{"id":11620,"date":"2025-08-29T17:41:15","date_gmt":"2025-08-29T21:41:15","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=11620"},"modified":"2025-08-30T01:24:11","modified_gmt":"2025-08-30T05:24:11","slug":"watching-the-chaos-at-the-cdc-with-sadness-and-alarm","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/watching-the-chaos-at-the-cdc-with-sadness-and-alarm\/2025\/08\/29\/","title":{"rendered":"Watching the Chaos at the CDC &#8212; with Sadness and Alarm"},"content":{"rendered":"<div id=\"attachment_11623\" style=\"width: 261px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-11623\" class=\" wp-image-11623\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280.png\" alt=\"\" width=\"251\" height=\"251\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280.png 1280w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280-300x300.png 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280-1024x1024.png 1024w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280-150x150.png 150w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280-768x768.png 768w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2025\/08\/rain-8590529_1280-144x144.png 144w\" sizes=\"auto, (max-width: 251px) 100vw, 251px\" \/><p id=\"caption-attachment-11623\" class=\"wp-caption-text\">Image by <a href=\"https:\/\/pixabay.com\/users\/jacksonmoccelin-26872884\/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=8590529\">Jackson Moccelin<\/a> from <a href=\"https:\/\/pixabay.com\/\/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=8590529\">Pixabay<\/a><\/p><\/div>\n<p>Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source.<\/p>\n<ul>\n<li>Need reliable data on an outbreak? The CDC.<\/li>\n<li>Need thoughtful, evidence-based guidelines? The CDC.<\/li>\n<li>Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC.<\/li>\n<li>Need the latest, most accurate surveillance information on HIV or influenza or dengue or you-name-it? The CDC.<\/li>\n<li>Need advice for your friend doing anthropology research in rural Bolivia and wondering whether they should take malaria prophylaxis (yes), and what it should be (multiple options)? The CDC.<\/li>\n<\/ul>\n<p>Did I always agree with every word? Of course not. Show me an ID doctor who always agrees with every guideline, and I\u2019ll show you a cephalosporin that covers enterococcus.<\/p>\n<p>For example, for years I\u2019ve thought we\u2019re too aggressive with &#8220;bat in bedroom, no bite&#8221; postexposure prophylaxis, <a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/human-rabies-from-bats-another-look-at-the-numbers\/2009\/05\/07\/\" target=\"_blank\" rel=\"noopener\">preferring the Canadian approach.<\/a> But I never doubted the people making the U.S. guidelines had done their homework with integrity; they weren&#8217;t part of some sinister rabies vaccine\/immunoglobulin cabal. It was a difference in opinion, that&#8217;s all.<\/p>\n<p>And I trusted the people. The ones I\u2019ve known who have worked at the CDC are mission-driven and incredibly hard-working. They\u2019re not looking for fame or fortune, to cultivate a brand, or to make a splash in the media. You don&#8217;t expect to see a TikTok video from a CDC official. They\u2019re the kind of colleagues who disappear into data sets, surveillance reports, and fieldwork, all in the service of preventing disease and saving lives.<\/p>\n<p>So what happened?<\/p>\n<p>In a word: COVID. The pandemic was the public health earthquake of our lives, and the aftershocks continue. The CDC is one of its casualties. Instead of learning from missteps and strengthening the institution, we\u2019re watching it be weakened &#8212; deliberately, in some cases, and it seems with pointless vengeance. The critics who scream the loudest treat it as if every imperfect COVID recommendation, every adjustment of guidance in real time, every policy now viewed as incorrect with 20-20 hindsight, was a betrayal and not a best effort to help us cope with this new, tricky virus.<\/p>\n<p>Let&#8217;s acknowledge that perfection was impossible in the face of an unprecedented global crisis. Guidance had to evolve, sometimes rapidly. To punish the agency now is like telling tennis star Carlos Alcaraz he can&#8217;t compete in the U.S. Open because he lost in the Wimbledon finals.<\/p>\n<p>Yes, the stakes were high during COVID, but nobody &#8212; NOBODY &#8212; got it 100% right.<\/p>\n<p>The result? One of our most reliable public health institutions <a href=\"https:\/\/www.nytimes.com\/2025\/08\/28\/health\/cdc-employees-director-trump-rfk-jr.html\" target=\"_blank\" rel=\"noopener\">is being destroyed by non-experts in medicine and public health.<\/a> People with <a href=\"https:\/\/www.bostonglobe.com\/2025\/08\/29\/metro\/cdc-kennedy-trump-vaccines-resignations\/\" target=\"_blank\" rel=\"noopener\">disturbing beliefs about infectious diseases in general and vaccines in particular<\/a>. And who knows what the next year or years will bring? Who will we turn to then?<\/p>\n<p>For those of us who have leaned on the CDC our entire careers, watching its destruction at the hands of non-experts is not just disorienting &#8212; it\u2019s heartbreaking, and makes me very, very sad.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC. Need the latest, most accurate [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-11620","post","type-post","status-publish","format-standard","hentry","category-health-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/11620","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=11620"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/11620\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=11620"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=11620"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=11620"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}