What’s working in public health? CDC director finds reason for hope in St. Louis

ST. LOUIS — The director of the U.S. Centers for Disease Control and Prevention got her fill of St. Louis Thursday in a uniquely extensive visit to a city that included speaking to medical students, meeting with the city’s health director, hearing from clinic leaders and touring one of those clinics in one of the city’s most impoverished areas.

“We in the CDC are only as good as our public health partners are in the community, and so as I travel, I really want to see what’s working in public health in the community and what’s not working, and I want to hear and learn,” said Dr. Rochelle Walensky, who became director just as COVID-19 vaccines were rolled out over a year ago.

When Walensky was asked to speak on the medical campus of her alma mater Washington University as part of an annual lecture by a visiting professor, she also sought a meeting with Dr. Mati Hlatshwayo Davis, director of the St. Louis Department of Health.

Davis said she saw an opportunity to not just meet with Walensky but also use her visit to inspire an overworked and burned-out staff, showcase the city’s success in fighting COVID-19 and highlight the critical work of federally qualified health centers — community clinics that care for those on Medicaid or without insurance.

What was originally planned to be an hour meeting with Davis turned into a day of touring the city’s no-cost testing center for sexually transmitted diseases, new COVID-19 testing locations and the CareSTL Health center on Dr. Martin Luther King Drive in north St. Louis. Walensky also met with all four leaders of the city’s community clinic systems.

Davis said they discussed ways to bolster the public health workforce and improve the large racial disparities in the city’s vaccination rates among children — less than 20% of vaccinated children between the ages of 5 and 11 are Black.

Davis said Walensky was extremely gracious.

“We need days like this,” Davis said. “We need help, but we also need hope.”

Walensky said the 1,400 federally qualified health centers across the country deliver care to one in three people living in poverty. Over the past year, these clinics have vaccinated about 20 million people.

“I wanted to hear how they’ve been able to do it, some of the challenges that they’ve had, they are going to be so key to the next chapter of COVID-19 but also the next chapter of equity and health around the country.”

Angela Clabon, the chief executive of CareSTL Health, said she was thankful to have Walensky acknowledge the struggles the clinics face in caring for the city’s most vulnerable residents through the pandemic.

“It’s an honor to know our voice will be heard in making decisions,” Clabon said. “We feel appreciated.”

Walensky began her visit to St. Louis Thursday morning speaking with medical students and faculty at Washington University about the challenges facing public health officials as the U.S. enters a new phase of the COVID-19 pandemic. She fielded questions posed by Dr. William Powderly, co-director of the infectious diseases division at the Washington University School of Medicine.

Walensky received a bachelor’s degree in chemistry with a concentration in biochemistry from Washington University in 1991 before earning a medical degree at Johns Hopkins University. She was invited to speak as this year’s Medoff Visiting Professor in the Department of Medicine.

Walensky, 52, said her experience as a medical provider and researcher has made her keenly aware of the challenges in a much broader role as CDC director, a job she’s held since January 2021.

“We provide guidance that has to be implementable in New York City, and the Navajo Nation and rural Montana and Guam — that’s the spectrum of our public health recommendations, and increasingly through this pandemic people have wanted our public health guidance to say to them, ‘Can I visit Grandma this weekend?’” Walensky said. “Nobody goes to the CDC guidance to say, ‘Can I have the fries at Shake Shack today?’ but that’s what they really want from us in this moment.”

She has experience advising patients as a physician, but balancing the need for individualized information with the need for sweeping public health guidance “has been a really interesting line to walk,” she said.

The CDC has to base its COVID-19 guidance on competing risks and benefits, constantly weighing the impact on things like mental illness, addiction and delays in medical care, Walensky said. In rolling out guidelines, the agency seeks feedback from local government and school officials and balances that with the latest science from its experts.

Sometimes the CDC decisions are criticized as caving to economic interests, such as when the CDC shortened the quarantine length just as the omicron variant was causing a surge.

Walensky said the country was about to see a million new cases a day and hospitals were in danger of not being able to get the supplies they needed, and “something had to be done.”

“We might be faulted for not making exactly the right decision in the moment, but I don’t want to be faulted for not making a decision, because that in and of itself is a decision,” she said.

Looking back over the pandemic Walensky praised the “extraordinary” effort to deliver 550 million vaccines in one year and the CDC’s increased ability to gather and quickly release large amounts of data. The CDC now has the ability to look at how vaccines impact cases and deaths, broken down by types of vaccine and age, within four weeks, she said.

What the CDC did not do well at was communicating what was not known yet about vaccines, she said. Experts did not talk enough about how immunity can wane, or how another variant could diminish effectiveness.

“When the vaccine came out, it was 95% effective. So many of us wanted to say, ‘OK, this is our ticket out. Yeah, we’re done.’ So, I think we had perhaps too little caution and too much optimism for some good things that came our way,” she said. “I think all of us wanted this to be done.”

Going forward, she said the CDC can do better at explaining how science is nuanced and can change when more is learned. Health guidance is based on what is known at the time.

“We’ve always said, ‘We are going to lead with science.’ That is entirely true, but I think the public heard that as science is foolproof, science is black and white. … Truth is, science is gray — and science is not always immediate. And sometimes it takes months or years to actually find out the answer, but you have to make decisions in a pandemic before you have that answer,” she said.

When asked how the university’s medical school and its students can help the CDC, Walensky said they can help ensure the next generation of providers is as diverse as the population, which helps improve health outcomes for everyone.

She also urged them to use their voices to promote trust in public health and listen to the needs of the individuals they care for.

Walensky told the students and staff that this was their “Super Bowl moment.”

“We are all tired,” she said, “but this is what we were called to do. This is what we were trained to do.”

Walensky said her visit to St. Louis was nostalgic and encouraging. 

“We were talking today about equity in action,” she said, “and I absolutely saw that, and it was really inspiring.”

Originally posted at 12:45 p.m. Thursday, March 3. Updated at 7:50 p.m.