Incoming CDC Director to Prioritize Communication, COVID-19 Vaccine Rollout

As Rochelle Walensky, MD, MPH, prepares to assume the role of CDC director on January 20, the former professor of medicine at Harvard Medical School and infectious disease physician at Massachusetts General Hospital and Brigham Women’s Hospital faces a myriad of challenges wrought by the ongoing coronavirus disease 2019 (COVID-19) pandemic.

January 21st marks the 1-year mark since the first case of COVID-19 was reported in the United States, while current data indicate the country has surpassed 400,000 deaths. In comparison, the 1918 flu pandemic took 675,000 American lives, while the US reported a total of 405,000 fatalities during World War II.

Even at the unprecedented speed with which pharmaceutical companies have developed vaccines for COVID-19, rollout has been fragmented at the state level while racial disparities in administration rates are beginning to become apparent.

In an effort to improve the national rollout of COVID-19 vaccines, Walensky plans to increase the CDC’s communication to combat any hesitancy in receiving the vaccine, and indicated she wanted to increase media appearances above those made by current director Robert Redfield, MD, who departs with any remaining Trump administration officials Wednesday. She said making sure science-based communication is effectively disseminated to the public in layman’s terms is a top priority.

“Science is now conveyed through Twitter. Science is conveyed on social media, on podcasts, and in many different ways. And I think that's critical,” Walensky said during a livestreamed interview with JAMA's Howard Bauchner, MD, the journal's editor-in-chief. When confronting vaccine hesitancy or anti-vaxxer sentiment on social media, “There's just this massive void and the right information, I think, is not getting out there… I want to make sure that the science is conveyed. We have to say it to one another. We have to say it to the public. And then we have to say it in other forms.”

Internally, Walensky hopes to bolster the voices of scientists already employed by the CDC. Under the Trump presidency, “they have been diminished. I think they've been muzzled,” Walensky said. “This top tier agency—world renowned—hasn't really been appreciated over the last 4 years, and really markedly over the last year. So I have to fix that.”

Although some states have been widely successful in administering the allotment of COVID-19 vaccines they were given, many have reported roadblocks. Part of the Biden administration’s plan to enhance rollout is to expand vaccine allocation to 4 key locations: federally qualified health centers, community vaccination centers (ie, stadiums), mobile units, and pharmacies.

“Part of the challenge with COVID-19 was that we had a frail public health infrastructure to start. It wasn't ready to tackle what it was given,” Walensky said. As director, she hopes to bring this reality to Congress’ attention. “We're in this because we had warnings for many, many other public health scares in the last 20 years and we didn't fix our public health infrastructure and our data infrastructure,” in response to those tests.

In order to meet President-elect Biden’s goal of 100 million vaccinations in 100 days, the constraints currently faced by federal and state governments need to be mitigated. “We have to titrate our supply and our eligibility so that we somehow hit the sweet spot, wherever it is we are, with how much supply we have and how many people are eligible,” Walensky said.

While the CDC set the initial guidelines for vaccine eligibility and revised them this month, the Trump administration left actual rules and distribution processes to states, resulting in wide variation across the country. Some states adopted stricter standards that led to the waste of vaccines, while loose adherence has led to long lines and confused residents.

Expanding the population of those eligible to administer the vaccine can also help alleviate these roadblocks. These individuals can include retirees, the Public Health Commissioned Corps, medical military, upper level medical and nursing students, dentists and veterinarians.

Increasing both the number of vaccination sites and vaccinators will also help address the equity problems brought to light by the pandemic. “We want to make sure that we can deliver volume, but also volume to the people in places that might be harder to reach.” In a collaborative approach, the federal government will step in at a state-by-state level and offer help based on each state’s unique challenges, Walensky said.