Next week marks one year since the Centers for Disease Control and Prevention confirmed the first coronavirus case in the United States.

Dr. Robert Redfield, the outgoing CDC director, has been heading the federal public health agency's response to the pandemic from the start.

Redfield's departure on Wednesday, when President-elect Joe Biden will usher in a new administration, comes as a record surge in COVID-19 cases is sweeping across the country. The U.S. has far surpassed all other nations with more than 23 million virus-related cases and more than 391,000 deaths, according to Johns Hopkins University.

But, even as the pandemic enters its deadliest stage yet, Redfield told NPR on Friday that the country is "about to be in the worst" months of the crisis.

As his tenure winds down, the CDC director said in an interview with All Things Consideredthat he stands by his federal health agency's response to the pandemic despite what he characterized as an early "learning curve" and conflicting public health guidance from President Trump.

If he has one criticism for the federal government's handling of the crisis, it's a failure of "consistency and unity of message" between the agency and the administration as it related to virus risk factors and public health measures such as the importance of masks to prevent the spread of infection.

When asked if the White House interfered with the CDC's work, Redfield said no.

"There was review and comments by different agencies within the White House," he said. "But at the end of the day, the CDC published the guidance that we believe is the most important for the American public."

The following excerpts have been edited lightly for length and clarity:

Why has the U.S. done so much worse than the rest of the world?

I think this virus has a unique ability to have differential pathogenesis in different people. And what it really does is it exploits the underlying health condition of the individual it infects. And so, I would argue one of the reasons we're having more significant death in this country than, say, Sweden is because unfortunately, the underlying health conditions — with obesity, diabetes, heart disease, kidney disease and the significant health disparities that we have in these illnesses in our nation — haven't been effectively addressed.

But in terms of how the U.S. has responded, in terms of how the CDC has responded ... are you able to defend the Trump administration's record on this as anything other than a catastrophic failure?

Well, I'm actually very proud of the response that CDC has done. I think if I have one criticism that I do believe is significant is the importance of consistency and unity of message. CDC, obviously, you know, on April 3 stressed the American public the importance of wearing a face covering, a mask. And that, coupled with social distancing and hand-washing and avoiding crowds, really could be an enormous defense against this pathogen if we all did it. But we all had to do it.

Last September, you testified before a Senate panel that masks were an effective tool to combat spread. Also, that a vaccine would not be widely available to the general public until summer or fall of this year, 2021. And a few hours later, the president came out, gave a press conference andcontradicted you on both points. He said you were confused. Were you confused?

No. I stand by my comments that masks are extremely effective and what I was trying to point out — if you had a vaccine, it was 50% effective and you were the half that it didn't work in, your mask is your best shot.

Dr. Rochelle Walensky, your incoming successor, in thispiece that she publishedinThe New York Timesthis week, wrote this: "Our team of scientists will have to work very hard to restore public trust in the C.D.C., at home and abroad, because it has been undermined over the last year." She went on: "The gold standard for the nation's public health — has been tarnished." How would you respond to that?

That's just not true. The men and women at CDC are highly respected across this nation and around the world. Clearly, there's no doubt that the lack of reinforcement and support from some individuals in the administration of the public health message had impact. But CDC continues to be the premier public health agency in the world.

So when the president came out and contradicted you and said, "[Redfield is] confused," do you have an obligation then to stand up and say, no, sir?

What I did was just repeat the position that I took, I didn't change the position, I just repeated the position as I did for you just now. I think it would have been, you know, preferred as a nation in April when we recommended it — and I started wearing a mask and all of us at CDC did and the doctors within the coronavirus task force did — it would have been very helpful if that was reflected by civic leadership throughout our nation that they all embrace it at the same time rather than, unfortunately, what appeared to be, this critical public health measure somehow got used as a political football.

When you say the CDC has done everything it could to get the right guidance out there, to get good public messaging out there, why did the CDC stop giving press conferences for critical months in the middle of the pandemic?

Yes, you know, I'm very disappointed in that. Again, the reality is --

But you're in charge of it. So why, when we went back and looked at the numbers. In January, you did 10 media telebriefings. In February, you did eight, and then it fell off a cliff. There were two in March, zero in April, zero in May. Why?

I would say, you know, that ultimately the ability to do those briefings had to be cleared by the secretary of health's office for us to be able to do those. That's the system that's in place under the current relationship between CDC and the secretary of health.

I interviewed you inApril of last year, and I asked you what your sense was of where we were in the arc of this. And here's what you said: "We're nearing the peak of the outbreak, the pandemic, in our country right now. ..." What goes through your mind when you hear those words now?

Well, as you know, we were looking at that at the time of what we call the first peak, the spring surge, and obviously that was at a time when we still didn't understand to the fullest degree asymptomatic, silent epidemic. What I say right now is, we're about to be in the worst of it. And I think if you'd listened to my comments in August and September, I told people that I really thought that the — December, January and February were going to be the roughest time this nation's ever, ever experienced from a public health point of view in the history of our nation.

When will we get to the point where the vaccine is going to be available to the general public — everybody can get one?

Well, you know, that would be speculative, but as I said even earlier in my testimony in Congress, I didn't see that day coming until end of the second quarter, beginning third quarter of 2021. And you noted that a number of people pushed out against me on that. ...

But I do want to not get people shocked when they understand, you know, when I said that we were going to be in for day after day after day — back in early December, of losing more people than we lost in Pearl Harbor and 9/11 every day — I didn't like saying that. But I said it because I believed it to be true based on the data and unfortunately, what we've continued to see that's a huge loss of human life. ...

This has been one of the greatest crises that this nation's had. There'll be plenty of time, I'm sure, in the years to come to figure out who could have done something better. All I can say from the time I got to be CDC director is that I did the best that I can.

Peter Granitz and Justine Kenin produced and edited the audio interview. Emma Bowman adapted it for the Web.

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