r.
Jeffrey P. Koplan, the departing director of the Centers for Disease Control
and Prevention, yesterday again defended his agency's handling of the
anthrax attack and the way the investigation was communicated to the public.
Dr. Koplan spoke in an interview as he announced that he would become
vice president for academic health affairs at Emory University, which like
the disease control agency is in Atlanta.
When Dr. Koplan announced his resignation as C.D.C.'s director last
month, news reports suggested that he was leaving under pressure from
officials of the agency's parent, the Department of Health and Human
Services.
But yesterday, Dr. Koplan (pronounced COPE-lun) said: "I resigned totally
of my own volition. Whatever people's perceptions are, I can only say that
this was my choice."
Dr. Koplan said he stayed as director nearly twice as long as he had
expected when then health secretary, Donna Shalala, hired him for the last
two years of President Bill Clinton's second term in 1998. In the last three
years, C.D.C.'s budget has doubled to $7.7 billion from $2.5 billion in
1998.
Dr. Koplan's move comes in the wake of widespread criticism of the
centers and the Department of Health and Human Services for lack of better
preparation for bioterrorism and poor communication in the early days of the
anthrax attacks last fall. But on the other hand, the agency was widely
praised for its scientific work.
Government officials were criticized then for communicating poorly with
health professionals and the public. Tommy G. Thompson, the health
secretary, and other officials were criticized for giving information that
many believed should have come from medical professionals.
Now, Dr. Koplan said, "we're all agreed that it's worthwhile early on to
have a public health professional talking to the press" about bioterrorism
related health issues.
Also, there were rumors that Dr. Koplan had threatened to resign in the
first days of the anthrax attack unless his agency was allowed to talk.
"That is absolutely untrue," Dr. Koplan said yesterday. He also said that to
have resigned "in the midst of the anthrax attack would have been both
unprofessional, unpatriotic and inappropriate."
But Dr. Koplan said he was "never, ever told that you can talk about this
and you cannot talk about that."
The disease control agency, critics have contended, is unaccustomed to
the rough and tumble of Washington politics.
But, Dr. Koplan said: "What's most important in an investigation of an
outbreak like this is not the rough and tumble of Washington politics but
the rough and tumble of dealing with a dangerous infectious agent when loose
in the field, and that is where we apply our attention. That is the
wrestling match I prefer for us to get into, not Washington politics. Let
those up there dwell with that."
Dr. Koplan said that the attention devoted to bioterrorism was deserved
but that other health issues needed to be addressed. "H.I.V. is right up at
the top, as are malaria, tuberculosis, tobacco use, overweight and obesity,"
he said.
Dr. Koplan said he recently returned from China, where AIDS is a
significant problem and threatens to have an effect as devastating there as
it has been in Africa.
"There is a wide range of other ailments that should not fall off the
page as we appropriately pay attention" to bioterrorism and other public
health problems, Dr. Koplan said.
Wherever public health is practiced, it, along with environmental and
occupational health issues, has long been intertwined with politics.
Yet in recent years, Dr. Koplan said, he has noted the increased effect
of politics on public health in many areas like maternal and child health,
child rearing, family planning, abortion, violence and tobacco use.
"You can hardly touch a public health issue these days that does not have
a political element to it, and I do not mean capital P partisan party
politics, but a small p," Dr. Koplan said. "Any one of the issues can end up
in a newspaper."
Investigations of outbreaks of disease that drew little attention in the
past now often become hot-button issues, and all political parties tend to
become involved, Dr. Koplan said.
"There has become a certain tendency for an opposition party to say, `You
guys are not doing enough or are not doing it fast enough or are not doing
it well enough,' " Dr. Koplan said. "Then if, even just two weeks later, the
other party is in charge, then it takes the issue on," Dr. Koplan said.
Dr. Koplan said that when he became director, "I never knew I would be
getting into this." But he stressed that he welcomed the increased attention
by politicians.
Dr. Koplan said the extra time as director allowed him to strengthen the
national public health structure and advance plans for new buildings and
laboratories so the agency can continue to attract top scientists.
Also, the agency has significantly increased financial and technical
support for state and local health departments and developed ways for
officials to evaluate program results.
Other accomplishments he cited include bolstering public health programs
to reduce the effect of afflictions like diabetes, heart disease and cancer
on an aging population and more actively coordinating clinical care and
public health. C.D.C. has also strengthened immunization and other programs
for children and adults. At the same time, it has striven to expand its work
with a variety of partners in global health, he said.