Effect Measure

CDC today

When Thomas Frieden took over as CDC Director less than a year ago, I didn’t know what to think. A smart, frenetic and intense former CDC epidemiologist who was most recently head of the New York City Health Department, he hadn’t made his reputation as a “people person.” He was reputed to being a quick study who sized up the science and once convinced, implemented science-based policy with a vengeance. His occasional appearances as the public face of CDC during the swine flu pandemic last fall were not auspicious. He appeared arrogant and blew off reporters’ questions if he didn’t know the answer (and like all people in that position, he got asked a lot of questions which no one knew the answers to). But his predecessor, Julie Gerberding, wasn’t a hard act to follow. Widely disliked by CDC veterans, she had tried to transform the agency from within into her personal vision of managerial valhalla and before long the agency began to lose its intellectual capital and institutional memory. We wrote about it quite a lot here. Lately, not so much, because CDC has been quieter and less roiled by controversy. Is this a good sign? We aren’t sure. But Frieden has gotten himself a nice profile in the New York Times which sounds good. Puff pieces in The Times aren’t unusual, unfortunately, so we’ll reserve judgment. But at least we weren’t dismayed by what we read, something that happened too frequently in the Gerberding era.

And some things seemed to hit just the right note as far as we were concerned:

Gone are the nonscientific managers whom Dr. Gerberding sprinkled throughout the agency?s top ranks. Gone is a layer of bureaucracy, agency officials said. Gone, too, are the captain?s chairs with cup holders from a conference room so fancy that agency managers dubbed it the Crown Room.

In their place, Dr. Frieden has restored not only much of the agency?s previous organizational structure and scientific managers, but also its drab furniture. And he has brought something new: a frenetic sense of urgency.


By the end of her tenure, Dr. Gerberding had become so removed from day-to-day management that some top agency officials went weeks without seeing or hearing from her, they said. Dr. Frieden, by contrast, sometimes wanders the agency?s hallways and drops in on scientists unannounced to ask about their work, both delighting and terrifying them.


Within two months, Dr. Frieden eliminated the ?coordinating centers,? a layer of management Dr. Gerberding had added between the agency?s scientists and top leadership. The Coordinating Center for Infectious Diseases, with 600 employees, became the Office of Infectious Diseases, with 12. No one was fired; the agency?s leadership was simply pared.


Dr. Frieden said that among his priorities for the agency, the most important are improving its disease tracking and supporting state and local government health offices.

?All of public health starts with more information,? he said. ?We have to analyze what we have better and disseminate it better.? (Gardiner Harris, New York Times)

These strike us as all the right moves. It’s an agency under a lot of budget stress and choices have to be made. Surveillance and support of state and local health should be at the top of the CDC agenda.

Gerberding knew how to ingratiate herself with the higher ups. Too bad she didn’t use it to better effect. It’s not clear Frieden has those skills so it remains to be seen if he can get done what it looks like he understands needs to be done.

We’re just going to have to see. I’m sure he would agree we should be demanding the evidence.


  1. #1 JerryM
    March 17, 2010

    “No one was fired; the agency’s leadership was simply pared.”

    I’m not fluent in management speak (nor evidently English). What’s that mean? Going from 600 to 12 but no-one being fired.

  2. #2 Noadi
    March 17, 2010

    Just a gues but I bet it means they were moved elsewhere in the CDC, probably with a pay cut. Resignation isn’t firing.

  3. #3 MoM
    March 17, 2010

    Several months ago, Dr. F came to visit a group of Local Health Dept administrators in my area. He said that he understood their perspective, since he had come from a Local Health Agency himself. (He didn’t mention that his “Local Agency” was bigger and had more budget and staff than several state agencies, probably including ours, but those in the room all knew that).

    Anyway, he asked good questions, listened to both the answers he got and the questions he was asked, took his own notes, and promised to get back with the answers he didn’t have at the time. Since I was only there tangentially and didn’t ask a question he needed to get back to me on, I’m not sure how the follow-up was, but my impression from that meeting was pretty positive.

  4. #4 CraigR
    March 17, 2010

    Frieden gave the closing plenary at the national STD conference last week, and did a good job. It was my first chance to hear him speak, and he said all the right things, including his intention to make science-based policy decisions. While a bit brusque during the Q&A — at one point telling a CDC staffer to defer his question to another day so that others present could speak — I think he is just what the agency needs.

  5. #5 Frank Mirer
    March 18, 2010

    Two sentinel events for the epidemic problems of the Gerberding CDC were: rapid downgrading of NIOSH; and siding with hospital management against effective respiratory protection for health care workers. Endemic problems have been the long term low priority of chemcal and occupational exposures. Also, a “don’t ask, don’t tell” attitude toward workplace outbreaks of legionnaire’s disease. The topline of the NIOSH web page still says “CDC – The National Institute for Occupational Safety and Health …”

  6. #6 Mark
    March 22, 2010

    My sense is they probably went back to their old jobs that they were pulled from before the creation of the Coordinating Centers. In my eyes (since departed from CDC), the real power at CDC is in the divisions, and they correctly diagnosed that the coordinating centers did not provide any value, but were rather merely another source of “feed the beast” requirements. Moreover, with flatline budgets, Gerberding was forced to rob Peter (the Centers, Institutes and Offices) to pay Paul (Coordinating Centers). The result was the Center level staffs were decimated when the Coord Ctrs were created. Centers and Divisions should benefit from this.

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