hcghr

An Interview with Ed Hunter

In Interviews on January 13, 2010 at 11:07 pm

Justin Banerdt, Staff Writer

Ed Hunter represents the Centers for Disease Control and Prevention in Washington before the United States Department of Health and Human Services, other Administration officials, and non-governmental entities. He also directs and oversees CDC’s legislative strategy. Since 2003, Mr. Hunter has been Deputy Director of CDC’s Washington Office. This office is the Washington, D.C. arm of the CDC Office of the Director, serving as a bridge between CDC and the Washington policy community.

HCGHR: What is your agenda while at the CDC and what changes do you hope to bring to the organization?

Hunter: The CDC is engaged very directly in a number of really high profile things right now. Obviously, getting the effective response to the H1N1 epidemic is key right now. That in many ways is dominating our leadership and much of our science base and certainly my office here in Washington. I am the head of the CDC Washington office where we deal a lot with Congress and other federal agencies and our Washington partners have a big stake in the 2009 H1N1 as well… There’s a lot of federal engagement and also clearly congressional engagement in a response of this magnitude. So our office is very much engaged in that and that is sort of a dominant thing for the agency since this virus appeared in April and it will certainly continue through the fall and throughout the flu season… Another is health reform. [Health reform is] a Washington policy agenda and there is a lot at stake for prevention through health reform, not just in health insurance and financing and whether there’s a public option and a lot of the other more visible things that are covered very well in the press. But there’s a lot of concrete things about what we can do to advance health, what we can do to advance prevention through the health system in terms of benefits and coverage for preventive screening and interventions. Also, what we can do at the community level to promote and protect health, [such as] setting the policies and other things in place in communities that actually keep people from needing medical care down the road. So that’s something that we are actively engaged in. Those are the two biggest things that I devote a lot of attention to and that the leadership of the CDC is very focused on right now.

HCGHR: How will the hype around H1N1 be affecting the CDC’s other activities this year? Will resources be shifted to deal with this problem and do you foresee that other projects may suffer from this?

Hunter: The CDC has a very well established preparedness and emergency response mechanism and we’re really using that mechanism to its fullest for this response… We have a whole network of staffing, roles, and capabilities that we’ve been sort of rehearsing and exercising over the past four or five years–not only for a pandemic but also for a response to naturally occurring disasters and other illnesses. A lot of this is built in anticipation of something like an anthrax attack that we suffered in 2001. So that mechanism and the roles and the exercises… are being brought into play… so we actually have a structure and a framework to use for this response. It obviously pulls in a tremendous amount of resources from across the agency. We have somewhere between 1,000 and 1,500 of our staff that’s actually actively engaged in the H1N1 response, from an epidemiology and investigation point of view, for vaccine distribution, vaccine safety monitoring—preparing those guidelines, the laboratory elements of this, and of course the communication and IT aspects of this are really normative. It is pulling from every part of the organization and obviously it is partly paid for by emergency supplemental funding from the Congress [and] partly paid for from resources the agency already had. So it certainly is extending us to the max for the capabilities that we have…. Many resources are from the state and local level and health departments that are already stressed from state budget cuts and just because of the economic situation. There have been some federal resources that have been brought to bare—to help them do vaccine planning and distribution [and] some of the other preparedness side. [However] that’s something where putting H1N1 on top of an already stressed state in local health department infrastructure is a real challenge.

HCGHR: What lessons is the CDC taking away from the H1N1 pandemic in preparation for one that could potentially be far worse, such as avian influenza?

Hunter: I think one thing is the premise of your question: that this one isn’t potentially bad is hopefully correct, but might be optimistic… We are not done with this one. Influenza is a very unpredictable virus, it’s very clever, it’s a worthy opponent to all the systems and technology that we have in place so one would like to think that this doesn’t change in severity. But I think we have a long history of doing after-actions and corrective actions in every public health event that we are in. On this type of emergency response we do a systematic after-action; we’ve done some of these on an interim basis from the spring. We are better at communicating with our counterparts in state and local governments and around the world. I think we are learning a lot about how we communicate well with the public and with our partner organizations… Tracking I think is tremendously improved from where we might have been a year ago… We have tried very hard to rebuild some of the capacity at the state and local levels and to understand what it takes to do things like that… I think we’ve learned a lot about all the different parts of the United States government that have something to contribute to making an effective guidance to the public or just, for example, to schools, where we are not the only experts on what happens… So working more closely with the Department of Education we know better how to communicate with schools about what they should do in a situation like this. We probably have been asked more questions, just by the nature of this as it unfolds and expands and consumes people’s attention. I think we’ve been coming to understand all the various dynamics of [how] something like this starts to affect all of society as opposed to a more limited medical or public health world… I think we have learned a lot about what’s involved in trying to coordinate/motivate across all parts of the government and to talk to the public directly and healthcare systems… [In the end] we hope that every response we do gives us information to improve the next one.

HCGHR: The topic of our upcoming publication is health, equity, and health access. How is CDC policy trying to currently address health inequity in developing countries and what are common obstacles in addressing this problem?

Hunter: CDC has a big role in global health, partly through the president’s PEPFAR program… But one of the unique aspects of CDC is to help strengthen the health systems of countries around the world, particularly developing countries. That’s one of the really key things: to try and not just tackle one problem at a time but to build the infrastructure in countries for laboratory capacity, epidemiological capacity, and the overall health systems through the health ministry and others so that this can be sustainable and some health problems can be addressed in a real systemic level. I think that’s one of CDC’s major involvements on the global side.

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