The Centers for Disease Control and Prevention's decision to fold Covid-19 and other respiratory-disease work into its influenza infrastructure is a good idea. If the agency gets the execution right, it could be an important one.
The reason is not complicated: We are no longer in 2020. Covid remains a serious respiratory pathogen, especially for older and immunocompromised Americans. But it is no longer a novel virus that requires a permanent emergency bureaucracy built around it. Influenza, Covid, RSV, and whatever comes next do not respect organizational charts. The CDC should not organize as though they do.
The real opportunity is bigger than eliminating duplicative offices. This reorganization gives the CDC a chance to leave behind the improvisational habits of the pandemic and build something public health badly needs -- predictability grounded in sound science.
Predictability is often caricatured as the enemy of scientific flexibility. It is nothing of the sort. Good regulatory science does not promise a predetermined answer; it promises that the rules of evidence will remain recognizable. My years at the Food and Drug Administration taught me that regulated communities can live with tough standards. They cannot work with standards invented after the data arrive.
The same principle should govern the CDC. Physicians should know how the agency reaches a recommendation. Manufacturers should understand what evidence is expected. State health officials need reasonable notice of when and why guidance may change. Patients deserve to know why last year's advice may not be right for them this year. That is competent public health.
Predictability means showing the rules of the road. What data matter? How will benefits and risks be weighed across different populations? What evidence would change the recommendation? Most important, it means no moving goalposts.
Recommendations should change when the epidemiology, the virus, or the evidence changes. The agency's scientific standards should not lurch with the political weather. In a credible public-health institution, predictability creates room for scientific flexibility.
During the pandemic, Americans were repeatedly told to follow the science. Fair enough. Too often, however, they were not allowed to see the roadmap. A mature respiratory-disease program should be able to answer a less theatrical and more useful question: What works, for whom, and under what circumstances?
That question matters enormously for vaccines. Risk is not uniform. A healthy 25-year-old is not an immunocompromised 75-year-old. Prior infection matters. Vaccination history matters. Circulating variants matter. Time since vaccination or infection matters. Public-health guidance that blurs those distinctions may be easier to print on a poster, but it is not better medicine.
The CDC should look at absolute risk and give priority to clinically meaningful outcomes. Randomized trials remain the gold standard where they are feasible. High-quality real-world evidence can answer questions that trials cannot. And sometimes the only scientifically honest answer is: We don't know.
Acknowledging uncertainty is part of honest science. The argument over whether the CDC is pro-vaccine or anti-vaccine is a false choice and a lousy way to practice medicine. The agency needs to be relentlessly pro-evidence.
Moving Covid work into the influenza structure also marks a necessary change in operating philosophy. Emergency response and long-term disease management are different disciplines. In an emergency, speed properly carries enormous weight. Decisions must be made with incomplete information, and precaution often gets the benefit of the doubt. But emergency rules are not meant to become permanent rules.
Mature respiratory-disease management requires surveillance, comparative-effectiveness research, longitudinal evidence, risk stratification, and regular reassessment. The CDC already has decades of experience doing this with influenza. That does not mean Covid is 'just the flu.' It is not. It means that the infrastructure used to monitor influenza strains, assess vaccine effectiveness, forecast disease burden, and prepare for respiratory season is a logical home for an integrated strategy.
Integration is not homogenization. Different viruses demand different scientific answers. They do not necessarily require different bureaucracies.
There is also the matter of trust. The CDC has a trust problem, and rearranging boxes on an organizational chart will not solve it. Better science might. Showing its work certainly would. Americans do not have to agree with every CDC recommendation, but they have a right to understand how the agency reached it. Show the data, identify the uncertainties, and tell us what evidence would cause the agency to change its mind. That is how credible regulators work.
The risks of the reorganization are real. CDC leadership must preserve the scientists who understand Covid, protect surveillance and laboratory capacity, sustain vaccine-effectiveness research, and avoid disrupting relationships with state health departments. Consolidation should eliminate needless duplication, not valuable expertise. A smaller organization chart is not, by itself, a public-health accomplishment.
The scorecard is straightforward. Are the data better? Are decisions faster? Are the scientific standards clearer? Are recommendations more consistent and more useful to physicians? Does the public understand them? If the answers are yes, the reorganization worked.
Covid taught the federal government how to operate in an emergency. Now it has to relearn how to practice public health: keep what worked, discard what did not, and stop treating improvisation as a permanent operating system.
That is the promise of this reorganization. Predictable rules. Visible evidence. No moving goalposts. It is not a retreat from pandemic vigilance. It is a return to sound science.
Peter J. Pitts, a former FDA Associate Commissioner, is president of the Center for Medicine in the Public Interest and Executive Chairman of Brainstorm Therapeutics
