CDC restructures to better battle bioterror

The Centers for Disease Control and Prevention recently announced that it is refocusing priorities and reorganizing operations this year to better protect the United States against biological attacks and to promote health amongst all Americans.

The agency will now focus its attention and funding on two "overarching health protection goals": preparedness against infectious, environmental and terrorist threats, and the prevention of disease, injury and disability, according to a CDC press release.

Most CDC offices will also operate within four coordinating units to allow personnel working in similar health fields to more easily collaborate, CDC spokesman Tom Skinner said Friday.

Planned changes were developed under the yearlong Futures Initiative, and should be in place when the agency begins its next fiscal year in October, Skinner said.

"The Futures Initiative is all about allowing the CDC to leverage its resources to be even more effective than we are now to responding to public health threats, whether they're caused by infectious, environmental or terroristic threats or chronic health conditions," Skinner said.

The agency has 8,000 full-time employees around the country in divisions working to research and prevent health problems. It began increasing its ability to respond to bioterrorism in 1998, and led the response to the 2001 anthrax attacks that killed five people, according to the General Accounting Office.

A 2003 GAO report (GAO-04-152) found that while the agency provided strong support to local health departments during the attacks, CDC officials acknowledged they were not prepared to coordinate the work of federal health personnel and had trouble managing information coming in from other public health agencies.

The agency subsequently created an Office of Terrorism Preparedness and Emergency Response, developed an emergency operations center and took other steps to better respond to bioterror, the report states.

Some public health experts have also charged the agency with playing down the importance of the smallpox immunization program and with failing to work well with local and state organizations.

Former Health and Human Services Department official Jerome Hauer questioned whether the CDC change would improve the agency's bioterrorism efforts. Large organizations sometimes change for the sake of change, but to minimal effect, he said.

"I think we have to see what happens on this," said Hauer, now director of the Response to Emergencies and Disasters Institute at George Washington University. "Only time will tell."

Details on how the CDC will allocate programming, funding and personnel to meet its priorities will be determined in the months leading to the new fiscal year, Skinner said.

The agency has requested $1.1 billion for terrorism response in fiscal 2005. Most of the money - $829 million - would be used for grants to help state and local agencies increase their ability to respond to biological incidents. Remaining money would fund CDC response capability increases, security, anthrax vaccine research and a surveillance initiative aimed at shrinking the time it takes for public health agencies to detect a biological problem.

The new organizational model will support the agency's efforts to meet its goals, Skinner said. "It's a matter of bringing people together to more effectively work on a common cause," he said.

Each of the four coordinating centers will include several agencies:

• The Coordinating Center for Infectious Diseases will house the National Center for Infectious Diseases, the National Immunization Program and the National Center for STD, TB and HIV Prevention.
• The Coordinating Center for Health Promotion will house the National Center for Chronic Disease Prevention and Health Promotion and the National Center for Birth Defects and Developmental Disabilities.
• The Coordinating Center for Environmental Health, Injury Prevention and Occupational Health will be home to the National Center for Environmental Health, the Agency for Toxic Substances and Disease Registry, the National Center for Injury Prevention and Control and the National Institute for Occupational Safety and Health.
• The Coordinating Center for Health Information and Services will include the National Center for Health Statistics, a new National Center for Health Marketing and a new Center for Public Health Informatics.

Each coordinating center will have a director who will report directly to Director Julie Gerberding, rather than having the head of each office do so. That will allow Gerberding to spend more time planning national and international health strategies, said Charles Schable, new head of Terrorism Preparedness and Emergency Response.

"Will it make the CDC react more promptly [to health emergencies]? I don't think so because we react pretty darn promptly," Schable said. "We don't need a management structure to respond," he added.

Schable's 150-person office will continue its work coordinating work by CDC departments and other federal, state and local agencies against bioterror, officials said.

"My office will coordinate a response, coordinate funds that will go to these various centers," Schable said.