CDC Director Rochelle Walensky ordered the review as part of her pledge to restore public trust in the beleaguered agency, which had seen its recommendations watered down or ignored during the Trump administration to align with the former president’s efforts to downplay the severity of the pandemic.
“I am focused on moving CDC forward with science, transparency and clarity leading the way,” Walensky said in a statement Monday. “It is imperative for the American people to trust CDC. If they don’t, preventable illness and injury can occur — and, tragically, lives can and will be lost. This agency and its critical health information cannot be vulnerable to undue influence, and this report helps outline our path to rebuilding confidence and ensuring the information that CDC shares with the American people is based on sound science that will keep us, our loved ones, and our communities healthy and safe.”
The review was done “to ensure that all of CDC’s existing covid-19 guidance is evidence-based and free of politics,” according to a memo from the agency’s principal deputy director, Anne Schuchat. Schuchat conducted the review, which was posted on the agency’s website Monday. Officials said they are revamping all pandemic-related guidance to ensure that science and transparency are paramount.
The July school reopening guidance was controversial because it was released weeks after Trump criticized the agency’s earlier recommendations as being “very tough and expensive.” The opening preamble extolling the importance of in-school classes was presented as a CDC document, but the agency was not part of the discussion or drafting, Walensky said. That guidance was removed in October.
“This is something that I will not allow as CDC director,” Walensky said. “The processes we have in place moving forward will ensure this cannot and will not occur.”
Schuchat does not identify the outside authors who wrote the three guidances not developed by CDC staff. Nor does her memo mention political interference by the Trump administration. The word “politics” appears only once, and Walensky and Schuchat appeared to go out of their way in interviews to avoid discussing it.
But the review provides official confirmation of what has been widely reported in press accounts at the time — that political appointees ordered revisions to critical CDC guidance. In addition to the three documents not written by CDC staff, the review also cited recommendations that should have used stronger language and that should have cited supporting scientific briefs.
In addition, the memo said that too often, it was difficult to “decipher the core recommendations” in long guidance documents, and “the crux of what was new or changed was difficult to find.” But the document, a copy of which was shared with The Washington Post, does not provide specifics.
Walensky said she plans to adopt Schuchat’s recommendations to ensure that scientific rationale for major guidance is clearly communicated — with executive summaries that identify what’s new. She said that key guidance will be reviewed quarterly, and briefings will be held for media and other public-health groups when they are issued.
The review also found instances in which guidance used weaker language, such as “considerations” and “if feasible,” even though evidence supported a stronger recommendation.
“I can’t speak to how the decisions were made or why the language was less directive than we wanted it to be,” Walensky said. “We need to have language that needs to be clear when the evidence base is sufficiently strong.”
President Biden’s administration is focusing on the need to “offer the public a unifying message about what we’re doing and help rebuild their faith in government,” said one health official who spoke on the condition of anonymity to talk about internal policy discussions. The official added that it’s harder to rebuild faith in government when people are “constantly reminded of how [the CDC] has been overridden.”
Schuchat and about 15 to 20 CDC staff members assessed the major guidance to “identify primary documents that needed updating or removal,” the memo said. Agency officials had already begun assessing key recommendations related to testing and schools in October, because of concerns from clinicians and others about the need for updates as coronavirus cases surged in the fall, Schuchat said in an interview.
Regarding testing recommendations alone, the CDC has “36 different testing guidances that descend from one,” Schuchat said. The agency is working on a major update, including recommendations for prisons, homeless shelters and other workplaces, the memo said. The CDC is trying to streamline the process so one major document can cover many circumstances.
Not all guidances have been updated to restore information removed for political reasons. In May, political appointees delayed the release of and then removed warnings contained in guidance for reopening churches that said that singing in choirs can spread the coronavirus. That warning has not been restored.
Schuchat said the dangers of singing are now covered in general guidance about events and gatherings. “We were trying not to have to update too many different things,” she said. Since May, the CDC has released much more information about the importance of consistent mask use, and the agency will continue to reassess its recommendations.