ANALYSIS: Client Profile - Not-so-clear lines of communication atthe CDC - Some say it's typical government bureaucracy. Others say thatbecause the Centers for Disease Control has to play by a different setof rules...

Last March, Dr. Jeffrey Koplan, the director of the Centers for

Disease Control (CDC), addressed the Association of Health Care

Journalists in Atlanta. His keynote speech addressed the question of how

well journalists cover the most important issues in healthcare.

But once Koplan finished speaking, the tables were turned by a group of

reporters led by Joanne Silberner, National Public Radio's health policy

correspondent. Why, they wanted to know, was it so difficult to get

simple, timely answers out of the CDC? Koplan referred the question to

PR colleagues.

Several sources who spoke to PRWeek used the terms "mean-spirited,"

"unresponsive," and "Kremlin" to describe the giant PR bureaucracy at

the nation's public-health guardian.

In its defense, director of communications Vicki Freimuth says that the

CDC deals with upwards of 20,000 press calls every year, and aims to

answer all of them within an hour. She also extends an open invitation

to listen to and fix any complaints about her unit's performance.

How much of the criticism has to do with the normal level of whining

that journalists do about their sources and how much is grounded in fact

is debatable. A review of any week's coverage of the CDC indicates that

the CDC is so regularly and routinely cited by the media at all levels

that it stands as one of the best and most-trusted sources of public

information on infectious disease in the world.

In addition to its media work, the CDC organizes around 20 integrated

social marketing campaigns a year, with total budgets in the hundreds of

millions of dollars.

Where the wires cross

The naysayers are right about the Byzantine nature of the CDC's PR


Here's how it works: Dr. Koplan is the head of the entire CDC. Reporting

to him is Martha Katz, the deputy director of policy and education.

Under her is Freimuth, the senior executive responsible for all of the

CDC's PR. Reporting to Freimuth is Golan, who has sole responsibility

for media relations. Under Golan are eight to 10 media officers who take

queries, which are then funneled through a main phone number.

Those media officers do not themselves answer questions or give


Their task is to direct messages to the appropriate officials. Therein

lies much of the problem reporters say they have with the CDC : they

feel that their questions are being dropped into a black hole from which

answers emerge haphazardly. In addition to the main media relations

unit, each separate center of the CDC has its own press officer.

On the non-media side (the CDC refers to it as "creative services"),

Freimuth oversees seven internal health communications staffers and four

outside agencies that are contracted every five years (see sidebar).

Each year, the shops are allowed to contend for as many as 18 different

projects, and as they progress, those projects are subject to further

"modifications" that change or add duties (according to Freimuth, there

were 18 modifications last year).

The upshot is that the four agencies find themselves constantly pitching

for new business. "It is administratively quite taxing," says Ogilvy SVP

Yolan Laporte. It can, however, be extremely lucrative.

Currently in play, for instance, is a dollars 125 million integrated

marketing youth-media task, which will be awarded by the end of

September. The task has the Sisyphean goal of persuading 9- to

12-year-olds to avoid risky behavior in the areas of sex, drugs,

violence, and eating habits.

One of the CDC's less well-known operations is its media entertainment

function. A permanent staffer in San Diego works with Hollywood to

advise on the accuracy of health messages in films and television shows.

It has a particular emphasis on inserting health messages into soap

opera scripts.

"Many of the regular viewers of soap operas are also people who suffer

from many of the health issues that we work on, disproportionately in

many cases," says Freimuth. "They may not be people who turn to the

Internet and be real active information seekers."

Getting the job done

Measuring the CDC's return on its investment in PR is a nebulous


The CDC relies on a series of before-and-after surveys for each task,

and also monitors responses to its hotline phone numbers and Web site


Of the dollars 14 million it spends on outside PR resources, dollars 4

million of that goes to research and evaluation. Still, the CDC's record

is an enviable one. If you've used a condom over the last two decades,

the CDC can take partial credit for persuading you to do so. If you

worry about skin cancer from sunbathing, that's a worry the CDC has

worked to give you.

On the HIV/AIDS issue, the CDC has achieved much success in the face of

considerable odds. "There are two ways Americans catch or get HIV, and

that is through sexual activity or drug use - two items that Americans

don't want to talk about," says Ogilvy's Laporte.

But the HIV campaign has seen difficulties. In 1994, the CDC selected

Anthony Keidis of the Red Hot Chili Peppers as an anti-AIDS spokesman,

only to fire him when it was discovered he had a conviction for sexual


Currently, the CDC finds itself struggling with a new phenomenon: HIV

infection rates in certain groups - particularly gay African-Americans -

are on the rise because treatments for HIV are providing patients with

longer, healthier lives. Complacency has reemerged.

As if the messages themselves - use condoms, don't share needles, etc. -

weren't unpleasant enough, the topics remain politically volatile.

School boards, city councils, and conservative media still routinely

refuse to transmit the kinds of graphic messages that the CDC is

touting. "In the first years of the HIV epidemic, the CDC was hamstrung

by the Reagan administration about how forthcoming it was allowed to be

in terms of what the real risks were," remembers Ed Maibach, Porter

Novelli's worldwide director of social marketing.

It's a fine line for the CDC to walk. Although it is not allowed by law

to lobby Congress for support, it must nonetheless maintain good

relations in Washington because that, as Maibach points out, "is where

the bread is buttered."

The CDC's main advantage in navigating political waters is that it

doesn't have an agenda and isn't trying to sell anything. Its messages

remain of personal interest to most of the public - the main problem is

that not everyone agrees that the CDC has the right to speak on public


Maibach points out that when Pepsi sells soda to children, "everybody is

in reasonable consensus that they have the right to do so. There isn't

necessarily a consensus about the role of the CDC educating young people

about imminent threats to their health."

The Centers for Disease Control, Atlanta

Director of the Office of Communications: Vicki Freimuth

Director of media relations: Kay Golan

Outside agencies: Ogilvy Public Relations Worldwide, Washington, DC;

Porter Novelli, Washington, DC; The Academy for Educational Development,

Washington, DC; Prospect Associates, Atlanta

Budget: dollars 14 million on outside PR resources, unknown spending on

internal PR.

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