CDC suffers as boss lets politics influence policy
Redfield’s actions erode credibility as virus surges across US
Dr. Robert Redfield, eyes closed and searching for words, explained to Congress why the health agency he leads had softened coronavirus protections for slaughterhouse workers.
The White House, meatpacking industry and other federal agencies were not involved, the director of the Centers for Disease Control and Prevention insisted during the September hearing. None of that was true. Redfield was sitting in the White House when he instructed his staff to change a series of safety recommendations to suggestions, adding dozens of qualifiers such as “if feasible” and “not required.” He turned to a West Wing aide and told her the edits came directly from Vice President Mike Pence’s chief of staff.
Smithfield Foods, the South Dakota meatpacking plant under scrutiny, had seen the tougher recommendations, one of the first documents outlining COVID-19 protections for the industry. The CDC emailed it the day before the edits were made. Federal agriculture and labor officials also weighed in.
Redfield’s actions in overruling the CDC scientists who had spent a week
investigating and writing the original guidance fit a pattern defining his leadership during the COVID-19 crisis. He has repeatedly allowed politics to undermine scientific best practices – and then publicly denied it.
The CDC started the COVID-19 crisis as the world’s public health gold standard. Polls show more than 8 in 10 Americans trusted its coronavirus information in early spring, before states across the U.S. began reopening. The agency earned that respect through decades of shielding its scientific independence from Washington politics.
Since then, the country’s faith in the CDC’s coronavirus guidance has evaporated by double digits. President Donald Trump has undermined the agency by airing his own mistrust in it. And CDC scientists and staff have expressed concerns over Redfield’s leadership.
The election of a Democratic president may put a timestamp on Redfield’s tenure. But the CDC’s leadership remains critical in the transition, with cases now rising in virtually all states.
President-elect Joe Biden moved fast this week to highlight Redfield’s statements that masks will be Americans’ best safeguard against the virus, even after a vaccine debuts – remarks that had drawn Trump’s ire.
But experts fear Redfield’s failures have scarred American public health institutions, with life and death implications for a winter surge of outbreaks.
“The integrity of the agency has been compromised,” said former CDC acting director Dr. Richard Besser. “That falls to the director of CDC.”
USA TODAY interviewed dozens of Redfield’s current and former colleagues, as well as his critics, supporters and an array of public health officials. Reporters reviewed internal CDC communications and more than 45 hours of his statements. While Redfield’s capitulation to the White House has received attention throughout the pandemic, this reporting provides the most comprehensive portrait of the nation’s public health leader as his credibility unravels.
Redfield forged his career on the front lines of the HIV/AIDS epidemic as a military doctor. When a once-in-a-century pandemic exploded this past winter, Redfield, a devout Catholic, told friends that answering the crisis felt like his calling.
With each surrender behind closed doors and milquetoast public appearance, however, Redfield has alienated both his staff and politicians in Washington.
In late September, Dr. William Foege, a former CDC director famous for eradicating smallpox, urged Redfield to orchestrate his own firing.
“Acknowledge the tragedy of responding poorly, apologize for what has happened and your role in acquiescing,” Foege wrote in a private letter to Redfield first reported by USA TODAY. “The public health texts of the future will use this as a lesson on how not to handle an infectious disease pandemic.”
Climbing cases, waning credibility
The CDC director in the next administration will face a country increasingly distrustful of the agency’s coronavirus information, nonpartisan Kaiser Family Foundation polling shows. Among Republicans in particular, faith in the CDC declined by 30 percentage points from April to September.
The erosion in credibility comes as the agency is leading efforts to distribute a COVID-19 vaccine.
“When CDC says it, you can take it to the bank,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “What the administration has done, above CDC, is they have made that suspect.”
Hours before the CDC was to release school-reopening guidelines in August, the White House revised the document’s introduction, downplaying health concerns and encouraging schools to reopen, according to three health officials involved.
“We didn’t feel like we had a choice” whether to publish, one of the officials told USA TODAY about the episode, first reported by The New York Times. CDC officials spoke on the condition of anonymity because they were not authorized to discuss the meetings.
Amid the delays and confusion, local politics – not clear scientific guidance – largely determined which students are back in the classroom and which are learning online.
At the urging of cruise companies, the White House pressured the CDC to hold up the agency’s sailing ban in March and later remove explicit warnings. At least four ships cast off in the week before the original no-sail order and went on to experience COVID-19 outbreaks while at sea.
Two federal officials recalled conversations with a frustrated Dr. Martin Cetron, the agency’s director of global migration and quarantine. Olivia Troye, one of Pence’s former top aides who worked directly with the CDC, remembers Cetron telling her, “We are going to kill Americans.”
Now CDC employee surveys show low morale, said a senior CDC official with access to the data. The official, like others interviewed by USA TODAY, blames Redfield’s deference to the White House.
Under Redfield, political appointees started screening the CDC’s weekly scientific journal, used to inform doctors and scientists nationally, considered sacrosanct. Redfield told Congress the publication’s scientific integrity had not been compromised.
By most measures, Redfield has been in a nearly impossible position: serving at the discretion of a president hostile to unpopular public health measures.
Though he declined to be interviewed by USA TODAY, Redfield has confided in private that the criticism weighs heavily on him.
“I try to stand up and say never mind the critic,” Redfield said in a July webcast interview with the medical journal JAMA, a nod to President Theodore Roosevelt. “The credit goes to the man or woman that’s in the arena all bloodied and marred, tries, comes up short, tries again, comes up short again.”
CDC leader faces reckoning
In late June, Alex Azar, who oversees the CDC as secretary of the Department of Health and Human Services, visited CDC headquarters in Atlanta. During a closed-door session, he laid out the agency’s early missteps: failures in developing a reliable COVID-19 test and in helping states control the first outbreaks.
“There will be a reckoning,” he told them, according to three officials in attendance.
Azar looked to Redfield to respond. Redfield paused, then he punted to a deputy. That deflection “took the air out of an entire room,” one of the attendees told USA TODAY.
HHS declined to comment about the meeting.
In a rare news conference last month at the CDC headquarters, Azar rejected the notion that politics had undermined the agency.
“What comes out of CDC at the end of the day,” Azar told reporters, “is Dr. Redfield’s conclusions around science and evidence, with the support of his team.”
Yet in the White House’s coronavirus task force meetings, Redfield has struggled to champion the work of CDC scientists. “The entire task force is full of sharks eating each other,” said one senior health official. “And Redfield is not a shark.”
Redfield, 69, had never run a large government bureaucracy when he was appointed in March 2018 to direct the CDC.
“He was ambitious to do something
globally in public health,” said Dr. Robert Gallo, a longtime colleague.
But ethics questions dogged Redfield’s early work on HIV/AIDS.
In July 1992, Redfield announced at an international scientific conference that his military lab had found a vaccine therapy that showed evidence of reducing the amount of HIV in patients.
Redfield, however, had presented results from only a portion of patients, exaggerating the therapy’s effectiveness. The episode led to two military investigations, which found no evidence of scientific misconduct.
Two decades later, when Redfield was appointed to run the CDC, Sen. Patty Murray, D-Wash., warned the controversy showed a “pattern of ethically and morally questionable behavior.” But the Senate did not have to confirm his selection to the $7 billion agency, which protects against everything from foodborne illness to Ebola.
From the start of the COVID-19 crisis, the challenge of Redfield’s position was clear. One of his senior officers, Dr. Nancy Messonnier, warned in February of likely disruptions to American life. The stock market tumbled, stoking criticism from Trump.
Messonnier and other leading agency experts virtually vanished from public view.
“There’s a special gulag,” said Dr. Jeffrey Koplan, a former CDC director, “for truth tellers removed from the CDC.”
The Trump administration had its own view.
“The CDC guys think that they don’t answer to the president and that they are somehow an independent agency outside of the executive branch just spewing information out into the ether without a policy or political concern,” said former White House adviser Joe Grogan, a member of the coronavirus task force until his departure in May.
Political turning point
Amid national food shortage concerns, the CDC’s April guidance on protecting meatpacking workers from COVID-19 marked a political turning point.
Two groups of scientists at the CDC approved a safety report on a massive COVID-19 outbreak at the Smithfield Foods pork plant in Sioux Falls, South Dakota.
A day later, the CDC issued an amended report, making explicit that the recommendations were “discretionary and not required.” The edits were first reported by MSNBC.
“We wanted to make clarification to make sure that people understood ours was a recommendation and not a regulatory requirement,” Redfield told lawmakers in September.
Sen. Tammy Baldwin, D-Wis., asked if the CDC had had any contact with Smithfield Foods, the U.S. Department of Agriculture or the White House before the report was edited.
“No,” Redfield responded. “Not at that time.”
Redfield subsequently called Baldwin to correct his testimony. The CDC had worked with both the labor and agriculture departments.
But Redfield did not mention what else had taken place inside the White House.
Pence’s chief of staff, Marc Short, relayed editing requests to Redfield in the
West Wing, according to Troye, Pence’s former aide. She sat next to Redfield as he dictated the changes to staff over the phone, an episode first reported by the New York Times. Short frequently spoke with executives from Smithfield and other meatpacking companies, Troye said.
The Smithfield pork plant, a sprawling complex of more than 90 buildings, was one of the largest known COVID-19 hot spots in the country this past spring, when about 1,300 workers contracted the virus and four employees died, according to the Occupational Safety and Health Administration.
“I remember crying,” Troye told USA TODAY about the watering down of the guidelines, “because I knew what those changes meant.”
Smithfield spokeswoman Keira Lombardo maintained that the CDC’s Sioux Falls report was a draft when changes were made. Regardless, she said the company opted for stronger worker protections than the CDC suggested. In a statement to USA TODAY, Smithfield disputed the number of deaths, saying there were two, not four.
“The aggressive measures we have implemented have proven to be successful,” Lombardo said, noting it has invested more than $600 million to protect employees.
In late April, the CDC co-published national guidance for meatpacking facilities with the Department of Labor that adopted many of the qualifiers from the final Smithfield report.
Political fingerprints
Redfield had outraged local health officers in early March by personally requesting a COVID-19 test, then in limited supply, for one of Trump’s political allies in Nevada after the Conservative Political Action Conference, records show.
In April, HHS told the CDC to issue a public health justification for closing the U.S. southern border to Mexico off from asylum seekers, according to four officials involved.
The CDC’s scientists refused, the officials said, citing evidence that COVID-19 already was spreading domestically and Mexicans were not importing the virus.
Redfield signed the order, written by attorneys at HHS but opposed by his scientists, which cites the risks at the crowded facilities.
“I determined it was in the public health interest, at that time,” he said in a statement provided to USA TODAY by HHS.
In August, many state and local health officers were aghast about the CDC’s abrupt change to its testing guidance: People exposed to the virus but not showing symptoms did not necessarily need to be tested.
Several weeks later, the CDC reversed the recommendation, which had been posted over the objections of its senior scientists. Questioned by lawmakers, Redfield said the agency had not intended to limit testing. He described his staff as engaged in the document, written cooperatively with other federal entities.
“He wasn’t telling the truth,” said Sen. Chris Murphy, D-Conn. “Dr. Redfield has become complicit in the White House’s attempts to try to slow down testing and bury the extent of the crisis.”