Unauthorized and Unprepared: Refocusing the CDC after COVID-19

Executive Summary

What This Paper Covers

The Centers for Disease Control and Prevention, the nation’s preeminent public health agency, has acknowledged that it failed badly during the COVID-19 pandemic. This paper examines why and suggests how the agency can be reformed and refocused.

What We Found

The basic problem was CDC mission creep, abetted by the lack of congressional authorization for the agency. Because the CDC has never been fully authorized by Congress, it lacks goals, circumscribed powers, and effective oversight. This led to a rapid and haphazard expansion of its responsibilities and the CDC became a large, diffuse agency with priorities that are far afield from its core mission of controlling and preventing communicable disease outbreaks.

CDC is now a collection of centers and programs that are disconnected from each other and from state and local authorities and duplicative of programs in other agencies and departments. These redundancies are unnecessary and costly and divert the CDC from its primary purpose to protect the nation from communicable diseases. Just a small fraction of CDC resources is devoted to communicable disease threats. The lack of focus left the agency unprepared for the pandemic and distracted it from an effective response.

Why It Matters

The CDC’s failures during the pandemic undermined public trust. Americans deserve a better, more focused, and less political public health agency. Unless the CDC is reformed and refocused on its core mission, it will be unprepared to act effectively in future pandemics which will surely come.

Policy Suggestions

We cannot rely on CDC to reform itself—bureaucracies rarely do. It is Congress’ job to define CDC’s role. Instead of blindly increasing funding, Congress should comprehensively authorize the CDC for the first time and reaffirm the agency’s original mission to combat communicable, infectious diseases. Congress must do the hard work of delineating the agency’s objectives and functions and cutting back on the many areas where the CDC does not have expertise and duplicates other authorized agencies’ programs. Congress should remove off-mission priorities—such as broad prevention initiatives, social determinants of health, environmental issues, and violence prevention—to agencies where they can be, or already are, better addressed. These reforms would help restore public trust and make the CDC a more effective agency that is better prepared to combat the next pandemic.