Former CDC director Rochelle Walensky, MD, MPH, Shared Insights with the Triological Society

In her three years as director of the U.S. Centers for Disease Control and Prevention (CDC), Rochelle Walensky, MD, MPH, encountered a seemingly endless stream of challenges during the COVID-19 pandemic, from threats due to new variants, to communication questions, to agonizing policy decisions.

When she took the stage to deliver the Joseph H. Ogura, MD, Lecture at the Annual Meeting of the Triological Society—held as part of the Combined Otolaryngology Spring Meetings (COSM)—Dr. Walensky had a new kind of challenge on her mind. A gunman had slain Amy St. Pierre, a researcher at the CDC in Midtown Atlanta, the day before.

“Amy was a valued member of our division of reproductive health, where she worked tirelessly to save the lives of both women and infants,” Dr. Walensky said, her voice somber, before her fireside chat-style session with Triological Society President Ralph Metson, MD. “And I just wanted to extend my sympathies to her family and to our CDC family as we grieve her loss.”

Once you kind of get your feet under you … and start to understand the government and to understand all of the challenges that you just mapped out, you quickly realize that, whatever your decision, someone will criticize it.  —Rochelle Walensky, MD, MPH

The moment offered a sense of the way in which Dr. Walensky’s time in the position has meant confronting layer after layer of complexity and gut-wrenching turns of events. In the discussion, Dr. Walensky captured the strain of her directorship, offered her observations about the country’s readiness for the next pandemic, and drew on her experience to offer career advice.

The day after the session, Dr. Walensky announced that she would be stepping down from the position on June 30, 2023, so her remarks serve as a fairly complete reflection on nearly her entire tenure in the position.

The Path to the CDC

Sitting in a chair opposite her, Dr. Metson asked her about the period leading to her appointment as CDC director.

“Most of the audience here today are clinicians,” he said, “[who are doing things] similar to what you were doing three years ago—seeing patients on the ward in the clinics of the hospital. And now you’re director of the CDC. Can you share with us a little bit about your journey to the CDC?”

Dr. Walensky said that her decision to go into infectious disease came in 1995, when she was at Johns Hopkins University in Baltimore. “It was during that time that the cocktail was actually FDA approved, the third drug for HIV,” she said. “And we were seeing … people dying of AIDS all the time. And in that year, we could actually give people hope. That really was the spawning of my career, both clinically, but also in my research world.”

When she became chief of infectious disease at Massachusetts General Hospital in Boston in 2017, she expected she would be in the position longer—the last two division chiefs held the job for 30 years, she said.

On March 6, 2020, however, she got a phone call about the first two COVID-19 cases at the hospital, while the start of a conference in Boston was nearing—a banner was being hung at the convention center in preparation.

“That meeting was canceled as people were literally in flight to get here,” said Dr. Walensky. “That first year was hard. Hard for everyone in this room, hard for everyone working clinically. It was scary and tragic.”

When she later received a message that Ron Klain would like to talk to her, she said she “recognized that name”—it was Ronald Alan Klain, who served as White House chief of staff under President Joe Biden from 2021 to 2023. Before she called Klain back, her husband told her, “Whatever he says, don’t say ‘no,’” she said with a laugh.

Handling the Pressure

Dr. Metson asked, “Every decision you’re making is scrutinized by the public, through social media, by the press. And then you’re working in a very politicized environment—I don’t have to tell you: science versus politics for every decision. How do you survive in a situation like that, mentally and physically?”

“Once you kind of get your feet under you,” Dr. Walensky answered, “and you realize that you no longer feel like a deer in the headlights and start to understand the government and to understand all of the challenges that you just mapped out, you quickly realize that, whatever your decision, someone will criticize it. In fact, a lot of people will criticize it. And, in fact, it may very well lead to front-page criticism. And so much of what that has been about is to put your head down and just do the right thing. And stand by doing the right thing. And, sometimes, right is gray [instead of black and white], and it may not always be obvious what the right thing is.

“Much of the criticism, interestingly, has been around things like, ‘Well, this is the way we think it should be done here,’” she added. “And I think people fail to realize that at CDC, our guidance, our policies, everything has to work in Manhattan and Boston and Guam and 574 tribal nations that we have in this country, and rural Alaska. And so, making policy and decisions for a country with all of those different settings and demographics is challenging.”

The vital source of her support has come from an “amazing family,” she said. Trying to work out on the weekends and going on long walks has also helped her cope, she said.

Receiving Mentorship from Anthony Fauci, MD

“I have had the gift of incredible mentors who are now incredible friends,” Dr. Walensky said. “Tony is the reason that I’m sitting in the chair that I’m in now.”

Dr. Walensky said that during the early days of the AIDS crisis when “die-ins” were being held with “red paint being thrown on the steps of the NIH,” Dr. Fauci’s response was, “Let them in and let me hear what they have to say.” That outlook resonated with her, she said.

“I think so much of that has really been true with COVID-19,” said Dr. Walensky. “Let’s listen to what the affected people are feeling and what they’re asking of us. And I think that was really, to me, one of his greatest contributions.”

Health Disparities

“I remember very early on in the pandemic,” Dr. Metson said, “watching you on a Zoom meeting live, and you said, ‘Social distancing is a privilege.’ I remember those words rang so true and made me think about everything from a different perspective. So, I’d like to ask you to please address the issue of health gaps and inequities in our society related to one’s social status or ethnicity or income or race. What is the CDC doing to address these disparities?”

“We know that infectious diseases hit the most vulnerable, hit the poor,” Dr. Walensky answered. “And so, this was no surprise in COVID-19 that we saw this. In fact, frankly, COVID-19 came to our shores among people who could ride on cruise ships and fly on airplanes, and it quickly affected our most vulnerable communities.”

This has been seen in the huge reduction in life expectancies for African Americans and Native American Indian tribes, she said.

“Ten weeks after I became CDC director, we declared racism [to be] a serious public health threat, and we have since had 200 public health departments across the country do the same.”

Dr. Walensky noted that the public health system still needs workforces “as diverse as the communities they serve, a culturally competent workforce.” The issue of health disparities doesn’t need more research, she said, because every time the question is looked at, “we find them. We don’t need to continue to document; what we need to do is implement solutions.”

Preparedness for the Next Pandemic

“You sit atop a pyramid with so much data beneath you and so much decision-making, so you have a really unique perspective,” noted Dr. Metson during their conversation. “From that perspective,” he asked, “could you give us your thoughts about the next surge, the next pandemic?”

Dr. Walensky said that one big issue is data collection. “There’s some assumption that we at CDC receive data in real time,” she said. “In fact, we don’t have the authority to do so. All data that we get at CDC is voluntary.” As the public health emergency came to an end, the data being collected lost some of their granularity, she said.

“What I will say about another pandemic is, everyone assumed the one-in-100-year pandemic would be influenza. And it was coronavirus. And what is true is that just because we got one doesn’t mean we won’t get another,” cautioned Dr. Walensky. “And so we have to be in a position of preparedness. We have a deficit of 80,000 public health workers in this country. 

We have data systems that still come to CDC by fax. And then we have a laboratory infrastructure that’s quite frail. So, we do need an investment in public health infrastructure to tackle whatever comes next.”

Toughest Moments at the CDC

Dr. Walensky said that on one Friday in July, when the CDC had just told the country that it was OK not to wear masks if you were vaccinated, she got a call that, in an outbreak in Barnstable County in Massachusetts, vaccinated people were transmitting the virus to others.

“That likely meant that we were going to need to put masks back on,” she said. “All things happen on Friday afternoon. That was a big gut punch. And we spent the weekend talking to colleagues around the world to see if we were seeing the same thing with those more experienced with [the] Delta [variant].”

The CDC had to make a dramatic policy decision, hoping they would have the data to demonstrate the reasoning, she said. “We knew we were ultimately going to need to put masks back on. Could we distribute the science in a way that everybody would quickly understand our need? We were able to do it within a week.”

We don’t need to continue to document [health disparities]; what we need to do is implement solutions. —Rochelle Walensky, MD, MPH

The other moment she highlighted came after the CDC’s Advisory Committee on Immunization Practices voted 9-6 not to endorse booster shots for frontline workers.

“That was unprecedented,” Dr. Walensky said. “We had to ask, ‘What do we do in a split vote? Can a director overturn it?’ And as you can imagine, just as the votes came in, my phones exploded with everybody who had an opinion about what I should do.”

In the end, she overruled the committee, and booster shots were made available to frontline workers. “There was no mechanism by which healthcare workers could get a booster dose,” she said. “At that time, I remember one story of a pregnant emergency department doctor who was saying, ‘I’m on the front lines; I really would like a booster dose.’ It would have actually been illegal for her to receive a booster dose. Those were some of the things that were influencing my thinking.”

Words of Advice

Despite the burdens imposed by the job, Dr. Walensky encouraged the audience to seek out the difficult course of action.

“I would say, just from this position that I’m in now, lean in,” she said. “If you think the job is too big for you and somebody else is offering it to you, it’s probably the right kind of job. I never had director of CDC on my bucket list, and, in fact, I can’t tell you how many times I said to my husband, ‘Do you really think I can do this?’ So if you’re just comfortable with your next job, you haven’t strived high enough.”

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Thomas R. Collins is a freelance medical writer based in Florida.