Centers for Disease Control - April 2021

Strengthening public health systems around the world

It's a little known fact that one person – Dr. Joseph Mountin – not only founded the US Centers for Disease Control and Prevention (initially named the Communicable Disease Center), but also started a seminal study, the Framingham Heart Study. In both cases, Mountin changed the direction of health, and public health, first in the United States, and eventually, around the world.

The Framingham study has been of central importance to understanding the role of hypertension and cholesterol in heart disease and stroke.

And the Centers for Disease Control has grown from communicable disease roots to encompass all causes of ill health, and from the United States to regions and countries around the world.

During the Covid pandemic, the Africa Centers for Disease Control and Prevention has played an important role strengthening laboratory services, outbreak control, communication, and data dissemination throughout the continent. Analogously, the Nigeria Centre for Disease Control has supported the states of that country to respond more effectively to Covid and many other infectious disease outbreaks.

There are discussions about establishing other CDCs in more regions and more countries around the world. There are useful resources for countries and regions to do so and a strong network, although the most important factor in success is the leadership, and particularly the founding leadership, of the institution.

While at the US CDC as director, I joined former director Dr. Jeff Koplan in summarizing why stronger national public health institutions – CDCs – are important to improving global health. We identifed 16 potential functions of such agencies (Table below), and outlined some pros and cons of including these functions.

A crucial issue is the independence of the CDC. Here's what we wrote in that article, more than a decade ago, about National Public Health Institutes (NPHIs, the generic name for CDCs):

"To be effective, an NPHI must have credibility and be independent, technically expert, and apolitical, which requires independence from parent ministries of health on technical issues. But if an NPHI is seen as being too independent, it might not be able to address important health challenges."

Each country, and region will need to establish, adapt, and improve their public health infrastructure. Public health institutes can be important resources to strengthen the ability to find, stop, and prevent health threats. To be effective, linkages are essential – with state/city/provincial/local CDCs, with health care systems, with social services, and with communities and the public

On February 15, 2020, I published an article in the bulletin of the China CDC outlining 5 key characteristics of an effective NPHI: funding, staff, connections with other organizations, technical independence, and effective communication.

When I stepped down as US CDC director in January of 2017, I identified the top threat to the organization to be maintaining technical independence. For every public health organization, this is essential – to be close enough to the government for its recommendations to be acted on, and faithful to science so that public trust is established, maintained, and strengthened.

Citation: Frieden TR, Koplan JP. Stronger national public health institutes for global health. Lancet 2010;376(9754):1721-2.