A year with the CDC: Director Rochelle Walensky's honest review of the challenges she's faced as a leader and what the agency could do better

• CDC Director Rochelle Walensky sat down for an exclusive interview with Insider a year into her job.
• She said a big challenge had been communicating "pretty complex science as it's evolving."

On January 20, 2021, Dr. Rochelle Walensky took the helm of a notoriously slow-moving federal agency amid the fastest-moving natural disaster the country's public-health experts had ever seen.

When she stepped into her new job as the 19th director of the Centers for Disease Control and Prevention, the US vaccination campaign was off to a rocky start, federal data on the coronavirus was so nonexistent that news outlets had taken on the task of tallying COVID-19 cases and deaths, and political appointees had been trying to obscure the true scale of the crisis.

Twelve months later, while the virus is still very much with us, the CDC has taken up the mantle of data tracking and disease surveillance like never before, booster shots are widely available, and COVID-19 data analysis from the agency is operating at its fastest clip yet.

It hasn't been the smoothest road, though. The agency's COVID-19 response has been heavily criticized, sparking "the CDC says" memes and numerous "Saturday Night Live "skits about its often confusing and conflicting advice.

Speaking to Insider on her first job anniversary, Walensky acknowledged that the CDC was still "working to adapt" its response to the pandemic. But she also argued — with compelling studies and new data to back her up — that the CDC deserved some serious credit for its moves toward becoming a nimbler, modern public-health agency.

In the interview, the CDC director touched on everything from her approach to leadership to the future of Omicron.

Walensky's answers have been lightly edited for length and clarity.

Walensky says she likes hearing dissenting opinions, but it's hard to make time for that in a fast-moving pandemic

Let's discuss your approach to leadership at the CDC. Coming from the private sector, and with so many accolades from that, how have you had to adjust in order to head up this huge federal agency?

I mean, there's leadership, and then there's leadership in a pandemic.

I like to meet people. It's been hard at an agency of 12,000 people when people are working remotely. It's been hard to get to know people. And that's how I sort of foster relationships.

When you foster relationships, you get honest opinions. You hear your dissension, because you welcome and open it. And then you have to make difficult decisions sometimes when there isn't unanimity or when there isn't full consensus, but at least you know that everybody's been heard.

That's harder at a time of a pandemic. It's harder at a time where you are just coming in — you have to make rapid, hard decisions before you've met all those people and understand and can get that honest feedback.

One of the things that I've done is met with each of our division directors and center directors. I think there are over 100 of them. I've met with each of them one-on-one in my first year to just get to know people and the work that they do and ask them how their teams are doing. I've let them know if they ever have challenges that they're welcome to reach out to me. And many of them have actually said that they've been at the agency, some for decades, and they never met personally with the CDC director.

So maybe it's a sign of the times, because this is how I feel like I need to do it when running into the people in the hallway is a little less common these days — but I really do try and hear different opinions. I want to hear dissenting opinions because I really think that that's how we get stronger as leaders.

Walensky stands by the CDC's guidelines, but she says she understands they've been confusing

I still hear things from friends like, "How can we trust the agency that told us not to wear masks way back at the beginning of this?" But as you've pointed out, guidance has to shift as science advances and we learn more and the virus changes.

Do you feel like, as CDC director, sometimes you're hesitant to get too deep into the scientific nitty-gritty in a way that maybe wasn't the case previously in your career, when you were communicating more with doctors and medical students and nurses?

Our responsibility is to communicate pretty complex science as it's evolving.

That's my job, to make decisions that are based on science. Increasingly, people want to understand the details in the nitty-gritty — people who may not be trained in epidemiology or science. So I have to be able to unpack it.

May 13, when masks came off [for vaccinated people], it was 10,000 cases a day. That's how many cases we had. We had the Alpha variant, which had really remarkable vaccine effectiveness. So the scientific decision at the time I wholly stand by. That was the right scientific thing to do. People were asking, "Well, if I'm vaccinated and protected, why can't I take off my mask?" And those were the right questions to be asking.

Perhaps the challenge that we had at the time was not saying "for now" — that there may be other variants that come down the pipeline that lead to future surges where our vaccines aren't going to work as well. And that's indeed what happened.

But I think if you look back at the science of May 2021, the science told us — had every indication, and we listened to it — that right now it's OK to take off your mask if you're vaccinated.

A lot hinges on several different key things. First, what is the science that we know? What is the epidemiology that's coming? How many cases do we anticipate coming? (We've made some of those decisions in the context of anticipating an Omicron surge.) And then what is implementable? What's feasible? What can people do?

Yes, given the curveballs of this pandemic, we perhaps need to sort of articulate a little broader: "But this could change." If there's new and evolving science, new and evolving variants, new and involving scientific information, then we will follow it, and then we will make changes accordingly.

Walensky says poop tracking is the future of COVID-19 surveillance — and disease tracking in general

Wastewater surveillance is very hot right now. In New York, Boston, it's been an incredible tool with Omicron. Can you talk a little bit about how you see that data becoming more and more useful for the agency nationwide? Any other tools besides wastewater that you're particularly looking forward to using?

When you think about wastewater, this is the first signal that you could possibly get — before people would even test. We can find disease in wastewater, and potentially not just COVID disease but many other diseases as well. We are posting new data on wastewater surveillance, which I think will be really exciting.

We've also scaled up genomic sequencing — tens of thousands of sequences that we're doing a week for COVID. And we can think about how we might use that sequencing to address other diseases, to address antimicrobial resistance.

All of our data-modernization efforts, our ability to connect the pipes of data across this country, give us windows into so many things that we couldn't see before.

I'll just give the example of our jurisdictional data on boosters that came out on January 21. Previously, we couldn't work with jurisdictions. Jurisdictions didn't necessarily have the capacity to map their immunization data with their testing data with their hospitalization and death data. They were all in different data systems. We now have 27 jurisdictions that represent two-thirds of the American population that can do just that. And by their ability to do that, within six weeks of Omicron's appearance in the United States we had data on vaccine effectiveness for Omicron from these 27 jurisdictions, millions of people.

I think that there's real interest in using this moment to make sure that we don't lose momentum.

On making quick decisions that break from her colleagues

What is your thought process when it comes to making rapid decisions? How do you decide whether you're going to go with or diverge from independent advisors or CDC scientists? One example I'm thinking of that generated a little bit of blowback was when you deviated slightly from the CDC's independent advisory committee on the booster recommendations for frontline workers. Bring us into that thought process a little.

It's actually pretty striking, given the multidisciplinary nature of the agency in and of itself, that we're moving quickly to make decisions based on science. Sometimes the science is gray. For the most part, there's large unanimity.

So when you look at the decision, as you say, with the ACIP meeting, there were lots of decisions that were made at that meeting about who should get boosters. There was one piece of that decision where I knew that, given the authorization status of this vaccine, one was not allowed to legally give it. You were not allowed to legally give it to healthcare workers if I didn't make that decision at that time.

I had listened to the ACIP deliberations, but I had also heard from people across the country. I had been talking to state health officers across the country and really hearing that their healthcare workers were needing and wanting the boost, and so that was the reason for that decision at that time.

The bigger picture is that we are making a lot of decisions a lot of the time, and many people are criticizing at the margins when, for the most part, there's unanimity on many of the decisions.

The CDC needs to let go of 'dotting every I and crossing every T'

One of your predecessors, Tom Friedan, recently said that there's an "in some ways charming, but in some ways problematic, cluelessness on the part of CDC staff that their recommendations, their guidance, their statements could have big implications." I'm wondering, do you feel that tension? And if so, how do you try to manage it?

There are two things that I'm working towards and that this agency is working to adapt.

One is, historically, this agency has had a reputation of dotting every I and crossing every T.

The science gets out, but it takes a longer period of time than others may have liked. We're working on that, and I think we've made a lot of progress. We recognize that data need to move faster. Part of the challenge has been the frailty of our public-health system to not allow for that data to move fast.

The second thing we actually also have to grapple with is that now we're in the middle of a pandemic, which CDC has never had to be in the middle of, to make decisions upon. Sometimes we actually have to make decisions when we don't even have all of the data that we need.

When the data are grayer than we would like, a failure to make a decision is a decision in and of itself. So we even have to act in times where we have imperfect information because the situation is imperfect itself. All of those things are things that we're working on together as an agency, and I think we've made a huge amount of progress just in the last year.

Walensky isn't thinking about relaxed post-Omicron guidance yet — she says her crisis 'barometer' has her on high alert

We're at a moment where people seem almost excited — if I can use that word — about the Omicron wave cresting and falling in the US. I'm wondering how you think about that and balance the idea of easing recommendations (maybe) with knowing that, realistically, some might need to come back. How are you thinking about this moment?

I sort of have to balance two different things.

I have to look at the current moment and the current surge. To just sort of place a reminder, we are at 600,000 cases a day, three times higher than any prior surge. We still have about 2,000 deaths every single day, about as much as we had during our Delta surge.

So while we're sort of tackling what is upon us at the moment, we also have to look down the field and say, well, what does this look like when this crests, when this comes down, when we maybe get to a time where we have many fewer cases and hospitalizations than we do now?

What I really consider my barometer here is looking at the hospitals. If our hospitals are not well-functioning, if our hospitals are not compensated (as we would say), if our healthcare workforce can't be present because there's too much sickness and beds are closed, if a motor-vehicle accident can't come into the emergency room and expect immediate care, then we still have a problem with COVID.

All of that is happening because our hospitals are too full. I really do look at them as a metric as to how we are doing as a society. If the hospitals are functioning well, and if the cases have come down such that we don't have overwhelmed hospital staff and beds, people waiting in the emergency department for hours, then we can start thinking about how our guidance might change in that context.

Walensky says she and Fauci are 'easy targets' for 'people who are unhappy' in the pandemic

The other question that I had is — I'm just wondering how you're doing?

I mean, Dr. Fauci has talked quite openly about the hate mail and threatening calls to his family, saying how the level of vitriol now doesn't even compare to what things were like during the early days of the HIV crisis. Does that resonate with you? How has the past year been?

Yes, it resonates with me.

Certainly there are people who are unhappy. Look, if you equate this pandemic to a natural disaster, which is what I think it is, we have many different ways that we can use science to try and cope and to improve outcomes, improve life, life expectancy, survival from this natural disaster. And many people want somebody to blame. And so we become easy targets, right?

But I will also say that I have the support of an incredible agency. I have the support of an incredible family. I have many, many academic and scientific colleagues and an incredible network that predated my being here. And I've developed an incredible network of state health officers and many others who I go to now for wisdom and advice.

I want to read and hear the criticism, but I also want to make sure that it's balanced by all these incredible people who have been here to support me.