CDC: the times they need a changin'

The Atlanata Journal Constitution, hometown paper of the federal Centers for Disease Control and Prevention (aka, "CDC") continues to lift the rocks and uncover the stuff beneath. In the latest installment it has obtained an internal memo from CDC's international health office to CDC Director Dr. Julie Gerberding about the problems in filling overseas posts (see also this post summarizing things at DailyKos by my Wiki partner, DemFromCT). The memo is long but revealing. One of the chief obstacles resides in a political office at the Department of Health and Human Services headed by George H.W. Bush's godson, William Steiger.

Steiger isn't an unknown. In fact, in international health circles, he is notorious. We wrote about him on the old site in December 2004:

A PhD in Latin American history with no prior health experience, Steiger was appointed to DHHS's Office of Global Health Affairs, one of [former HHS Secretary Tommy] Thompson's centralizing managerial "reforms" ("one HHS"), which Steiger characterized in Science magazine as a "major expansion" of HHS's international activities. Yes, expansion into political meddling: "I see an increasing and pervasive squeezing of academic freedom by bureaucratic control," is how Gerald Keusch, former Director of NIH's Fogarty International Center put it. Steiger quickly got a reputation for "throwing [U.S.] power and authority around" in International Health matters.
(Effect Measure, December 6, 2004)

It is to Steiger's office at DHHS that CDC must go, hat in hand, each time it wants to fill an overseas slot:

Steiger, in a written statement Wednesday night, said his office only takes one month to approve overseas positions and that reviews are "necessary because these posts need to be strategic and align with both the department and the president's goals and priorities."

Jeff Levi, executive director of the Trust for America's Health, questioned why HHS officials in Washington are contributing to the CDC's hiring delays. "CDC isn't sending political people abroad to do global disease detection. They're sending scientists," said Levi, whose Washington-based group examines public health preparedness.

Levi said having CDC scientists overseas is important in creating a stronger global disease detection system. The vacancies create the risk that "we won't get the warning we need and we won't be as prepared as we should be," he said. (Alison Young, Atlanta JOurnal Constitution)

Let's repeat this. In Steiger's view, the CDC "posts need to be strategic and align with both the department and the president's goals and priorities." And why does CDC allow this kind of political micromanagement? Five previous CDC Directors, meeting recently at a symposium at George Washington University, took the unusual step of voicing publicly their concern about political meddling into science:

"This is not just with FDA decisions or climate change or at EPA," [former CDC Director William Foege] said. "We see this in public health as well."

Citing an example of politics dictating CDC decisions, Foege said that in April 2004, the World Health Organization requested the participation of CDC scientists at a conference on HIV/AIDS, and the office of then-HHS Secretary Tommy Thompson insisted on clearing the participants in advance.

"CDC acquiesced in that, and politics trumped science in a way that I never thought would happen," Foege said. (Jeff Nesmith, Atlanta Journal Constitution)

Yes, CDC acquiesced. But CDC isn't a person. it was really CDC Director Julie Gerberding who failed to fight for her agency's independence and acquiesced, even as she did her own damage with an ill-advised and incompetently executed reorganization she claimed would make the agency nimbler and more flexible. This nimble and flexible:

• There are 12 steps that must take place at CDC in preparing a package prior to sending the package to AHRC [the federal hiring office in Atlanta]. Once the package is received in AHRC, there have been 49 steps which AHRC took. It has taken as long as 3 months to get the vacancy advertised. Currently, vacancies that are being advertised this week, were received in AHRC in December 2006. Again, we have been informed in the last week that several changes within AHRC are underway that will shorten this process and that these changes will be monitored by HHS and CDC. We hope they will have the desired effect on streamlining and speeding up their internal processes.
• Most overseas positions require senior level staff (GS 14/15) and sources for recruitment for these staff within CDC are drying up. Most highly qualified staff interested in overseas assignments have been placed. It is now a challenge to hire staff with sufficient institutional knowledge and language skills to work in other countries.
• We have no career track for international public health. An overseas assignment may be a side track for a CDC employee or a headquarters career track. We need to establish early-career and mid-career positions overseas and better define the repatriation process for returning staff. (from the CDC Memo)

That's just three of a dozen or so bullet points in the eight page internal memo detailing institutional barriers to filling 116 empty or soon to be empty overseas slots. Slots that include postings in China and Indonesia, two bird flu hotspots.

We can't do better than DemFromCT's bottom line:

2008 will be a 'change' election. The practice of having political minders in every facet and level of government isn't just affecting science, it's potentially affecting the world's health. That is not an acceptable situation, and yet another thing that has to change. We need a public health system that's more in tune with the public's needs. And don't miss the references above to FDA and climate change and EPA. Elections have consequences, and it'll take years to clean up the mess the last two elections have caused in the worlds of health and science. (DemFromCT, DailyKos)