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For starters, it’s pretty clear that the CDC has a target on its back, largely because of the way the agency has responded to the Covid-19 pandemic, shutting down most of the country to control the virus.

“COVID-19 has exposed the Centers for Disease Control and Prevention (CDC) as perhaps the most incompetent and arrogant agency in the federal government. “CDC has continually misjudged COVID-19 based on its lethality, transmissibility, and origins for treatment,” Severino wrote.

“Irresponsible bureaucrats like Anthony Fauci should never again be given such broad, unchecked authority to issue health ‘guidelines’ that will surely be the basis of federal and state mandates.” “Public health bureaucrats should never again be allowed to withhold information, ignore information, or mislead the public about the effectiveness or risks of recommended health interventions.”

Substitute “Tom Frieden” for “Anthony Fauci” and this paragraph would nicely sum up how many patients and physicians feel pain over the former CDC director and the CDC’s 2016 opioid guidelines. Developed in secret under Frieden’s leadership, the agency’s guidance process likely violated federal open meetings and conflict of interest laws by hiding behind an almost comical “cone of silence.”

Although the recommendations are voluntary, the opioid guidelines were quickly adopted as mandatory policy by many states, regulators, and law enforcement agencies – resulting in hundreds of doctors losing their medical licenses or going to prison for “overprescribing” opioids.

Severino, a lawyer who appears well-positioned to fill another key health care position if Trump is elected to a second term, argues that the CDC has far exceeded its authority in creating medical guidelines.

“What was most problematic was that the CDC presented itself as some kind of ‘super doctor’ for the entire nation. “CDC is a public health agency, not a medical institution,” he wrote. “She is not authorized to issue professional medical opinions relating to a specific patient. We have learned that when the CDC says what people “should” do, it easily becomes a “must” backed by severe penalties, including criminal penalties.

“The CDC’s guidance is analogous to that of other public health associations or medical societies: it is informative, not prescriptive. CDC guidance cannot be prescriptive under statute or regulation.”

Divided in two

How can you tame the CDC? The solution, according to Severino, is to cut the CDC in half and cut a significant portion of its funding.

“The CDC should be divided into two separate entities with two separate functions,” he wrote. “These separate functions should be split into two completely separate agencies, separated by a firewall. We need a national epidemiology agency solely responsible for publishing data and required by law to publish all data collected from states and other sources. Public health should be the responsibility of a separate agency with severely limited ability to make policy recommendations.”

Frieden calls the proposal “very dangerous and very wrong.”

“We are not dividing the army because it is too big. We don’t divide corporations because they’re too big,” Frieden said Policy. “A large organization needs a large management structure as well as flexibility.

Severino argues that the CDC Foundation, a nonprofit organization that works closely with the agency to promote health policy, should be prohibited from accepting donations from the pharmaceutical industry. Last year, the foundation received nearly $275 million in donations, most of which came from Pfizer, Biogen, Merck and other health care companies.

“This practice creates a clear conflict of interest that should be prohibited,” Severino wrote. “The CDC and NIH foundations, whose boards include pharmaceutical executives, should be abolished. Private donations to these foundations – most of them from pharmaceutical companies – should not be allowed to influence government decisions about research funding or public health policy.”

Severino also wants greater transparency and conflict of interest policies, not just at the CDC but at HHS and all federal agencies dealing with health care. He believes there should be a long “grace period” to prevent federal regulators from encroaching on industries they helped regulate after their government positions end. A 15-year grace period “wouldn’t be very long,” Severino said.

To be clear, the Leadership Mandate is more of a wish list than anything else. Everything depends on the result of the 2024 presidential elections. If it becomes a playbook for a second Trump administration, some of its recommendations could be imposed by executive order, but many would require congressional approval. CDC directors, appointed directly by the president, will need Senate confirmation next year, along with other Cabinet members, under the new law.

Whatever happens, it’s clear that conservative supporters are taking shots at the CDC.

“The federal government’s public health apparatus has lost the trust of the public. Before another national public health emergency occurs, this apparatus must be thoroughly restructured,” Severino wrote.