Officials from the Centers for Disease Control and Prevention (CDC) have been disoriented when Richard Horton, editor of the Lancet , February 11 published reviews the institution's Centre for global health that he had received an anonymous letter. But CDC kept mum. When Horton ran complaints by two most anonymous reviewers center CDC March 3, CDC Director Thomas Frieden and the head of the division under attack, Kevin De Cock, decided to take the criticisms point by point, that they are in a rebuttal (PDF) yesterday appeared online in on Lancet.
CDC formed the Centre for Global Health there are 18 months to meet five major programs of work in this area. In addition to specialty center for HIV / AIDS De Cock has divisions that focus on parasitic diseases and malaria, the global disease detection and emergency response, health systems strengthening and global immunization . The center has a budget of more than $ 300 million, employs 1,100 staff, and has people on the ground in 55 countries.
The first letter writer asked that an "objective assessment" of the program took place, claiming that the center needed a change of direction and "looks more and more like a big missed opportunity. " Excerpts of two letters, which appeared under the title, "Is CDC an organization based on science," was even more severe, suggesting that a congressional investigation "might be in order." As noted by Horton, the letters "raise questions on leadership, resource management, proper use of authority and power to the CDC, and the scientific rigor of the research CDC."
No complaints offer specific examples, and many more severe attacks are the opinion which can neither be proved or disproved: staff morale is "very low", there are "huge amounts of tension and confusion, "" there is no strategic direction ... other than spending money at lightning speed, "and employees have not talked about waste" for fear of losing their jobs . "But others are lined questions of fact. Contractors working abroad purportedly deliver "low quality products and services with minimum supervision and appropriate monitoring." It is supposed to be a "duplication," a rivalry between the CDC and the US Agency for International Development that affect programs in the country, "inappropriate" use of funds. "We were surprised and puzzled," De Cock said, adding that "no evidence for the claims being made has been presented."
The refutation of the CDC, measured in tone, says the center's achievements in the epidemiology training course, in collaboration with ministries of health in many countries, and countries in helping emergency sanitary fight. The center has helped efforts against HIV / ADS, malaria, cholera, cryptic liver disease, plague, measles, lymphatic filarisis, and polio. Frieden and De Cock also note that CDC last year began a program review.
De Cock accepts that there is room for improvement in its organization. "We do not claim to be a perfect organization," he said. And he acknowledges that tensions exist with other US government agencies. "It is no secret that the collaboration between the different intra-governmental organizations can be challenging," said -he.
The allegations of waste, he says, are unfounded. "If you make global health, you must travel," he said. "People travel in economy class, unless you have a health reason." It characterizes the claim that a central evaluation is "long" absurd. "Long delay?" he asks. "When this assessment should have been done? We are 18 months. "
Horton said the letters were from CDC members of staff who raised concerns internally, but were ignored." They felt that their only recourse was to us Contact "says Horton." It seems that it is the responsibility of the CDC to listen to the questions raise and executives to address these issues appropriately. According to our correspondents, which was not done in this case. "
De Cock firmly rejects the idea that there is a culture of repression and intolerance of dissent." We are committed as an organization to open scientific debate, "he said." I committed to this. "in his view, this is a" golden moment "in efforts global health of the CDC as it is "a top priority for the agency."
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