As director of the Centers for Disease Control and Prevention, Rochelle Walensky is constantly making critical decisions about public health in the United States.

Walensky recently sat down with reporters to answer questions about the challenges of responding to the COVID-19 pandemic at the national level. This Q&A was conducted during the 2021 Health Coverage Fellowship, which Mississippi Today health care reporter Will Stribling participated in.

Editor’s note: This Q&A has been edited for length and clarity.

Reporter: How did the U.S. get to the point where we’ve fallen behind on rapid antigen testing to the point where there are shortages on pharmacy shelves? What needs to be done on the testing front? 

Walensky: I think we have been doing a lot of testing.I think the way that we are using testing is evolving, not only with the times of how testing is being utilized, but also with the new tests that are becoming available. That evolution, I think, is that appropriate natural evolution and there are many different strategies for testing available.

Mississippi Today: What has the CDC learned throughout this pandemic about effectively communicating with the public? I know there’s been a lot of criticism directed your way, especially around some messaging that was perceived to be bungled near the beginning of the pandemic. What have y’all learned on that front?

Walensky: There are a lot of lessons to be learned here. So much of what we have to do is communicate and I’m learning that in this position as well. I think part of the challenge that we have had is, and I like this analogy, people look at the weather every day to see whether they should bring an umbrella. But if the science changes (related to the pandemic), they’re not necessarily willing to be as flexible as today I need my raincoat or umbrella. 

There was this moment. I remember it well. It was a Friday evening, when I saw the data from Provincetown that essentially showed that if you had a breakthrough infection with the Delta variant that you could transmit the disease to others. We hadn’t seen that from breakthrough infections yet. We all saw the data and our jaws kind of dropped. The data were going to be published about a week later, which in publication land, is extraordinarily fast. And then the question was when and how do we communicate this to others? We knew we essentially needed to put masks back on vaccinated people, at least in this moment. And the question in my mind was, do we wait until the paper comes out in a week? Or do we not and say, the data is forthcoming, it’ll be out shortly, I made the decision that we need to do this so that the public is aware, but while recognizing that everybody wanted to see the data.

And I felt that it was important that parents know that they might bring disease home to their own vaccinated kids, that people might bring disease home to their immunocompromised family members. I tell that story, because I am fully aware that I’m making decisions where I will be criticized, regardless of what I do. In those situations, and really in all situations, I put my head down, and I say, ‘what’s the right thing for public health? What’s the right thing for health in the country?’ And that’s what I do. And then you pick up the pieces wherever they land. You have to communicate those decisions well, you have to get out there, you can’t be afraid to own your decisions. And I haven’t been.

Reporter: We’ve heard from state officials and local officials frustration that they’ve had with the CDC about a lack of data, or in some cases, they felt that they were kind of going it alone. So can you speak a little bit to what the biggest challenges that you see that might be driving some of these concerns that we’re seeing in our own work, and that local states are?

Walensky: I came in a year into this, and the public health infrastructure in the country was frail to begin with. Just to give you a sense of where our public health infrastructure is in this country, between 2010-2021 we have had H1N1, we have had Zika, we’ve had Ebola and we’ve now had COVID-19. And in that decade, this country lost 60,000 public health jobs. So we started really frail. We started with an infrastructure where the data from public health could not communicate with the data from a health system. People were faxing in COVID tests. We just didn’t have the laboratory infrastructure, the data infrastructure, the data systems. Even the investment in data to this day is orders of magnitude literally, less than it would cost a single system to upgrade their electronic health record. So the resources that have been there have been thin, and we are doing our best to work with them. 

Mississippi Today: You’ve talked about how the work of CDC is meant to be preventative care. But we hear all the time in America that we don’t have health care, we have sick care, and that is baked into the way that public health is funded. I’ve heard from our state health officer in Mississippi that when a crisis like Ebola or COVID-19 emerges, they get all of this money that is really chained to responding to that specific crisis. No funding is given for building better public health infrastructure so they can be better equipped to deal with future crises. You also can’t use an inconsistent block of funding like that to hire public health workers. So how do we reconcile this disconnect and fix these issues if we want to have a public health system that really is focused on preventing future crises from barreling out of control?

Walensky: I’ve been to the (U.S. Capitol) Hill eight times to testify and I spent a lot of time talking about longitudinal resources. We have a lot of resources now, but we don’t have educated public health workers to hire. And even if we did, we can’t hire on a two year budget. We need to hire on a five year or 10 year budget. This, I call it staccato funding,  disaster to disaster does not create a pipeline of people who have secure jobs in public health. It doesn’t have community workforces who are from the communities they serve. You know, I say that if we had had public health workers in Chelsea, Massachusetts, who went to churches and did blood pressure screenings every week, then when it came time to do testing, when it came time to do vaccinations, it would have been easy, right? They would have had trusted people on the ground. We haven’t had that and we’ve never had it.

The other thing I will say is, we need disease agnostic resources. So much of our funding at CDC and to the public health departments is line item (meaning it’s restricted to work related to a specific disease). If we have a line item for every disease, how do we treat a community? What are the things that we do to improve health in a community? It’s a huge problem and I’m trying to sort of chisel away some of the line items so we can have disease agnostic, longitudinal funding. 

Reporter: When is this pandemic going to end? What do you see as sort of the necessary factors to ending this? 

Walensky: Well, I would say nobody really wants it over more than I do. That may not be entirely true, but I’m probably pretty high up there. This is not going to be a very satisfying answer, but I’ll give it to you anyway. I think a lot of it depends on human behavior. We have a lot of the science right now. We have vaccines. What we can’t really predict is human behavior, and human behavior in this pandemic hasn’t served us very well. We are battling with one another, and not battling with the common foe, which is the virus itself. We have 55% of people fully vaccinated, perhaps we have some more protection by some people who’ve been recently infected.

But with the Delta variant, our R0 (a mathematical term that indicates how contagious an infectious disease is) is eight or nine. That means we need a lot of a lot of protection in that community to not have disease. And the real challenge is that there are some communities that are really well vaccinated and really well protected. And then there are pockets of places that have very little protection. And the virus isn’t stupid, it’s going to go there. So really, what this depends on is how well we coalesce together as a humanity and a community to do the things that we need to do in those communities to get ourselves protected.

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