Some stories just won’t go away. Problems with transparency in China, an impotent government facing a bird flu crisis in Indonesia — and morale, expertise and credibility going down the toilet at the US Centers for Disease Prevention and Control (aka CDC). Yesterday a very long article in the Atlanta Journal Constitution went over the ground again (hat tip to reader LG). The occasion was an unprecedented letter to CDC Director Julie Gerberding from five of the last six of her predecessors, sent last December:
An exodus of key leaders and scientists from the Centers for Disease Control and Prevention has raised “great concern” among five of the six former directors who led the agency over the past 40 years.
Their concerns, expressed in a rare joint letter to current CDC Director Dr. Julie Gerberding, come amid growing staff complaints about whether her strategic shifts in the agency’s focus are putting public health at risk, according to interviews with current and former CDC officials and documents obtained by The Atlanta Journal-Constitution.
Critics say the agency is changing to a top-down management style that stifles science and that new layers of bureaucracy are being created, making agency operations more cumbersome.
The most visible sign of potential trouble at CDC is the loss of more than a dozen high-profile leaders and scientists since 2004. By the end of this year, all but two of the directors of CDC’s eight primary scientific centers will have left the Atlanta-based federal agency. The wave of departures — which numerous CDC leaders call unprecedented — also includes the agency’s top vaccine expert and world experts in several diseases. Just last week CDC’s pandemic flu coordinator said he’s leaving. (Alison Young, Atlanta Journal Constitution)
This is not a new story here. A few of many previous posts here, here, here, here and here. There are several things at issue. One is the catastrophic reorganization that Gerberding initiated and pursues with bullheaded purpose. Beyond the (de)merits of the plan itself, so much time and energy within the agency is wasted in meetings, office and title shuffling, and reorganization related paperwork and bureaucracy that even if it were the best plan in the world it would be like a cancer eating up the agency from within.
But it isn’t the best plan in the world. Allegedly designed to put the agency on a broader base to respond to a wider range of health threats, it is changing the agency from one whose expertise was an inch wide but a mile deep in several selected but important areas, like infectious diseases, to one whose health expertise is a mile wide and an inch deep all over the place. With its new breadth and shallowness has come a dramatic exodus of institutional memory and world class scientific knowledge:
The chorus of strongly voiced concerns coming from inside the agency is what alarmed five former CDC directors and spurred them to send the joint letter to Gerberding on Dec. 22.
“We have all gone through periods of change and recognize the difficulties attendant to change. However, we are concerned about the previous and impending losses of highly qualified and motivated staff,” wrote former CDC directors Dr. William Foege, Dr. James Mason, Dr. David Satcher, Dr. Jeffrey Koplan and Sencer.
Their leadership of the agency spans Republican and Democratic administrations dating back to 1966.
“We are concerned that so many of the staff have come to us to express their concerns about the low morale in the agency. We are concerned about the inability of many of the partners to understand the direction in which CDC is headed,” they said in the letter.
“I think all of us were receiving virtually constant messages from staff expressing concerns about morale and their ability to do their work — and all of it unsolicited,” Koplan said in a recent interview. He preceded Gerberding as CDC director and now is vice president for academic health affairs at Emory University’s Woodruff Health Sciences Center.
The CDC staff members who are raising concerns, Koplan said, are not complainers.
“In my 34 years of affiliation with the CDC, I’ve never seen this level of concern,” Koplan said. “The rate and number of turnover has been exceptional. And it’s not just senior leadership, which would be huge in and of itself.”
Retirements among one category of scientists last year were up 77 percent over previous years, CDC employment data show.
The badly conceived and executed reorganization isn’t the only issue affecting morale. Gerberding has surrounded herself with yes-men and receives criticism badly. There is an air of intimidation and fear in the agency. She is not trusted and viewed by many in the agency as more interested in control and power than furthering the public health mission. Part of that charge has been a willingness to bend the agency’s priorities to those of the Bush administration, whether they make sense or not, and her failure to fight or stand up to the administration regarding its cuts into CDC’s programmatic bone and muscle.
Some examples from the AJC article:
- While the CDC’s overall budget from Congress has risen dramatically in recent years, to $8.4 billion this year, much of the increases are because of terrorism and other urgent threats. Many of CDC’s bread-and-butter programs have taken significant cuts.
- Since 2001, funding for domestic HIV/AIDS programs is down by 19 percent, tuberculosis by 16 percent and injury prevention by 12 percent. Terrorism funding is up 701 percent; the Strategic National Stockpile (vaccines, emergency medical supplies) is up 895 percent.
- Financial erosion left CDC without a mumps specialist when the disease swept the Midwest this year. The agency’s rabies researchers this year didn’t have enough funding to keep crucial supplies in stock until Gerberding diverted $325,000 to them from a discretionary fund. Bathrooms in many CDC buildings now only are cleaned every other weekday.
Not everyone interviewed by the AJC was negative. Here’s one of the most positive views:
“A large proportion of us are more focused on trying to get our work done,” said Dr. Rick Goodman, a former editor-in-chief of CDC’s Morbidity and Mortality Weekly Report who now works in the agency’s public health law program. “We’ve got a lot to do. We get compensated well. We have good job security, health care benefits, and it’s a pretty decent place to work.”
Jeez. If the best you can say is the pay is good and you have job security and benefits, then we are really in trouble. We’ve worked with CDC scientific colleagues for decades and the people we worked with used to be some of the best in the business. The agency is now full of second and third raters and its competency in even simple programmatic matters, like designing a data collection system, is dreadful. They can’t even do paperwork right. And if you speak out about your concerns, the job security isn’t that good either. Like others, we watch in horror as the agency is being systematically destroyed just at the point in history when we need it most.
But the Bush Administration is sticking with Dr. Julie, even though five of six former Directors, Republican and Democrat, think things are amiss. Just like the Bush Administration is sticking with Donald Rumsfeld, even though half a dozen retired Generals think things are amiss. Is there a pattern here? I see The Medial of Freedom in Dr. Gerberding’s future.