Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19.

The US Centers for Disease Control and Prevention (CDC) has responded to criticism claiming that the agency's COVID-19 response was lacking by proposing internal reforms intended to improve its performance during the next pandemic. The reforms are aimed at improving surveillance, analytic capacity, and agency communications. This article conducts a counterfactual analysis of the CDC's proposed reforms to ask how they might have changed outcomes in four cases of guidance controversy during the pandemic if they had been completed in advance of COVID-19. Although the CDC's planned reforms have merit, they are predicated on the ability to come to scientific closure in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise are likely to threaten any effort to improve pandemic response.