As the newly appointed chief medical officer at the nation’s top public health agency, Debra Houry says her job is to make sure the Centers for Disease Control and Prevention (CDC) is ready to respond quickly to the next pandemic.
Houry was named to her position as part of CDC Director Rochelle Walensky’s massive agency reset aimed at correcting mistakes and regaining the public’s trust after the COVID-19 and mpox responses.
“COVID certainly showed where we could improve, but I think the agency itself has just been changing too. And so we needed to look to where we can really be more proactive and flexible and respond to the public,” Houry, who is based in the CDC’s Atlanta headquarters, said in a recent interview from D.C.
The CDC has been under intense criticism from Republicans, Democrats and the general public for a delayed and inconsistent response to the pandemic, and the changes are meant to make the agency more nimble.
A new culture at the CDC
Walensky came on as director in January 2021 after long saying the agency needed to move faster and communicate better. In April, she called for an in-depth review of the agency, and the initial public announcements came in August.
“My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness,” she said in an August statement.
Houry said moving quickly is a challenge for a government organization as large as the CDC with many long-tenured career officials, but it’s a way to try to ensure success.
“With change management, the longer you do it, the more people have angst, concern,” she said.
Houry, who comes from a background in emergency medicine, is part of a new leadership team that reports directly to Walensky, including the former director of Maine CDC Nirav Shah, who is taking over as principal deputy director.
That direct line, Houry said, is important, because it helps the agency deputies make sure all the various divisions are talking with each other. Houry said she wants to knock down the “artificial separations” between divisions so that there’s much more communication and collaboration.
“I think when there’s more layers, it’s easier to … hide is not the right word, it’s like it’s easier to stay in your silo. And when those layers are removed, the silos don’t exist,” Houry said.
Houry has been at CDC since 2014, serving first as director of the National Center for Injury Prevention and then most recently as acting principal deputy director. Prior to her time at CDC, she was a professor in the Department of Emergency Medicine at Emory University School of Medicine.
Prioritizing action and outreach
Houry said she knows CDC has a reputation for being an academic-focused agency. One of the main criticisms it faces is that it is too focused on data analysis at the expense of action.
Experts have said the agency was too slow to recognize the extent of the coronavirus’s spread in the early days of the pandemic and continuously issued confusing and often contradictory guidance about masks and quarantines. The initial tests to detect the virus were also flawed, and rollout of vaccines was seen as sluggish.
CDC has also struggled with how to communicate to a pandemic-weary and politically divided public, some of which is skeptical of health officials more broadly.
Walensky’s plan aims to fix that, and Houry is helping to lead the charge to make CDC much more response-ready.
One of the main changes is to make deployments a normal part of an emergency response.
During the earliest days of the COVID-19 pandemic, the agency needed to reassign people, and it was done on a volunteer basis for just a couple months at a time.
Houry said the short rotations led to too much turnover, so there was a need to not only make deployment longer but also mandatory.
“I think it became clear that we needed to have a bigger bench for responders, but we also had other priorities and other issues that we had to make sure we were covering … across the agency,” Houry said.
“But it became very clear, both under the prior administration and the current administration, that we needed to have longer rotations. The goal is to have the majority of the agency ready to deploy on a response and not for one to two months but for six months at a time minimum,” she added
The initial phase of the reorganization wrapped up at the end of February, and Houry said she understands that Congress wants to see progress.
“People want to make sure that moving boxes is not all that we’re doing. And I agree, because if it’s just a reorganization, you know … that doesn’t solve things. It’s like, how do you change the culture? How do you change processes?” Houry said.
Houry said Walensky is also pushing to get more flexibility from congressional appropriators.
“We have not received significant increases for a lot of our core work,” Houry said.
The CDC’s nearly $11 billion budget is also too specific, she said.
“I think we have 150 budget lines. And so that makes it hard to be nimble. If we had fewer budget lines with more flexibility, we could be more nimble,” Houry said.
Improving staff morale
She said the lines are targeting specific diseases and can’t be shifted. But if instead of a budget line on Lyme disease, a line on malaria, it could be combined into an all-encompassing tropical disease unit.
Another concern is agency morale. CDC employees have been enormous strain since 2020, and Houry said she hopes the reorganization can take some of the pressure off.
“Our staff are awesome. You know, they’ve worked hard for the past few years, even pre COVID but they truly are 24/7,” Houry said.
She thinks morale is improving.
“I think staff are feeling, they certainly are still tired because you know, we have several different responses going on. But they’re able to be part of these changes. And for many of them, it’s exciting. We’re looking at, how do we do our science differently?” Houry said. “People are inspired. So I think it’s an exciting time for the agency and it’s time for us to really innovate.”