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

• E-mail
• Print
• Link

The agency mobilized its resources with characteristic speed, expertise, and resilience. In the largest response in CDC's history, more than 500 epidemiologic, laboratory, industrial hygiene, communications, and other staff were detailed from their regular jobs, laboratories were reassigned to anthrax investigations, field teams were established in the outbreak sites, and researchers worked 24-hour days on the investigation.

The events created formidable challenges in management, coordination, and communication at CDC and brought unprecedented public scrutiny as the agency coped with the evolving outbreak itself and fast-track preparations for its new role in the war on bioterrorism. Public health agencies became part of the government-wide effort to combat bioterrorism, in partnership with agencies responsible for security and law enforcement, emergency response, intelligence, and the military. Preparation for a potential bioterrorism attack spotlighted the importance of identifying unusual health events early and responding rapidly in a highly coordinated fashion to prevent large-scale devastation.

The events also provided vivid examples of the importance of a stronger public health infrastructure. For example, news stories recounting how county and state public health officials investigated the first and subsequent cases of anthrax documented the value of strong local public health capacity (17). The rapid recognition of anthrax by a laboratorian in the Florida Department of Health, who recently had been instructed in anthrax diagnosis at CDC, demonstrated the importance of training and workforce development. In response to this unprecedented attention and recognition, CDC funding to state and local health departments for terrorism preparedness was increased to a historic $1 billion in fiscal year 2002.

The Shared Agenda of Global Health

On the eve of the new millennium, CDC's global linkages were evident. The spread of infectious diseases from developing to developed countries, the opposite movement of unhealthy habits like smoking and reliance on motor vehicles, and concerns about health security were creating a common public health agenda worldwide, and CDC was committed to expanding its activities in support of global health (18). This involved forging stronger ties with the World Health Organization (WHO), recognizing that its successes and CDC's were integrally aligned, and enhancing existing ties with the World Bank to address the development challenges of the 21st century.

With the worldwide eradication of polio seemingly within reach, CDC created the STOP (Stop Transmission of Polio) program in 1998, in collaboration with WHO and other partners. Modeled on the teams recruited from CDC to interrupt transmission of smallpox in the final phase of eradication, the program mobilized short-term CDC teams to provide field support for local polio eradication efforts.

CDC's Global AIDS Program (GAP) began in 2000 and now works in 25 countries with a budget of more than $700 million. GAP leverages CDC's efforts to prevent HIV infection, improve care, and build capacity to address the growing global HIV/AIDS pandemic. The program provides financial and technical assistance through partnerships with communities, governments, and national and international entities working in resource-constrained countries.