The Centers for Disease Control and Prevention sparked considerable outrage when, at the end of July, it recommended people wear masks indoors in areas with "substantial and high" rates of COVID-19 transmission, including those fully vaccinated.
"The CDC's updated guidance deeply undermines vaccine confidence," Republican Rep. Cathy McMorris Rodgers said at the time.
The CDC seemed to be trying to boost confidence in COVID-19 vaccines when just over 2 months prior, in May, it announced that those who had received the shots no longer had to wear masks in most situations.
Such incidents have led to complaints that the agency engages in mixed messaging and goal-post shifting.
“It’s certainly a fair criticism,” said Vladimir Kogan, an associate professor of political science at Ohio State University. “The CDC finds itself in a hard position. No matter what they do, people are going to criticize them because some of these recommendations at their core rely on value judgments on which reasonable people can disagree.”
But the CDC's difficulties are also the result of problems that typically plague bureaucracies, from serving multiple goals to political pressure to ineffective leadership.
“Agencies like the CDC have these multiple constituencies that they have to be responsive to, and they have multiple goals that they have to balance,” said Kogan.
Getting the country vaccinated against COVID-19 is an important CDC goal. However, by early May, that goal was getting harder to achieve, as the daily number of people getting shots had been falling since mid-April. That likely informed the CDC’s decision in May to announce that those vaccinated could largely forgo masks, as it might incentivize more people to receive a vaccine.
But another goal the CDC must pursue is stemming the outbreaks of infectious disease. By July, the CDC faced a surge in COVID-19 cases caused by the more infectious delta variant. The best way to stop new COVID-19 outbreaks is more vaccinations, but the CDC could not reverse the decline in vaccinations that began in April. When the CDC obtained research that even vaccinated people could become infected with the delta variant and spread it, urging the vaccinated to mask up probably seemed like a good idea.
The CDC's research found 346 “breakthrough infections” among people vaccinated in Barnstable County, Massachusetts. Of those, four were hospitalized, and no deaths were reported.
“Breakthrough infections will occur, but we don’t need to exaggerate their effects,” said Cameron English, the director of biosciences at the American Council on Science and Health, a pro-science consumer advocacy organization. “If you keep telling people, ‘The vaccines are great, but there are a lot of breakthrough infections, but vaccines are great,’ it’s that oscillating that causes the problem.”
In this instance, the CDC may have harmed the case for COVID-19 vaccines.
“To the people that haven’t been won over yet, this communicates that these very effective vaccines can’t be that effective because you are telling them to wear a mask,” said English. “The changing guidance back and forth raises questions for people about what the CDC is saying and doing, whether or not that’s justified.”
The CDC has also shifted goal posts on its statements and policies regarding the safe reopening of schools.
In early February, the newly appointed CDC director, Rochelle Walensky, said, “I want to be clear. There is increasing data to support that schools can safely reopen and that safe reopening does not suggest teachers need to be vaccinated.”
Yet, the guidance on schools that the CDC released in mid-February did not reflect Walensky’s statement. Indeed, it seemed designed to keep as many children away from schools as possible. The guidance stated that schools would open or close based on a four-tier system, with each tier based on the rate of new COVID-19 cases in the previous week. For example, a school would fall into the most restrictive tier if the county it was located in had a rate of 100 new cases per 100,000 residents. When the guidance was released, over 90% of the United States fell in the most restrictive tier.
“That just didn’t make sense. The evidence we had at the time was that schools were safer, that there was less transmission inside schools than outside them, so it was not obvious why you’d want school closed,” said Kogan. “If anything, it suggested that you wanted kids in school because they were more at-risk outside of it.”
Political pressure likely explained the outcome.
At the time, many local teachers unions insisted that all educators would need to get vaccinated before classes could reopen. Like United Teachers Los Angeles, a few insisted that students would have to be vaccinated as well.
Since teachers unions were big supporters of President Joe Biden, it wasn’t surprising when the White House began to walk back Walensky’s comments from early February. “The president himself has talked about the importance of a priority of vaccinating teachers,” said White House spokeswoman Jen Psaki.
As the CDC developed guidance on school reopenings, teachers unions played a role in developing it. Emails later obtained through the Freedom of Information Act showed that the American Federation of Teachers reviewed the guidance and provided input before it was released. A CDC official referred to the organization as a “thought partner” during the process in one email.
Walensky also vacillated on whether social distancing between students should be 3 feet or 6 feet.
“Walensky was for 3 feet before she was against before she was in favor of it again,” said Kogan.
Given the limits of classroom size, requiring students to socially distance at 6 feet instead of 3 would keep schools from operating at full capacity.
Before she became head of the CDC, Walensky seemed to agree with that. In the summer of 2020, she advised the Newton Public School District in Massachusetts that “if people are masked, it is quite safe and much more practical to be at 3 feet.”
But in the CDC guidance released in February, 6 feet of distance was now required for schoolchildren. Walensky justified it by saying new research supported the 6-feet standard.
Kogan, though, said the research supported 3 feet. That included a meta-analysis in the Lancet that found 3 feet sufficient if people wore masks.
Then in late March, the CDC reversed course, releasing new guidance finding 3 feet acceptable as long as all students wore masks.
English argued that this back-and-forth probably undermines public trust in the CDC.
“You can compare it to any other situation. If you had a colleague or you were in a relationship with someone who behaved like the CDC, how would you react? It would damage their reputation in your mind,” said English.
It’s not yet clear from opinion polls if public trust in the CDC is dropping. A Harvard-Robert Wood Johnson Foundation survey found that in 2021, 54% of the public gave the CDC good marks, down from 59% when the survey was last taken in 2009. But a recent Annenberg Public Policy Center poll found that 76% trusted the CDC as a valid source of information. No survey on trust in the CDC has been taken since the agency changed its guidance on masks for the vaccinated in July.
Despite the CDC’s missteps, Kogan expressed some sympathy for the agency.
“One reason I think guidance keeps shifting is due to the uncertainty surrounding the pandemic,” Kogan said. “While we know more than we did, there is still a lot that we don’t know.”
English expressed a similar sentiment.
“I think the CDC is in a tough position because if anything goes wrong, people look to them, and they take the blame for it,” he said.
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Tags: Healthcare, Coronavirus, Centers for Disease Control and Prevention, Rochelle Walensky, Jen Psaki, Joe Biden, Delta Variant, Vaccination, Face masks, CDC, Teachers Unions, American Federation of Teachers, Public Schools
Original Author: David Hogberg
Original Location: CDC undermines public trust with mixed messages and shifting goal posts