Chief of CDC’s ‘weather service’ strives to help local health agencies use infectious disease forecasting | Science
In August 2021, amid criticism for bungling its response to the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention (CDC) launched an ambitious effort to prevent a similarly poor performance going forward. The Center for Forecasting and Outbreak Analytics (CFA) is intended to become the nation’s pandemic “weather service.” It aims to forecast the location, scale, and severity of infectious disease outbreaks in enough detail to help local officials advise on practical issues like whether nursing homes should allow visitors or a school district should require masking.
CDC’s 12th center is also a response to widespread criticism that the agency failed in one of its most basic functions: public communication. Confusing or controversial pandemic guidelines on school openings, masking, and boosters were among its many missteps by the summer of 2021.
Nearly 2 years later, according to its director, CFA has scored its first successes, rapidly predicting the severity of a U.S. COVID-19 wave when the Omicron variant arose and publishing prompt, detailed status reports during the mpox outbreak last year. The center has hired more than 50 of a planned 132 employees. Their inaugural in-person meeting at CDC’s home base in Atlanta is set for August. Some employees will be stationed there; others will work remotely; and others will occupy the center’s planned physical headquarters in Washington, D.C.
The center also just broadcast its first major call for grant applications. It plans to award $263 million to about a dozen groups over the next 5 years to develop innovative, speedy, practical disease forecasting methods and ways to get their outputs–like the arrival timing and the expected number of cases of a disease in a town, city, or state–into the hands of local public health officials.
CFA’s ambitions could be limited, however, by the effective freeze on funding increases at civilian agencies resulting from last month’s debt ceiling deal. The center, along with the rest of CDC, also faces harsh scrutiny from Republicans in Congress, who at a hearing yesterday charged that the agency is trying to overstep its authority in areas like data gathering.
Infectious disease modeler Dylan George, who left an industry position to join the center at its inception and who was promoted to CFA director in March, spoke last week with ScienceInsider about the center’s early days and challenging future. This interview has been edited for brevity and clarity.
Q: You said soon after CFA’s launch that the opportunity to use disease forecasting and analytics to save lives in the United States “gets repeatedly squandered because we aren’t organized.” Has that changed because of CFA?
A: We have been thrown into the fire already. For example, when the Omicron variant was coming, when we started seeing data out of South Africa, we were able to gather our team together, gather a handful of [consultant] academics very quickly, parameterize some models, and predict a lot of cases in January. This was around Thanksgiving 2021. Within a week we were talking to [CDC Director] Rochelle Walensky and within 10 days the White House. Then we spoke with state and territorial epidemiologists. It happened faster because CFA existed.
Subsequently, one of the harder challenges was trying to assess the clinical severity of Omicron. [CFA senior adviser] Marc Lipsitch was able to work with CFA colleagues and Kaiser Permanente of Southern California to actually track cohorts of people infected with Delta versus Omicron and show—fortunately for us—that Omicron cases were not as severe as those infected with the Delta variant.
Q: What are other examples of CFA’s accomplishments?
A: When mpox broke out we engaged closely with [CDC’s] incident management team to develop what we call the technical reports, trying to get more technical information out but presented so that an average individual would understand. There were four of them [during the 2022 outbreak and two additional risk assessments] that were just dropped recently.
The main innovation here is: Do it fast. Do it repeatedly.
The local public health officers and the state epidemiologists, they really appreciated the information. … Now, not only is CFA using that approach, but other groups within CDC are, too.
Q: What changed for you when the COVID-19 public health emergency ended last month and various reporting requirements went away?
A: It definitely impacts what we are trying to do. The end of the public health emergency rescinds some of the authorities for us to collect data from states and localities. It’s going to be a persistent, challenging issue. There are lots of concerns about data privacy, about making sure that data are used appropriately. Those are all valid concerns and we need to be very cognizant of them. Also, there are states’ rights issues.
To fully realize the potential of the CFA we need to work with state and local jurisdictions in a much more intimate way. And CDC’s Data Modernization Initiative has to succeed. [Its goal is to] get information from electronic health records, from immunization records, from vital statistics like death records, and from electronic laboratory records from those repositories to public health agencies in a much more streamlined and interoperable and faster way.
We need to think through as a nation how to use data authorities differently so we have a line of sight of what’s happening in our communities and can prepare them to protect themselves from oncoming public health emergencies.
Q: You have a new funding announcement out to help researchers develop predictive disease models that health departments or hospitals can use to guide local disease responses, like masking and school openings or closures. What would a successful outcome look like on the ground?
A: During the early days of the pandemic, Seattle’s mayor [Jenny Anne Durkan] was getting briefings from the [Bill & Melinda Gates Foundation’s] Institute for Disease Modeling, which had developed models, for instance, of where COVID-19 was spreading locally. I was on an external advisory board to help her figure out how to actually translate the models into action. After that discussion, [Durkan] was able to say to her fire chief: “Go put testing sites in X, Y, and Z locations. Get it up and running and move.”
It was that fast, within days. It was really intoxicating to see how an inspired leader with the right information could move very quickly to actually keep the people in that community safe.
Q: How might the tight 2024 spending levels resulting from the debt ceiling deal affect your center?
A: We’ve gotten caught in that crossfire. We’re a startup in government, and are not at full force, so we only asked for half of what we needed in fiscal year 2023. But we are asking now for the full year-on-year budget of $100 million in 2024. We need to get our full budget so we can realize our full potential.
Q: What keeps you awake at night?
A: I think within my lifetime we are going to face another pandemic of similar or worse magnitude than COVID-19. I’m concerned about not being ready to respond as effectively as we can. More than anything else I worry that people feel that just because we were successful with messenger RNA vaccines and we were able to do it faster than we’ve ever been able to … that we don’t need any other tools in the toolbox. If we don’t have a way to unleash data for action, we won’t be as prepared for the next pandemic as we need to be.
In August 2021, amid criticism for bungling its response to the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention (CDC) launched an ambitious effort to prevent a similarly poor performance going forward. The Center for Forecasting and Outbreak Analytics (CFA) is intended to become the nation’s pandemic “weather service.” It aims to forecast the location, scale, and severity of infectious disease outbreaks in enough detail to help local officials advise on practical issues like whether nursing homes should allow visitors or a school district should require masking.
CDC’s 12th center is also a response to widespread criticism that the agency failed in one of its most basic functions: public communication. Confusing or controversial pandemic guidelines on school openings, masking, and boosters were among its many missteps by the summer of 2021.
Nearly 2 years later, according to its director, CFA has scored its first successes, rapidly predicting the severity of a U.S. COVID-19 wave when the Omicron variant arose and publishing prompt, detailed status reports during the mpox outbreak last year. The center has hired more than 50 of a planned 132 employees. Their inaugural in-person meeting at CDC’s home base in Atlanta is set for August. Some employees will be stationed there; others will work remotely; and others will occupy the center’s planned physical headquarters in Washington, D.C.
The center also just broadcast its first major call for grant applications. It plans to award $263 million to about a dozen groups over the next 5 years to develop innovative, speedy, practical disease forecasting methods and ways to get their outputs–like the arrival timing and the expected number of cases of a disease in a town, city, or state–into the hands of local public health officials.
CFA’s ambitions could be limited, however, by the effective freeze on funding increases at civilian agencies resulting from last month’s debt ceiling deal. The center, along with the rest of CDC, also faces harsh scrutiny from Republicans in Congress, who at a hearing yesterday charged that the agency is trying to overstep its authority in areas like data gathering.
Infectious disease modeler Dylan George, who left an industry position to join the center at its inception and who was promoted to CFA director in March, spoke last week with ScienceInsider about the center’s early days and challenging future. This interview has been edited for brevity and clarity.
Q: You said soon after CFA’s launch that the opportunity to use disease forecasting and analytics to save lives in the United States “gets repeatedly squandered because we aren’t organized.” Has that changed because of CFA?
A: We have been thrown into the fire already. For example, when the Omicron variant was coming, when we started seeing data out of South Africa, we were able to gather our team together, gather a handful of [consultant] academics very quickly, parameterize some models, and predict a lot of cases in January. This was around Thanksgiving 2021. Within a week we were talking to [CDC Director] Rochelle Walensky and within 10 days the White House. Then we spoke with state and territorial epidemiologists. It happened faster because CFA existed.
Subsequently, one of the harder challenges was trying to assess the clinical severity of Omicron. [CFA senior adviser] Marc Lipsitch was able to work with CFA colleagues and Kaiser Permanente of Southern California to actually track cohorts of people infected with Delta versus Omicron and show—fortunately for us—that Omicron cases were not as severe as those infected with the Delta variant.
Q: What are other examples of CFA’s accomplishments?
A: When mpox broke out we engaged closely with [CDC’s] incident management team to develop what we call the technical reports, trying to get more technical information out but presented so that an average individual would understand. There were four of them [during the 2022 outbreak and two additional risk assessments] that were just dropped recently.
The main innovation here is: Do it fast. Do it repeatedly.
The local public health officers and the state epidemiologists, they really appreciated the information. … Now, not only is CFA using that approach, but other groups within CDC are, too.
Q: What changed for you when the COVID-19 public health emergency ended last month and various reporting requirements went away?
A: It definitely impacts what we are trying to do. The end of the public health emergency rescinds some of the authorities for us to collect data from states and localities. It’s going to be a persistent, challenging issue. There are lots of concerns about data privacy, about making sure that data are used appropriately. Those are all valid concerns and we need to be very cognizant of them. Also, there are states’ rights issues.
To fully realize the potential of the CFA we need to work with state and local jurisdictions in a much more intimate way. And CDC’s Data Modernization Initiative has to succeed. [Its goal is to] get information from electronic health records, from immunization records, from vital statistics like death records, and from electronic laboratory records from those repositories to public health agencies in a much more streamlined and interoperable and faster way.
We need to think through as a nation how to use data authorities differently so we have a line of sight of what’s happening in our communities and can prepare them to protect themselves from oncoming public health emergencies.
Q: You have a new funding announcement out to help researchers develop predictive disease models that health departments or hospitals can use to guide local disease responses, like masking and school openings or closures. What would a successful outcome look like on the ground?
A: During the early days of the pandemic, Seattle’s mayor [Jenny Anne Durkan] was getting briefings from the [Bill & Melinda Gates Foundation’s] Institute for Disease Modeling, which had developed models, for instance, of where COVID-19 was spreading locally. I was on an external advisory board to help her figure out how to actually translate the models into action. After that discussion, [Durkan] was able to say to her fire chief: “Go put testing sites in X, Y, and Z locations. Get it up and running and move.”
It was that fast, within days. It was really intoxicating to see how an inspired leader with the right information could move very quickly to actually keep the people in that community safe.
Q: How might the tight 2024 spending levels resulting from the debt ceiling deal affect your center?
A: We’ve gotten caught in that crossfire. We’re a startup in government, and are not at full force, so we only asked for half of what we needed in fiscal year 2023. But we are asking now for the full year-on-year budget of $100 million in 2024. We need to get our full budget so we can realize our full potential.
Q: What keeps you awake at night?
A: I think within my lifetime we are going to face another pandemic of similar or worse magnitude than COVID-19. I’m concerned about not being ready to respond as effectively as we can. More than anything else I worry that people feel that just because we were successful with messenger RNA vaccines and we were able to do it faster than we’ve ever been able to … that we don’t need any other tools in the toolbox. If we don’t have a way to unleash data for action, we won’t be as prepared for the next pandemic as we need to be.
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