A genuine fear among many in the public health community was that Obama would not replace Dr. Julie Gerberding as Director of the Centers for Disease Control and Prevention (aka, the CDC). I am relieved to report that she will be out in 9 days, although she isn't going willingly and will wring every last second of power and salary out of it: literally. Her requested resignation is effective at noon on January 20 just as Obama becomes the 44th President of the United States:
CDC Director Julie Gerberding's controversial tenure will end Jan. 20 -- after Barack Obama is sworn in as president, employees of the Atlanta-based agency were informed in an email sent late Friday evening.[snip]
"As part of the transition process, the Administration requested resignation letters from a number of senior-level officials, including Dr. Julie Gerberding. This week, the Administration accepted Dr. Gerberding's resignation, effective January 20. As Dr. Gerberding noted in a November e-mail to CDC leadership, she has always expected that she would be leaving after the administration changes," the written statement said. (Alison Young, Atlanta Journal Constitution)
Gerberding has been accused -- correctly in our opinion -- of politicizing the agency, destroying CDC's morale, reorganizing its structure and its priorities to within an inch of its useful life, and failing to defend the agency and public health in general in the face of a systematic onslaught by the Bush administration. Her management style was autocratic and hamhanded and she repeatedly allowed incompetent cronies and lapdogs to make important decisions about scientific programs. She was a sycophant of the first order. Good riddance. Gerberding did have one real strength. She was an amazingly effective and credible public communicator, an extremely valuable skill. Unfortunately there was so much else bad. You'll find (the usual) excellent analysis by DemFromCT over at Daily Kos.
Until a new Secretary of Health and Human Services is confirmed (presumably it will be Obama's nominee, Tom Daschle), CDC will be run by an Acting Director, its Chief Operating Officer William Gimson, a Gerberding loyalist and apparatchik. This is a caretaking role. We hope Dashcle acts quickly to name someone with a reputation for integrity who has the respect of CDC scientists and the public health community. Gerberding didn't. Three years ago, five former CDC Directors took the unprecedented move of writing an open private letter [to Dr. Gerberding] warning the agency had lost its way as a result of her attempts to reorganize it. She continued on the same path and as a result the predicted loss of key scientific talent and institutional memory continued. CDC is now a much weaker, less respected and less effective public health agency at a time when we need the opposite.
Another (dangerous) Bush legacy
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Yay!
I don't think she was the main problem.. I think we've had trouble trying to integrate valid security concerns with bioweapons which have mostly been the purview of law enforcement and the military with traditional public health issues which have generally been more openly and easily discussed especially by people with gravitas in the infectious disease field...
But right now we have a major disconnect between agencies like the CDC and the public. Two recent areas where these problems have come up are with the smallpox vaccination attempt and pandemic preparation planning. There needs to be a more realistic connection with the public on these issues to get them properly communicated. Obama's pick of the CNN medical correspondent to be the new Surgeon General could be a good move in that direction....
Even more important would be for the CDC people who have the experience and gravitas with these issues to get more airtime.
medmatters: I don't agree. Bioterrorism became the driving force at CDC and seriously distorted priorities (the failure to catch the H2N2 pandemic strain sent as a clinical lab competency test is a case in point; it wasn't a bioterrorism agent so they didn't pay attention to it, according to Gerberding). Gerberding's incompetent management was a serious morale problem at CDC and they have lost a tremendous amount of talent and institutional memory. As for the Surgeon General, yes, that would be a good thing to get a good communicator in there. Whether Gupta is the right one is an open question. But the SG is not part of CDC and has little power or role other than communicating. The smallpox program failed because it was an ill-conceived program. Pandemic prep has failed because the Bush administration has gone about it the wrong way, lining the pockets of their friends and starving public health. Gerberding was a loyal Bushie in this.
She also prevented good CDC people from speaking to the press. She tightly controlled information.
One of the things that i love about science is that no one is above reproach.
I write this for the benefit of future historians. The five former Directors did not write an open letter. Actually we mailed it to Dr. Gerberding's home to keep it from entering into the document control system, from whence it would have rapidly become widespread. We wrote hoping that we could address the problems at CDC not as advoceries but as a group offering to be of help. We did have one meeting with Dr. Gerberding, but no further communication.
David J. Sencer, MD, MPH
Dr. Sencer; Thank you for the clarification. I have made a correction in the post. I regret our error.
revere, fair claims.. My main point is that we need an overall leadership plan.. White House to HHS/DHS/DOD to CDC that realistically and effectively communicates these problems to the public. The law enforcement/military and public health issue priorities need to get better integrated. With this structure in place then talented people will be better able to stand up to the plate.
Dr. Gerberding failed because she was an incompetent manager, lacked an appreciation for real science and dismissive of public input, imo.
The important thing, at this point, is to make sure her replacement is better. Based on the short list of possible candidates listed at the AJC, it is possible that the next director may be worse, at least from the standpoint of pandemic preparedness.
Atlanta Journal Constitution
Among the candidates for CDC director whose names have surfaced in the public health community, according to advocates, are CARE president Gayle, New York City health commissioner Dr. Thomas Frieden, Baltimore health commissioner Dr. Joshua Sharfstein, and Los Angeles health director Dr. Jonathan Fielding.
Here is a YouTube clip of Dr. Thomas Frieden on the Charlie Rose show from August 30, 2006:
http://www.youtube.com/watch?v=k7kVR1owSOI
Starting at about 21 minutes into the show he discusses panflu. Watch him say he thinks a pandemic is "unlikely", period. Watch Charlie Rose try to pin him down, even mentioning the Indonesia cases specifically. Watch Dr. Frieden tell Mr. Rose that NYC's plan is solid: they'll adjust bus and train schedules so people aren't so crowded together.
If he becomes CDC director, we may look back at the Gerberding years as the good old days.
I have made this point many times, but will try again: Public Health officials who treat the American public like children and ignore their concerns will fail in improving public health.
I will once again make my plea that President-elect Obama consider Dr. Roz Lasker for Director of the CDC. She knows how to listen to the public and has sound ideas on pandemic preparedness.
Gerberding was the problem. She capitulated to the Administration at every turn. She was highhanded and inaccessible to the staff. CDC always has taken pride in not being a DC agency, yet she let DC folks distort priorities and micromanage her staff. The Global AIDS Program became a part of PEPFAR, which one reason it was moved to her office. She bloated the place with un-needed bureaucracy and managers while spending a fortune on management contracts to people who had even less understanding of public health than she. None of the mentioned candidates is perfect: Helen Gayle was not highly respected in her CDC AIDS role, although she did have sense enough to listen to competent people. LA's public health system is annually imperiled by budget problems and it's unclear if that would bring realism or chaos to CDC management. Sencer and co. were naive if they thought a letter, public or otherwise, would convince Gerberding to deal with her problems--she was an incompetent manager and they would have been better off putting an ad in major media outlets calling for her resignation. Sadly, CDCers tend to think of themselves as beyond politics which is naive and stupid position for anyone in public health. If the staff had taken more assertive action---organizing a union, standing up to management and idiot contractors, Gerberding would have been out long ago, although up until the '06 elections, the alternatives may have been worse. Koplan, the rumored to be a Republican, was never confirmed by the GOP Congress, did himself in with his lackluster response on Anthrax. Still, it's good to see that he's on the transition team. He was good in terms of strategic planning and has probably had plenty of exposure to disgruntled CDCers at Emory (much of the teaching faculty consists of ex- or moonlighting CDCers). Hopefully, some things will change, although it will take many years to reverse the damage done to the agency by Gerberding.
There are other names floating around besides the ones from the AJC. Jeff Koplan coming back to CDC for a period of time keeps coming up a lot. Jim Marks from RWJF is another possibility. Nicki Laurie from Rand. Jose Cordero. Any thoughts on them or other names you folks have heard?
Optimist: Fielding is a medical care person, although lots of public health experience at the state and local level. Sharfstein is on the Obama transition team on the FDA. It's rumored he is a top candidate for that post. He used to work for Waxman. I don't know anything about the names you mention. But Gerberding was a surprise choice, too.
My hope is it is someone who will work with state public health depts. to strengthen public health in all its aspects, but also return to the science based strength of CDC. CDC has tried to do too much with too little. Infectious disease and environmental health from the science side are where I'd put the emphasis, both strengths in times past. This would include surveillance and laboratory work.
A good scientist who is a good manager would fit the bill, I think. But every person brings certain strengths and weaknesses to the table and it's hard to set out qualifications. People who look great on paper can be a bust and people who seem to have no experience can turn out great.
Jim Marks' name keeps floating up and I have the impression he is lobbying pretty hard for the job. He was part of the disgraceful obesity paper episode, where not only were the numbers miscalculated for obesity, but the whole methodology was already known to be completely wrong and to exaggerate the numbers to a huge extent. Just for that he should be disqualified. It was far more of a fiasco than people realize.
Carolyn - I don't know all the facts on the obesity paper but, even if true, they shouldn't disqualify someone. People need to be judged on their entire record and allowed to make mistakes if they admit them and learn from them. Jim Marks is a big thinker plus a strong leader and manager and he has connections to the disgruntled 'old guard' at CDC. Someone like that is exactly what is needed now.
To my knowledge Jim Marks hasn't even ever admitted the huge errors in the Mokdad paper on obesity and other "actual causes" of deaths and in fact at least until recently was still telling people to use those numbers, even though CDC admitted the paper was wrong and no longer uses those numbers, so I am not sure what he might have "learned" here. That's just one example of sacrificing science for politics - something CDC doesn't need any more of.
Revere: Yes, Fielding is an MD, but his specialty is in Preventive Medicine. He also has an MPH and MA (in the history of science) from Harvard as well as an MBA from Wharton.
Considering the whole of his training and background, I think Dr. Fielding has what could be a great set of credentials for a director of the CDC given that he would bring experience from public health, heathcare services, and the business to the position. Forging effective partnerships among those sectors should probably be one of the highest priorities for the CDC in the coming decade- both for public health preparedness and disease prevention efforts.
Hey, Revere, I've got the right degrees and no experience, pick me!
Seriously...what about tapping someone from one of the regions who did a pretty good job of pandemic and disaster prepping--I don't know the names of the people, but King County, WA seems to have reacted to the panflu issue better than anyone. Could someone 'from the sticks' like King County run the CDC? Or is that the public health equivalent of nominating Sarah Palin...
Flemming might be a good choice from WA. I think one of the problems with the CDC over the past 8 or so years has been an overemphasis (more activity and $ than there should have been) on pandemic and disaster preparedness. Sorry Lisa. The CDC needs to develop and EXECUTE a strategic plan around the key public health issues of the day (and next week). These are chronic disease, food safety, child health, environmental health. The common theme? They focus on reducing preventable morbidity and mortality. The problem with Gerberding is that she couldn't execute and she didn't surround herself with people who could. It's lack of discipline, lack of credibility, and lack of leadership. The problem is that whe chose to go into battle with the likes of Gimson, Perkins, Solomon, etc. And no one will follow those guys...
i hope daschle can procure a better funding structure for CDC and public health. they need more discretionary funding to promote efficiency and entice states/local public health to integrate systems with CDC. Way too much money is going to redundant and incompatible systems. Strengthening communications and surveillance is good for bioterrorism, chronic conditions, and outbreaks. Firefighting style funding for bioterrorism, west nile, etc is good politics, but bad public health. this isn't the only thing CDC does, but it is a large part of it and one of the most visible.