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Organization of the Centers for Disease Control and Prevention

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Since 1980, the U.S. Centers for Disease Control and Prevention has been organized around constituent centers, institutes, and offices (CIOs). Five centers were created in 1980, from which the current centers are descended, with the exception of the National Institute for Occupational Safety and Health and National Center for Health Statistics, which were absorbed from outside CDC.

During 1980–2005, the CIOs were in a flat structure reporting directly to the CDC Director. In 2005, they were collected into four Coordinating Centers in a matrix organization framework as part of the CDC Futures Initiative, but in 2009 the Coordinating Centers were replaced with leaner Deputy Director offices. The 2023 CDC Moving Forward returned to a flat structure.

History

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Early history

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From its establishment in 1946 until 1980, CDC's organization was mainly oriented around a functional framework of epidemiology, laboratory, and training divisions. During this time, the number of top-level divisions ranged between four and twelve.[1]

Creation of individual centers

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CDC Director William Foege spearheaded the creation of individual centers within CDC
Organization of CDC in 1999

CDC's modern organization of having multiple constituent centers, institutes, and offices (CIOs) was established in 1980, at the same time its name changed from the singular "Center for Disease Control" to plural "Centers for Disease Control". The 1980 reorganization replaced the functional framework with an outcome-oriented one, and allowed expansion into areas other than communicable disease. The new organization was spearheaded by CDC Director William Foege and inspired by Health Canada's organization, which was divided into biological, environmental, lifestyle, and medical care divisions.[1]

Five centers were established in 1980, with three more spun off from these five prior to 2003:[1]

  • The Center for Infectious Diseases was largely created from merging the pre-existing Laboratory Bureau and Epidemiology Bureau.[1]
  • The Center for Environmental Health was an outgrowth of CDC's heavy involvement in recent environmental health incidents such as chemical contamination in Triana, Alabama and Love Canal, the Three Mile Island nuclear accident, and the eruption of Mount St. Helens; it a;so inherited existing programs in rat control, lead, dental disease, cancer clusters, and birth defects.[1]
    • In 1992, the National Center for Injury Prevention and Control was spun off from the National Center for Environmental Health.[2]
    • In 2001, the National Center on Birth Defects and Developmental Disabilities was spun off from the National Center for Environmental Health due to Children's Health Act of 2000.[3][4]
  • The Center for Health Promotion and Education incorporated programs in lifestyle studies, nutrition, family planning, and anti-smoking activities. By 1990, it was called the Center for Chronic Disease Prevention and Health Promotion.[1]
  • The Center for Prevention Services was one of two that inherited CDC's traditional service functions.[1] In 1996, it became the National Center for HIV, STD, and TB Prevention.[5]
    • In 1993, the National Immunization Program was spun off from the Center for Prevention Services.[6] It would become the National Center for Immunization and Respiratory Diseases in 2006.[7]
  • The Center for Professional Development and Training also inherited some of CDC's traditional service functions.[1] Around 1986, it merged with the Laboratory Program Office to form the Training and Laboratory Program Office,[8] which was renamed the Public Health Practice Program Office in 1989.[9]

Additionally, there two centers during this period that were absorbed by CDC from outside:[1]

  • The National Institute for Occupational Safety and Health (NIOSH), whose predecessor organization dated back to 1914,[10] had been absorbed by CDC in 1973.[11]
  • The National Center for Health Statistics, whose earliest predecessor dated back to 1899, was absorbed into CDC in 1987.[12]

Futures Initiative era

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CDC Director Julie Gerberding spearheaded the Futures Initiative, which collected the CIOs into four Coordinating Centers in a matrix organization structure.

CDC's Futures Initiative began in 2003 and was spearheaded by CDC Director Julie Gerberding.[13][14] It was partially in response to criticism of the agency's response to the 1999 West Nile virus outbreak, the 2001 anthrax attacks, and the 2002–2004 SARS outbreak. It was also noted that these emergency response activities were putting pressures on the CDC Director's time, who also was responsible for to directly overseeing all 11 CIOs.[15][16]

The strategic planning involved a broadly deliberative process seeking input from employees, partners, and other stakeholders for selecting strategic objectives.[14] It emphasized preparedness as well as health promotion and disease prevention, and also streamlined the funding process for grants to state and local health departments.[13][14] It reoriented CDC around a matrix organization structure that was less hierarchical, which was intended to prevent silos and enhance organizational flexibility and information sharing.[14][15]

Organization of CDC in 2007, with the Coordinating Centers

The reorganization became official in April 2005.[14][17] The existing CDC centers were collected into four Coordinating Centers:[14]

  • Coordinating Center for Infectious Diseases
  • Coordinating Center for Environmental Health and Injury Prevention
  • Coordinating Center for Health Promotion
  • Coordinating Center for Health Information and Service

During this time, there were three independent CIOs: the Coordinating Office for Global Health, the newly formed Coordinating Office for Terrorism Preparedness and Emergency Response, and NIOSH.[14]

There were a few changes on the CIO level as well. An Office of Terrorism Preparedness and Emergency Response was created in August 2002.[16] Two new centers for Public Health Informatics and Health Marketing were created in 2005.[14] In 2007, the Center for Infectious Diseases was split into the National Center for Zoonotic, Vectorborne, and Enteric Diseases and National Center for Preparedness, Detection, and Control of Infectious Diseases, and the National Immunization Program became the National Center for Immunization and Respiratory Diseases.[18]

There were negative effects in the immediate aftermath of the reorganization, including unpopularity with employees, low morale, and loss of long-term staff.[14] Because many of CDC's leaders were scientists rather than managers, their aversion to the administrative burden of a reorganization led to its perceived failure.[15] In December 2005, five former CDC directors sent Gerberding a letter expressing concern about the reorganization.[19]

Post-Futures Initiative era

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Organization of CDC in 2015, with three deputy directors
Organization of CDC in 2021, with four deputy directors

The Coordinating Centers were abolished in 2009 by new CDC Director Tom Frieden.[20][21][22] Centers were instead placed under Deputy Director offices, which were much leaner than the former Coordinating Centers. For example, the Coordinating Center for Infectious Diseases had 600 employees, while the Office of Infectious Diseases had 12.[21]

There were initially three Deputy Director offices, which was increased to four in 2018:[22][23]

  • The Deputy Director for Infectious Diseases succeeded the Coordinating Center for Infectious Diseases.
  • The Deputy Director for Noncommunicable Diseases, Injury, and Environmental Health (later Deputy Director for Non-Infectious Diseases) succeeded the Coordinating Center for Environmental Health and Injury Prevention, and the Coordinating Center for Health Promotion.
  • The Deputy Director for Public Health Scientific Services (later Deputy Director for Public Health Science and Surveillance) succeeded the Coordinating Center for Health Information and Service.
  • The Deputy Director for Public Health Service and Implementation Science was created in 2018, absorbing three CIOs that had been independent since the 2009 reorganization.[24]

Several changes on the CIO level also occurred in 2009:

  • The former National Center for Zoonotic, Vectorborne, and Enteric Diseases and National Center for Preparedness, Detection, and Control of Infectious Diseases were realigned, with their programs moved into the new National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, as well as other parts of CDC.[25]
  • Five program offices covering surveillance, epidemiology, informatics, laboratory science, and career development were formed,[23][26] which merged into the Center for Surveillance, Epidemiology and Laboratory Services in 2013.[27][28]
  • The Office of State and Local Support was formed,[23] which in 2018 became the Center for State, Tribal, Local and Territorial Support.[24]

CDC Moving Forward era

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Organization of CDC in 2024

Another reorganization occurred in 2023 as a response to lessons learned from CDC's response to the COVID-19 pandemic.[29][30] The Deputy Director level was removed, returning CDC to a flat structure. The infectious disease and non-infectious disease centers, Global Health Center, and NIOSH remained as CIOs, while the new Public Health Infrastructure Center was created by merging the Center for Surveillance, Epidemiology and Laboratory Services and the Center for State, Tribal, Local and Territorial Support. The other five CIOs (Office of Science, Office of Laboratory Science and Safety, National Center for Health Statistics, Office of Health Equity, and Office of Readiness and Response) were absorbed into the Office of the Director.[31]

Current organization

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Infectious disease centers

These centers were under the Coordinating Office for Infectious Diseases and later the Deputy Director for Infectious Diseases.[23]

Non-infectious disease centers

These were under either the Coordinating Center for Environmental Health and Injury Prevention, or Coordinating Center for Health Promotion. They were later under the Deputy Director for Non-Infectious Diseases.[23]

Other centers
Office of the Director components
  • Chief of Staff
  • Office of the Chief Operating Officer
  • Office of Policy, Performance, and Evaluation
  • Office of Equal Employment Opportunity and Workplace Equity
  • Office of Communications
  • CDC Washington Office
  • Office of Science
  • Office of Laboratory Science and Safety
  • Office of Public Health Data, Surveillance, and Technology
  • Office of Health Equity
  • Office of Readiness and Response

References

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  1. ^ a b c d e f g h i j k l m n o Etheridge, Elizabeth W. (1992). Sentinel for Health: A History of the Centers for Disease Control. University of California Press. pp. xxviii, 310–315, 342–343. ISBN 978-0520910416.
  2. ^ a b Sleet, David; Bonzo, Sandra; Branche, Christine (December 1998). "An overview of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention". Injury Prevention. 4 (4): 308–312. doi:10.1136/ip.4.4.308. ISSN 1353-8047. PMC 1730415. PMID 9887426.
  3. ^ a b Boyle, Coleen A.; Cordero, José F.; Trevathan, Edwin (Dec 2012). "The National Center on Birth Defects and Developmental Disabilities: Past, Present, and Future". American Journal of Preventive Medicine. 43 (6): 655–658. doi:10.1016/j.amepre.2012.08.015. PMC 4445684. PMID 23159262.
  4. ^ a b Pub. L. 106–310 (text) (PDF), Title VI, Subtitle B
  5. ^ a b 61 FR 35219
  6. ^ a b 58 FR 59043
  7. ^ a b Schuchat, Anne; Anderson, Larry J.; Rodewald, Lance E.; Cox, Nancy J.; Hajjeh, Rana; Pallansch, Mark A.; Messonnier, Nancy E.; Jernigan, Daniel B.; Wharton, Melinda (Jul 2018). "Progress in Vaccine-Preventable and Respiratory Infectious Diseases—First 10 Years of the CDC National Center for Immunization and Respiratory Diseases, 2006–2015". Emerging Infectious Diseases. 24 (7): 1178–1187. doi:10.3201/eid2407.171699. PMC 6038744. PMID 29916350.
  8. ^ a b Cook, B. Kinnas (2012-12-06). Federal Yellow Book: The Directory of the USA Federal Government Departments and Independent Agencies. Springer Science & Business Media. ISBN 978-94-009-4213-4.
  9. ^ a b 54 FR 23537
  10. ^ a b The President's Report on Occupational Safety and Health. Commerce Clearing House. 1972. pp. 153–154.
  11. ^ a b Snyder, Lynne Page (1998). "The National Institute for Occupational Safety and Health, 1971–1996: A Brief History" (PDF). Retrieved 2021-05-05.
  12. ^ "Records of the Public Health Service [PHS], 1912-1968". National Archives. 2016-08-15. Retrieved 2021-08-04.
  13. ^ a b Mary, Quirk (July 2004). "CDC reorganisation begins". The Lancet Infectious Diseases. 4 (7): 390. doi:10.1016/S1473-3099(04)01076-X.
  14. ^ a b c d e f g h i Whitford, Andrew B. (2006). "Strategic Transformation in Public Health: In the Case of the Centers for Disease Control and Prevention". SSRN Electronic Journal. doi:10.2139/ssrn.872540. ISSN 1556-5068. S2CID 152608295.
  15. ^ a b c Herrington, Melody (Spring 2022). "Herding Scientists: A Story of Failed Reform at the CDC". UGA SPIA Online Magazine. Retrieved 2023-09-05.
  16. ^ a b "Centers for Disease Control and Prevention: Agency Leadership Taking Steps to Improve Management and Planning, but Challenges Remain". U. S. Government Accountability Office. 2004-01-30. pp. 3–5, 15–16, 19. Retrieved 2023-09-05.
  17. ^ Gerberding, Julie Louise (2005-04-21). "The Futures Initiative: Letter from Dr. Gerberding". U.S. Centers for Disease Control and Prevention. Archived from the original on June 29, 2016. Retrieved 2008-12-28.
  18. ^ a b "Infectious disease center increases public health impact". American Veterinary Medical Association. 2007-05-15. Retrieved 2024-11-03.
  19. ^ Kaiser, Jocelyn; Couzin, Jennifer (2006-10-13). "Gerberding Defends Her Transformation of CDC". Science. 314 (5797): 246–247. doi:10.1126/science.314.5797.246. ISSN 0036-8075. PMID 17038602. S2CID 153903954.
  20. ^ Koenig, Robert (2009-08-07). "New Chief Orders CDC to Cut Management Layers". Science. doi:10.1126/article.41382 (inactive 1 November 2024).{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  21. ^ a b Harris, Gardiner (2010-03-15). "Obama's C.D.C. Director, Wielding a Big Broom". The New York Times. ISSN 0362-4331. Retrieved 2023-09-05.
  22. ^ a b "Science, efficiency to drive CDC changes". Atlanta Journal-Constitution. 2010-01-04. Archived from the original on 2010-01-04. Retrieved 2024-11-03.
  23. ^ a b c d e f 74 FR 68630
  24. ^ a b 83 FR 48427
  25. ^ a b c "CDC reorganization creating emerging and zoonotic disease center". American Veterinary Medical Association. 18 January 2010. Retrieved 2023-09-05.
  26. ^ 75 FR 45134
  27. ^ "History of CSELS". U.S. Centers for Disease Control and Prevention. 17 December 2018. Retrieved 2024-11-03.
  28. ^ 78 FR 70049
  29. ^ Steenhuysen, Julie (2022-08-17). "U.S. CDC plans to focus on public health response after pandemic failings". Reuters. Retrieved 2022-08-17.
  30. ^ LaFraniere, Sharon; Weiland, Noah (2022-08-17). "Walensky, Citing Botched Pandemic Response, Calls for C.D.C. Reorganization". The New York Times. ISSN 0362-4331. Retrieved 2022-08-21.
  31. ^ a b Choi, Joseph (2023-01-24). "CDC informs staff of reorganization after pandemic criticisms". The Hill. Retrieved 2023-08-22.
  32. ^ 63 FR 38408
  33. ^ 45 FR 67772
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