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Institutional Innovation in the Midst of Cultural Change: CDC, the CFA and Mission Mystique

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
June 6, 2022

Can a government agency successfully stand up an innovative new unit in the midst of a period of loss of public trust and reform? The U.S Centers for Disease Control and Prevention (CDC) is attempting to do just that. The CDC officially launched the Center for Forecasting and Outbreak Analytics (CFA) in April 2022. Its official creation began with a memo during the early days of the Biden administration, but it is the brain child of several prominent epidemiologists who argued strongly that the United States needs the equivalent of the National Weather Service in regard to infectious disease outbreaks.

The CFA is a response to a frequent criticism of the CDC’s performance during the COVID-19 pandemic that the agency was unable to provide reliable and useful real-time information during a public health emergency. In books and articles, a recurring criticism is that the culture of the CDC is too academic in nature, geared toward doing research for scientific publications, rather than providing more actionable intelligence. The CFA’s website states the center’s goals as: “Enable timely, effective decision-making to improve outbreak responses using data, modeling and analytics.” The three core functions of the CFA are to “Predict,” “Inform” and “Innovate.”

Prior to COVID-19, many Americans may have expected that the CDC was already prepared to carry out these functions without the addition of a new unit. The CDC recently announced its own in-depth investigation into why the agency fell short at a number of key points during the pandemic. While many would argue that political interference certainly played some role in the CDC’s operations, even those who would tend to support the agency have advocated for a cultural change. The review was announced on April 11th and was estimated to last for one month. Jim Macrae, a former acting director of the Health Resources and Services Administration, was tasked with leading the effort.

In his 2011 book Mission Mystique, Dr. Charles Goodsell designated the CDC as an exemplary public organization based on the criteria he established. The establishment of the Center for Forecasting and Outbreak Analytics may be the first step toward reaffirming the CDC’s status as a Mission Mystique agency. It certainly speaks to the criterion which states “Agency renewal and learning are on-going.” The CFA exemplifies the CDC’s capability to adopt new types of data, as well as new methods of surveillance and analysis, to inform understanding of emerging infectious diseases.

Whether the criteria of the CFA meeting a societal need viewed as urgent and having a distinctive reputation based on achievement will be met depends in large part on the success of the CFA and the ability of the CDC to reestablish trust with the American people. Due to the proliferation of dis/misinformation regarding the COVID-19 pandemic and political opposition to public health measures in response to it, there is likely be to be significant skepticism about the predictions regarding emerging pandemics and responses to them. Success will be determined by how accurate the CFA’s predictions are and its ability to better target interventions based on them.

Like many public health organizations at the federal, state and local level, the CDC will need to reinvigorate its employees’ sense of pride and enthusiasm in its mission. This relates to Goodsell’s criteria of intrinsic motivation. Officials who may once have derived great self-esteem from working at the CDC have had that sense of pride eroded by the drumbeat of criticism from the public, politicians and the media. While the CDC has enjoyed considerable successes throughout its history, it has seen its share of scandals and failures which may become a more prominent focus in the wake of perceived failings during COVID-19. New initiatives like the CFA will need to serve as the foundation for future successes upon which the CDC can reclaim its reputation.

As the CDC goes through its review process and as it implements any changes suggested by the review, the agency will need to be open to internal opposition and contestation, as suggested by Goodsell. As much as there has been criticism of the CDC’s culture, there is certain to be some in the agency, perhaps in leadership, that will push back against reforms. It is also uncertain whether CDC will have the qualified autonomy to institute appropriate change. In the wake of COVID-19, conservative politicians across the U.S. have taken some serious actions to restrict the power of public health officials. So while innovations like the CFA may better position the CDC to identify the need for public health interventions, receiving permission from politicians to take preventative measures remains an area of uncertainty.

It is clear that an organization like the Center for Forecasting and Outbreak Analytics will be necessary if we have any hope of preventing a future pandemic on the scale of COVID-19 or worse. However, even as the success of the CFA is essential to the future relevance of the CDC, the CFA will likely only succeed if the CDC successfully undergoes serious structural reforms. Hopefully, principles like those articulated by Goodsell will guide the agency’s reforms. 

Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of “Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies.”  Myers serves as an academic advisor to the Continuity of Supply Initiative and assistant director of Indiana State’s Center for Genomic Advocacy. Email: [email protected] Twitter: @nagremye1980

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