A Year After CDC, It’s Still About the People 

One year ago in April, I walked off CDC’s campus for the last time, after spending over 20 years in the agency. I did go back once, to get an encrypted drive of the electronic files that I was permitted to bring with me. The IT security technician met me at the Visitors’ Center entrance, so I wouldn’t have sign in as a guest.

A few weeks ago, I met a long-time colleague for coffee at General Muir, the deli across the street from CDC’s main campus. I’ve had hundreds of meals there, including the Shabbat dinner before my son’s bar mitzvah the week it opened. I hadn’t driven that route in months, and I remembered how beautiful my ride to work through Druid Hills in full bloom had been every spring, even last spring. Maybe it was the most beautiful thing about April 2025.

That April Fool’s Day, reduction-in-force notices were issued to over 2,000 CDC employees. The terminated positions were chosen by administrative code, ending whole divisions, branches, and offices, and decimating several national centers and institutes. This was the second wave of mass layoffs, following the loss of probationary employees on Valentine’s Day.

I left later in April, when CDC employees were offered early retirement. It broke my heart to leave a place that made me proud, the place where I felt the most powerful sense of belonging that I’ve ever experienced. Those are my people, and I still miss them. 

After coffee, I went to the CVS across the street from CDC. I went in the back door, but I left through the front, where a gunman had stood last August as he shot bullets into my former office and hundreds of others. I marveled at how far those bullets travelled, how many buildings were targets, and that no CDC employees were hurt, partly due to the bravery of Officer David Rose, who gave his life to protect them. I squinted at my former 11^th floor window, recalling the photos of broken glass strewn across my former desk. I’m glad I never saw the bullet holes myself, but I also felt sorry that I wasn’t there to help pick up the pieces.

I started at CDC in 2001, during George W. Bush’s administration. I was there on 9/11, when we evacuated due to the threat that hijacked planes might be heading for Atlanta. That was the last time I remember the people on the CDC campus being as afraid as they were last summer. 

Since that first year, I worked in a bipartisan way with every Congress and administration of this century. I started 2025 expecting that we on the CDC leadership team would work with the incoming administration and new appointees, as we always had. What happened next was truly stunning. For the first time, there was no two-way information flow. Instead, there was an unceasing barrage of executive orders and directives from the Department of Government Efficiency and HHS that left no time for discussion, analysis, or planning. At first, we in leadership thought that we could build channels to move the flood of incoming changes in constructive directions. But this was impossible given the pace and volume of the changes and the orders to stop regular processes like communications and publications.

What I found the hardest to believe was how quickly rules that seemed immutable folded. We had always operated within the bounds of stable government systems, knowing that government workers were protected, that grants and contracts were our word. And we didn’t move too fast, because we couldn’t. As government leaders, we knew that change is incremental, that the legislature would weigh in, that outside groups would share opinions and exert pressure. 

I learned many lessons that year. The biggest one was that government can move fast — what we knew about incremental change was tradition, not fact. We had been tying our own hands by holding on to procedures designed to avoid risk. What we thought were guardrails turned out to be dotted white lines. Some of the federal actions taken during my last months at CDC still may be found unlawful. But others will not. And we should all learn from that.

I especially want us to apply this lesson to building a new public health workforce. Almost nothing is more rule-bound and byzantine than government hiring — it is slow, hard to understand, uses outdated job categories and descriptions, is often not salary-competitive, and favors those already in government. At CDC, we pushed for years for new ways to hire technology experts. But we got approval for direct hiring authority and higher salaries to compete with industry only after a global pandemic convinced the Office of Personnel Management. Even with those flexibilities, to attract talent, we would recruit mission-driven candidates by leaning on two pillars: CDC’s reputation as a world-class organization, and the federal government’s job security. Today, neither of those pillars is still standing. And most of the technology experts we hired were purged with the “probationary employees.” 

With so many other public health staff gone, federal public health will need to rebuild. I hope that federal, state, and local public health agencies will realize that they can cut through the red tape that typically binds every governmental hire to craft a workforce that fits what communities need now.

The future public health workforce needs more than technical skills in science and data. There is no doubt that government agencies need nimbler, multi-disciplinary staff who know how to leverage new technology, communicate in new information environments, and engage with all of our different communities. Public health agencies need to let go of the old model where employees stay their whole careers; we should expect talent to move in and out of government. It’s time to leave behind the constraints of institutional knowledge and embrace new models, where ideas from other industries are welcomed.

Government health agencies also need leadership. Leadership does not require being the smartest person in the room, or the one with the most degrees. For too long, the best scientists have been chosen to lead health agencies without support to develop the skills needed to run massive, politically charged bureaucracies. Attention to study design and statistical methods is necessary, but in public health and health care, those things don’t make a difference without strong policy and operations, political savvy, and community voices to develop evidence-based solutions and build support for those solutions.

Milbank’s leadership programs focus on weaving these skills together, supporting state policymakers to make public health and health care work for every community, even in today’s polarized environment. Milbank-trained leaders are bringing this mix of skills and disciplines to state policymaking. For example, Minnesota’s paid family and medical leave program was sponsored by two Milbank alumni, Former Rep. Ruth Richardson and Senator Alice Mann. Their yearslong effort leaned on strong evidence, coalition building, storytelling, and data. Fellow Milbank alumna Morissa Henn used the adaptive leadership framework and the Milbank community to help generate solutions to youth suicide in Utah and the behavioral health system in New Hampshire.

Likewise, state leaders are taking on a cross-agency challenge as they implement rural health transformation. With ambitious goals across health care delivery, Medicaid, public health, and health-related social services, and with very aggressive timelines, state agencies are finding new ways to lead together to redesign rural health.

When I visited the General Muir deli earlier this month, I received a gift. My former colleague had designed and made a quilt for me, using CDC colors and a chandelier pattern to symbolize the illumination that leaders can bring to complex work—the light that I tried to bring. During my time at CDC, we moved incrementally toward building public health leadership and a public health workforce for the future by moving carefully and following traditional government pathways. Now we know that we can and should move fast, toward a more engaged, trusted, collaborative public health system created with and for our communities.

If you are interested in applying or nominating a colleague for the 2026-27 cohorts of the Milbank Fellows Program or Emerging Leaders Program, please see our application brochures.