The Centers for Disease Control and Prevention (CDC) is the leading national public health institute of the United States. The CDC is a federal agency under the Department of Health and Human Services and is headquartered in unincorporated DeKalb County, Georgia, a few miles northeast of the Atlanta city limits.[3][4]

Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability. The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens. In addition, the CDC researches and provides information on non-infectious diseases such as obesity and diabetes and is a founding member of the International Association of National Public Health Institutes.

History

The Communicable Disease Center was founded July 1, 1946, as the successor to the World War II Malaria Control in War Areas program[5] of the Office of National Defense Malaria Control Activities.[8] Preceding its founding, organizations with global influence in malaria control were the Malaria Commission of the League of Nations and the Rockefeller Foundation.[9] The Rockefeller Foundation greatly supported malaria control,[9] sought to have the governments take over some of its efforts, and collaborated with the agency.[10]

The new agency was a branch of the U.S. Public Health Service and Atlanta was chosen as the location because malaria was endemic in the Southern United States.[2] The agency changed names (see infobox on top) before adopting the name Communicable Disease Center in 1946. Offices were located on the sixth floor of the Volunteer Building on Peachtree Street. With a budget at the time of about $1 million, 59 percent of its personnel were engaged in mosquito abatement and habitat control with the objective of control and eradication of malaria in the United States[2] (see National Malaria Eradication Program).

Among its 369 employees, the main jobs at CDC were originally entomology and engineering. In CDC's initial years, more than six and a half million homes were sprayed, mostly with DDT. In 1946, there were only seven medical officers on duty and an early organization chart was drawn, somewhat fancifully, in the shape of a mosquito. Under Joseph Walter Mountin, the CDC continued to advocate for public health issues and pushed to extend its responsibilities to many other communicable diseases.[2] In 1947, the CDC made a token payment of $10 to Emory University for 15 acres (61,000 m2) of land on Clifton Road in DeKalb County, still the home of CDC headquarters today. CDC employees collected the money to make the purchase. The benefactor behind the “gift” was Robert W. Woodruff, chairman of the board of The Coca-Cola Company. Woodruff had a long-time interest in malaria control, which had been a problem in areas where he went hunting. The same year, the PHS transferred its San Francisco based plague laboratory into the CDC as the Epidemiology Division, and a new Veterinary Diseases Division was established.[5] An Epidemic Intelligence Service (EIS) was established in 1951, originally due to biological warfare concerns arising from the Korean War; it evolved into two-year postgraduate training program in epidemiology, and a prototype for Field Epidemiology Training Programs (FETP), now found in numerous countries, reflecting CDC's influence in promoting this model internationally.[2]

The mission of CDC expanded beyond its original focus on malaria to include sexually transmitted diseases when the Venereal Disease Division of the U.S. Public Health Service (PHS) was transferred to the CDC in 1957. Shortly thereafter, Tuberculosis Control was transferred (in 1960) to the CDC from PHS, and then in 1963 the Immunization program was established.[2]

It became the National Communicable Disease Center (NCDC) effective July 1, 1967.[8] The organization was renamed the Center for Disease Control (CDC) on June 24, 1970, and Centers for Disease Control effective October 14, 1980.[8] An act of the United States Congress appended the words "and Prevention" to the name effective October 27, 1992. However, Congress directed that the initialism CDC be retained because of its name recognition.[2]

Currently the CDC focus has broadened to include chronic diseases, disabilities, injury control, workplace hazards, environmental health threats, and terrorism preparedness. CDC combats emerging diseases and other health risks, including birth defects, West Nile virus, obesity, avian, swine, and pandemic flu, E. coli, and bioterrorism, to name a few. The organization would also prove to be an important factor in preventing the abuse of penicillin.

In May 1994 the CDC admitted having sent several biological warfare agents to the Iraqi government from 1984 through 1989, including Botulinum toxin, West Nile virus, Yersinia pestis and Dengue fever virus.[2]

On April 21, 2005, then-CDC Director Julie Gerberding, formally announced the reorganization of CDC to "confront the challenges of 21st-century health threats".[2] The four Coordinating Centers — established under the G. W. Bush Administration and Gerberding — "diminished the influence of national centers under [their] umbrella", and were ordered cut under the Obama Administration in 2009.[2]

The CDC's Biosafety Level 4 laboratories are among the few that exist in the world,[2] as well as one of only two official repositories of smallpox in the world. The second smallpox store resides at the State Research Center of Virology and Biotechnology VECTOR in the Russian Federation. The CDC revealed in 2014 that it had discovered several misplaced smallpox samples and also that lab workers had potentially been infected with anthrax.[23]

Organization

The CDC is organized into "Centers, Institutes, and Offices" (CIOs) which allow it to be responsive and effective in its interface with public health concerns. Each organizational unit implements the agency's response in a particular area of expertise. Within "Offices" are Centers, Divisions, and Branches.

CIOs are

  • CDC Washington Office
  • Center for Global Health
  • National Institute for Occupational Safety and Health
  • Office for State, Tribal, Local and Territorial Support
  • Office of Equal Employment Opportunity
  • Office of Infectious Diseases
    • National Center for Emerging and Zoonotic Infectious Diseases
      • Division of High-Consequence Pathogens and Pathology (DHCPP)
        • Viral Special Pathogens Branch (VSPB)
    • National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    • National Center for Immunization and Respiratory Diseases
  • Office of Minority Health and Health Equity
  • Office of Noncommunicable Diseases, Injury and Environmental Health
    • National Center for Chronic Disease Prevention and Health Promotion
    • National Center for Environmental Health/Agency for Toxic Substances and Disease Registry
    • National Center for Injury Prevention and Control
    • National Center on Birth Defects and Developmental Disabilities
  • Office of Public Health Preparedness and Response
    • Division of Emergency Operations
      • Emergency Operations Center (EOC)
  • Office of Public Health Science Services
    • Center for Surveillance, Epidemiology and Laboratory Services
    • National Center for Health Statistics
  • Office of the Associate Director for Communication
  • Office of the Associate Director for Policy
  • Office of the Associate Director for Science
  • Office of the Chief of Staff
  • Office of the Chief Operating Officer

Budget and workforce

CDC’s Fiscal Year 2014 budget was $6.9 billion.[24][25]

As of 2008, staff numbered approximately 15,000 (including 6,000 contractors and 840 Commissioned Corps officers) in 170 occupations. Eighty percent have earned bachelor's degrees or higher; almost half have advanced degrees (a master's degree or a doctorate such as a PhD, D.O., or M.D.).[26] CDC job titles include engineer, entomologist, epidemiologist, biologist, physician, veterinarian, behaviorial scientist, nurse, medical technologist, economist, public health advisor, health communicator, toxicologist, chemist, computer scientist, and statistician.[27]

In addition to its Atlanta headquarters, the CDC has other locations in the United States and Puerto Rico. Those locations include Anchorage; Cleveland; Cincinnati; Fort Collins; Hyattsville; Morgantown; Pittsburgh; Research Triangle Park; San Juan, Puerto Rico; Spokane, Washington; Detroit; and Washington, D.C. The CDC also conducts the Behavioral Risk Factor Surveillance System, the world’s largest, on-going telephone health survey system.[28]

The CDC offers grants that help many organizations each year bring health, safety and awareness to surrounding communities throughout the entire United States. As a government-run department, the Centers for Disease Control and Prevention awards over 85 percent of its annual budget through these grants to accomplish its ultimate goal of disease control and quality health for all.[29]

The CDC operates the Public Health Associate Program (PHAP), a two-year paid fellowship for recent college graduates to work in public health agencies all over the United States. PHAP was founded in 2007 and currently has 159 associates in 34 states.[30]

Directors

The President of the United States appoints the director of the CDC and the appointment does not require Senate confirmation. The director serves at the pleasure of the President and may be fired at any time.[31] Sixteen directors have served the CDC or its predecessor agencies.[3][3]

  • Louis L. Williams, Jr., MD (1942–1943)
  • Mark D. Hollis, ScD (1944–1946)
  • Raymond A. Vonderlehr, MD (1947–1951)
  • Justin M. Andrews, ScD (1952–1953)
  • Theodore J. Bauer, MD (1953–1956)
  • Robert J. Anderson, MD, MPH (1956–1960)
  • Clarence A. Smith, MD, MPH (1960–1962)
  • James L. Goddard, MD, MPH (1962–1966)
  • David J. Sencer, MD, MPH (1966–1977)
  • William H. Foege, MD, MPH (1977–1983)
  • James O. Mason, MD, MPH (1983–1989)
  • William L. Roper, MD, MPH (1990–1993)
  • David Satcher, MD, PhD (1993–1998)
  • Jeffrey P. Koplan, MD, MPH (1998–2002)[3]
  • Julie Gerberding, MD, MPH (2002–2008)
  • Thomas R. Frieden, MD, MPH (2009–present)[31]

Foundation

The CDC Foundation[3] operates independently from CDC as a private, nonprofit 501(c)(3) organization incorporated in the State of Georgia. The creation of the Foundation was authorized by section 399F of the Public Health Service Act to support the mission of CDC in partnership with the private sector, including organizations, foundations, businesses, educational groups, and individuals.

Data and survey systems

Publications

Diseases

Influenza

The CDC has launched campaigns targeting the transmission of influenza, including the H1N1 swine flu. The CDC has launched websites including [flu.gov] to educate people in proper hygiene.[45]

Other infectious diseases

The CDC's website (see below) has information on other infectious diseases, including smallpox, measles, and others. The CDC runs a program that protects the public from rare and dangerous substances such as anthrax and the Ebola virus. The program, called the Select Agents Program, calls for inspections of labs in the U.S. that work with dangerous pathogens.[46]

During the 2014 Ebola outbreak in West Africa, the CDC helped coordinate the return of two infected American aid workers for treatment at Emory University Hospital, the home of a special unit to handle highly infectious diseases.[47]

As a response to the 2014 Ebola outbreak, the U.S. House of Representatives proposed and passed a Continuing Appropriations Resolution to allocate up to $30,000,000 towards CDCP's efforts to fight the virus.[48]

Non-infectious diseases

The CDC also works on non-infectious diseases, including obesity.[49]

Historically, the CDC has been relatively free of political manipulation.[50]

Tuskegee Study of Untreated Syphilis in the Negro Male

For 15 years, the CDC had direct oversight over the . In the study, which lasted from 1932 to 1972, a group of African American men (nearly 400 of whom had syphilis) were studied to learn more about the disease. Notably, the disease was left untreated in the research subjects and they never gave their informed consent to serve as research subjects. The Tuskegee Study was initiated in 1932 by the Public Health Service. The CDC took over the study in 1957.[51]

The CDC's response to the AIDS crisis in the 1980s has been criticized for promoting some public health policies that harmed HIV+ people and for providing ineffective public education. The agency's response to the 2001 anthrax attacks was also criticized for ineffective communication with other public health agencies and with the public.[50]

CDC zombie apocalypse outreach campaign

On May 16, 2011, the Centers for Disease Control and Prevention's blog published an article instructing the public on what to do to prepare for a zombie invasion. While the article did not claim that such a scenario was possible, it did use the popular culture appeal as a means of urging citizens to prepare for all potential hazards, such as earthquakes, tornadoes, and floods.[52]

According to David Daigle, the Associate Director for Communications, Public Health Preparedness and Response, the idea arose when his team was discussing their upcoming hurricane information campaign and Daigle mused that "we say pretty much the same things every year, in the same way, and I just wonder how many people are paying attention." A social media employee mentioned that the subject of zombies had come up a lot on Twitter when she had been tweeting about the Fukushima Daiichi nuclear disaster and radiation. The team realized that a campaign like this would most likely reach a different audience from the one that normally pays attention to hurricane preparedness warnings and went to work on the zombie campaign, launching it right before hurricane season began. "The whole idea was, if you're prepared for a zombie apocalypse, you're prepared for pretty much anything," said Daigle.[53]

Once the blog article became popular, the CDC announced an open contest for YouTube submissions of the most creative and effective videos covering preparedness for a zombie apocalypse (or apocalypse of any kind), to be judged by the "CDC Zombie Task Force". Submissions were open until October 11, 2011. They also released a zombie themed graphic novella available on their website.[54] Zombie-themed educational materials for teachers are available on the site.[55]

Gun violence

One area of current partisan dispute related to CDC funding is studying gun violence. While many believe the CDC is banned from researching gun violence, the 1996 Dickey Amendment actually prohibits the CDC from advocating for gun control, not from funding or conducting research. This effectively censors CDC researchers from reporting otherwise scientifically accurate results merely because they might indicate that guns should be restricted to promote health. In the immediate aftermath of Charleston, South Carolina massacre in 2015, the US House of Representatives Appropriations Committee rejected an amendment, supported by Democrats but opposed by most Republicans, which would have provided $10 million in funding ear-marked for gun violence research.[56][57]

For similar agencies elsewhere, see the list of national public health agencies.