications expert Peter Sandman sees strong evidence the White House kept control of all government messaging about Covid.
“Once Biden was in office and had appointed several White House pandemic officials, it became clear that the White House, not CDC, would be the principal locus of media information about the federal COVID-19 response. CDC Director Rochelle Walensky has been fairly visible.The CDC’s experts in infectious diseases, pandemic management, and vaccination under her, not so much,” he said.
White House political aides say they must defend the decisions made by the CDC — which critics and supporters alike often say whipsaw between being too slow and conservative, or too sudden and extreme.
Walensky’s announcement last week that vaccinated Americans could shed their masks in most places caught the White House off guard, multiple sources said, and staffers scrambled to prepare presidential remarks in response.
The experts CNN spoke to agreed the White House should lead communications about the logistics of vaccine supply. “But I would have expected to see a lot more CDC briefings on COVID-19 science,” Sandman said.
“Under Trump, the White House COVID-19 briefings were far too undisciplined. Under Biden, they feel too disciplined — too structured, too predictable,” he added.
“The Biden team doesn’t make false claims as often or as spectacularly as Trump did. That’s surely an improvement. What’s unchanged from Trump to Biden: The briefings seem dictated more by the White House political agenda than by new data.”
Missed opportunity
Sandman says the CDC missed an opportunity to reboot when Trump left office and the Biden administration took over. That should have been the time for CDC to admit to mistakes and reorganize its communications strategy.
“To earn that second chance at regaining trust, we believe the CDC must first come clean about how it lost trust,” Sandman told CNN.
It must also “assert that its principal mistakes were its own, not forced on it by the President or the administration,” he added.
“Tell people what it thinks it did wrong, and invite others to add to the list (and) say how sorry it is for these defects in its performance, how many deaths it knows it caused.”
CDC has not apologized for its failure to develop an accurate coronavirus test quickly enough in the first weeks of the pandemic, Sandman said.
And now CDC is not admitting that its mask guidance has been conflicting and confusing, he said.
While CDC should say science is informing its policies, it should also admit that the updated mask guidance came in part from a desire to provide a carrot to the vaccinated.
Yet Walensky has denied that CDC wanted to provide an incentive to get vaccinated.
“I think it would be really amazing if our new guidance got more people vaccinated and was an incentive for more people to get vaccinated, but I don’t make CDC guidance — my whole agency does not make CDC guidance — based on what it will help people do. We have to do it based on the disease that’s out there, access to vaccines and based on the science that emerged,” she told a Senate Appropriations committee hearing Wednesday.
A caring face
The CDC should also be working to convey empathy and caring, Pollard said, and should have worked to get buy-in from state and local officials, medical and nursing associations and others before announcing the changed guidance.
“One of the things I think they missed with the mask guidelines is they didn’t develop detailed guidances for states and businesses that these groups could use to implement the changes,” Pollard said.
One CDC staffer, who asked not to be named because they were not authorized to speak about internal matters, said the CDC had policies in the past to do precisely that. “We would have had rounds and rounds of calls to bounce the language off everyone, including the media,” the staffer told CNN.
That’s what CDC should still be doing, Blendon said. “When you are not trusted, you have to really go out and talk to the intermediaries — why you made the conclusion, where you are going with it,” he said.
“It has to be a campaign to tell people why this science convinced you to make a major change in policy.”
It’s communications 101, said Pollard. “They didn’t develop this guidance, they didn’t work with key stakeholders ahead of this announcement. There were no coordinated messages getting out,” he said.
So instead of working to reinforce CDC’s message, groups such as National Nurses United attacked it as confusing. “We have spent so long trying to redevelop the trust that people have with their government entities about what’s right and what’s not right,” the group’s president, Jean Ross, told CNN.
Getting buy-in
The CDC director should be speaking directly with such groups as well as with the media, Blendon advised.
“It is important, when there is an era of distrust, to have the central figure known as a person, as a human being,” he said. “They have to look people in the eye and say, ‘I really believe this is the right thing to do.’ “
And it’s important to prepare people for evolving policies. “You have to say with humility that the science can change again,” Blendon said.
Having a trained communications professional in a senior position could help CDC incorporate this advice into its strategy.
But career staff at CDC and in its parent Health and Human Services say that job — associate director for communications at CDC — has been open for more than a year. An acting associate director — Abbigail Tumpey — is in the role but doesn’t have the clout a permanent director would have.
So CDC’s media relations team is fragmented and often overlooked, the staffers told CNN. While morale is low, senior officials at CDC are so relieved to be free of the burden of oversight from Trump-era political appointees that they have not raised much of a fuss over their lack of input.
“The messaging has not been clear or consistent. A professional trained in that probably would help,” Pollard said.
Walensky said soon after she started her job earlier this year that she was putting another trusted and seasoned CDC staffer, Dr. Anne Schuchat, in charge of reviewing all CDC guidance.
Schuchat, who in previous administrations had frequently held public briefings in which she expressed sympathy, explained uncertainty and answered questions patiently, announced her retirement last week. As with much news coming from CDC, it was leaked to media outlets before it was announced.
The lack of a coordinated announcement led to speculation that Walensky and Schuchat had fallen out—something Schuchat denies. “It’s all good. Long awaited retirement this summer,” she told CNN.
CNN made repeated requests to speak to Schuchat, Walensky and other officials for this story, but one scheduled interview was canceled and CDC eventually declined to make anyone available.
