The US Centers for Disease Control and Prevention

The US Centers for Disease Control and Prevention (CDC) may be considered the core of the world's response SWAT team. Established in 1946 as the Communicable Disease Center to help control malaria in the United States, the CDC has become one of the world's most prestigious organizations for responding to epidemics. Its mission is: "To promote health and quality of life by preventing and controlling disease, injury, and disability." Funded by appropriations from the US Congress, it operates as an independent agency under the United States Department of Health and Human Services (HHS). As such, the bulk of its work is in the United States, but over time it has widened its functions to be worldwide in scope, and so now is an essential cluster group of the WHO Collaborating Centers (About CDC, at http://www.cdc.gov/about/default.htm; see also WHO Collaborating Centers at CDC by CIO, at http://www2a.cdc.gov/od/ gharview/GHARwhocollabs.asp). Like the WHO, the CDC tends to be organized around specific diseases and programs, and is influenced by the politics and funding priorities of the United States Government.

In 2003, the CDC launched a 22-month-long, large-scale strategic planning effort to improve its ability to achieve its mission. The ensuing restructuring effort, approved by Congress in April 2005, sought to streamline management and operations, reduce management levels, and increase coordination. It organized the CDC into coordinating centers and offices - the Coordinating Center for Environmental Health and Injury Prevention; the Coordinating Center for Health Information and Services; the Coordinating Center for Health Promotion; the Coordinating Office for Global Health; the Coordinating Center for Infectious Diseases, which includes the Coordinating Office for Terrorism Preparedness and Emergency Response; the National Center for HIV, STD, and TB Prevention; and the National Institute for Occupational Safety and Health (NIOSH). In addition, the CDC provides administrative support for the Agency for Toxic Substances and Disease Registry (ATSDR), a sister agency of CDC, and the Director of the CDC also serves as the Administrator of the ATSDR.

The Coordinating Center for Infectious Diseases is of particular significance for infectious diseases. It is "responsible for infectious diseases control, HIV/ AIDS, STD, and TB prevention, and immunizations in the United States and around the world." The Coordinating Office of Global Health falls under its auspices, and is responsible for "national leadership and support for CDC's global health activities" and collaboration with CDC's global health partners (National Coordinating Office for Global Health, at http://www.cdc.gov/ogh/). In addition, the Coordinating Center for Infectious Diseases encompasses the National Center for Infectious Diseases (NCID), the National Immunization Program (NIP), and the National Center for HIV, STD, and TB Prevention (NCHSTP) (see CDC website, at www.cdc.gov).

In the United States, by offer or invitation, the CDC units and centers implement and fund programs on infectious disease control and prevention. They also work with state governments and other national partners to conduct surveillance, epidemic investigations, laboratory and epidemiological research, as well as training and public education programs that develop, evaluate, and promote prevention and control strategies for communicable diseases. With 160 staff based in more than 43 foreign countries, it is also a key player on the global stage, providing technical assistance and support to investigate and respond to epidemics at the request of the WHO and national governments. It is a key contributor of staff and technical resources to WHO's GOARN. CDC experts serve as ad hoc technical advisers and trainers at the request of individual US states, nations, and the WHO. The CDC, like the WHO, realized that, to improve response capacity, collaboration and resource sharing are vital. While it remains a vital responder today, it usually does so under the auspices of the WHO, taking advantage of the WHO's logistical resources (Enserink, 2004). Despite the CDC's long-standing history of international outbreak assistance and efforts to help build capacity in developing nations, there is little formal organizational support for these activities (CDC, 2002). While the 2005 restructuring effort makes global health a strategic priority, it remains unclear whether the CDC will be given adequate funding to support the human, epidemiologic, diagnostic, and logistic activities to respond to international outbreaks. If given adequate resources, the mission is also to offer the WHO and host country Ministries of Health support to evaluate public health conditions following the containment of specific epidemic outbreaks. This could include guidance on improving surveillance, disease prevention, future outbreak response and training, and capacity development efforts for local organizations (CDC, 2002).

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