— "We were in a much better place up until about 7 or 8 months ago," says Debra Houry
In this installment of “Exit Interviews,” MedPage Today editor-in-chief Jeremy Faust, MD, sits down with Debra Houry, MD, MPH, the former chief medical officer and deputy director at the CDC, to reflect on her decade of service and the circumstances surrounding her resignation.
In part two of this three-part interview, Houry explains why the departure of Susan Monarez, PhD, marked a tipping point, shares her reaction to recent Senate testimony, reflects on lessons from COVID, and warns that staff reductions and stalled reforms have left CDC less prepared for the next outbreak.
Watch the first part of this interview here.
The following is a transcript of their remarks:
Faust: Can you tell me briefly, as much as you know, about Dr. Monarez and her last days at the agency and at HHS? Did you know that basically she was going to lay it all on the line for vaccines?
Houry: The week before it all unfolded I knew she was being called to HHS, and that was when I had made my decision that I was leaving. I had actually told my leadership team — I think it was a few days before I resigned — that I would not be at CDC by the next vaccine committee meeting. I just told them I hadn’t decided when it would be yet because I knew even though I wasn’t involved in a lot of that, I wasn’t going to be viewed as complicit in that committee.
So with Susan, when I knew she couldn’t make decisions that she was trying to do, that’s when I knew that was the tipping point. She had tried to change one of the staffing on the committee, she wanted to post documents for public comment, and when she was unable to do that, I knew that she wasn’t going to be successful, which meant I couldn’t be successful as a scientific leader.
She called me after her meeting on Monday and told me how it had gone, and I called Dan [Jernigan] and Demetre [Daskalakis] and a few others and just let them know that when Susan left, I planned to leave as well.
Faust: Let’s talk a little bit about what happened last week in the United States Senate with Secretary Kennedy. What was your takeaway from those interactions?
Houry: I thought like Senator Cassidy really pushing on mRNA and even highlighting the lack of conflicts of interest in the prior ACIP [Advisory Committee for Immunization Practices] members was really helpful. I thought he took a very evidence-based approach and held firm on vaccines and science.
I thought overall most of the senators expressed concern about where Health and Human Services was going for the secretary, and I was also very disappointed in some of the secretary’s answers, like when he didn’t know how many people died from COVID. One, it’s on our website. Two, myself and Demetre and Dan had offered to brief the secretary many times, and I have never briefed the secretary — and neither had they — on things like vaccines or measles or H5N1. He didn’t see a problem with having people that were expert witnesses for lawyers that were suing vaccine manufacturers as a conflict of interest. I thought that was problematic. Certainly, you want to make sure you’re balanced, but that doesn’t seem very balanced.
And then just on a personal note, when he talked about “new blood” and things like that, he actually didn’t know who the leaders were who left. I was not running the COVID response at the beginning of COVID. I was actually running President Trump’s drug overdose work, and Drs. Layden and Daskalakis were in local health departments at the time.
I hear what the secretary is saying, but if he knew the experts, then he would know that that actually was not us that was working on those issues that he had issues with.
Faust: And just going back to February of 2020, which is a time where a lot of knowledge wasn’t available, that was a tough time for the CDC, but famously Nancy Messier basically went out there and got ahead of things and said, look, COVID is going to be a problem. It’s going to disrupt our lives in ways that we haven’t seen before. Can you just reflect on that moment actually?
Houry: Yeah. So I think that was a pivotal moment where Nancy really stood up and said, here’s what we know and what we don’t know, and that’s what risk communication is. I think certainly that caused a lot more attention to the potential severity of COVID and caused probably actions that may have happened before we had the data and the science.
I think what I would say is during COVID, everybody learned a lot, including CDC, and we certainly had missteps. But what I was proud of at CDC is all the changes we were making.
So we had improved our lab quality. There were ways to ensure that lab tests were really valid and timely. Our data, now we’re able to have dashboards and near real-time data. Staff were trained to be ready for responses. And so we were in a much better place up until about 7 or 8 months ago when the proposed reorganization for things like Administration for a Healthy America went in place, a lot of the terminations.
So I think that’s what concerns me is, we learned from COVID and we’re on the right path, and now I am concerned that we’re no longer prepared for the next outbreak.
Faust: You’ve been at the CDC since 2014, is that correct?
Houry: Yes, 11 years.
Faust: And during that time, you were personally responsible for the growth of at least one major center, the injury center, and you saw other things happen that were really positive, including some data modernization. People don’t realize that before 2020 it was a very different scene and that the CDC actually could react relatively quickly — slow by the standards of maybe popping up a website overnight, but light speed by CDC and government standards generally.
Houry: Yes.
Faust: Yes. But, now we see since February, these reduction-in-force actions where thousands of employees have been sent packing who were doing great work, do you think that the agency’s capacity to do its mission is diminished right now? And could you cite an example if that’s true? I’m specifically wondering about the measles response because I sort of hear two things like, OK, we were able to do our work, but we were sort of handcuffed in some way.
Houry: So I would say we’re less prepared because we’ve lost 750 ready responders from our noncommunicable centers because of administrative leave and termination. And for me, that’s important.
When you look at Zika — I like Oropouche because that’s actually the disease I’m worried about now, but people are more familiar with Zika. It’s similar, it’s this virus that can cause birth defects, and you have to have then environmental health, reproductive health, and our birth defect specialists working together with infectious disease physicians to really understand how to respond. And if you’re splintered and don’t have those experts, you can’t do that.
With regard to measles, I would say we had adequate capacity and staff on the ground. Some of the initial issues we had were just around contracting and being able to get money out the door, and that had nothing to do with CDC, that was just many of the government policies that were in place at the time. We were doing what we call Epi-Aids where we sent teams to Texas. We had, as soon as the state requested, we were able to provide that support. We were able to get vaccines to the state.
So I actually think the measles response was pretty successful from a CDC perspective. I think what was less successful was with some of the messaging that came out of the department around measles. I think I understand the need to ensure that populations that aren’t receptive to vaccines are doing other prevention measures, including taking vitamin E for treatment, not for prevention. But I think when you’re promoting vitamins over vaccines, that can be problematic. We were trying to promote vaccines.
Faust: But I think one thing that maybe the public doesn’t understand is the decreased progress that’s happened in recent months. And I’ve heard from some of your former colleagues that Secretary Kennedy’s office himself actually stood in the way of some of the data modernization efforts that were underway, including a project that would bring closer-to-real-time data on 127 nationally notifiable diseases, and that this was a very down-the-middle sort of not controversial project. The idea that, hey, if there’s a polio outbreak, everyone should know about that and we’re going to put that in one place rather than the old way where things were, frankly a little hard to find on the CDC website, and that the secretary or his office actually told you, no, we’re not doing this.
Houry: So I think it was more of the program is still working on it, but we are not launching the beta version or the early version at this time. I can’t tell you what further discussions have happened since I’ve been gone for nearly 2 weeks now. But the plan had been to really look at, as you mentioned, some of these diseases and what happens if you’ve got comorbid conditions. What’s the vaccine rates in those communities so you know how to protect yourself.
So in my mind, it’s almost mom-and-pop. It’s data we already had and just looking for visualization. But there are clearance processes at HHS and it has not gone all the way through yet. So still in the works.
