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Inside the Fall of the CDC
Following on the heals of yesterday’s Politico piece documenting Political Interference in CDC’s Morbidity and Mortality Weekly Report (MMWR), today ProPublica released a story “Inside the Fall of the CDC” which tells the more complete tale of how the Centers for Disease Control and Prevention, long the gold standard in the world on public health, could crumble in the face of “unprecedented political interference in public health policy, and the capitulations of some of the world’s top public health leaders.” This is a sad story made all the more disturbing as this same playbook is being followed across many executive branch agencies. The Trump administration is “appropriating a public enterprise and making it into an agent of propaganda for a political regime,” one CDC scientist said in an interview as events unfolded. “It’s mind-boggling in the totality of ambition to so deeply undermine what’s so vitally important to the public.”
When the next history of the CDC is written, 2020 will emerge as perhaps the darkest chapter in its 74 years, rivaled only by its involvement in the infamous Tuskegee experiment, in which federal doctors withheld medicine from poor Black men with syphilis, then tracked their descent into blindness, insanity and death.
With more than 216,000 people dead this year, most Americans know the low points of the current chapter already. A vaunted agency that was once the global gold standard of public health has, with breathtaking speed, become a target of anger, scorn and even pity.
How could an agency that eradicated smallpox globally and wiped out polio in the United States have fallen so far?
ProPublica obtained hundreds of emails and other internal government documents and interviewed more than 30 CDC employees, contractors and Trump administration officials who witnessed or were involved in key moments of the crisis. Although news organizations around the world have chronicled the CDC’s stumbles in real time, ProPublica’s reporting affords the most comprehensive inside look at the escalating tensions, paranoia and pained discussions that unfolded behind the walls of CDC’s Atlanta headquarters. And it sheds new light on the botched COVID-19 tests, the unprecedented political interference in public health policy, and the capitulations of some of the world’s top public health leaders.
Political Interference in CDC’s MMWR Report
Politico obtained government emails that a Trump political appointee instructed the CDC to alter a Morbidity and Mortality Weekly Report (MMWR) pertaining to schools holding in-person classes.
The report in question was “SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020”
The Journal of the American Medical Association (JAMA) issued an editorial on the importance protecting CDC independence as did the Scientific American.
Internal Emails Show How Chaos at the CDC Slowed the Early Response to Coronavirus
‘The CDC fumbled its communication with public health officials and underestimated the threat of the coronavirus even as it gained a foothold in the United States, according to hundreds of pages of documents ProPublica obtained. The agency was struggling with one of its most important duties: keeping track of Americans suspected of having the novel coronavirus. It had “an ongoing issue” with organizing – and sometimes flat-out losing – forms sent by local agencies about people thought to be infected. The email listed job postings for people who could track or retrieve this paperwork. “Help needed urgently,” the CDC wrote.’
https://www.propublica.org/article/internal-emails-show-how-chaos-at-the-cdc-slowed-the-early-response-to-coronavirus
Government Health Web Sites Expose Personal Data
A new article in Communications of the ACM by Timothy Libert, a doctoral student in the Annenberg School for Communication, demonstrates that web sites – including government web sites such as CDC.gov and Healthcare.gov – pass personal health information to companies that are not subject to regulation or oversight.
- Libert, Tim. “Privacy Implications of Health Information Seeking on the Web.” Communications of the ACM 58, no. 3 (February 23, 2015): 68–77. [free copy at arxiv] [subscriber only copy at ACM doi:10.1145/2658983].
Brian Merchant provides a non-technical summary and analysis of Libert’s paper:
- Looking Up Symptoms Online? These Companies Are Tracking You, by Brian Merchant, Motherboard (February 23, 2015)
Libert says that this health information may be inadvertently misused by some companies, sold by others, or even stolen by criminals. He identified more than eighty thousand unique health-related Web pages and monitored the HTTP requests initiated on the page to third parties by companies such as Google, Facebook, Twitter, Experian, and Acxiom. Ninety-one percent of those pages make such third-party requests, putting user privacy at risk. Some 70% of those third-party requests transmit information on specific symptoms, treatments, and diseases to those companies.
Merchant explains: “[T]he CDC has installed Google Analytics to measure its traffic stats, and has, for some reason, included AddThis code which allows Facebook and Twitter sharing; … the CDC also sends a third party request to each of those companies. That request… makes explicit to those third party corporations in its HTTP referrer string [what you searched for]… From there, it becomes relatively easy for the companies receiving the requests, many of which are collecting other kinds of data (in cookies, say) about your browsing as well, to identify you and your illness. That URL, or URI, which very clearly contains the disease being searched for, is broadcast to Google, Twitter, and Facebook, along with your computer’s IP address and other identifying information.”
Libert makes clear that Government web pages are the least likely of all sites he studied to use third-party cookies, with only 21% of pages storing user data in this way, compared to 82% of dot-com sites. But fully 88% of government sites have some sort of third-party request and 86% download and execute third-party JavaScript.
Merchant notes that the use of third-party cookies and javascript and requests is not necessarily due to any insidious intent but is simply convenient “because developers are installing ‘free’ tools like Google Analytics and social media ‘share’ buttons on their sites, and most users have no idea that means information about their searches is being shared with third parties.” This potentially allows data brokers like Experian, which has information from other sources about loans and which provides credit scores, to combine health information with financial information on individuals. Merchant quotes Libert:
“Given that I found Experian tracking users on thousands of health-related web pages, it is entirely possible the company not only knows which individuals went bankrupt for medical reasons, but when they first went online to learn about their illness as well…”
Merchant also quotes Libert on alternative search engines:
“Even if you use an iPhone, DuckDuckGo, and Hotmail, the second you open your browser there is a huge chance Google gets your data.” That’s because Google is absorbing your information through a variety of hosted services and domain names, from Google Analytics, which measures site traffic, to DoubleClick, an advertising service, and YouTube, its video platform.
Wikipedia was one of the only sites that trafficked in health information that sent no third party requests to corporations.
New Issue of Emerging Infectious Diseases (Jan. 2009) from the Centers for Disease Control and Prevention (CDC)
The January issue of Emerging Infectious Diseases (EID) focuses on Travel-related Infections. One of the historical reviews, Venetian Rule and Control of Plague Epidemics on the Ionian Islands during 17th and 18th Centuries, describes the efforts taken by the Venetian Administration to fight the spread of plague on the Ionian islands in the 17th and 18th centuries. The authors state that “prevention was based on widespread use of an information network of daily reports of Venetian consuls in Mediterranean areas to Venetian authorities, detailed interrogation of sailors who arrived in Venetian ports, effective control of all local movements in plague-infested areas, and activation of the cordoni di sanità.” It sounds like the Venetian administration contained plague effectively using its information system.
By the way, the cover art of the EID issues are beautiful. Please take a look at some of them here.
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