The agency may be just one cog in the nation’s public-health apparatus, but it is a crucial one. In an ideal world, its edicts would hold sway not only over schools but also nursing homes, prisons and meatpacking plants. It would guide elected officials and private institutions alike through not just global pandemics but all manner of public-health threats: food-borne pathogen outbreaks, the opioid crisis, gun violence. In an ideal world, its efforts would succeed, more often than not, at keeping people safe and helping them stay healthy. This is the C.D.C. we need. But as the last year has made clear, it is not the C.D.C. we have.
The C.D.C. we have is hardly a monolith: Some of its many pockets are bursting with innovation; others are plagued by inertia. But scientists and administrators who have spent decades working with and for the agency say that three problems in particular affect the whole institution: a lack of funding, a lack of authority and a culture that has been warped by both. Some of these problems come down to politics, but most are a result of flaws in the agency’s very foundation.