ASTHO Responds to Senate HELP Request for Information on CDC Reform
October 20, 2023
The Association of State and Territorial Health Officials (ASTHO) submits the following comments in response to your Sept. 26, 2023, request for information (RFI) to the Senate Health, Education, Labor, and Pensions (HELP) Committee concerning the modernization of the Centers for Disease Control and Prevention (CDC), particularly given our collective COVID response. ASTHO is a nonpartisan professional association representing the nation’s state, territorial, and freely associated state health officials and their leadership teams. ASTHO members—the chief health officials of these jurisdictions—are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.
CDC is one of the most important partners of state and territorial health departments, providing both scientific expertise as well as program support for numerous categorial and cross-cutting public health programs. CDC has always depended upon close collaboration with state and territorial health leaders to protect the state of the nation’s current and future health. As part of our nation’s federalist system, states and territories are largely responsible for preventing, detecting, and controlling infectious diseases and other health responses in their jurisdictions through the work of public health agencies. Close collaboration, transparency, and consistency in public health policy between federal and state processes are essential but understandably challenging, particularly given that states and territories have autonomy in implementing certain non-federally mandated health policies.
It is our view that failures or inadequacies in the COVID response that are often attributed to CDC were most often attributable to multi-agency failures and generally the result of emerging, conflicting, and changing understandings of the SARS-CoV-2 virus, unclear or transient leadership, opaque or inconsistent collaboration between federal and state policy development processes, and differing implementation of public health policy in the states. In many ways, this is a natural and expected outcome of the U.S. federalist system in which federal agencies provide resources and guidance to states and territories. Numerous afteraction reports from prior pandemics including H1N1, SARS, Ebola, Zika, and others have consistently indicated that communication and shared decision-making between state and federal agency leaders, as well as active collaboration with state health officers, is essential but elusive during large-scale national and international responses.
Please download the PDF for ASTHO's full comments on the specific questions included in the Request for Information.