Too Many Deaths, Too Many Left Behind: A People's External Review of the U.S. Centers for Disease Control and Prevention's COVID-19 Pandemic Response

The US population has suffered worse health consequences due to COVID-19 than comparable wealthy nations. COVID-19 had caused over 1.1 million deaths in the United States as of May 2023 and contributed to a 3-year decline in life expectancy. A coalition of public health workers and community activists launched an external review of the CDC's pandemic management from January 2021 to May 2023. We used a modified Delphi process to identify core pandemic management areas, which formed the basis for a survey and literature review. Our analysis yields three overarching shortcomings of the CDC's pandemic management: 1) CDC leadership downplays the serious impacts and aerosol transmission risks of COVID-19; 2) CDC leadership has aligned public guidance with commercial and political interests over scientific evidence; 3) CDC guidance focuses on individual choice rather than emphasizing prevention and equity. Instead, the agency must partner with communities most impacted by the pandemic and encourage people to protect each other using layered protections to decrease COVID-19 transmission. As emerging variants can already evade existing vaccines and treatments, and long COVID can be disabling and lacks definitive treatment, multifaceted, sustainable approaches to the COVID-19 pandemic are essential to protect people, the economy, and future generations.