Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) is a national public health institute in the United States. It is a United States federal agency, under the Department of Health and Human Services,[2] and is headquartered in Atlanta, Georgia.[3]

"Centers for Disease Control" redirects here. For affiliated agencies outside the US, see List of national public health agencies.

Centers for Disease Control and Prevention
CDC logo
Agency overview
FormedJuly 1, 1946 (1946-07-01)
Preceding agencies
  • Office of National Defense Malaria Control Activities (1942)
  • Office of Malaria Control in War Areas (1942–46)
  • Communicable Disease Center (1946–67)
  • National Communicable Disease Center (1967–70)
  • Center for Disease Control (1970–80)
  • Centers for Disease Control (1980–92)
JurisdictionFederal government of the United States
HeadquartersAtlanta, Georgia, U.S.
33°47′58″N 84°19′42″W
Employees10,899 (2015)[1]
Annual budgetUS$11.1 billion (FY18)
Agency executives
Parent agencyUnited States Department of Health and Human Services
Websitewww.cdc.gov

Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally.[4] The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens. The CDC also conducts research and provides information on non-infectious diseases, such as obesity and diabetes, and is a founding member of the International Association of National Public Health Institutes.[5]

History
See also: Centers for Disease Control and Prevention timeline

Establishment

The Communicable Disease Center was founded July 1, 1946, as the successor to the World War II Malaria Control in War Areas program[6] of the Office of National Defense Malaria Control Activities.[7]

Preceding its founding, organizations with global influence in malaria control were the Malaria Commission of the League of Nations and the Rockefeller Foundation.[8] The Rockefeller Foundation greatly supported malaria control,[8] sought to have the governments take over some of its efforts, and collaborated with the agency.[9]

The new agency was a branch of the U.S. Public Health Service and Atlanta was chosen as the location because malaria was endemic in the Southern United States.[10] The agency changed names (see infobox on top) before adopting the name Communicable Disease Center in 1946. Offices were located on the sixth floor of the Volunteer Building on Peachtree Street.[11]

With a budget at the time of about $1 million, 59 percent of its personnel were engaged in mosquito abatement and habitat control with the objective of control and eradication of malaria in the United States[12] (see National Malaria Eradication Program).

Among its 369 employees, the main jobs at CDC were originally entomology and engineering. In CDC's initial years, more than six and a half million homes were sprayed, mostly with DDT. In 1946, there were only seven medical officers on duty and an early organization chart was drawn, somewhat fancifully, in the shape of a mosquito. Under Joseph Walter Mountin, the CDC continued to advocate for public health issues and pushed to extend its responsibilities to many other communicable diseases.[13]

In 1947, the CDC made a token payment of $10 to Emory University for 15 acres (61,000 m2) of land on Clifton Road in DeKalb County, still the home of CDC headquarters as of 2019. CDC employees collected the money to make the purchase. The benefactor behind the "gift" was Robert W. Woodruff, chairman of the board of The Coca-Cola Company. Woodruff had a long-time interest in malaria control, which had been a problem in areas where he went hunting. The same year, the PHS transferred its San Francisco based plague laboratory into the CDC as the Epidemiology Division, and a new Veterinary Diseases Division was established.[6]

Growth
The Communicable Disease Center moved to its current headquarters in 1960. Building 1 is pictured in 1963.

An Epidemic Intelligence Service (EIS) was established in 1951, originally due to biological warfare concerns arising from the Korean War; it evolved into two-year postgraduate training program in epidemiology, and a prototype for Field Epidemiology Training Programs (FETP), now found in numerous countries, reflecting CDC's influence in promoting this model internationally.[14]

The mission of the CDC expanded beyond its original focus on malaria to include sexually transmitted diseases when the Venereal Disease Division of the U.S. Public Health Service (PHS) was transferred to the CDC in 1957. Shortly thereafter, Tuberculosis Control was transferred (in 1960) to the CDC from PHS, and then in 1963 the Immunization program was established.[15]

It became the National Communicable Disease Center (NCDC) effective July 1, 1967, and the Center for Disease Control (CDC) on June 24, 1970. At the end of the Public Health Service reorganizations of 1966–1973, it was promoted to being a principal operating agency of PHS. It was renamed the Centers for Disease Control effective October 14, 1980.[7] In 1987, the National Center for Health Statistics became part of CDC.[16] An act of the United States Congress appended the words "and Prevention" to the name effective October 27, 1992. However, Congress directed that the initialism CDC be retained because of its name recognition.[17]

Since the 1990s, the CDC focus has broadened to include chronic diseases, disabilities, injury control, workplace hazards, environmental health threats, and terrorism preparedness. CDC combats emerging diseases and other health risks, including birth defects, West Nile virus, obesity, avian, swine, and pandemic flu, E. coli, and bioterrorism, to name a few. The organization would also prove to be an important factor in preventing the abuse of penicillin. In May 1994 the CDC admitted having sent samples of communicable diseases to the Iraqi government from 1984 through 1989 which were subsequently repurposed for biological warfare, including Botulinum toxin, West Nile virus, Yersinia pestis and Dengue fever virus.[18]

Recent history
Arlen Specter Headquarters and Emergency Operations Center

On April 21, 2005, then–CDC Director Julie Gerberding formally announced the reorganization of CDC to "confront the challenges of 21st-century health threats".[19] The four Coordinating Centers—established under the G.W. Bush administration and Gerberding—"diminished the influence of national centers under [their] umbrella", and were ordered cut under the Obama Administration in 2009.[20]

As of 2013, the CDC's Biosafety Level 4 laboratories are among the few that exist in the world,[21] and serve as one of only two official repositories of smallpox in the world. The second smallpox store resides at the State Research Center of Virology and Biotechnology VECTOR in the Russian Federation. In 2014, the CDC revealed they discovered several misplaced smallpox samples while their lab workers were 'potentially infected' with anthrax.[22]

The city of Atlanta annexed the CDC headquarters effective January 1, 2018, a part of the city's largest annexation within a period of 65 years; the Atlanta City Council voted to do so the prior December.[3] The CDC requested the Atlanta city government annex the area. Previously, the headquarters were in an unincorporated area,[23] statistically in the Druid Hills census-designated place.[24]

Organization
CDC's Roybal campus in Atlanta, Georgia
Tom Harkin Global Communications Center
CDC Building 17 in Atlanta, Georgia, as seen from Emory University

The CDC is organized into "Centers, Institutes, and Offices" (CIOs), with each organizational unit implementing the agency's activities in a particular area of expertise while also providing intra-agency support and resource-sharing for cross-cutting issues and specific health threats. Generally, CDC "Offices" are subdivided into Centers, which in turn are composed of Divisions and Branches.[6] However, the Center for Global Health and the National Institute for Occupational Safety and Health are freestanding organizational units and do not belong to a parent Office.

As of August 2019, the CIOs are:

The Office of Public Health Preparedness was created during the 2001 anthrax attacks shortly after the terrorist attacks of September 11, 2001. Its purpose was to coordinate among the government the response to a range of biological terrorism threats.[26]

Locations

Most CDC centers are located in Atlanta. A few of the centers are based in or operate other domestic locations:[27]

In addition, CDC operates quarantine facilities in 20 cities in the U.S.[31]

Budget

CDC's budget for fiscal year 2018 is $11.9 billion.[32] The CDC offers grants that help many organizations each year advance health, safety and awareness at the community level throughout the United States. The CDC awards over 85 percent of its annual budget through these grants.[33]

Workforce

As of 2008, CDC staff numbered approximately 15,000 personnel (including 6,000 contractors and 840 United States Public Health Service Commissioned Corps officers) in 170 occupations. Eighty percent held bachelor's degrees or higher; almost half had advanced degrees (a master's degree or a doctorate such as a PhD, D.O., or M.D.).[34]

Common CDC job titles include engineer, entomologist, epidemiologist, biologist, physician, veterinarian, behavioral scientist, nurse, medical technologist, economist, public health advisor, health communicator, toxicologist, chemist, computer scientist, and statistician.[35]

The CDC also operates a number of notable training and fellowship programs, including those indicated below.

Epidemic Intelligence Service (EIS)

The Epidemic Intelligence Service (EIS) is composed of "boots-on-the-ground disease detectives" who investigate public health problems domestically and globally.[36] When called upon by a governmental body, EIS officers may embark on short-term epidemiological assistance assignments, or "Epi-Aids", to provide technical expertise in containing and investigating disease outbreaks.[37][38][39] The EIS program is a model for the international Field Epidemiology Training Program.

Public Health Associates Program

The CDC also operates the Public Health Associate Program (PHAP), a two-year paid fellowship for recent college graduates to work in public health agencies all over the United States. PHAP was founded in 2007 and currently has 159 associates in 34 states.[40]

Leadership
David Sencer points to a depiction of Triatomine sp., which transmits Chagas disease

The Director of CDC is a Senior Executive Service position[41] that may be filled either by a career employee, or as a political appointment that does not require Senate confirmation, with the latter method typically being used. The director serves at the pleasure of the President and may be fired at any time.[42][43][44] The CDC director concurrently serves as the Administrator of the Agency for Toxic Substances and Disease Registry.[45]

Twenty directors have served the CDC or its predecessor agencies, including three who have served during the Trump administration (including Anne Schuchat who served two terms as acting director).[7][46]

Datasets and survey systems

Areas of focus
Donald Henderson as part of the CDC's smallpox eradication team in 1966
CDC and MSF staff preparing to enter an Ebola treatment unit in Liberia, August 2014

Communicable diseases

The CDC's programs address more than 400 diseases, health threats, and conditions that are major causes of death, disease, and disability. The CDC's website has information on various infectious (and noninfectious) diseases, including smallpox, measles, and others.

Influenza

The CDC targets the transmission of influenza, including the H1N1 swine flu, and launched websites to educate people about hygiene.[55]

Division of Select Agents and Toxins

Within the division are two programs: the Federal Select Agent Program (FSAP) and the Import Permit Program. The FSAP is run jointly with an office within the U.S. Department of Agriculture, regulating agents that can cause disease in humans, animals, and plants. The Import Permit Program regulates the importation of "infectious biological materials."[56]

The CDC runs a program that protects the public from rare and dangerous substances such as anthrax and the Ebola virus. The program, called the Federal Select Agent Program, calls for inspections of labs in the U.S. that work with dangerous pathogens.[57]

During the 2014 Ebola outbreak in West Africa, the CDC helped coordinate the return of two infected American aid workers for treatment at Emory University Hospital, the home of a special unit to handle highly infectious diseases.[58]

As a response to the 2014 Ebola outbreak, Congress passed a Continuing Appropriations Resolution allocating $30,000,000 towards CDC's efforts to fight the virus.[59]

Non-communicable diseases

The CDC also works on non-communicable diseases, including chronic diseases caused by obesity, physical inactivity and tobacco-use.[60]

Antibiotic resistance

The CDC implemented their National Action Plan for Combating Antibiotic Resistant Bacteria as a measure against the spread of antibiotic resistance in the United States. This initiative has a budget of $161 million and includes the development of the Antibiotic Resistance Lab Network.[61]

Global health

Globally, the CDC work with other organizations to address global health challenges and contain disease threats at their source. They work with many international organizations such as the World Health Organization (WHO) as well as ministries of health and other groups on the front lines of outbreaks. The agency maintains staff in more than 60 countries, including some from the U.S. but more from the countries in which they operate.[62] The agency's global divisions include the Division of Global HIV and TB (DGHT), the Division of Parasitic Diseases and Malaria (DPDM), the Division of Global Health Protection (DGHP), and the Global Immunization Division (GID).[63]

The CDC is integral in working with the WHO to implement the International Health Regulations (IHR), an agreement between 196 countries to prevent, control, and report on the international spread of disease, through initiatives including the Global Disease Detection Program (GDD).[64]

The CDC is also a lead implementer of key U.S. global health initiatives such as the President's Emergency Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative.[65]

Travelers' health

The CDC collects and publishes health information for travelers in a comprehensive book, CDC Health Information for International Travel, which is commonly known as the "yellow book."[66] The book is available online and in print as a new edition every other year and includes current travel health guidelines, vaccine recommendations, and information on specific travel destinations. The CDC also issues travel health notices on its website, consisting of three levels:

"Watch": Level 1 (practice usual precautions)

"Alert": Level 2 (practice enhanced precautions)

"Warning": Level 3 (avoid nonessential travel)[67]

Vaccine safety

The CDC monitor the safety of vaccines in the U.S. via the Vaccine Adverse Event Reporting System (VAERS), a national vaccine safety surveillance program run by CDC and the FDA. "VAERS detects possible safety issues with U.S. vaccines by collecting information about adverse events (possible side effects or health problems) after vaccination."[68] The CDC's Safety Information by Vaccine page provides a list of the latest safety information, side effects, and answers to common questions about CDC recommended vaccines.[69]

Foundation

The CDC Foundation operates independently from CDC as a private, nonprofit 501(c)(3) organization incorporated in the State of Georgia. The creation of the Foundation was authorized by section 399F of the Public Health Service Act to support the mission of CDC in partnership with the private sector, including organizations, foundations, businesses, educational groups, and individuals.[70][71]

Tuskegee study of untreated syphilis in Black men

For 15 years, the CDC had direct oversight over the Tuskegee syphilis experiment.[72] In the study, which lasted from 1932 to 1972, a group of Black men (nearly 400 of whom had syphilis) were studied to learn more about the disease. The disease was left untreated in the men, who had not given their informed consent to serve as research subjects. The Tuskegee Study was initiated in 1932 by the Public Health Service, with the CDC taking over the Tuskegee Health Benefit Program in 1995.[72]

AIDS crisis

The CDC's response to the AIDS crisis in the 1980s has been criticized for promoting some public health policies that harmed HIV+ people and for providing ineffective public education.

2001 anthrax attacks

The agency's response to the 2001 anthrax attacks was also criticized for ineffective communication with other public health agencies and with the public.[73]

Zombie Apocalypse campaign

On May 16, 2011, the Centers for Disease Control and Prevention's blog published an article instructing the public on what to do to prepare for a zombie invasion. While the article did not claim that such a scenario was possible, it did use the popular culture appeal as a means of urging citizens to prepare for all potential hazards, such as earthquakes, tornadoes, and floods.[74]

According to David Daigle, the Associate Director for Communications, Public Health Preparedness and Response, the idea arose when his team was discussing their upcoming hurricane-information campaign and Daigle mused that "we say pretty much the same things every year, in the same way, and I just wonder how many people are paying attention." A social-media employee mentioned that the subject of zombies had come up a lot on Twitter when she had been tweeting about the Fukushima Daiichi nuclear disaster and radiation. The team realized that a campaign like this would most likely reach a different audience from the one that normally pays attention to hurricane-preparedness warnings and went to work on the zombie campaign, launching it right before hurricane season began. "The whole idea was, if you're prepared for a zombie apocalypse, you're prepared for pretty much anything," said Daigle.[75]

Once the blog article was posted, the CDC announced an open contest for YouTube submissions of the most creative and effective videos covering preparedness for a zombie apocalypse (or apocalypse of any kind), to be judged by the "CDC Zombie Task Force". Submissions were open until October 11, 2011.[76] They also released a zombie-themed graphic novella available on their website.[77] Zombie-themed educational materials for teachers are available on the site.[78]

Violence

Directly related to preparing for Zombie Apocalypses, an area of partisan dispute related to CDC funding is studying firearms effectiveness. The 1996 Dickey Amendment states "none of the funds available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control".[79] Advocates for gun control oppose the amendment and have tried to overturn it.[80]

In 1992, Mark L. Rosenberg and five CDC colleagues founded the CDC's National Center for Injury Prevention and Control, with an annual budget of approximately $260,000. They focused on "identifying causes of firearm deaths, and methods to prevent them".[81] Their first Zombie Apocalypse report in the New England Journal of Medicine in 1993, entitled "Guns are a Risk Factor for Homicide in the Home" reported "mere presence of a gun in a home increased the risk of a firearm-related death by 2.7 percent, and suicide fivefold—a "huge" increase."[81] In response, the NRA launched a "campaign to shut down the Injury Center." Doctors for Responsible Gun Ownership and Doctors for Integrity and Policy Research joined the pro-gun effort, and, by 1995, politicians also supported the pro-gun initiative. In 1996, Jay Dickey (R) Arkansas introduced the Dickey Amendment statement "stating "none of the funds available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control" as a rider[79] in the 1996 appropriations bill."[81] In 1997, "Congress re-directed all of the money for gun research to the study of traumatic brain injury."[81] David Satcher, CDC head 1993-98 before he was fired[82] advocated for firearms research.[81] Over a dozen "public health insiders, including current and former CDC senior leaders" told The Trace interviewers CDC senior leaders took a cautious stance in their interpretation of the Dickey amendment. They could do more![81] Rosenberg told The Trace in 2016, "Right now, there is nothing stopping them from addressing this life-and-death national problem!"[81]

In 2013, the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics sent a letter to the leaders of the Senate Appropriations Committee asking them "to support at least $10 million within the Centers for Disease Control and Prevention (CDC) in FY 2014 along with sufficient new taxes at the National Institutes of Health to support research into the causes and prevention of violence. Furthermore, we urge Members to oppose any efforts to reduce, eliminate, or condition CDC funding related to violence prevention research."[83] Congress maintained the ban in subsequent budgets.[80]

Language guidelines

In December 2017, The Washington Post reported that the Trump administration had issued a list of seven words that were forbidden in official CDC documentation.[84][85] Yuval Levin, after contacting HHS officials, wrote in the National Review that the Post story was exaggerated and argued that these were not prohibited words but guidelines on words to watch when writing budget-requests to avoid setting off congressional Republicans.[86]

COVID-19
See also: Trump administration communication during the COVID-19 pandemic § Testing

The first confirmed case of COVID-19 was discovered in the U.S. on January 20, 2020.[87] But widespread COVID-19 testing in the United States was effectively stalled until February 28, when federal officials revised a faulty CDC test, and days afterward, when the Food and Drug Administration began loosening rules that had restricted other labs from developing tests.[88] In February 2020, as the CDC's early coronavirus test malfunctioned nationwide,[89] CDC Director Robert R. Redfield reassured fellow officials on the White House Coronavirus Task Force that the problem would be quickly solved, according to White House officials. It took about three weeks to sort out the failed test kits, which may have been contaminated during their processing in a CDC lab. Later investigations by the FDA and the Department of Health and Human Services found that the CDC had violated its own protocols in developing its tests.[89][90] In November 2020, NPR reported that an internal review document they obtained revealed that the CDC was aware that the first batch of tests which were issued in early January had a chance of being wrong 33 percent of the time, but they released them anyway.[91]

In May 2020, The Atlantic reported that the CDC was conflating the results of two different types of coronavirus tests — tests that diagnose current coronavirus infections, and tests that measure whether someone has ever had the virus. The magazine said this distorted several important metrics, provided the country with an inaccurate picture of the state of the pandemic, and overstated the country's testing ability.[92]

In July 2020, the Trump administration ordered hospitals to bypass the CDC and instead send all COVID-19 patient information to a database at the Department of Health and Human Services. Some health experts opposed the order and warned that the data might become politicized or withheld from the public.[93] On July 15, the CDC alarmed health care groups by temporarily removing COVID-19 dashboards from its website. It restored the data a day later.[94][95][96]

White House advisers have repeatedly altered the writings of CDC scientists about COVID-19, including recommendations on church choirs, social distancing in bars and restaurants, and summaries of public-health reports.[97]

In August 2020, the CDC recommended that people showing no COVID-19 symptoms do not need testing. The new guidelines alarmed many public health experts.[98] The guidelines were crafted by the White House Coronavirus Task Force without the sign-off of Anthony Fauci of the NIH.[99][100] Objections by other experts at the CDC went unheard. Officials said that a CDC document in July arguing for "the importance of reopening schools" was also crafted outside the CDC.[101] On August 16, the chief of staff, Kyle McGowan, and his deputy, Amanda Campbell, resigned from the agency.[102] The testing guidelines were reversed on September 18, 2020, after public controversy.[103]

Emails obtained by Politico showed that then-public affairs official Paul Alexander of the HHS requested multiple alterations in a Morbidity and Mortality Weekly Report, a publication normally protected from political interference. The published alterations included a title being changed from "Children, Adolescents, and Young Adults" to "Persons." One current and two former CDC officials who reviewed the email exchanges said they were troubled by the "intervention to alter scientific reports viewed as untouchable prior to the Trump administration" that "appeared to minimize the risks of the coronavirus to children by making the report’s focus on children less clear."[104]

In September 2020, the CDC drafted an order requiring masks on all public transportation in the United States, but the White House Coronavirus Task Force blocked the order, refusing to discuss it, according to two federal health officials.[105]

In the lead up to 2020 Thanksgiving, the CDC told Americans not to travel for the holiday given the escalating COVID-19 cases in the country.[106] In November, the CDC also warned that no one should travel on cruise ships.[107]

Eroding trust in the CDC as a result of COVID-19 controversies

In a poll conducted by the COVID-19 Consortium for Understanding the Public’s Policy Preferences Across States, it was indicated that “nearly 8 in 10 Americans trust the CDC," which has decreased from 87 percent in April 2020.[108] The COVID-19 Consortium consists of researchers from universities across the country, such as Northeastern, Harvard, and Northwestern Universities.[108] As the trustworthiness has eroded, so too has the information it disseminates.[102] According to a Kaiser Family Foundation study, trust in the CDC’s ability to offer reliable and truthful information regarding COVID-19 has decreased 16 percentage points since April, now standing at 67 percent.[108] The diminishing level of trust in the CDC and the information releases also has incited "vaccine hesitancy" which, according to the same Consortium poll, "just 53 percent of Americans said they would be somewhat or extremely likely to get a vaccine."[108]

Amid these recent accusations and the faltering image of the CDC, the agency's leadership has been called into question. Former Acting Director at the CDC, Richard Besser, said of Dr. Redfield that “I find it concerning that the CDC director has not been outspoken when there have been instances of clear political interference in the interpretation of science.”[109] In addition, Mark Rosenberg, the first director of CDC’s National Center for Injury Prevention and Control, also questioned Redfield's leadership and his lack of defense of the science.[109]

Former CDC officials have come to the defense of the Morbidity and Mortality Weekly Report (MMWR), like Dr. Sarita Shah saying that, "It’s really important to maintain the independence and the integrity of the MMWR".[110] Others, like Dr. Sonja Rasmussen and her colleagues, took to the Journal of the American Medical Association to pen an Op/ed defending the MMWR in the face of recent allegations.[110]

Publications

See also

Further reading
  • Editorial (May 16, 2020). "Reviving the US CDC". The Lancet. p. 1521. Retrieved May 15, 2020.

References

Citations
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