CDC chief poses framework for resolving future issues

Overcoming complacency is a first step toward resolving public health's mega-challenges.

By Susan J. Landers — Posted Oct. 2, 2006

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When Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH, came to George Washington University's School of Public Health and Health Services in Washington, D.C., on Sept. 12, she told the students how she had spent her weekend -- and it wasn't lounging in the sun.

Her agency was dealing with a possible toxic dump from a ship off the African coast that had allegedly killed several people. A policy statement was in the works on an extremely drug-resistant strain of tuberculosis. Disease detectives were in the process of alerting 150,000 people who attended a Tennessee horse show of their possible exposure to a rabid horse. And preparations were under way for the first joint conference of health promotion, chronic disease prevention and birth defect experts.

In the background, ongoing West Nile virus concerns and planning for a pandemic flu outbreak were also on the to-do list.

Fortunately, no one ran screaming from the room. Dr. Gerberding was urging the students to "step up to the plate." Her speech was the first in George Washington University's new Public Health Grand Rounds series.

Dr. Gerberding provided an outline for tackling the seemingly overwhelming issues that face public health. She numbered among those challenges the conflicts that are ravaging the world and severe climate changes that hold the potential to trigger even more serious natural disasters than have been seen recently.

Students must consider the roles played by complacency, capacity and connectivity in devising solutions, she said. For example, complacency may have been a reason that the nation was unprepared for the terrorist attacks of five years ago and for the devastation of Hurricane Katrina last year.

Facing big challenges

Both of those situations had been visualized before they occurred. A terrorist attack using planes as weapons was depicted in a best-selling novel, and the potential for severe hurricane damage on the Gulf Coast had been recognized for years.

But rather than prepare for these potential catastrophes, complacency took over, she said. A general rule is that the larger, more costly and more unpredictable the problem, the less likely it is that effective action will be taken, Dr. Gerberding said.

Initiative is needed to overcome this inertia. "We have to imagine threats and then initiate action and invigorate people through our passion and our communication and our ability to lay out a path to solutions," Dr. Gerberding told her audience.

The scale of the health challenges that loom is enormous, she allowed. If an avian flu pandemic on the same scale as that of the 1918 flu epidemic should strike, 745,000 Americans would need ventilators. "And I can assure you that if a pandemic struck in a year, we could not ventilate 745,000 people. We do not have the beds, the ventilators or the nurses and clinicians," she said. "So scaling up will be very hard to do and will require different standards than we are used to."

But the challenge is not insurmountable. "What you have to do is bring people together and get out of their way. When bureaucrats and governments try to control the process, it doesn't work."

Additional investment also will be necessary to prepare to handle such large-scale threats, she noted. And the effort won't be unprecedented.

"We have been there and done that," said Dr. Gerberding, pointing to the near-eradication of polio in the world. AIDS provides another opportunity for success, she said.

Recent progress has been bolstered by large contributions from the Bill and Melinda Gates Foundation, which itself was enhanced by funds from Warren Buffett, she said.

A good example of connectivity is the meeting between Irish rock band U2's lead singer Bono, Bill Gates and President Bush, she said.

George Washington University's Public Health Grand Rounds are sponsored by Pfizer as part of its Milestones in Public Health Series.

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External links

George Washington University's School of Public Health and Health Services for a webcast of remarks by CDC Director Julie Gerberding, MD, MPH, at launch of Public Health Grand Rounds, Sept. 12 (link)

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