As the nation heads into the thick of respiratory illness season, some public health experts and clinicians have expressed concern about whether the CDC is still equipped to adequately track circulating viruses and to give timely reports on hospitalizations, deaths, and vaccine effectiveness.

The CDC’s core job is to collect and synthesize public health data nationwide, providing guidance to help clinicians and communities prepare and respond to evolving health threats, such as regional whooping cough outbreaks.

But the agency has been affected by layoffs, firings, and resignations, and HHS Secretary Robert F. Kennedy, Jr, has been open about skepticism over the need for widespread vaccinations. Just how much has CDC been affected by these changes?

The federal government shutdown from September 30 until November 12 meant that CDC staff was mostly not allowed to work, just as respiratory viruses started circulating. The agency did not update its FluView weekly influenza surveillance report for about 5 weeks. It took the CDC a few weeks to catch back up to issuing timely reports.

As of its November 22 report (latest available at press time), lab tests, outpatient visits, and hospitalizations were all trending upward, with the A(H3N2) strain being most frequently reported. That strain mutated over the summer and is now a mismatch for the current vaccine.

Jason Goldman, MD, president of the American College of Physicians, said that given staff cuts and Kennedy’s interference with the CDC’s Advisory Committee on Immunization Practices, “I can’t trust what they’re putting out to be accurate or factual.”

“It’s a public health crisis,” Goldman told Medscape Medical News.

A new survey by the National Foundation for Infectious Diseases (NFID) indicates that trust in the CDC is waning. NFID found that vaccination for respiratory illnesses is declining, in part because of confusion about safety and effectiveness. Only 13% of adults said the CDC was the most trusted source for vaccine information; among adults aged 18-28 years, social media ranked as slightly more trustworthy than the CDC.

Normally, at this time of year, the agency would be regularly reminding the public about the importance of being vaccinated for respiratory illnesses, but those campaigns — including the successful “wild to mild” campaign about taming the flu virus — were canceled, said Fiona Havers, MD, who resigned from the CDC in June and is now an adjunct associate professor at Emory School of Medicine in Atlanta.

Havers told Medscape Medical News that she agreed that “anything coming out about vaccines or vaccine policy at this point from CDC should not be trusted.”

But, she said, “the basic disease tracking systems are still producing high-quality, reliable data.” Havers helped oversee the agency’s Respiratory Virus Hospitalization Surveillance Network and COVID tracking data.

She said that former colleagues still at the CDC have said that “they haven’t had any issues with interference with their data.”

CDC Data Crucial

While state, county, and local health officials track what is happening in their backyards, the national data collected by the CDC are essential.

“While states have strong tools for monitoring state health trends, the funding, coordination, and analytic support provided by CDC are what allow jurisdictions to see the bigger picture, compare trends, and detect emerging threats that may not be visible from local data alone,” said Susan Kansagra, chief medical officer of the Association of State and Territorial Health Officials, in a statement to Medscape Medical News.

“Without CDC’s investment and national synthesis, states are left with fragmented information that makes it harder to anticipate what’s coming and to plan an effective response,” she said.

The national data help clinicians know if they need to start testing for respiratory viruses and help hospitals plan for bed management, said Havers. They assist state and local health officials to educate clinicians about what is circulating and are “also critical for vaccine messaging,” she said.

“It’s so important for us to be able to have good data, evidence, and surveillance so we know what to expect and what we’re facing,” agreed Goldman. Knowing what is circulating lets clinicians treat empirically as test results aren’t always quickly available, he said.

Goldman, who practices in South Florida, gets an influx of out-of-state patients over the winter. “Knowing what is coming in from other parts of the country will certainly help my clinical judgment,” he said. And, he said, “with air travel being so prevalent and people being able to move very quickly from one area to the other, national surveillance data is even more important than ever.”

Not every state tracks every respiratory illness — resources and politics can both play a role.

“A lot of money that usually flows from CDC directly to state health departments has been cut,” said Havers. Even without those cuts, “there’s a huge variation between state and local jurisdictions in terms of the resources and the quality of their respiratory virus tracking and other disease tracking capabilities,” she said.

Florida, for instance, tracks respiratory syncytial virus (RSV), COVID, and influenza. As of press time, its dashboard for flu was a week behind the CDC’s. It showed rising emergency room visits and cases, but the predominant virus was A(H1N1), the 2009 pandemic strain. Texas data through November 22 showed increasing RSV, flu, and COVID.

South Dakota, however, does not track RSV cases on its infectious disease tracker.

Can Alternative Surveillance Help?

Hospitals, private insurers, and others have created methods to track circulating respiratory viruses and illnesses, but it’s not clear that these could replace the coordination and resources available to the CDC.

Walgreens, for instance, has a public dashboard that tracks overall acute respiratory illness, flu, and COVID and shows the level of activity projected onto a US map. The index is based on multiple sources, including Walgreens influenza and COVID testing and treatment data, over-the-counter “cold and flu” purchasing trends, and wastewater viral levels from the CDC (when available). A score ranging from 0 to 10 is computed weekly.

The Yale School of Public Health launched its free PopHIVE in July. The public-facing, real-time database collates anonymized hospital records (including from Epic electronic health records), anonymized search data, CDC syndromic surveillance systems, and national health surveys. At press time, the influenza dashboard showed the start of an uptick.

Goldman noted that most clinicians won’t have the wherewithal to seek out non-CDC information sources. “We barely have time as a do everything that we need to do, let alone try and vet the different resources out there,” he said, adding that surveillance “is something a functional federal government should be doing.”

Havers reported having no conflicts of interest.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.