CDC wants to change ‘outdated’ rules hampering agency’s ability to fight Covid, polio and other diseases
This summer, when the shocking news broke that there was a case of polio in New York City, the US Centers for Disease Control and Prevention immediately reached out to Shoshana Bernstein.
The agency urgently needed to increase polio vaccination rates in Rockland County, New York. And while Bernstein is neither a doctor nor a public health official, she is exactly what the CDC was looking for: a local vaccine educator who is part of the Orthodox Jewish community, one of the few groups with low vaccination rates.
Over the next several months, Bernstein spent hours and hours in meetings with CDC officials, including agency director Dr. Rochelle Walensky and then more time preparing presentations on educational campaign ideas.
She wasn’t paid a penny for her time.
“If I won the lottery, I would do this for free because I have a passion for public health,” Bernstein said. “But I can’t. I had to put other projects on hold to do pro bono work for the CDC. I have a family to pay bills for. I had to tell them, ‘I can’t go on with this if you don’t pay me.’ ”
It’s an old problem for the CDC: Despite having a multibillion-dollar budget, the agency has no authority from Congress to hire consultants in time when an emergency arises.
Walensky plans to appeal to Congress to allow flexibility to carry out this type of crisis hiring, similar to the authority some other federal agencies have.
“I want to make that very clear [we] they are not looking for a blank slate option to free up resources. What we are saying is that in certain situations we have to be nimble and act urgently in culturally sensitive ways that we don’t currently have the capacity to do,” Walensky said.
She told CNN that the agency’s “inability to move quickly and nimbly when needed” was “frustrating.”
“We don’t have the ability even in an emergency or urgent moment to say ‘we need to move here quickly,'” Walensky said. “We have to provide resources to people who can actually do the job [to] deliver that message quickly.”
dr. Tom Frieden, director of the CDC from 2009 to 2017, said he feels Walenski’s pain. He experienced the same inflexibility during the 2014 Ebola outbreak.
“If we want the CDC to get better at fighting disease, we have to stop tying their hands behind their backs,” he said. “This is kind of the pain of working in a government system.”
Their names are Duvi and Rochel and they could be the key to ending polio in the US.
Over the years, some members of the Orthodox Jewish community have fallen victim to well-orchestrated campaigns of vaccine lies. To counter this, Bernstein is working on several projects, including an animated one video with siblings Duvi and Rochel and a vaccine hero named Super V.
The characters sprinkle their conversations with Yiddish expressions. Duvi wears a yarmulke, or head covering, and Rochel wears a long-sleeved dress, typical of their community. Singing the melody of a popular Jewish song, Duvi thanks “Hashem” – or God – for the vaccines.
The project is funded by the New Jersey Department of Health, and Bernstein suggested to the CDC that versions of the cartoon could be made for other communities. She also told the CDC about a publication she wrote called “Tzim Gezint” – “To your health” – which helped to increase awareness measles vaccines during an virus outbreak in 2018
Walensky said the CDC liked Bernstein’s ideas, but he couldn’t pay her.
“Shoshana is someone who is known to the CDC for her work in the same community several years ago with measles and her outstanding work in successfully reaching this community,” Walensky said. “One of the things that is frustrating from my perspective [is] that we don’t have the capacity to finance it or provide it with resources.”
This financial inflexibility was also evident during the Covid-19 pandemic, when the CDC wanted to develop culturally specific vaccine education programs for communities with low vaccination rates.
A senior CDC official called it an “antiquated” system that “has not evolved over time.” The official spoke on condition of anonymity so she could speak freely about it.
The CDC is preparing a presentation to urge Congress to fix it, Walensky said.
She said she hopes to “move the needle” by using “real-time examples of how public health has been harmed by our inability to take action” during the pandemic.
One of the main arguments to Congress will be that other federal agencies have the authority to contract with foreigners during emergencies, according to a senior CDC official who spoke on condition of anonymity.
Spokesmen for the Federal Emergency Management Agency (FEMA) and the US Agency for International Development (USAID) tell CNN that their agencies can enter into certain types of contractual arrangements with outside organizations.
CDC will ask Congress for flexibility for several types of funding arrangements, Walensky said.
For example, during the 2014 Ebola outbreak, the agency tried to encourage people in West Africa to stay in Ebola treatment units, but it proved difficult, the senior official said on condition of anonymity.
“You want to be able to [arrange for food] for these families and these children so they can stay within the borders [treatment units] and don’t wander off when they just need a meal,” the official said.
“The lack of flexibility to be able to help out in the field is so difficult. … It’s heartbreaking.”
CDC staff in West Africa faced financial inflexibility for even the simplest things, such as printing Ebola educational materials, the official added, speaking on condition of anonymity.
“I think people would be surprised to find out how hard it is to do anything,” she said.
Ed Hunter believes that.
Hunter retired from the CDC in 2015 after 40 years with the agency. His most recent position was legislative director in the agency’s Washington office.
He said that every CDC director he has worked with has experienced “the same story: that there are such limits to what you can do [given] the specifics of appropriations coming from Congress and the timelines and complexities of the federal procurement system.”
“This is something that has been front and center at CDC for years and a real challenge to address,” he said.
Walensky said she hopes things will be different this time.
“We are not asking for money. We are looking for capacity. We ask the authorities to be able to do our work,” she said. “[But] I don’t know if I will be more successful than my predecessors.”
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