Laboratory i think is really important. We also form a laboratory simple and has developed a Laboratory Task force. No test will leave the agency now without triple review. That is something that is now in place. In terms of the Core Public Health infrastructure, laboratory, data, and workforce. And what i really believe as i certainly would not have imagined in 2022 in addition to covid i would be dealing with a National Monkeypox challenge. If you could have predicted [ laughter] but what it really does say is we need a nimble workforce that knows how to deal with Public Health challenges, whatever they may be because we dont know what tomorrows are. So we have a workforce, a laboratory system, and a data system that is really strong and really elevated us to our core cap abilities. Whatever the subject matter is the challenge, we will be prepared to tackle it. It is a lot to do in the cdc and looking at it from a Headquarters Point of view, but i think our commission and many of us believe it is a broader system issue than just the cdc and our local state and Health Departments are critical to the front line have the same challenges. They need data, competent workforce, and resources, and a whole lot of other things. And we could say the same thing about our schools and Public Health for that matter. Generally among the poorest funded and resourced components of universities, and arguably, they are the front line of creating Better Health protection for everyone, but we dont treat them like they are valuable treasures and resources. So in your reform of the cdc, how are you thinking about the responsibility and advocacy for the rest of the system . Dr. Walensky i think this is really key. I was really energized that there were 200 other areas of Public Health that followed suit or were motivated and working in that direction also. I have since also heard that state departments of Public Health are actually looking at the overview of what went well, what did not go so well in the last year and have, but to your point about workforce, i think someone did a review and estimated that our Public Health workforce is about 80,000, which is truly extraordinary when you think of the work we have to do. These are folks that often left Public Health. We have a lot of folks who are retiring, people who retired, stuck it through the pandemic, wanted to do their best. But also, fall to realized this has been a hard job, a divisive job. Many have been threatened, and people have left. The good news is the Public Health schools, the applications are up. Med School Applications are up. People are interested in leading into this moment. I am an hiv researcher because of when i trained. That is what i wanted to do. And so, you know, i think there is this is a time where we can energize people to the field, but we need the infrastructure. We do need the support from congress, from a Bipartisan Congress to say these are valued , reviewed physicians because they are helping others. Thank you for that. In terms of the workforce, you mentioned this before, talking about the very high importance of having a prepared workforce that can respond to emergencies in front of it. What does that look like at the cdc . Many people dont know how challenging it is for people to diverge from their day jobs and be deployed overseas for the ebola crisis or in the united states. What would it take to get the workforce where it needs to be, and how do we do that . Dr. Walensky that is a very important point. 20,000 in the cdc, and most people dont know that during most of our pandemic response, we had 2500 are deployed to hotspots, so that is 25 of the agency at any given time that was working. That means two things. One is they had to be deployed. Agreed to be deployed. Nothing else stopped because they were deployed and the response. What we have to do i think as an agency is make sure that there is a vote for everybody in our agency and the response. I call them unsung hero calls. I call heroes who maybe have not been seen or heard for the work they are doing, but somebody booked all the flights for people that deployed, up all night booking flights all night long. That person was deployed, right . We need all level of expertise. And we have that at the cdc, but we dont have everybody trained in order to do that every single day, and we dont have an incentive structure in the agency that says, you are celebrated because you deployed. That is actually a lot of work i think we need to do, set up the incentive structure to be able to say, you know, extra something. By design, whatever it is, factors for promotion, whatever they may be, because right now it feels like you are abandoning your home, your home work if you agree to deploy. That is a challenge. The difference between deployment and embedding, so deployment as a crisis, lets send people there to help deal with the problem. The other complementary model is embedding where people are permanently detailed to serve in the Public Health department at a local level or state level or international setting. And there have been several reports and commentaries on the cdc recently that have called for much more embedding to move the workforce closer to the front lines of Public Health. Is that part of the reform that you envision . Dr. Walensky i think it will take resources and people and mechanisms by which we do it, but i do completely agree and they are not mutually exclusive to be clear. I do completely agree that by working in a state or local department of Public Health, you understand the local challenges. You understand how some decision that may come from cdc results in some big old challenge that happens locally. So much of what we need to do, and i said that, is partnership and being a good partner and listening. Again, we are only as good as our arms and they can only help us as much as we can provide them information as well. The first monkeypox case was not found by somebody at cdc. It was found by somebody in a local jurisdiction. It was reported to the local department of Public Health. We really have to be amazing partners here. Julie i have to say i admire your candor and your courage as you take this on. Just even being able to step forward and say, we did not do everything right and we have a responsibility to fix it takes a lot of leadership, confidence, encourage, but i also know firsthand it is difficult to do and i am sure you are already experiencing some bumps in the road. How do you get help . Who are you going to turn to to help carry this forward . And how can the commission help you . Dr. Walensky first of all, thank you for that. I will say i have had a lot of support to do this. I think for the time i am in this position, my job is to better Public Health in the country. And i think we saw some challenges over the last two and a half years. My job is to get to a better place. Some of the challenges, you know, the cdc was not set up for a pandemic. It was not necessarily set up for some infectious threat that would touch 330 million americans literally. We think about 95 of us have gotten covid already. And of course, globally, right . One of the things we need to do my having learned this lesson hard, one of the things we need to do. So i have had a lot of individual support. The agency i think the people in the agency read the headlines too. They want to be in a good place. They want us to be in a better place. Bipartisan congressional support. There are a lot of things i can do within the agency and the ways that this review shed light on things we can improve upon or ways we can change and set structures that are set up. There are many things that have made it so we cannot be nimble. Data authorities are among them, as we talked about. Human resource authorities. We dont have the capacity. We are not permitted to hire the way fema does, to draw on resources the way fema does. Contractual authorities. Even in a pandemic, how quickly can we move . Do we have to compete for a contract that will take three much to compete the contract . What if we need a contract in new york city for three months to battle polio . Do we need to wait three months . How can we get data faster and do studies faster before the public of emergency is declared . So there are numerous areas that would from a bipartisan standpoint allowed to be more nimble. I will do all the work that i can from inside the agency, and ask for a little bit of grace and time, making challenges. Some of the challenges did not happen overnight. She just will not happen overnight either. But also to say there are a lot different ways looking at infrastructure outside of cdc, that we could be more nimble. Julie i know you have said a lot about this from the standpoint of the workgroup. When you look at all of these reports that have already been disseminated, you have to feel like you are getting a lot of advice. What are the things you are most interested in focusing on . Dr. Inglesby i think it is exciting to hear, and maybe you can say a little bit more about this, your interest in changing culture and incentives to try to align with what americas expectations for the ccr or your expectations, so it would be great to hear about that. What you say that is really important, we heard lawmakers from capitol hill. Some of them have said we need more accountability. You said the same thing in your talk about reform. Maybe you can say what you are thinking about accountability. What does that mean in this case . How do you do that . Dr. Walensky when i think about the incentive structures, we have traditionally been an academiclike agency. We talked to academicians, Public Health officials, scientists, and likeminded people. Over the last two and a half years, we learned we need to talk to the american people. We need to be action oriented, and our science needs to be action oriented. If one would be promoted for a publication or publication productivity, how do we promote people for Public Health action . How do we promote people not just because the publication made a peer review in the journal but because the publication led to something on the ground that changed practice . Even if it was some lesser tier because it was important from Public Health. Aligning the incentives so that we now communicate with the American Public in things that are not sort of esoteric but that the American Public and understand and aligning to action, deployment, embedding, other things. In fact, sometimes when we implement, we have to implement differently in different places. How do you learn that what you implement in frontier america will be different from what you implement it in innercity america . You do that by deploying to those areas and see what is culturally sensitive. Julie one of the challenges that is implicit in some of these local Public Health efforts and Communications Challenges is the fact that we are working in this society that does not have high Scientific Literacy and certainly does not have a high Health Literacy. We dont need to recap all of the issues there on social media with misinformation and disinformation, but that is the root cause of many of the challenges you are facing and getting the uptake of the guidance and recommendations and then layered into that of course is the political divide that sometimes amplifies that. Is that part of your communication plan . Dr. Walensky it is. If you look about two weeks ago, we released updated covid19 guidance. One of them was school guidance. If you look at that as sidebyside and what we did a favorite 2021, they look different. The potentially look different. They are talking to different audiences. Much of what happened in many of our initial guidance documents was, what about this and this and this . We can take that out and not all of those need to be in a guidance document. They can be infrequently asked questions. What do i see my grandma or my pets . We have been doing a lot of that. I think from a comedic patience standpoint, it has been interesting. We have the Health Literacy challenge that united. That you noted. We also have the challenge that first of all we are making decisions with imperfect time, sometimes with imperfect data. Controversy is always great on the news. If we have a piece of guidance that had 12 really important areas of guidance and one of these pretty uniform agreement on a lot of them but one of the 12 we did not have all the data and we had to land on a certain place, that is the one they highlight and you can get really smart people who i very much respect on the pros and cons of that. I could fall on either side of the pros and cons because we did not have enough people to perform it, but that is the one. And then of course people say they are confused. And that makes sense that they would be confused. So how do you create a communication space where we can admit we did not have all the information. We need to make a decision because not making a decision is a decision in and of itself. This is where we are for all the pros and cons. Julie it is really tough. We are going to ask iranians to have a chance to come to the microphone and a couple minutes, so think of your questions. There will be one microphone in the room. Tom, do you want to . Dr. Inglesby i wanted to ask you before, what are the things that stand out as part of the challenge . Typically outside. I just want to check with you that the budget of the cdc is a very difficult thing to run. There are lines directed from congress . Page after page after page, and my understanding is you cannot move money from one line to the next when you have a large on except a crisis, you do not have a large sum of money to be able to deploy to that crisis. Is that true still . And what would it take to change that . [laughter] dr. Walensky laughing. Yes, it is exactly true. It really is a challenge. Early in covid, when it became clear we needed contract tracers, our best contact tracers are in clinics. Mobilizing them to do and this is what i am talking about with the court and for structure, we need investment infrastructure. Less about budget to be people in the labs on the data to be there with those line items because i believe in the line items. It is not that i dont want to have every single part of a line item that exists is quickly important. But they lock us in in a way that does not allow us to be nimble. The words i use are disease agnostic resources so that today when we have a monkeypox challenge, we can borrow from covid of yesterday if we need to. And that is really, i mean the permission in layers we need to get in order to be limbo is paralyzing in our ability to move forward. Julie i think every cdc director who has ever looked at the cdc budget knows exactly what you are talking about. It is completely enforceable and you have no authority to move money from one budget to another. Maybe a smidgen about nothing that can really support. Disease agnostic resources, that might be something we want to include in our report pressure. Dr. Walensky disease agnostic resources. [laughter] julie thank you. Thank you so much, dr. Walensky, for being with us. I am carl hoffman, a member of the commission, and run a no global nonprofit run a global nonprofit. Let me just say at the outset that i think everyone here admires you. I am not sure how many here envy you because of how difficult your job is for all the reasons you have been talking about. Let me take you back to the comments about the cdcs very impressive overseas work. As an american, of course, i am a beneficiary of what the cdc does domestically. And now i work and have worked in my previous life and interacted with cdc overseas and found out to be very rewarding as well. But it is a complicated ticket of thicket of players and agencies just thinking about the cdc overseas in terms of health and management. Can you talk about how the cdc and usaid and state department and other agencies, dod for that matter, how you look at that as a collective, how you see your role in that, the agencys role in that collective government response . Dr. Walensky it is a great question and am glad i can enter into having come back because i have a much better sense. We speak with one voice. I see cdcs role as critically important at the table at the forefront. Much of that is technical expertise. Teaching to sort of it is the old term to teach them how to fish rather than give them a fish. You want to mentor you are providing the Technical Support but also fostering towards independence. That is a lot of what we do. But based on our infrastructure, the teaching, and as you say, in some countries, i have seen it where in this region of the country, they were doing Covid Vaccination by cdc. Sometimes in other places, we are all doing the entire country while looking at different areas in which we are doing it, but laboratory system, setting up Emergency Operations centers, the field of epidemiology training program, laboratory and training program, they are taking the next generation in the country. That is parallel to what we are doing here but with one u. S. Voice and country. Dr. Walensky, i cant imagine what it was like coming into cdc and running cdc in the midst of a pandemic. You lifted up a while ago the declaration you made of racism in the Public Health crisis and the Ripple Effect that had on the country with Health Departments. When i look at what you laid out last week, you mentioned in their a Health Equity office. I am wondering what some of your thoughts are on what needs to change at cdc so that cdc is an agency that meets the needs of all americans and that not only will the next pandemic not have a disparate impact based on race , but the everyday issues that people face will not have such a disparate impact by race. Dr. Walensky yeah, thank you. So this is clearly something with my work in hiv i have been passionate about. And it was really mobilizing at a time when morale was pretty low when i started, to say we will do something about Health Equity. Everyone was on board. What happened was our Different Centers and divisions came together and talked about everything they were doing and Health Equity. It was one of those things where we were able to break down silos and look at the intersection of all the important work that was being done. This office will raise that. It will an office that reports to the director. We do want to raise up our key core capabilities. We talked about the lab and workforce and data, but also our policy, communications, and equity is being a really key important one. We talked a lot about promoting a workforce that is as diverse as the communities we serve. We talked about our Core Infrastructure and our core capabilities. And also, what of the things i did early on was proposals. Everybody put forward a proposal. I really did not want to document the problem anymore. We know that wherever you looked, there was an inequity problem. We know with monkeypox vaccination, we never saw the data, but as soon as we did, there would be a equity problem. We have to document the problem. In addition to document to the problem, lets look at how we can implement solutions. I charged every Single Center and division for putting forward proposals on how they can address equity. Everybody came forward and it was really mobilizing. They have a year to sort of work on this proposals. We should be starting to see some of them. Not all of them will work but some of them will work in different parts of the country, right . That is a lot of immobilizing work we are doing and i am hoping we will be setting an example for other Health Departments. Julie you know, you have been talking a lot about workforce and we have not really touched on the Commission Court. Could you say a little bit about the Commission Court and what you might imagine the future role of the court of the cdc might be . Dr. Walensky the core has been key. From a deployment standpoint, much of the folks in the car, we were saying you cannot take the core because they are deploying the core to our own key missions. Lots of the core relies with what the corridors, with the secretary of healths office, but i believe one that is key and quickly important. Other areas i want to mention, bolstering up our program, looking at payment, americorps for Public Health programs. And then we of course course have this Incredible Opportunity with 3. 9 billion in workforce resources in the states. I think we need to invest in our Public Health workforce at the Commission Core level but also in many of these other areas. Thanks. I am jeff, a senior associate here at csis. For the first 40 minutes of the 45 minute of your discussion, we were talking about Public Health but did not talk about the public at all, and i was glad to hear you talk toward the end about the hard lessons the cdc learned about Public Communications during the covid pandemic. Recently when tony fauci announced his retirement, we were all reminded in the early days of the aids epidemic one of the breakthroughs that happened was when tony fauci and others, it was not just tony fauci, began listening to aids activists and listening to what they were saying about the design of Clinical Trials and how Community Trials could be conducted and we could get data faster and things could really change. So i wonder, just with that in mind, if you could talk about what you are thinking about how to bring the communitys voice more directly into the work that cdc does because that is one of the ways will be able to really address the equity issues you were just talking about. But i am curious to know if there are advisory groups, if there are ways you can build on those kinds of models to bring those voices more directly into your work. Dr. Walensky yeah. That is actually a terrific question. In fact, it was in those moments where tony inspired me very early in my career. I will tell you anecdotally that i had the great privilege of being on a white house call very early in the monkeypox pandemic, and the monkeypox outbreak, god forbid, where one of the advocate said, could you imagine if we were on a call in the cdc within a week of an outbreak that was affecting our community . And i have a phone call with Community Folks every week for exactly the reasons as you note. But i think one of the things that is really important here is ensuring the community as part of our workforce. It gets back to the Diverse Communities we serve. How do we know what the work in georges Vaccine Centers is if we do not want to Community Needs in the Vaccine Center . And we need to listen. There is no question we need to listen, but we need to recruit people in health and all of those areas. It is what we have been doing globally, what we do on the ground globally. And then of course i think we need to rely on community and also on our local jurisdictions to understand and recognize. One of the things we have been doing that is interesting is put Forward Guidance to articulate if somebody has a challenge to our guidance, our guidance has to be applicable in manhattan and American Samoa and Cherokee Nation and alaska. And so as we think about all the areas that our guidance applies to, we need to understand what the communities in those areas need. As we talked about, wastewater surveillance or even our covid19 community levels, we needed to recognize we could not do wastewater surveillance because there is no wastewater surveillance in alaska. Wehave to listen to that. Public health cannot work from above. We are not an empire. I really understand and agree with your premise that science needs to happen faster and good science takes time. We understand that. But most of us believe the real secret of the cdc is the science, what goes on in the lab , what goes on across the entire agency, and all the different domains of Public Health. How does that science vary with Infectious Disease and the outbreaks . Are we doing ok in the other domains . Dr. Walensky i think we are, and i want to be clear because i firmly believe in the peer review process. Almost everybody got better because it got through the peer review process. Things i had not considered were addressed through that process. The statistics got better through the peer review process. So that is still happening and it is still happening well and i do not want to discount that because so much Critical Science is happening, informative science is happening at the cdc and they cannot be mutually exclusive. I think back to july 24. That was the day i saw the data, a friday afternoon from massachusetts, and i was clear that people who were vaccinated were transmitting delta. That changed. We look at those data friday afternoon, corroborated it with data coming out of the u. K. Over the weekend. We saw another Outbreak Company at a correctional facility. We have three places we were seeing this and needed to change the guidance before it was going to get out. That is what i mean. We need to make those data public so when we change our guidance, people recognize this is the science around it and we are not going to wait for peer review. Julie we have two people at the microphone. In each of you ask your question and we will try to summarize . Good to see you. Harvard school, Public Health. One of the surprising and positive upshot of what we have gone through in the pandemic is the realization that the author system now sees itself a little bit more outside the four walls. I wonder if you are thinking about changes in the cdc beyond. What are other ways you are thinking about connecting more of the bridge that is so critical between formal health care and formal Public Health . Dr. Walensky you want to just ask the second question . Because we want to make sure to get to both of them. I wonder if you could talk a little bit about any changes you are considering to the way outbreak response is structured at the cdc. We heard specifically about the framework. The first task, a response, and as it do you want to ask the second question. With the federal forecasting until recently. I was wondering if you could say anything about considering outbreaks structure and the cdc and the response framework and the pathogenics. So that you have a response. So that the cdc becomes longer. Are there any processes that you will do that. Dr. Walensky to your question, it is good to see whether weight. While we need partnership between an Emergency Response and people understand yes . The outbreak or the systemic pathogen. In the partnership has not necessarily happened. So we are raising a response to the level the level of response to the director and we are working on this now. We are actively working on this. We do need more training and response and different layers of response. And how one would start or deploy towards a response. We are actively working on that and thinking about the structure we need to have as we move forward. That is actively happening. I think youre totally right, one of the things up work hard to do is to say that our clinic was run by the state. Which we did not talk about very much. But why we need to have more fluid communication with our state labs. So we need to foster these connections. I think the pandemic has given us this opportunity from a vaccine standpoint. And more than a case standpoint we have data in the hospitals then how can we look at hash how can we examine that . If we have vaccine data that lines up with the state or hospitalization rates but more people in the hospital. And then connect the two. One of the things we are actively working on, is to say once we have our pipes connected, are they going to connect with the other centers of the world to make sure that all the systems connect. There are mechanisms in which that can happen and i think health care is motivated to do it. Thank you for that. I will let tom around us up and turned it over to you to close this out. I want to thank you for sure for being here and your leadership and incredible service. Under challenging circumstances but i also want to thank steve the leader of our old commission. He is genius at putting this together and our commissioners who are here and that members of the group and my coach susan brooks pray for her daughters wedding that she has a good reason for not being here. And our production crew. Thank you so much for your role and the team that has been managing this. One of you closes out . Dr. Inglesby i would say that we really appreciate you being here and doing this form. What i heard today where many of the very important changes that you wanted to make around data and culture and accountability and workforce. And maybe some of the unsolved capabilities at the cdc which are strong and need to be supported. And he also helped us understand things that will be important to the ecosystem that surrounds these to be able to make the changes you want to make. And as this commission and larger immunity of Public Health and what youre planning we will engage in the process of change in the time ahead. And we were talking about the cdc and taking a moment to think the workforce of the cdc who i think has been at work for 2. 5 years without a break working weekends and late nights and also at a personal health risk also often. And we thank you for being a leader in challenging times. [applause] [indiscernible] [indiscernible] it immigrants. The act also established a system for very crying the status of employees. He is a former commissioner of the Immigration Service and he talks about that plans on legislation tonight starting at 8 00 eastern on sees fan. And prime. There are a lot of places to get political information, but only at cspan do you get it straight from the source. No matter where you are from, or where you stand on the issues, cspan is americas network. Unfiltered, unbiased, word for word. If it happens here, or here, or here, or anywhere that hatters, america is watching on cspan. Powered by cable. s cspan, senator joni hurst on the direction of the Republican Party and the legacy of the public and president ronald reagan. She outlines policy recommendations for restoring her leadership her remarks are from the