CDC on the skids

The open secret that CDC was in disarray poked its head above water Saturday in a story in the Washington Post, "Internal Dissension Grows as CDC Faces Big Threats to Public Health." For months there has been a rush to the exits by some of the agency's most senior scientists, as Director Dr. Julie Gerberding "restructures" CDC out of existence and opens the door wider to political interference. Last week a National Academy panel criticized the agency for lack of leadership in implementing the ill-fated smallpox vaccination program of health care workers, a program that was flawed from the outset in purpose, public health rationale and buy-in from the nation's public health establishment.

Gerberding's restructuring has caused deep resentment at CDC and was reportedly done in a heavy handed style that brooked no discussion or explanation. As one senior CDC scientist told me, the only "rationale" given was "deal with it." Like other incompetent managers, Gerberding blames complaints on "resistance to change." Assuming the massive changes she is calling for make sense (something disputed by many), it is clear she has failed to prepare the ground.

"CDC folks are a very dedicated bunch . . ., [but] it's gone from dedication to make change to being aghast at the process and the changes being made," one senior official said. Among the 34 people interviewed for this article, this official and a number of other current and former CDC staff spoke on the condition they not be identified because of their intense loyalty to the agency and, in some cases, because they fear retribution.

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Taken together, the turbulence at the agency has created a "crisis of confidence" and an atmosphere of fear in which employees feel "cowed into silence," wrote one top CDC official, Robert A. Keegan, in a widely circulated memo to Gerberding and other top leaders.

"I think there is a crisis," added Keegan, deputy director of the global immunization division, in a phone interview. "Clearly there is a real problem with morale. People are feeling tired and frustrated and don't know where we're headed."

With respect to the Bush administratioin, however, Gerberding has been unusually accommodating. Among other strong criticisms, the National Academy panel had this to say:

"The ability of the Centers for Disease Control and Prevention to speak authoritatively as the nation's public health leader, on the basis of the best available scientific reasoning, was severely constrained, presumably by the top levels of the executive branch," the panel wrote.

But her "make nice" strategy didn't protect CDC from deep cuts in the Bush budget request, cuts that come despite a potential public health catastrophe of an influenza pandemic. As a result the agency still has no final pandemic plan, has grossly insufficient stockpiles of antiviral agents and no firm plans to secure the needed amount and has failed to provide leadership to state and local public health on this and many other issues. CDC is now coasting on a reputation that it no longer deserves. Its decline into second class status started before Gerberding's tenure and is symbolic of the overall leadership crisis in public health in this country. But she has accelerated the fall at a time when we can least afford it.

I wonder how many people will die because of the Bush administration's lack of support for public health, their meddling in the judgments of competent scientists, and the lack of leadership at top levels? Gerberding and her agency have failed to provide independent leadership at a time when we need it most. When will she publicly fight for public health?