Director's perspective—Jeffrey P. Koplan, M.D., M.P.H., 1998-2002

Morbidity and Mortality Weekly Report,  August 24, 2007  by Jeffrey P. Koplan

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CDC: Known and Trusted

CDC approached the new millennium with strong programs, strong partners, and a strong reputation. Emblematic of scientific integrity, evidence-based information, and public trust, the quality of CDC's "brand" rivaled any in corporate America and was unique among federal agencies. CDC built on this brand recognition to advance its public health mission into the 21st century. Introduction of a new design element (Figure 1) showcased the agency as a valuable federal asset.

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Beyond the importance of name recognition was the real substance of what CDC and public health represented to the nation and to the world. Taking a cue from the "top 10" lists proliferating at the end of the century, a series in the Morbidity and Mortality Weekly Report (MMWR) distilled reflections about 10 major public health accomplishments into a case for the value of public health (1). Each of the 10 breakthroughs highlighted an achievement that had a profound effect on the length and quality of the lives of Americans. The series celebrated achievements in immunizations, motor-vehicle safety, safer workplaces, control of infectious diseases, reduced deaths from coronary artery disease and stroke, safer and healthier foods, healthier mothers and infants, family planning, fluoridation of drinking water, and recognition of tobacco use as a health hazard. This inventory of landmark accomplishments provided rich material to demonstrate the value of public health and remains an inspiration for future achievements.

The 50th anniversary of the Epidemic Intelligence Service (EIS), a year-long celebration starting in February 2001, provided another opportunity to reflect on past successes (2). For the agency's premier cadre of epidemiologists, known worldwide for their esprit de corps and service on the front lines (Figure 2), the recognition illuminated a half-century of work in responding to thousands of public health threats around the globe, from polio to toxic shock, asthma to Ebola. The EIS began during the Cold War as a response to the threat of biological warfare and manmade epidemics. In its 50th year, the EIS came full circle when called on to respond to the terrorist attacks in the fall of 2001.

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To launch the agency into the 21st century, CDC identified three areas for priority attention. These priority areas were 1) improving the science base to drive public health programs; 2) renovating and investing in the public health infrastructure; and 3) expanding CDC's role in global health.

Maintaining the Basics of Public Health

CDC's accomplishments have always stemmed from broad-based programs grounded in the underpinnings of public health: epidemiology, surveillance, laboratory science, education and communication, policy intervention, and preparedness (3). These programs not only save lives but also improve the quality of life.

Since CDC's early years, the agency has counted immunization among its most vital programs, recognizing it as a core public health activity and perhaps the best example of primary prevention. With measles elimination as the main driver, the National Immunization Program achieved major advances in coverage and health impact and provided lessons for the future.

At the beginning of the 21st century, childhood immunization levels in the United States were at or near record highs, and most vaccine-preventable diseases were at record lows (4). Racial and ethnic disparities in vaccination coverage had also been markedly reduced. As the culmination of a 34-year effort, measles was declared no longer endemic in the nation, and the Western Hemisphere was close to interrupting measles transmission (5) and moving toward elimination of rubella.

Other achievements were less obvious but no less important. As chronicled in MMWR, CDC continued to respond routinely to outbreaks and to address risk factors for adverse health outcomes. One of these success stories was the decrease in neural tube defects resulting from the requirement, as of 1998, that manufacturers add folic acid to enriched flour and non--hole-grain products (6).

Along with the familiar outbreaks of infectious diseases, CDC also tackled a parade of unusual epidemics and new and unforeseen threats. Increased travel and migration, international trade and global transport of foods and other products, economic disruptions, and microbial adaptation accelerated and expanded the movement of disease. A new paramyxovirus, Nipah virus, was identified in 1999 as the cause of an outbreak of severe encephalitis in persons with close contact with pigs in Malaysia and Singapore (7). An outbreak in Saudi Arabia and Yemen in 2000 marked the first appearance of Rift Valley fever outside Africa (8). The summer of 1999 brought West Nile virus to New York City, the first time that this mosquito-borne virus was reported in the Western Hemisphere (9).

CDC renewed its commitment to infectious disease control in the face of these and other threats, including a virulent strain of avian influenza, a human variant of bovine spongiform encephalopathy, and new drug-resistant forms of Staphylococcus aureus, plus the heightened awareness of bioterrorism. Noteworthy new programs included FoodNet, an active surveillance network for foodborne disease; PulseNet, a molecular subtyping network that received Innovations in American Government awards in 1999 and 2002; and multifaceted programs to reduce antimicrobial resistance by decreasing unnecessary prescribing of and demand for antibiotics.