It is not possible to serve two masters with opposing goals. In the case of the Centers for Disease Control and Prevention (CDC), it has not always been obvious that such a dichotomy exists, but it has become ever more apparent since Trump and Covid-19. Before that, many of us relied on the CDC for accuracy, integrity, public health science, and sound policy. Indeed, most of those who labor there do their utmost to live up to that ideal, and the CDC has had many notable achievements, such as the eradication of polio and control of Ebola. But, like the FDA, the CDC is not an independent agency free from corporate or political pressures, which has now been brought into excruciating focus. Indeed, the CDC is now openly complicit in the capitalist dictate to prioritize the health of the economy over that of workers. The CDC has now declared that its job is to prevent hospitals from being overwhelmed instead of keeping people healthy. By ending mask mandates CDC has left the most vulnerable to fend for themselves and insured that the racism, ageism, and lack of concern for the poor manifest throughout the pandemic will continue. Thus it is essential, although difficult, that we continuously evaluate which CDC recommendations actually protect our health versus those designed or mitigated to protect the dollar.
How it Began
In 1942, the CDC’s predecessor, the Office of Malarial Control in War Areas, was created as mosquito-borne malaria and yellow fever continued to emerge from the wetlands of the southeast US and infect nearby military bases. As in the motivation for most public health initiatives, the need was to keep workers (or soldiers in this case) in good working condition. Such had been the reasoning behind the attack on hookworm in 1910 and many other public health initiatives (see https://multiracialunity.org/2017/08/04/more-about-health-profit-and-public-health/). The permanent CDC was then established in 1947 to surveil disease in the US and the world.1
A profound change occurred in 1983 when the agency was authorized to accept gifts from industry and other private parties. This practice was expanded in 1992 when Congress created the non-profit CDC Foundation (CDCF), and the large inflow of funds led to conflicts of interest and corruption. Since 1995 the CDCF has received $161 million from corporations, and according to a report by the Office of the Inspector General at the Department of Health and Human Services (DHHS), in 2007 the CDC failed to identify conflicts of interest among its advisory committee members over half the time.1 From 2014-2018 alone, CDC received $80 million from Pfizer, Biogen and Merck;2 Roche, the maker of Tamiflu, donated $193,000 to fund a CDC flu prevention campaign.3 The CDC’s record on lead abatement (in which HUD, EPA, the White House and Congress also played large roles) is another story of compromise. In 1987 CDC called for complete abatement of the lead hazard, which was affecting mainly poor and black children, but in 1991 stated “In general the most thorough abatements are believed to be the most effective in reducing blood lead levels and residual lead in the environment, but given the limited resources for abatement, a balance must be struck between doing the best possible abatements in fewer units and using reasonably good less expensive methods in more units.”1a
In 2002, the Bush administration replaced lead experts on the CDC advisory panel with five individuals friendly to the paint industry.1b Lead poisoning remains a major problem today.
In 2016 a group of over a dozen senior scientists, calling itself CDC Scientists Preserving Integrity, Diligence and Ethics in Research, filed an ethics complaint stating that the agency was being influenced “by corporate and political interests.” The CDC responded by claiming that “its public-private partnerships are synergistic and beneficial.”2 The CDC’s policy on so-called prohibited donors actually states that “The fact that a potential donor is a prohibited source does not necessarily mean that a proposed gift may not be accepted; only that it must be carefully evaluated for possible conflicts of interest.”3 Some examples cited by the scientist petitioners were inflation of the success of the WISEWOMAN program for women’s health, and the ties to Coca Cola of top officials who blamed lack of exercise as opposed to sugar intake for obesity.5 In 2018, Director Brenda Fitzgerald resigned when her investments in drug, insurance and tobacco companies were disclosed.
Covid Under Trump
Long before Trump, the pandemic, and the appointment of Robert Redfield as Director, the CDC had been suffering from budget and staff cuts. But the weaknesses and lack of independence of the CDC were brought into sharp focus with the onset of the Covid-19 pandemic. Several missteps were made early in 2020, when the agency focused only on the risk of infection spreading from China and did not consider spread from Europe. When a prominent CDC did give a public briefing warning of the threat, the stock market fell. Trump responded by putting Vice President Pence in charge of Covid policy. When the CDC updated its hospital tracking data, Trump instead handed date collection to a private contractor and then ordered hospitals not to report to CDC. In April of 2020, at the insistence of the Trump administration, the CDC deleted language warning of the dangers of gathering for worship, especially with a choir singing.
The CDC also made several glaring mistakes on its own. Instead of using test kits to identify the virus that were available from the World Health Organization, CDC insisted on creating its own, which turned out to be flawed and unusable, and was also slow to develop testing able to detect new variants. The delayed start of testing obscured the early outbreaks in Washington, New York, and New Jersey. CDC was also slow to recognize that the virus was airborne and recommend mask wearing.6
An early crisis involved cruise ships that began exploding with cases. Although the CDC tried to bring infected passengers home safely and prevent further sailings, they were overruled by the White House. Meanwhile, the administration began to turn back asylum seekers at the southern border, even expelling children with negative tests. Despite the objections of CDC officials, Redfield signed the order. When, in June, the CDC posted school guidelines suggesting masks and social distancing and closures in high prevalence areas, the DHHS wrote new contradictory guidance supporting school opening and minimizing any risks. In August, 2020, the CDC announced that close contacts of a Covid patient did not have to test if they were asymptomatic, advice reversed a month later. Even if not sufficiently stringent, when the CDC did issue workplace guidelines, as in May 2020, OSHA almost never enforced them.4 A full ten months into the pandemic, CDC advised “To preserve the supply of N95 respirators for health care workers and other medical first responders, CDC recommends non-valved, multilayer cloth masks or nonmedical disposable masks for community use.” 7 Many CDC scientists quit in disgust over this year.6
And Then Biden
However, the coming of a Democratic administration did not mean that Covid policy was freed from political and economic intrusion. Although Biden promised to put science in charge, in fact the interests of the economy have come first. The main administration strategy to control Covid was to increase vaccinations, and 75% of the population now has had at least one dose, but 60 million eligible Americans are still unvaccinated. Booster shots and vaccination of children 5-11(first shot) are only at 26% and 30%. Finally, as of January, 2022, free rapid tests are being mailed to all households that request them, and PCR tests are quite readily available. However, the CDC made clear even during the super infectious Omicron surge that its guidelines did not supersede state or local ones.7a
Advice on what masks to wear has been sorely lacking, with many people still using quite ineffective cloth ones.9 Only after two years did the CDC begin to explain to the public the difference between N95 and lesser masks and still touted K95s, even though the majority are counterfeit. True there was a real mask shortage at the outset, but the campaign should have been produce more, not concur that medical grade masks are not essential for all. In May 2021, the CDC declared that the vaccinated no longer had to mask in public places, which relied on voluntary masking by the unvaccinated. Cases soon began to rise, and the policy had to be reversed.8
Very devastating to public safety has been the new recommendation to shorten isolation and quarantine to five days from ten if asymptomatic and return to work without a test or even a mask requirement.9 The request for this policy came from Delta Airlines the week before Christmas as too many employees were out sick. The Association of Flight Attendants and National Nurses United objected, as Amazon, CVS and American Airlines, among others, applauded.10 Nonetheless, no vaccination or testing is required to travel domestically, with pre-flight testing only a suggestion. The need, according to current Director Rochelle Walensky, is to “keep the critical functions of society open and operating.”11
The CDC is even now allowing no work restrictions for vaccinated and exposed asymptomatic health workers in contingency and crisis situations and even allowing those with symptoms to work on “restricted” patients when staffing shortages are severe or after 5 days if symptoms are improving under moderate shortages.12These policies not only keep hospitals and businesses staffed, but in a disgusting way they are essential to US workers whose sick leave averages seven days annually if they have it, and the 10% of workers with no sick leave, including half of those earning under $15/hour. Meanwhile health insurance company profits and premiums are rising and Pfizer and Moderna are earning $1000 a second.13
The CDC was in support of opening public schools as of the 2022 school year and has supported all students wearing masks if community transmission levels are high. However, their policy does not describe what masks are best and social distancing was reduced from six feet to three.14 Although proper school ventilation is also described, there is no mention of the fact that 36000 buildings nationally need ventilation upgrades at the cost of $1million each or about $72 billion total.15
In the last decade public health has lost nearly 80,000 workers in local, state and national agencies who need to be replaced, and there is a great need to improve data collection systems. However, since neither states nor doctors are required to report to the CDC, data accuracy is inherently limited. There is also a need to train many new health care providers, all of which would cost tens of billions of dollars. Walensky is promoting this investment even as she goes along with tailoring recommendations to accommodate business.167 In perhaps its most heinous policy, the CDC has continued to support a restrictive immigration policy Title 42, barring the entry of asylum seekers, except unaccompanied minors, who are neither tested nor treated, on “public health” grounds while allowing tourists to enter the country if tested.17
Lessons We Must Learn
Some critics of the CDC believe the solution is to make it an independent agency, free from DHHS oversight and with a director and funding not subject to congressional authorization.17This might solve some problems, but not the major conflict. The CDC exists in a society in which the measure of success is profits made, and working people, be they blue or white collar, are valued only as a means to create those profits. As such, the public’s health is necessary only to provide enough workers in good working condition and to control contagion so as to protect the corporate class. To guarantee the wellbeing, happiness, and health of the working population as a goal in itself would be of no merit and much too expensive.
How is it that so many of us accept this trade off? It has much to do with the illusion of individual responsibility that we are taught, that each of us is responsible for our own status in life, including our health. It’s a matter of our habits, our nutrition, whether we exercise, while factors of stress, poverty, environmental hazards and health care are downplayed. Racism also plays a huge part, since non-white workers suffer a hugely disproportionate share of poor health and healthcare, dangerous and underpaid work, low grade housing and a contaminated environment. As long as too many white workers believe that they are at least relatively shielded from such conditions and that black, Latin, Native American and immigrant workers deserve their lot, the ability to wage struggles for better conditions for all is deeply compromised.
It is true that the capitalist government and its agents, such as the CDC, do not have our best interests in mind as such, but they do need for enough of us to be healthy to produce and not endanger their own health. Public health guidance is thus often in line with what is actually good for our health. We must carefully analyze all government guidelines as to the true motives behind them, which may be as glaringly racist and abusive as the Tuskegee experiments or simply expedient like delayed mask messaging. Other messages, like that for nearly everyone to get vaccinated are clearly correct. However, the refusal to do more to enable international vaccinations clearly puts us all at risk from evolving variants, but not enough to override the pharmaceutical industry’s greed for profits.
Many groups who long been abused by the US medical system, such as black and Native American, hesitate to accept any government given advice. Many right wingers, who live with the illusion that freedom is the absence of any social constraints or interdependence, refuse to comply with any government advice. Instead we must analyze the advice and demands from the institutions of our society, and adopt those which are to our benefit. At the same time we must fight to change our society from one based on the inherent conflict between workers and capitalists, between public health and private greed, to one run by and for working people in which agencies will be guided only by our best interests. That will require revolutionary change. For now we must keep our wits about us and organize to stay well and strong.
Ellen Isaacs is a physician and long time anti-racist and anti-capitalist activist. She is co-editor of multiracialunity.org and can be reached at [email protected]. This article first appeared on multiracialunity.org
1a.Rosner D and Markowitz G, Building the World that kills us: The politics of Lead, Science and Polluted Homes, 1970-2000, J Urban History, 42(2)333-9