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The CDC’s new leader follows the science. Is that enough?

“I’m a different kind of CDC director than my previous 18 predecessors, and sort of a different kind of character in public health,”  said Dr. Rochelle Walensky.
“I’m a different kind of CDC director than my previous 18 predecessors, and sort of a different kind of character in public health,” said Dr. Rochelle Walensky.Jim Lo Scalzo/Associated Press

On her first day as director of the Centers for Disease Control and Prevention in January, Dr. Rochelle Walensky ordered a review of all COVID-related guidance on the agency’s website. Some of its advice had been twisted by the Trump administration, and her message was clear: The CDC would no longer bend to political meddling.

Four months later, Walensky announced that vaccinated people could stop wearing masks in most settings. The recommendation startled not just the White House but also state and local leaders, prompting criticism that she had failed to prepare Americans for the agency’s latest about-face during the pandemic.

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The two announcements captured the challenge that will define Walensky’s tenure at the CDC: restoring an agency once renowned as the world leader in public health but whose reputation has been battered by political interference, even as the country transitions out of a pandemic that has left nearly 600,000 Americans dead.

President Biden had promised that the CDC director he chose would be free to make scientifically grounded decisions without interference from politicians. Walensky, a widely respected infectious disease expert known for her battles with drug companies over prohibitive prices, seemed ideally suited.

Walensky’s appointment instantly made her one of the most influential women in the nation and was greeted with enthusiasm by public health experts and CDC staff members. But that enthusiasm has been tempered by occasional missteps in communications, an aspect of the job that is more important and challenging than it has ever been.

“Rochelle at baseline is an excellent communicator, but I think in a situation this fraught — politically, operationally and how quickly the science moves — you’re going to make mistakes,” said Dr. Celine Gounder, a former adviser to Biden’s team on COVID-19. “The question is, how does she acknowledge those and learn from those and move forward from there?”

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Gounder, who has known Walensky since 2004 and considers her a friend, said Walensky was still the best person she could think of to lead the CDC.

The CDC foundered at the beginning of the pandemic, pilloried for its botched coronavirus test and antiquated data systems. Its advice on masking, asymptomatic spread of the virus, and the threat indoors was muddled. By late 2020, reports that the Trump administration had rewritten recommendations purported to be from agency experts further damaged public trust.

Dr. Anthony Fauci, the administration’s lead adviser on the pandemic, defended Walensky’s track record and said he had full confidence in her ability to lead the CDC and the country out of the pandemic. The job, he noted, has a steep learning curve.

“Give her a little time,” he added. “By the end of one year, everybody’s going to be raving about her. I guarantee it.”

When the pandemic began, Walensky, 52, was chief of the infectious diseases division at Massachusetts General Hospital. She ordered the hospital staff to wear masks before it became the national norm and advised then-Mayor Martin J. Walsh and Governor Charlie Baker on testing and prevention of COVID-19.

Scenes from Mass General were still fresh in her mind when she arrived at the CDC. “I came directly from a hospital that had a morgue sitting outside,” she said in an interview. Even apart from the fact that she is only the third woman to lead the agency, “I’m a different kind of CDC director than my previous 18 predecessors, and sort of a different kind of character in public health.”

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Walensky was known as a tough-minded advocate for people with AIDS. She tussled with pharmaceutical companies to lower prices for HIV treatments. She criticized the drug company Gilead’s pricing of its preventive therapy for HIV and the exclusion of women from its clinical trials as “unacceptable.”

In 2019, she testified before Congress about the prohibitive cost of preventive therapy and treatments for HIV and made similar arguments about the pricing of Gilead’s COVID drug remdesivir.

Walensky was not on the Biden’s administration’s initial list of candidates for CDC director. It was Fauci, who had known and admired her work on HIV, who recommended her. Her leadership of the CDC is demonstrably different from that of her predecessor, Dr. Robert Redfield. Under him, the agency quietly made changes to its guidance, sometimes dictated by the Trump administration, with no public announcement.

CDC scientists are now routinely involved in conversations with the White House, where previously they were sidelined and silenced. And where Redfield was reticent, Walensky has often taken a surprisingly direct approach.

During a news briefing March 29, as infections began to rise again, she looked into the camera and, in a voice quavering with emotion, pleaded with Americans not to stop taking precautions against the coronavirus.

“I’m going to pause here, I’m going to lose the script, and I’m going to reflect on the recurring feeling I have of impending doom,” she said, her eyes glistening with tears. “We have so much to look forward to, so much promise and potential of where we are and so much reason for hope. But right now I’m scared.”

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The day of her urgent plea, she appeared on MSNBC’s “The Rachel Maddow Show,” where she said vaccinated people “do not carry the virus” — an overly optimistic statement that the CDC had to walk back. Later that week, new guidance from the agency said that vaccinated people could safely travel, but Walensky added that the agency did not actually want them to travel at all, a stance that left some Americans perplexed.

The most recent instance, when Walensky announced that vaccinated people could go mask-free indoors, was supported by the latest research, scientists said. But many felt the agency had rushed the decision to end mask use without considering parts of the country where infections were still high, and without grasping the mistrust and culture clashes the new advice would engender.

“CDC got the medical and epidemiological science right, but what they did not get right was the behavioral science, the communications and working collaboratively with other stakeholders,” Gounder said. “That was a big oversight.”

Data since the announcement seem to have proved Walensky correct: Infections are still declining, even as much of the country reopens at a vigorous pace. And as promised, the agency has set about issuing more practical masking guidance regarding settings like summer camps (mostly no) and public transportation (yes).

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Walensky and the CDC declined to comment on how the mask recommendations were handled.

Walensky has a long list of ambitious goals for the agency post-pandemic, including modernizing the nation’s public health infrastructure.

COVID remains her focus for now, and the flawed communications in recent weeks suggest that she is still finding her way. But in a recent interview, she was unapologetic about the rapid shifts in CDC guidance or in her tone: The virus’s hold on the country is loosening, but large parts of the population remain unvaccinated, and the pandemic is not yet over.

“There are two things happening at the same time,” she said. “It’s my responsibility to tell both of those stories.”