Day: August 17, 2022

The head of the top U.S. public health agency on Wednesday announced a shake-up of the organization, intended to make it more nimble.

The planned changes at the Centers for Disease Control and Prevention — CDC leaders call it a “reset”— come amid ongoing criticism of the agency’s response to COVID-19, monkeypox and other public health threats. The changes include internal staffing moves and steps to speed up data releases.

The CDC’s director, Dr. Rochelle Walensky, told the agency’s staff about the changes on Wednesday. It’s a CDC initiative, and was not directed by the White House or other administration officials, she said.

“I feel like it’s my my responsibility to lead this agency to a better place after a really challenging three years,” Walensky told The Associated Press.

The CDC, with a $12 billion budget and more than 11,000 employees, is an Atlanta-based federal agency charged with protecting Americans from disease outbreaks and other public health threats. It’s customary for each CDC director to do some reorganizing, but Walensky’s action comes amid a wider demand for change.

The agency has long been criticized as too ponderous, focusing on collection and analysis of data but not acting quickly against new health threats. But public unhappiness with the agency grew dramatically during the COVID-19 pandemic. Experts said the CDC was slow to recognize how much virus was entering the U.S. from Europe, to recommend people wear masks, to say the virus can spread through the air, and to ramp up systematic testing for new variants.

“We saw during COVID that CDC’s structures, frankly, weren’t designed to take in information, digest it and disseminate it to the public at the speed necessary,” said Jason Schwartz, a health policy researcher at the Yale School of Public Health.

Walensky, who became director in January 2021, has long said the agency has to move faster and communicate better, but stumbles have continued during her tenure.

In April, she called for an in-depth review of the agency, which resulted in the announced changes. Her reorganization proposal must be approved by the Department of Health and Human Services secretary. CDC officials say they hope to have a full package of changes finalized, approved, and underway by early next year.

Some changes still are being formulated, but steps announced Wednesday include:

—Increasing use of preprint scientific reports to get out actionable data, instead of waiting for research to go through peer review and publication by the CDC journal Morbidity and Mortality Weekly Report.

—Restructuring the agency’s communications office and further revamping CDC websites to make the agency’s guidance for the public more clear and easier to find.

—Altering the length of time agency leaders are devoted to outbreak responses to a minimum of six months — an effort to address a turnover problem that at times caused knowledge gaps and affected the agency’s communications.

—Creation of a new executive council to help Walensky set strategy and priorities.

—Appointing Mary Wakefield as senior counselor to implement the changes. Wakefield headed the Health Resources and Services Administration during the Obama administration and also served as the No. 2 administrator at HHS. Wakefield, 68, started Monday.

—Altering the agency’s organization chart to undo some changes made during the Trump administration.

—Establishing an office of intergovernmental affairs to smooth partnerships with other agencies, as well as a higher-level office on health equity.

Walensky also said she intends to “get rid of some of the reporting layers that exist, and I’d like to work to break down some of the silos.” She did not say exactly what that may entail, but emphasized that the overall changes are less about redrawing the organization chart than rethinking how the CDC does business and motivates staff.

“This will not be simply moving boxes” on the organization chart, she said.

Schwartz said flaws in the federal response go beyond the CDC, because the White House and other agencies were heavily involved.

A CDC reorganization is a positive step but “I hope it’s not the end of the story,” Schwartz said. He would like to see “a broader accounting” of how the federal government handles health crises.
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Despite a nationwide vaccination campaign that started in May, Malawi is struggling to contain a cholera outbreak that has infected more than 1,073 people and caused 44 deaths. 

The figures from the Malawi Ministry of Health, updated as of Aug. 16, 2022, are triple the numbers recorded when the vaccination campaign was launched three months ago. 

The report also says the outbreak has spread to 10 districts from eight in May. The hardest hit districts include Blantyre with 489 cases, Neno with 128 cases, and Nsanje with 289 cases.  

George Mbotwa, spokesperson for a health office in Nsanje district, which borders Mozambique south of Malawi, said continued incidents of cholera in the district are largely because of movements of people between the two countries. 

“What is worrisome is that we have now continued to record the cases when by now we would have contained the situation,” he said. “It’s because some of these cases we are sharing with Mozambique. So, the cases will be coming from Mozambique and then reporting to health facilities in Nsanje, then being recorded as Nsanje cases.”

Mbotwa said the situation is slowly improving, after officials on the Mozambican side agreed during recent discussions to set up cholera treatment sites on their side of the border.  

“The Mozambican side by then didn’t have cholera treatment sites, and now they have them there, so people are able to report the cases right there, unlike coming with cases to Malawi,” he said. 

Cholera is an acute diarrheal infection caused by ingesting food or water contaminated with bacteria. The disease affects both children and adults, and if untreated, it can kill within hours.  

Penjani Chunda, environmental health officer in Blantyre, said although Blantyre is largely an urban area, cholera cases are on the rise because most people fetch water from unprotected sources like rivers and streams. 

“In most parts of Blantyre, we don’t have portable water sources,” he said. “It might be like an urban setup, but it has no portable water sources, and we have got dry taps in some of the areas and [water] kiosks are not working at all.”  

The spokesperson for the Health Ministry, Adrian Chikumbe, said health authorities are currently distributing chlorine for water treatment, and providing public education on good hygiene.  

Chikumbe also hopes the second phase of the national oral cholera vaccination campaign, which is expected to start soon in the most-hit districts, will help contain the situation.     

 
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In the past year, there has seen a dramatic transformation in the way customers pay for their purchases in Banuri, a village in the Himachal Pradesh state of North India. Whether at a small grocery store or a street cart, instead of handing over cash, they use a simple system that involves scanning a code on a smartphone to make an online payment.

“Even if someone buys only half a kilogram of vegetables, he can pay digitally. We do the smallest of transactions,” said Nishant Sharma, a vegetable vendor in Banuri as he hands over a cauliflower to a customer that costs 75 cents. “It is much easier than handling cash.”

In recent years, a government initiative called “Digital India” has helped millions plug into new digital technologies as internet access expands to distant areas. One of them is a payments system that is transforming the way retail business is transacted in vast rural areas and small towns, where more than two thirds of India’s 1.4 billion people live.

Much like glitzy city stores, street vendors to small shops are making the switch to digital payments. But instead of credit or debit cards, they use India’s Unified Payment Interface popularly known as UPI. It is a payment system that involves no merchant fees and can be used for the smallest of transactions to make instant transfers across bank accounts. It was developed under the initiative of India’s Central Bank.

“It is the ease of the technology and overall reduction in transaction cost that has made this system popular. It takes place with the click of a button, it is cost-effective, and easy to manage,” said economist N.R. Bhanumurthy, Vice Chancellor at D.R. Ambedkar School of Economics University in Bengaluru. “It is certainly a huge transformation from what we did in the past and has changed the way we do business.”

Its expansion has also been helped by a massive push in recent years to bring more people into the banking system. More than 80% of adults now have bank accounts, compared to just one-third of adults some years ago. Affordable smartphones that cost as little as $50 are in the hands of about 750 million people. The COVID-19 pandemic, when cash transactions were discouraged, also prompted many to switch to digital payments.

“The Digital India Movement can bring about revolutionary changes in India and the lives of the common man,” Prime Minister Narendra Modi said at an Independence Day address on Monday. According to the Indian leader, 40% of the real-time digital transactions made in the world now take place in India.

Whether in big towns, cities, or small villages, India’s retail sector is dominated by millions of small stores and shops, who for decades only did business in cash.

The speed and scale with which they are embracing the new payment system is evident in Banuri village. The owner of a chemist shop, Akhilesh Sharma, said about 70% of his customers pay online. It has eased his life.

“Whenever I open PhonePe or Google Pay app, all the transactions are done in my business account,” said Sharma. “In cash, I have to count the money at the end of the day, and it is a little long process. Then I have to go to bank and deposit the cash.”

Economists say digital payments boost business by facilitating transactions. Small town and village residents, especially younger customers, are also discovering the benefits of going cashless.

“I don’t have to worry about carrying money,” said Vikas Sharma, a resident of Palampur. “Earlier when I went to a crowded place, I worried about getting my wallet stolen. Now all I need is my phone.”

Digital transactions are just one of the benefits that the internet has brought people living in outlying areas. For older people such as a retired government employee, Romesh Dogra, the biggest benefit is connecting via video calls with his three daughters who live outside his district.

“I get energized daily when I talk to my grandchildren,” said Dogra, a retired official. “I can watch them growing up. Life has become good.”

There are still gaps to plug in — internet speeds can pose a challenge, especially in villages and small towns. And while the numbers of people with access to the internet have doubled to nearly 700 million in the last five years, millions are still not connected. But with rapid progress, it may not take long for India’s digital footprint to expand.
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In India, an initiative to bring internet access across the country has helped millions plug into new digital technologies. One of them is a payments system that is transforming the way business is being done in the vast rural areas of the country. Anjana Pasricha has a report.
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