Science Friday

As The CDC Falters, How Do We Fill Public Health Gaps?

October 6, 2025

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  • While state and local public health agencies can and must step up to fill immediate gaps, there is no replacement for a competent national public health system like the CDC. 
  • Dr. Tom Frieden advocates for a 'build forward' approach using his 'see, believe, create' formula to make public health faster, more impactful, and better at communication. 
  • Public trust in the CDC is currently compromised due to political operatives running the agency, necessitating that public health communication distinguish clearly between established facts and evolving evidence. 

Segments

Filling Gaps Beyond CDC
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(00:00:24)
  • Key Takeaway: State and local governments, philanthropy, and NGOs must step up to fill public health gaps created by federal shortcomings.
  • Summary: State and local governments, philanthropy, and non-governmental organizations are necessary to fill immediate public health gaps, though they cannot fully replace a competent national system. The goal should be to build forward by innovating to make public health faster, more impactful, and better at communication. Dr. Frieden’s ‘Formula for Better Health’ involves three steps: see, believe, and create.
Local Health Department Authority
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(00:02:38)
  • Key Takeaway: Local health departments possess regulatory authority, allowing them to address specific, high-burden problems amenable to intervention, such as the NYC smoking ban.
  • Summary: The scope of authority varies, but local health departments can define what matters to people and implement interventions. Technical rigor requires addressing problems with a large burden that are amenable to intervention, avoiding programs for small problems. The successful ban on smoking in NYC restaurants and bars demonstrated success by making the pollution visible and pre-bunking industry backlash.
Federal Rollbacks and Local Action
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(00:05:40)
  • Key Takeaway: Federal rollbacks on environmental regulations, like PFAS and PM 2.5 standards, create critical areas where local innovation is needed, despite resource limitations.
  • Summary: While states cannot fully close the resource gap left by the CDC, they can innovate on issues like emerging contaminants in water (PFAS, microplastics). Current federal actions contradict stated goals, such as eliminating chronic disease programs while claiming to address chronic disease. PM 2.5 soot pollution is estimated to kill 100,000 Americans annually, highlighting a preventable harm that requires action.
Restoring Trust and Communication
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(00:07:59)
  • Key Takeaway: Public health guidance from the CDC is currently untrustworthy due to political influence, requiring a communication strategy that validates legitimate questions rather than vilifying skeptics.
  • Summary: The current CDC guidance cannot be trusted because the agency is run by political operatives, which is a significant problem for public health. Loss of trust accelerated during COVID-19, often breaking down along partisan lines, which is unfortunate as health should transcend politics. Effective communication requires listening to legitimate questions, distinguishing them from misinformation, and acknowledging that good science leads to humility, not absolute certainty.
Individual and Community Directives
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(00:11:00)
  • Key Takeaway: Individuals should support their local health departments and advocate for better primary care access, as healthcare spending is high but access remains poor.
  • Summary: Individuals should support their local health department as it functions as essential health protection, similar to police or fire departments. It is scandalous that the US spends $4.5 trillion on healthcare while a third of Americans lack a primary care provider. Advocacy for better primary care access is a crucial action individuals can take at their level.