THE DISEASE DETECTIVES

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The Independent Culture
Shortly after the end of World War II, American military leaders joined forces with physicians and local public health officers to ask the US Congress to create an agency dedicated to the elimination of threats from infectious disease. The military leaders - chief among them General Douglas MacArthur - had witnessed the terrible toll malaria, cholera, influenza and other diseases took of their troops. And the local public health officers had come to realise that many microbial disease threats required better expertise than they could muster in their cities and towns.

In 1946 the US Centre for Communicable Disease Control was created; its laboratories and offices were erected in the then poor southern town of Atlanta, Georgia. The site was chosen partly to placate Southern Congressmen who felt that old Civil War animosities had unfairly kept the former Confederate states from receiving their fair share of federal programmes. Public health workers went along with the choice for other reasons: still impoverished, plagued by some of America's worst racial discrimination and with quasi- tropical conditions, Georgia was a hotbed of infectious disease ranging from syphilis to polio.

Nearly five decades later Georgia is a rapidly expanding state, centre of one of the US's few booming economies. The Centre for Communicable Disease Control has not fared as well as its host, however. After a period of rapid expansion, celebrated victories over microbes and international leadership in epidemic investigation, the centre is in deep trouble. Budget- cutters in Washington are, in Southern parlance, "a-hackin' and a-hewin' at the core" of the CDC's funds, and the future of the agency is now imperilled.

During the glory days from the l950s to1980 the CDC (which stands for Centres for Disease Control, the name by which the agency and its many subsections are known) thrived on the classic Yankee "can-do" mentality, charging into battle against viruses, bacteria and parasites not only within the US but anywhere in the world where its services were requested. Key to the agency's success was its Epidemic Intelligence Service, an elite corps of MDs trained to act as one-man (or, in a handful of cases, woman) disease conquerors. The "disease cowboys", as they have been dubbed, were often multilingual and skilled in both laboratory and field work. They were expected to handle everything from treating cholera patients to identifying species of microbe-carrying mosquitoes. If need be, they would conduct complicated, even dangerous, laboratory work inside a jungle tent or handle delicate diplomatic debates in the midst of an epidemic located in a country whose government looked none too kindly on the US. As the CDC's reputation gained even greater stature, the agency's scientists developed expertise in every aspect of the microbial world, and the World Health Organisation came to rely it routinely to respond to outbreaks all over the planet.

By the late 1970s, however, the CDC began to fall victim to its own success. American political and medical leaders declared that virtually all infectious disease threats were nearly eradicated in the US and Western Europe, and the Office of the Surgeon General called for increasing attention to be paid to chronic problems such as cancer and cardiovascular disease. Spending on microbial disease began to shrink: not only at federal level but in state and local budgets, too.

When Aids appeared in the US in 1981 the CDC spent the first four years of the epidemic begging Congress and then-President Ronald Reagan for funds to research and combat the expanding epidemic. The agency's scientists insisted that the human immunodeficiency virus (HIV) could not be expected to remain for long transmitted only among homosexual men - a group held in official contempt by the Reagan administration. Their insistence led to a credibility gap between the White House and the administration's Public Health Service - one so large that it eventually toppled the nationally popular Surgeon General, C Everrett Koop.

By the mid-1980s it had become chic to view a host of social problems as "diseases" or human frailties that could be mitigated through public- health intervention. Congress continued cutting infectious-disease budgets at the CDC - except for those related to Aids and sexually transmitted diseases - but the overall CDC budget swelled dramatically as senators and congressmen added prevention of alcoholism, drug abuse, teenage pregnancies, firearms violence, car accidents, family violence and child abuse to the growing list of CDC tasks.

By 1992 the agency's name was changed to the Centres for Disease Control and Prevention, and non-Aids/non-STD infectious-disease expenditure accounted for barely two per cent of its annual budget. Most of the CDC's "disease cowboys" retired or were shuttled off into bureaucratic jobs.

Today the CDC continues to operate the best BL4 (Biosafety Level 4) laboratory in the world, where the most lethal, incurable contagious organisms are studied: Ebola, Lassa, Marburg, Machupo and the like. But the CDC's BL3 laboratories, where such things as drug-resistant tuberculosis, yellow fever and cholera are studied, have dilapidated to such a degree that they pose a serious hazard to both the scientists and the people of Atlanta.

Now some powerful members of the Senate have called for dramatic cuts in the CDC's Aids budget. And the Republican Speaker of the House of Representatives, Newt Gingrich, has questioned the continued necessity of the entire Public Health Service. When Congress reconvenes after its summer recess later this month, the future of the CDC, its disease detectives and America's ability to combat the world's microbial threats will be decided. LG

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