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Key scientists leave Centers for Disease Control
The Atlanta Journal-Constitution
Published on: 09/10/06

An exodus of key leaders and scientists from the Centers for Disease Control and Prevention has raised "great concern" among five of the six former directors who led the agency over the past 40 years.

Their concerns, expressed in a rare joint letter to current CDC Director Julie Gerberding, come amid growing staff complaints about whether her strategic shifts in the agency's focus are putting public health at risk, according to interviews with current and former CDC officials and documents obtained by The Atlanta Journal-Constitution.Critics say the agency is changing to a top-down management style that stifles science and that new layers of bureaucracy are being created that make agency operations more cumbersome.

The most visible sign of potential trouble at CDC is the loss of more than a dozen high-profile leaders and scientists since 2004. By the end of this year, all but two of the directors of CDC's eight primary scientific centers will have left the Atlanta-based federal agency. The wave of departures — which numerous CDC leaders call unprecedented — also includes the agency's top vaccine expert and world experts in several diseases. Just last week CDC's pandemic flu coordinator said he's leaving.

As the nation's 9-1-1 for public health, CDC is responsible for preventing and tackling outbreaks, bioterrorism and pandemics, along with the more routine, deadly threats of seasonal flu, HIV, rabies, injuries and obesity.

The urgency of these missions has current and former CDC scientists deeply concerned the agency's new strategy of looking at health issues broadly and reorganizing its divisions puts it on a course to potential disaster, causing it to lose its footing, like FEMA did before it faced Hurricane Katrina.

Gerberding and top officials at the Department of Health and Human Services, CDC's parent agency, credit the strategic changes with putting the agency in its best position ever to respond to the threats of a modern world. And they point to a host of accomplishments as evidence of the agency's continued prowess — from development of a faster test for botulism to groundbreaking genetic research on bird flu to outbreak responses.

"I think we have been incredibly high-performing throughout this period of time," Gerberding said in an interview.

Still, Gerberding said she will be hiring a first-ever employee ombudsman for the CDC. It's an attempt to address a crescendo of employee concerns, which in recent months have included criticism of the reorganization's merits, a whistleblower alleging CDC mismanagement of bioterrorism funds, and lunch-time picketing by minority employees claiming discrimination, CDC officials said.

Gerberding said some low morale is to be expected as the agency enters its third year of her sweeping effort to broaden CDC's approach to health issues, changing its organizational chart from deep silos of expertise on individual diseases to a wider structure meant to encourage more collaboration on broader health issues.

It's a process that has plunged much of the agency's leadership into time-consuming meetings and has generated significant angst as long-standing divisions have been shuffled or eliminated. For instance, CDC's old National Center for Infectious Diseases has had its components broken apart and spread across four newly created "national centers." While they all remain under one newly created "coordinating center," disease experts are scattered in a way that some fear will make communication and innovation more difficult.

Assistant Secretary for Health John Agwunobi said change is always difficult and that Gerberding's transformation of the agency is vital to the nation's future.

"CDC is delivering on its mission, some would say better than it ever has done," said Agwunobi, whose department oversees CDC. "We have great confidence in Julie Gerberding."

Others are less confident in the direction CDC is headed.

"You're seeing a gradual erosion into the scientific base, and that's very worrisome," said Dr. David Sencer, one of five former CDC directors who sent the joint letter of concern to Gerberding in December, then met with her this spring.

Statements like this from some of the nation's top scientists are what has caused the Senate Finance Committee to become "deeply concerned," said U.S. Sen. Charles Grassley, its chairman. The committee, prompted by a CDC whistleblower, is probing CDC's oversight of a $3.8 billion bioterrorism grant program. It's also examining reports that turmoil in the agency is putting its scientific mission at risk.

"The citizens of the United States fully expect that in the event of natural disasters, attacks by bioterrorists, and outbreaks of life-threatening diseases, the agencies of their federal government will quickly and effectively respond to those situations," said Grassley, R-Iowa.

The Journal-Constitution has found it difficult to quantify whether the agency's ability to respond in a crisis has been significantly harmed. Grassley's investigators have experienced similar difficulty.

But Grassley said: "The beliefs expressed by those experts cannot be safely ignored or minimized."

Examining the exodus

The CDC is one of the most trusted agencies of the federal government, one that is unique in its mission, its location outside the nation's capital, and its work force of world-class experts and public health professionals driven by a noble and critical purpose. Locally, CDC and its 9,000 employees and 5,000 contractors are part of the fabric of Atlanta — people proud and protective of their agency.

To Gerberding and her top management team, the current spate of departures and ongoing morale issues are the result of a confluence of many factors. They include budget cuts imposed by Washington, a shift in funding away from traditional diseases toward the more high-profile threats of terrorism and pandemics, and an aging federal work force.

Add to all that the stress of the agency reorganization.

"I don't know any organization that's gone through significant change where morale hasn't been an issue," Gerberding said. "But I don't like the fact that it is an issue here. And I can assure you that all of us are taking the situation very seriously and listening and trying to understand the things that we can fix and try to improve our ability to cope with the things that we can't fix."

The chorus of strongly voiced concerns coming from inside the agency is what alarmed five former CDC directors and spurred them to send the joint letter to Gerberding on Dec. 22.

"We have all gone through periods of change and recognize the difficulties attendant to change. However, we are concerned about the previous and impending losses of highly qualified and motivated staff," wrote former CDC directors Dr. William Foege, Dr. James Mason, Dr. David Satcher, Dr. Jeffrey Koplan and Sencer.

Their leadership of the agency spans Republican and Democratic administrations dating back to 1966.

"We are concerned that so many of the staff have come to us to express their concerns about the low morale in the agency. We are concerned about the inability of many of the partners to understand the direction in which CDC is headed," they said in the letter.

"I think all of us were receiving virtually constant messages from staff expressing concerns about morale and their ability to do their work — and all of it unsolicited," Koplan said in a recent interview. He preceded Gerberding as CDC director and now is vice president for academic health affairs at Emory University's Woodruff Health Sciences Center.

The CDC staff members who are raising concerns, Koplan said, are not complainers.

"In my 34 years of affiliation with the CDC, I've never seen this level of concern," Koplan said. "The rate and number of turnover has been exceptional. And it's not just senior leadership, which would be huge in and of itself."

Retirements among one category of scientists last year was up 77 percent over previous years, CDC employment data show.

Foege, Mason and Satcher did not grant interviews. Dr. William Roper, who was CDC director during the administration of President Bush's father, was the lone former director who was not a part of the letter. Roper declined to comment about the letter.

Gerberding said she welcomed the former directors' input. "They brought the ombudsman idea forward. It was something we had already considered, but not quite in the way they had framed it."

Two contractors will initially act as ombudsmen as they research what the permanent job will entail.

Gerberding said she remains in contact with the former CDC directors. "I think they're like I would be when I'm no longer the director: Concerned, but respectful of the fact that they're not seeing the whole picture either."

Scientists break silence

Until now, many of the agency's current and former scientists have refused to talk publicly about what they see as the agency's problems. Concern has reached critical mass in recent months, prompting even some who are still employed by the agency to fear that staying silent will do more harm to CDC than airing the agency's laundry in public.

They say changes at the agency are putting CDC's performance at risk.

"The sense I get is a lot of the decision-making and a lot of the resources are getting moved away from the scientific underpinnings of the agency," said Dr. Stephen Ostroff, who was deputy director of CDC's National Center for Infectious Diseases until he left the agency last year. Ostroff was a leader of CDC's much praised responses to outbreaks of SARS and monkeypox.

"I think there really is the potential for lots of people to take their eye off the ball because they're so heavily engaged in so many of these other things going on in the agency: the reorganization and goals management," Ostroff said.

In a memo to Gerberding last fall, the agency's Division Directors Council warned that her plans to adopt 21 new agency goals simultaneously involved a "risky" diversion of staff time and "will produce even greater confusion and threaten our ability to meet CDC's ongoing commitments."

Dr. Harold Margolis, one of several high-profile scientists who has left CDC since 2004, cited the all-consuming reorganization and a shift away from letting science drive programs as some of the reasons for his departure.

CDC's historic success, he said, has been driven by good science. "It was generated from a lot of smart people working together from the bottom. The point was it was not dictated from the top," said Margolis, who was chief of CDC's viral hepatitis division for 17 years.

Dr. Stephen Cochi, a senior adviser in CDC's Global Immunization Division, said the agency's staff is proud of its history of successfully tackling public health problems.

"The capacity of CDC to do that has been seriously eroded in a very short period of time," Cochi said. "The American people need to be concerned."

Cochi, like others, said scientists are less empowered to make decisions, are discouraged from offering alternative approaches to solving problems, and face increased layers of bureaucracy that make it more difficult to do their jobs.

Cochi, who has been at CDC for 25 years, is featured in a CDC film about polio eradication played prominently in the agency's new visitors center.

Cochi received a disciplinary letter last fall for sending an e-mail to staff — while he was acting director of CDC's National Immunization Program — that was critical of the reorganization's potential impact. Cochi was not chosen to be a permanent director.

"I believe there is a danger," he wrote, that the National Immunization Program "may become less focused, and have more bureaucratic obstacles imposed on it. I am particularly concerned about budget cuts and redirections of immunization program dollars."

In a Nov. 30 disciplinary letter, Dr. Mitchell Cohen, director of CDC's newly created Coordinating Center for Infectious Diseases, told Cochi: "These statements are misleading, inaccurate, or are in contrast to the intent of the proposed reorganization."

Cohen's letter said Cochi should be well aware that the intent of the reorganization is to strengthen the agency. "It is important to note that as a part of the senior management team, you are obligated to support the agency's executive leadership decisions."

Declining morale, trust

Various personnel surveys of CDC staff, analyzed by the Journal-Constitution, have documented increasing employee concerns about the agency's direction, trust in its leaders and the adequacy of agency resources.

Yet even with the declining morale indicators, about two-thirds of CDC employees say they are satisfied with their individual jobs and would recommend the agency as a good place to work.

Dr. Kevin Fenton, one of the new slate of center directors promoted in the wake of the departures, said many employees embrace Gerberding's vision for the new CDC.

"What you have is a real mixture of opinions depending on who you speak to and where they are in their career trajectory," said Fenton, who joined CDC in January 2005. Last November, he was promoted to director of CDC's national center for HIV, sexually transmitted diseases and tuberculosis. "I can see why we need to change," he said, but "that rationale for change may not have been articulated clearly enough or widely enough or repeatedly enough to sink in."

Despite numerous task forces and listening sessions that Gerberding said she held to ensure the reorganization has been inclusive, there is skepticism. Some believe that the efforts were largely for show.

And there is a specific distrust of Gerberding herself and the agency's chief operations officer Bill Gimson, according to interviews with their supporters and detractors. That's coupled with what some say is a climate of fear that discourages honest communication, and an effort to "spin" the official information disseminated to employees.

"They don't trust Julie and Bill," said Dr. Dixie Snider, who retired this summer after working in CDC's Office of the Director for 13 years, including since 2004 as Gerberding's Chief Science Officer. "It's a reality that the leadership is aware of. I think everybody is just befuddled about how do you fix that."

Trust issues range from a general lack of confidence that CDC's leadership will "do the right thing" when faced with political pressure from Washington; to questions of whether the reorganization was motivated more by a desire for control and power than designed to fix anything that was broken; to a belief that official staff communications are designed more to burnish a public relations image than give employees the unvarnished truth, according to interviews.

Snider, who joined CDC in 1973, thinks the perception is unfair. He said Gerberding has been the most open and collaborative director he's worked with.

Gerberding is the first female CDC director, and is a relative newcomer to the agency, joining in 1998. In July 2002, she was tapped to head the agency following her high-profile role in leading CDC's response to the 2001 anthrax attacks. It was anthrax, Gerberding says, that showed her how CDC needed to be more nimble in working across its divisions.

The lack of trust in CDC's top leadership is publicly reflected in dozens of postings on an independent CDC employee blog that began publishing on the Internet in January, as well as in a governmentwide poll of federal employees. Between 2002 and 2004, CDC employees who said the agency's leaders maintained high standards of honesty and integrity dropped from 51 percent to 45 percent.

"There is a disconnect between what is said is happening and what we see or feel is happening," said Bob Keegan, creator of the blog www.cdcchatter.net, which he said gets about 30,000 hits a day. Keegan, deputy director of the CDC's Global Immunization Division, is a recipient of the agency's Watson Medal of Excellence, a top employee award.

Carlos Alonso, a health communication specialist in CDC's National Center for Health Marketing, is a reader of the blog, which he said "furnishes a sobering and welcome counterweight" to official CDC information.

"Suffice it to say that when respected employees of any organization decide to take to the streets, or design external blogs to voice frustrations and outrage, the commonly accepted avenues of internal communication have either lost their credibility, or broken down completely," said Alonso, a 23-year CDC employee.

Gerberding declined to be interviewed about the trust issues being raised by her staff.

Proof of harm?

A lack of trust, an exodus of leaders and a major reorganization is a potentially dangerous mix, said Donald Kettl, director of the Fels Institute of Government at the University of Pennsylvania.

"Can you spell FEMA? It's the same kind of issue that they faced," he said.

"If there is a high level of conflict and tension, it makes it hard for people who need to, to work together — and work well — because they need trust," Kettl said.

Kettl published an article in December lauding Gerberding's efforts during the anthrax crisis and how she's using those lessons to transform CDC. But he said he didn't examine whether the changes have helped or hurt the agency.

"The only proof of this is how an organization responds in a crisis," he said.

Gerberding and others in the agency's senior leadership point to CDC's responses to the deadly outbreak of Severe Acute Respiratory Syndrome (SARS), the monkeypox outbreak, the agency's handling of flu vaccine shortages in 2004 and response to Hurricane Katrina as proof the agency hasn't suffered.

But these examples don't appear to provide that proof, critics say. SARS and monkeypox happened in 2003 — as the reorganization was beginning and before the departure last year of two key leaders who ran those responses. Dr. James Hughes and Ostroff, the director and deputy director of CDC's National Center for Infectious Diseases left the agency last year.

CDC has received mixed reviews on its performance leading up to and after the vaccine shortage, according to reports by the Government Accountability Office and the Trust for America's Health, a nonprofit watchdog group. And Hurricane Katrina, while a huge rescue and humanitarian response that tested FEMA, was not a public health crisis for CDC.

"We really haven't had an infectious disease emergency since Jim and I have gone," Ostroff said. "I don't think the systems have been recently tested."

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