A Conversation with Rochelle Walensky, MD, MPH

CDC Director Rochelle Walensky, MD, MPH, addressed the MD and PhD graduates and their guests at Thursday’s Convocation Ceremony. Walensky answered questions gathered from students and faculty about her journey, women in leadership roles and lessons learned from the pandemic, and other issues facing our nation today.

Please share with us how you got to where you are today.
My passion for public health became clear in 1991 during the AIDS crisis when the disease ravaged inner-city Baltimore, where I was completing my medical training. I remember admitting countless patients and feeling hopeless because we had little to offer clinically and therapeutically in the early day of the AIDS endemic. Challenging and touching conversations with patients ignited my call to service and fight against disparities. I would routinely call on those moments as a professor at Harvard Medical School, chair of the NIH’s AIDS Research Advisory Council, chief of infectious diseases at Massachusetts, and even today as the CDC director. My passion for disease prevention and treatment has remained steadfast, and I’m grateful to the mentors and collaborators who have helped me help others.

How do you feel about women in leadership roles?
Women in leadership are integral to producing fresh perspectives and new ideas. We must continue to offer opportunities and support women in fields where they are underrepresented. Inclusivity throughout our public health workforce is how we can create the best outcomes. This is why it is important that our workforce be as diverse as the communities we serve.

What are your biggest lessons learned during the pandemic or knowing what you know now, what would you have had the CDC do differently with regards to COVID pandemic response?
I know the word is overused at this point, but the pandemic was truly unprecedented. Never in the CDC’s 76-year history has the agency been forced to make decisions so quickly with limited and changing science. Before COVID-19, public health was somewhat unknown and chronically under-resourced. In addition, traditional scientific and communication processes in the context of a frail public health infrastructure left us woefully unprepared for the size and scope of COVID-19. At CDC, we are building on the lessons learned from COVID-19 to improve how we deliver our science and programs. These include:

• Sharing scientific findings and data faster: Release scientific findings and data more quickly in response to the need for information and action, as well as being transparent about the agency’s current level of understanding
• Translating science into practical, easy-to-understand policy: Enact a standardized policy development process for implementing guidance documents and other public health communications
• Prioritizing public health communications: Prioritize and enhance public-facing health communication practices and staff expertise
• Promoting results-based partnerships: Work more effectively with our public health partners to accomplish result-oriented goals and address the limitations of a siloed approach to solving major public health problems
• Developing a workforce prepared for future emergencies: Focus on diversity, equity, inclusion, accessibility, and belonging to strengthen the CDC workforce’s response to infectious and non-infectious public health emergencies, including new skills, training, capabilities, and aligning incentives for commitment to these efforts

How has the COVID-19 pandemic changed your thinking about how to handle emerging infectious diseases?
The COVID-19 pandemic highlighted CDC’s role as a response agency. CDC is an exceptional science-based agency; traditionally, the agency has taken a more academic approach to our work. However, during the COVID-19 response, we learned that we must be a response-based agency too that can quickly respond to any emerging public health threat. I made this a priority for the agency to critically reflect on and implement lessons learned so that we can better prepare for future health threats. Through the initial implementation of my Moving Forward initiative, CDC is now disseminating science faster, communicating more efficiently, and becoming more of a response-based agency.

Given the gravity of the opioid epidemic and overdose-related death, how might it be possible to create a national dashboard for reporting opioid related deaths in as timely and detailed a method as we were able to achieve for COVID deaths?
CDC uses multiple sources to track the drug overdose epidemic. Examples of these systems include the Drug Overdose Surveillance and Epidemiology System and the Unintentional Drug Overdose Reporting System. CDC’s National Center for Health Statistics also provides monthly provisional drug overdose death counts.

CDC’s Overdose Data to Action initiative supports collecting and using this data to inform prevention and response efforts like prescription drug monitoring programs, community-level interventions, empowering individuals, and developing partnerships with public safety experts.

While CDC can get a national picture of overdose deaths from the National Vital Statistics System, this data can take time to collect and finalize. The additional data dashboards fill in some gaps, but the agency does not have the authority to require states to report specific, standardized data on overdose outcomes. As it does for most of its data, CDC relies on different surveillance systems, voluntary data sharing, or individual data use agreements to gather information from states and jurisdictions. Without standardized reporting, sharing and comparing this data across jurisdictions, cities, and states becomes complicated and limits what we can provide in a timely manner concerning the national picture of overdose-related health outcomes.

What can be done to bolster faith in the CDC amongst groups that have turned away from science during the COVID-19 pandemic?
So much about trust is really about accountability. To bolster faith, we are acknowledging past mistakes and show how we are working to do better in the future. This is a key focus in the CDC Moving Forward initiative I launched in August 2022. The priorities of Moving Forward include sharing data and decisions quickly, communicating uncertainty and developments, and sharing science and guidelines directly.

CDC has already started to put these priorities into action in response to recent public health threats. During the mpox response, CDC prioritized making timely data publicly available through web postings of key data finding including results of the American Men’s Internet Survey on behavior change and an early look at vaccine performance data. In both cases data were posted online even before they were packaged for publication. Similarly, CDC has continued to make timely and transparent data available on avian influenza through multiple and ongoing updates to our Avian Influenza Technical Report.

CDC is committed to building on trust through good science, good recommendations, and a good relationship with the public.

How do you deal with political discourse in public health policy discussions?
At CDC, our recommendations and public health decisions are based on science and protecting people. We must also recognize that public health policy impacts everyone and consider multiple perspectives. Coordinating across the government is critical when implementing our science-based policies.

As CDC Director, I prioritized one-on-one conversations with legislators of all political parties so that they understand where we are coming from and what our science is telling us. I emphasize the significance of public health, the role of CDC, and the need for government support to protect our country’s health and security. Public health is a critical component of policy making, and it is important that CDC has a seat at the table and a voice in key decisions impacting the nation’s health.

Science has become politicized with results frequently cast as true or untrue. How can scientists communicate their level of uncertainty about their research…Is there a way to cultivate an educated consumer base that understands how science works. Do you have any examples of scientists who are doing that now?
I have learned about the importance of communicating limitations and uncertainty throughout the pandemic and during my time as CDC director. Ambiguity is a normal part of science and a fact of life; people deserve to know when they can expect changes. Part of CDC Moving Forward is communicating directly with the public using plain language and understandable resources. COVID-19 and mpox showed us that partnering with a diverse group of trusted messengers is critical in sharing our science and recommendations. To cultivate an educated public, we must earn and sustain their trust, prioritize diversity and accessibility, and be honest and thorough when uncertainty arises.

What can be done to reshape the dialog of guns and gun control into a public health policy?
We should approach firearm injuries and deaths as a public health issue to accurately capture the complexity, urgency, and need for solutions. It must be understood that there is no single cause or solution to gun violence and that circumstances and needs vary across the country. Furthermore, it is important to recognize that, like many other public health issues, gun violence is often the result of poverty, racism, gender inequality, and other underlying social determinants. When we have this conversation in the context of a comprehensive public health framework, evidence-based solutions that protect individuals, families, and their communities become more conceivable.

Implementing safer public health policies is a team effort, requiring support from various partners. Looking through a public health lens, we recognize that we need to engage everyone on this topic from gun owners to law enforcement. At CDC we have invested in research in this area spanning from firearm suicide prevention to safe storage of firearms in the home.

We all share the same goal of preventing adverse outcomes; let’s find areas where we agree and promote safe practices and interventions that can save lives.

What role can the CDC play in addressing the physician and health care worker shortages in rural areas?
A robust public health infrastructure requires a diverse workforce representing the communities they serve regardless of zip code. We are establishing the Office of Rural Health to build on our existing rural health work and provide a home for focused action and leadership. The goal is to integrate the best science and solutions to ensure that rural health needs are reflected in public health programs. We plan to make the most of this opportunity by developing a strategic plan, establishing federal leadership, integrating rural health into our major programs, and collecting better data to propose better solutions. A well-resourced environment and healthcare system are essential in attracting and retaining physicians and health care workers in rural areas.