"Off with their heads!"

Internal Dissension Grows as CDC Faces Big Threats to Public Heath
6 March 2005, Rob Stein, The Washington Post

excerpt:

The Centers for Disease Control and Prevention is being roiled by internal dissension as the nation's top public health agency is facing such unprecedented threats as bioterrorism, a potential flu pandemic and the obesity epidemic, say current and former officials and several outside experts.

The Atlanta-based agency has been thrown into turmoil by a combination of factors, including the upheaval of a drawn-out restructuring, the departure of dozens of its most respected scientists, concerns about political interference and a pending budget cut of nearly $500 million, they say.

Although the impact remains a matter of debate, the uproar is causing widespread alarm among public health authorities, and some say the deep discord may have already contributed to several recent crucial missteps, including confused messages during this winter's flu vaccine shortage, an embarrassing error in a highly publicized estimate of obesity's toll, and a failed program to vaccinate hundreds of thousands of front-line health workers against smallpox to prepare for a possible bioterrorist attack.

Last week, an independent panel of the National Academy of Sciences criticized the CDC for failing to provide clear leadership in the smallpox vaccination campaign and suggested that political 'constraints' imposed by Washington played a role.

The tumult has been exacerbated, say some current and former agency employees, by CDC Director Julie L. Gerberding's management style. Her critics say she tends to squelch open discussion and has failed to protect the agency from the specter of deep budget cuts and undue influence from Washington.

Taken together, the turbulence at the agency has created a 'crisis of confidence' and an atmosphere of fear in which employees feel 'cowed into silence,' wrote one top CDC official, Robert A. Keegan, in a widely circulated memo to Gerberding and other top leaders.

"I think there is a crisis," added Keegan, deputy director of the global immunization division, in a phone interview. "Clearly there is a real problem with morale. People are feeling tired and frustrated and don't know where we're headed."

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"I would describe it as a kind of Alice in Wonderland environment where the CDC director is like the Queen of Hearts," the senior official said. "You know, 'Off with their heads.' It's a very autocratic and unpredictable environment."