Former CDC Directors on the Public Health Economy: Infrastructure is Broken

Former CDC directors gathered in April 2022 to discuss the state of the Centers for Disease Control and Prevention (CDC) - the leading federal public health research and response agency in the US. The Covid pandemic raised the profile and public criticism. They mostly limited their discussion to the traditional public health infrastructure of surveillance, public health research, and emergency preparedness and response. Their critical assessment of the CDC can be extrapolated to support Public Health Liberation (PHL) theory on disorder in the public health economy, which contravenes the public health commitment and capacity to address health inequity. Accelerating health equity particularly by income and race is the mission of Public Health Liberation. The challenges within the CDC are structural, political, and cultural, encumbered by underfunding and a lack of mission-driven strategic focus. By its own admission, “The Centers for Disease Control and Prevention (CDC) faces structural and systemic operational challenges, which were exacerbated during the COVID-19 pandemic…However, since the pandemic, we also acknowledge that CDC is responsible for some large, public mistakes.”

Their discussion highlights the interaction of the political economy with public health aims and provide evidence of the assumptions of public health realism that posits hyper-competition and tensions to explain constraints on the CDC and the public health economy broadly. Rick Berke, Co-Founder and STAT Executive Editor moderated a critical dialogue among Bill Foege (CDC Director, 1977 to 1983), Tom Frieden (CDC Director, 2009 to 2017), Julie Gerberding (CDC Director, 2002 to 2009), Robert Redfield, (CDC Director, 2018 to 2021), and Bill Roper (CDC Director, 1990 to 1993). The purpose of this essay is to ground CDC challenges within PHL theory and practice.