‘It’s Been a Pretty Rocky Road.’ CDC Director Dr. Rochelle Walensky Reflects on Her Tenure During COVID-19

Dr. Rochelle Walensky became director of the U.S. Centers for Disease Control and Prevention (CDC) in January 2021, a fraught time in the country’s public health response to the COVID-19 pandemic. Americans’ confidence in the nation’s leading public health organization was at an all-time low, and Walensky had to not only manage the national response but rebuild public trust at the same time. She faced criticism over some aspects of the pandemic response, including confusing messaging and delays in processing data related to cases and severity of the disease. While most public health experts acknowledged that she led the agency, and the country’s pandemic response, with a science-based focus, she became the target of political opponents who blamed her, and the CDC, for complications related to COVID-19 vaccines and for avoidable hospitalizations and deaths from the disease.

Walensky resigns as director effective June 30; she spoke with TIME about her historic and tumultuous tenure.

This interview has been edited for brevity and clarity.

TIME: Two and a half years into the pandemic, should we be in a better place than we are now in terms of COVID-19 cases and illness?

Walensky: Well, I would say we are in a much better place than we were for sure with over 95% of people having immunity of one flavor or another and many people have immunity both related to prior vaccination or prior infection. So there is a lot of protection out there. But we also know as with all respiratory viruses, they are likely to circulate some, they may very well circulate a little bit more over the fall, when respiratory viruses tend to thrive. And we at CDC will continue to be vigilant to get the message out of all the things that people can do to protect themselves. And I think the public now knows what those things are.

You helmed the agency at the most urgent time during the pandemic. Given that we are now seeing COVID-19 on the decline, why did you decide to step down now? Why not see the end of the pandemic through?

Well, it’s been an extraordinary tenure. When I came in, it was really about getting the agency, country, and world out of the darkest days of the pandemic. Certainly, I knew I was coming in to conquer COVID-19.

One of the other things that we really did during my tenure was CDC Moving Forward, our strategy and plan for how to take where we are in public health at CDC and across the country, and pivot to be the public health agency of the future. How do we become the public health agency that America deserves and desires? We did a lot of that work over the last year, and I feel like I’ve charted the course now for what we need to do in the future. What became very clear to me was that this work will take longer than a year. Having tackled and gotten us through the darkest days of COVID-19, which is really what I came in to do—the end of the public health emergency, having launched CDC Moving Forward and recognizing that this was going to be a strategy for the long term, not the immediate term—now just felt like the right time to step down.

When you went to the CDC in 2021, some people said you were faced with an impossible task of trying to restore people’s trust in the agency. Can you give us examples of specific things that took you by surprise after you started in the job?

I knew I had a hard task ahead of me—I did not go into this naïve. Not all of the things that I thought would be hard, were hard, and things that I didn’t expect to be hard, ended up being harder.

I really did not expect that there would be so many people who were working to undermine the message of science, the message of public health—nefarious actors who really were working to undermine what good health would look like for individuals and for the country. That was harder than I thought it would be.

For example, the vaccine is such a cornerstone of what we do in prevention of infectious threats, and that is being challenged. I don’t know that we could have rewound the clock two and a half years ago and [known], this incredible thing that we were celebrating with how well this vaccine worked, and how this was really going to be among the most important things to get us out of this pandemic, that that would somehow turn into people weaponizing it for political gain. That messaging has been a challenge.

The CDC has really taken a lot of criticism during this pandemic and in some ways become a scapegoat when things went wrong. Do you think that criticism was fair?

From the day I was nominated, we were going to lead with the science and that science was going to be the foundation of our guidance. And as I look back on the last two and a half years, we absolutely did so in those big decisions—keeping in mind that sometimes the science is not clear. Even if the science is still emerging, somebody has to be making those decisions, and that is us. In that context, I can appreciate that not everybody would agree on a decision and that we were going to be taking the heat when people didn’t agree. And I’ve stood by the decisions that I’ve made.

One of the things that has been challenging is as a scientist—I know science changes. That is the purpose of science. That is the goal—to have more and more science emerge to have one question that is answered, then link to another question that needs to be asked. I don’t know that America was feeling that way. I think America [wanted], here’s the answer and now we are done.

We had been, early on, less articulate about saying, ‘This may change, we will tell you more when we know it, and you need to be ready to understand when to pivot, and when, and if we learn more.’ I have been much more intentional about that, [after] learning those lessons.

Throughout the pandemic public messaging came from a group: the COVID-19 briefings included the White House, Dr. Fauci at NIH, sometimes the Secretary of the Department of Health and Human Services (HHS), and the Surgeon General, as well as yourself. How did the decision to address the nation as a group come about, and did you ever argue that the CDC should be the single voice that the public hears from about the pandemic?

It was intentional, because we were all very much on the same page. And we wanted to make sure that America heard that all of us were on the same page. And that unified unifying message, I think, is critically important. Especially when the other message out there was, ‘this is confusing.’ So we really wanted to have one voice, one scientific voice from the scientific agencies.

You have said that something like COVID-19 is too big for a single agency like CDC to manage alone. What can the CDC do during a public health crisis, and what can it not do, based on its powers?

I really appreciate this question, because I think that this is lost on not only the American public, but even scientists who are asking for things from CDC. This is among the things we are doing in CDC Moving Forward—and asking for Congressional help so we can be a nimble agency. We have real challenges in our workforce, in our ability to pay overtime, our ability to pay danger pay.

The other one is data. We have 3,000 jurisdictions that send us data. Sometimes it’s standardized, sometimes it’s not. Sometimes it comes by fax, sometimes by email, sometimes by web. And we cannot compel that data—those data to come to us voluntarily. During the public health emergency, we were able to get more data [than usual]. But one of the things I have kind of become accustomed to is when people ask, we want to see the data from CDC, I say please also ask the question, does CDC actually get the data that you’re looking to get? Because oftentimes, we don’t. We want to be able to say in jurisdiction X, there’s an outbreak so in the next jurisdiction Y, you should be looking for it too.

So would it take a public health emergency or an act of Congress to give CDC the ability to collect the data it needs to follow something like an outbreak?

To be very clear, we’re not looking for protected individual data. We want to be able to see an infectious threat or a non-infectious threat when it happens. If we were to have one case of disease X show up in a hospital and another case of disease X show up in a neighboring county in a hospital, if they both don’t report it to us, we can’t say, ‘wait a minute, there’s something going on locally.’ And they each think that they have the only case that’s out there.

I do want to make sure the public is aware that we have made enormous strides during the pandemic in our data-modernization efforts and our syndromic-surveillance efforts and things that we can do in our death-reporting efforts. So that is squarely within CDC’s control. With death reporting [from any cause], 80% of death reports come to us within 10 days, way faster than they had before. Syndromic surveillance we now have 70% of emergency departments reporting to us a list of syndromes. So there has been much improvement but [when it comes to] a rare disease, a new infection and new outbreak, we still rely on the voluntary reporting of states.

You came to the CDC from academia, without experience in government. Looking back, was not having that public sector experience a help or a hindrance?

There were relationships that I needed to build, and I needed to understand how certain things worked. But I was able to do that. And I am actually really proud of those relationships, and I will carry with me the interactions that I have with our state and local health officers, who now regularly call me and say something doesn’t feel right here.

But I do think having a fresh perspective, having a network in infectious diseases that I was able to call upon, was clearly beneficial to me as well.

When you were appointed director, you didn’t need to be confirmed by the Senate, and neither will your successor, Dr. Mandy Cohen. But beginning in 2025, the Senate will confirm the CDC director. Do you think that’s going to help or hurt the influence of politics on science and the ability of the CDC director to do the job?

It has been told to me that among the reasons to do that is to make sure that the CDC director is accountable. And what I will say in that regard is I have testified in front of Congress every time I’ve been asked—it’s been 17 times in the last 28 months. I can appreciate why there was a desire for Congress to do this. What I can say, however, is I think we would have lost a lot of ground to not have a CDC director be able to come in on the first day of this administration and take on what I took on in what could have been six months to a year before a confirmation.

Where did you turn during the darkest and most challenging days of the pandemic?

There were some hard days over the last two and a half years—the phone call about Omicron; the first case of mpox that colleagues reported to me; when we lost a CDC employee in the Atlanta shootings. Those were some dark times, and I turned to the people at the agency and their wise counsel. I have said to the agency, in certain moments when you think this is impossible, you realize it’s the people that make it possible. We have this wonderful saying in clinical medicine—’never worry alone.’ And I worried a lot, but I never worried alone.

Where do you go from here? You’ve now spent time in academic and the public sector, is the private sector next?

My next chapter is very intentionally blank. I am really looking forward to catching up with family and friends that have been so incredible to me over the last—I’ll call it four years.

I do know that I have this deep passion in health and in public health, and in helping people who’ve been underserved and in areas where we can really improve health across this country and indeed, across the world. So, I suspect from whatever perch, I will be championing that, but I don’t know exactly what it will be yet.

What do you hope will be your legacy, both at the CDC and for the public?

When I came, it was, morale was low. People were home; they were working very, very hard. They were under-appreciated, and CDC was being smeared across the headlines. I do think today, the news about CDC is really the science we produce, and that is back to where it should be. There has been some bruising that happened in the last three years. And I think that we’re raising our heads from that. I hope that America has recognized that we’re here to worry about health so that everybody else doesn’t have to. And I hope that the morale of the agency is way better than where I found it.

For the public, I think they will see that we have worked hard to not only address the COVID 19 pandemic, but to address a density of public health threats, the likes of which we’ve never seen. I think America needs to recognize that we are at risk of more, and that there needs to be a real investment in health and public health for us to be the successful public health agency of the future. Over the last two and a half years, it’s been a pretty rocky road, but we are in a way better place as a country.