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Last Updated

14 Dec 2002

Source: Wall Street Journal, November 14, 2001.

CDC Is Stretched Thin as It Takes A Lead Role Fighting Bioterrorism


ATLANTA -- Two days after the Sept. 11 terrorist attacks, disease detectives crammed into a hallway here at the Centers for Disease Control and Prevention. Their plan: depart the next morning for New York City to watch for a feared bioterrorism attack.

But first the epidemic intelligence officers had to scramble to download the proper software onto their laptop computers so they could file reports to Atlanta. And other equipment was lacking altogether. Under an $11 million budget that hasn't increased in four years, the CDC's epidemic intelligence service doesn't have the money to outfit its elite squad of medical sleuths with all the communications gear they need.

"I'd love to get every officer a two-way beeper," says Doug Hamilton, the veteran epidemic officer who deployed 34 of his troops to New York. "We can't afford it."

The CDC, part of the U.S. Department of Health and Human Services, has long had to beg for help in its investigation of mysterious death and disease. It acquired the property for its main Atlanta campus only after Coca-Cola Co. baron Robert Woodruff helped give the agency land on the cheap in the 1940s. In the past two years, prominent Atlantan executives, including Home Depot Inc. co-founder Bernard Marcus and officials from BellSouth Corp. and United Parcel Service Inc., took it upon themselves to lobby for funding for the CDC after touring the agency's campus. "As we walked through, it was almost like, 'This has to be a joke,' " says Phil Jacobs, the head of BellSouth's Georgia operations.

Now that the battle against bioterrorism has emerged as a top national priority and the CDC is on the front lines, fixing the agency's problems are more urgent than ever. In addition to aging facilities and a lack of adequate technology, the agency has struggled with poor financial controls.

Its budget has nearly doubled to $4.2 billion in the past three years, but the extra money is spread across dozens of health programs. Work on infectious diseases and bioterrorism vies for dollars with research programs on issues as varied as carpal tunnel syndrome and teen smoking. In addition, more than 70% of the agency's budget is passed on to state and local health departments.

Now, Congress seems poised to boost spending to fight bioterrorism, but the bulk of any increase is likely to go toward buying additional smallpox vaccine and expanding the national pharmaceutical stockpile under the auspices of the CDC. Under a plan being developed by Sens. Edward Kennedy, a Massachusetts Democrat, and Bill Frist, a Tennessee Republican, state and local health departments may get as much as $1 billion to prepare for bioterrorism, and the CDC could get up to $200 million above its regular $4 billion budget. But the extra funding faces several hurdles, including President Bush's warnings to Congress that he will veto excessive spending.

Even as it has fought for funds, the CDC has had significant victories over the past five decades. The agency opened its doors in 1946 to fight malaria in the South. By 1950, the threat of malaria had subsided thanks to the CDC's work. But the start of the Korean War introduced the threat of biological warfare. Alexander Langmuir saw a need for an early-warning system against man-made epidemics and created the Epidemic Intelligence Service within the CDC in 1951. The symbol for the new epidemic office was a worn shoe sole inside a globe, representing the exhaustive detective work the service carried out world-wide.

In one of its biggest triumphs, the CDC helped to wipe out smallpox in the 1960s and 1970s. In 1976, the CDC sent a team of officers to investigate why more than two dozen men at an American Legion meeting at a Philadelphia hotel had died suddenly. The eight-month investigation tracked the so-called Legionnaires' bacterium to a contaminated water-supply system in the hotel air-conditioning unit. The long fight against AIDS began in the early 1980s. And the service has investigated numerous outbreaks of Ebola in Africa over the past 20 years.

Back at home, the CDC faced problems with aging facilities and arcane accounting systems. A government audit and an outside consultant have criticized the agency for "significant weaknesses" in its financial management. "Science rules in CDC's culture," a PricewaterhouseCoopers LLC study reported last year. "While the business of CDC is indeed science, this maxim has led to a culture that has not recognized the value of financial management."

Last year, the CDC hired PricewaterhouseCoopers to help improve its arcane budgeting process. Under pressure from the General Accounting Office, it also hired a top finance officer with an accounting degree. Its other two top finance executives don't have accounting backgrounds.

Virginia Bales, a CDC deputy director and chief financial officer, says that in response to auditors' concerns, her office has provided financial training to more than 1,000 CDC managers in the past two years and more than doubled the number of agency accountants over the same period. "We've made huge strides in financial management excellence," says Ms. Bales.

Meanwhile, some of the agency's top scientists still work in World War II-era Quonset huts where tarps shield expensive lab equipment from leaky roofs. Potential hires have walked away after seeing the aging brick campus and other facilities. Last month, an old power line fried, delaying critical lab tests of anthrax samples for 12 hours. Despite security concerns, meetings last week to train dozens of CDC employees on how to respond to a smallpox outbreak were moved to an offsite location because of a space crunch at the CDC's main campus at Emory University.

Under CDC director Jeffrey Koplan, the agency has been making progress on renovating its facilities. Dr. Koplan, who toiled in a windowless cubbyhole early in his CDC career, has sought to compress a 10-year building plan to five years. He has had help. After their tour of the agency, Mr. Jacobs and other Atlanta executives formed the Friends of CDC. They hired a Washington lobbyist and helped win the CDC $175 million in building funds last year, triple what it had the previous year. A Senate proposal would grant the CDC $250 million in construction money this year.

High on the priority list is the office where deliveries are made -- and where a bomb could be detonated. The office is too close to the labs that hold killer viruses. Plans call for the delivery station to be moved beyond the agency's perimeter.