One of the most dismaying “features” (or is it a bug?) of the US government is the too cozy relationship of key agencies with industries they are either regulating, investigating or affecting in some ways. The revolving door syndrome perhaps reached its peak in the Bush II administration, but it’s been a chronic problem going back decades or longer. Yesterday we learned of another example when Big Pharma giant Merck & Company issued a press release announcing it had hired Dr. Julie Gerberding (often referred to by CDC employees simply as “JLG”), the first female Director of CDC (hat tip Daniel Cressey, Nature’s blog, The Great Beyond). She served George W. Bush through a tumultuous and controversial tenure from 2002 to its last day, Jan 21, 2009. Talk about hanging on to the last minute. Her job? Head of the vaccines Division:
Dr. Gerberding will lead the company’s $5 billion global vaccine business. Merck currently markets a broad range of pediatric, adolescent and adult vaccines and is a leading provider of vaccines in countries around the world; in the U.S., Merck markets vaccines for 12 of the 17 diseases for which the U.S. Advisory Committee for Immunization Practices currently recommends vaccines. She will be responsible for the commercialization of the current portfolio of vaccines, planning for the introduction of vaccines from the company’s robust vaccine pipeline, and accelerating Merck’s on-going efforts to broaden access to its vaccines in the developing world. Dr. Gerberding will also collaborate with leaders of Merck Manufacturing Division and Merck Research Laboratories to manage the critical linkages between basic research, late-stage development and manufacturing to expand Merck’s vaccine offerings throughout the world. (Merck Press Release)
We were critical of Gerberding through most of her CDC tenure (here, here or here or just put site:http://effectmeasure.blogspot.com gerberding into your Google search bar; there were so many posts about her I couldn’t possibly list them all). I always gave her high marks as a risk communicator, one of the best I’ve ever seen. Even I believed her. Her successor, Thomas Frieden, is a walking public communications disaster area: arrogant sounding, dismissive and a poor listener when it comes to what the press and public are asking. So Gerberding has him beat, hands down (although the Acting Director, Rich Besser, who presided over the opening months of the flu pandemic was superb, even better than Gerberding and Anne Schuchat is also excellent). The problem with Gerberding was that she didn’t speak cogently, persuasively or credibly to her paymasters in the Bush administration. She did two things, one unforgivable, one incompetent and destructive.
The unforgivable one was not to fight for public health publicly and with every tool at her disposal. I’m not privy to what she did to argue for public health at the highest levels of the administration (my suspicion she was more of a sycophant than and advocate), but publicly she was passive and and relatively uncomplaining in the face of official neglect or hostility to CDC’s mission, to protect the public health. But it was worse. The incompetent and destructive thing, as the many blog posts linked above indicate, was that she took a managerial wrecking ball to the place, bringing in management consultants, contractors and pushing hard on a major restructuring that threw the agency into dissarray and emptied it of its institutional memory as professional scientists headed for the exits. It got so bad that bevies of ex-CDC Directors were voicing concern publicly and privately, an extraordinary thing to have happen.
I’ve reviewed the literature on influenza vaccine and feel confident that it is a rational and effective public health measure. But I have long been disturbed at the dogmatic way CDC has pushed a seasonal vaccination campaign that targeted my age group (over 65) and refused to acknowledge the questions about reduced efficacy in the elderly. Here’s an example of one of our posts from over 2 years ago:
On the other hand, the data present a serious challenge to the CDC program which concentrates on blanket coverage of the 65 plus age group. Both epidemiological and biological data suggest that immune response declines with age. Us older folks just don’t respond as well to the vaccines. This in turn suggests that instead of blind faith in the current program, alternative ideas should be explored, including shifting the target to younger age groups responsible for transmitting the virus in the population. If indeed it is true that there is some cross-reactivity between subtypes, vaccinating younger age groups might have special importance prior to a pandemic.
The authors [of the paper being discussed in the post] also have other options:
Refocusing on the likely complications of immune senescence should help clear the way for more vigorous pursuit of other options for influenza control. These options include the development of more-immunogenic vaccines for elderly people, use of larger doses of vaccine, the combining of live and killed vaccine formulations, use of antivirals in a more aggressive manner for treatment and prophylaxis, and indirectly protecting elderly people through increased vaccination of transmitter populations. Implementation of any of these alternative approaches must be accompanied by valid assessments of their effectiveness. (Simonsen et al., The Lancet Infectious Diseases [subscription required]
These are good suggestions. I fear they will fall on deaf ears at CDC, however. Those folks are “true believers.” We all know what that means: blinders and ear plugs in place and full speed ahead. (Effect Measure, September 26, 2007)
Now we have the spectacle of the most recent CDC Director heading up Merck’s vaccines Division. Revolving door syndrome just at at time when we need confidence in the recommendations of CDC the most. History repeating itself. Good for JLG. Bad for public health.