Five years after the peak of Covid-19, as the nation searches for its next Centers for Disease Control and Prevention director, the most immediate threat to U.S. pandemic preparedness may not be a novel virus, but the erosion of public trust. The country remains vulnerable as avian influenza spreads, vaccination rates decline, and outbreaks of measles and dengue reemerge.
Without restoring confidence in the CDC, even the strongest scientific guidance will fall short of protecting the public, as well as the nation’s economic stability and security.
Covid-19 caused more than 1.2 million deaths in this country and in doing so exposed a fundamental truth: The CDC did not fail for lack of expertise, but from a loss of focus, speed, and credibility. Early in the pandemic, the inability to deploy reliable diagnostic testing left the nation unprepared at a critical moment. Fragmented data systems across states and jurisdictions produced delayed and inconsistent information, forcing policymakers to make high-stakes decisions in a fog.
These operational failures were compounded by flawed communication. Scientific uncertainty is inevitable in such a crisis and should be acknowledged with humility. Instead, public guidance was at times delivered with unwarranted confidence and revised too slowly as evidence evolved. Ultimately, ineffective and harmful measures, such as prolonged school closures and restrictions on outdoor activity, were implemented without clearly communicating expected benefits, limitations, and trade-offs. When guidance changed, as it should in a dynamic situation, those shifts were often insufficiently explained. The results were predictable: confusion, frustration, and an erosion of confidence.
Not surprisingly, public trust declined sharply. According to the Pew Research Center, confidence in public health officials fell from 79% in March 2020 to 54% by September 2022. Credibility is the CDC’s most essential asset. Without public confidence, even sound recommendations will fail to marshal broad support.
The CDC stands at an inflection point. As new leadership is considered, the lesson of the pandemic is not that the agency should be weakened, but that it must be refocused after drifting from its core mission. Restoring trust will require disciplined reform and leadership that is prepared to implement it.
The current moment presents an opportunity to do so. Under new leadership and amid a broader emphasis in Washington on efficiency and mission clarity, there is a chance to regain public confidence by aligning the agency’s considerable technical expertise with faster execution, sharper priorities, and more effective communication. Independent reviews from the Government Accountability Office and the National Academies have already documented what went wrong.
The question now is whether the CDC can translate those lessons into action with the speed, clarity, and focus that future public health emergencies will demand. The selection of the next director will be critical in determining whether these reforms are realized. The new CDC director must focus on six key areas.
First, pandemic and infectious-disease surveillance must continue to be the CDC’s top priority. This includes expanding genomic sequencing capacity, broader wastewater monitoring of diverse pathogens to assess community-level transmission, and early-warning partnerships such as those available through nongovernmental organizations like the Global Virus Network. The next pandemic may arrive with warnings that must be quickly recognized and responded to before the human emergency is imminent.
Second, the nation’s public health data infrastructure must be brought into the modern era. Despite $5.3 trillion in annual health care spending, public health data systems remain fragmented and antiquated. Real-time, standardized reporting across states should be mandatory, with federal funding tied to interoperability and compliance. In a crisis, delayed or unreliable data are not merely inconvenient; they are dangerous.
Third, diagnostic surge capacity must be treated as critical national infrastructure. Testing platforms, including accessible “point-of-care” screens, should be prevalidated, scalable, and immediately deployable through public-private partnerships. The delays of 2020 were the result of system design failures that must be corrected.
Fourth, scientific integrity must be both substantive and visible. Public health recommendations should rest on transparent evidence, with clear distinctions between data, interpretation, and policy judgment. Advisory processes must be open, methodologically rigorous and insulated from political or ideological pressures.
Fifth, communication must become a core competency. In a crisis, the public does not need perfection, but accuracy and clarity are essential. Guidance should be timely, concise, and delivered in plain language. Explanations should clarify what is known, what is uncertain, and what may change. This is central to public confidence, which is necessary for public compliance.
Sixth, the CDC should renew its focus on chronic diseases and mental health, which drive about 90% of U.S. health care spending and most leading causes of death. Improving pregnancy outcomes must be foundational to reducing long-term disease burden, supported by stronger prevention efforts, advancing the Department of Health and Human Services’ nutrition initiatives, addressing unhealthy behaviors, and expanding surveillance to scale effective interventions. Emerging tools like GLP-1 therapies should be integrated into an evidence-based strategy. However, this broader focus must not detract from the CDC’s core mission of protecting against infectious diseases.
As physician-scientists, we have spent decades confronting diseases, many of them preventable, and have seen how public health can save millions of lives. The CDC has demonstrated its value before, from identifying Legionnaires’ disease to tracking HIV and reducing vaccine-preventable mortality. It can do so again. But history also shows that in public health, failure carries a steep price.
Another dangerous pathogen is inevitable. Whether it becomes a contained outbreak or an international emergency may depend as much on scientific discovery as on institutional credibility. The CDC must be positioned as the nation’s clear scientific authority, and the next director will be decisive in whether that authority is restored, providing evidence-based guidance that states can act on to strengthen preparedness before the next pandemic arrives.
The CDC need not do everything, only the most important things well. Speed, clarity, and trust are not optional. They are the difference between control and crisis.
Charles J. Lockwood, M.D., is executive vice president of USF Health, dean of the University of South Florida’s Morsani College of Medicine, and a member of the Global Virus Network board of directors. Robert C. Gallo, M.D., is founding director of the University of South Florida’s Institute for Translational Virology & Innovation and co-founder and international scientific director of the Global Virus Network. He is best known for his pioneering discovery of human retroviruses, including HIV as the cause of AIDS. Sten H. Vermund, M.D., Ph.D., is senior associate vice president of USF Health, dean of the University of South Florida College of Public Health, and chief medical officer of the Global Virus Network.
