“It will be a powerless unit with the essential tasks taken away.”
This is how an infectious disease expert described the government’s plan to upgrade the Korea Centers for Disease Control and Prevention (KCDC) to an independent administrative agency.
The government said the plan aimed to enhance KCDC’s expertise and autonomy to better fight infectious diseases after the Covid-19 pandemic.
However, the hidden purpose of the plan is to grow the size of the Ministry of Health and Welfare instead, said Lee Jae-gab, a professor of the Infectious Disease Department at Hallym University Kangnam Sacred Heart Hospital. More specifically, growing the KCDC’s National Institute of Health (NIH), expanding its subunit Disease Research Center, and placing the two under the health and welfare ministry will be a bad idea, he said.
On Wednesday, Lee filed a petition on the Cheong Wa Dae’s website to make the controversial issue public.
As criticism over the government’s plan mounted, President Moon Jae-in on Friday ordered the government to reconsider the moving of NIH and a new National Infectious Disease Research Institute to the health ministry. The plan involves revising the Government Organization Act by the Ministry of the Interior and Safety.
Lee emphasized that people need to keep their eyes on the issue until lawmakers pass a revision bill. He said he filed the petition on Cheong Wa Dae because the National Assembly still has to review NIH's transfer.
“Lawmakers should discuss this matter a lot at the National Assembly and help change the plan in the right direction,” Lee said in an interview with Korea Biomedical Review on Thursday.
|Lee Jae-gab, a professor of the Infectious Disease Department at Hallym University Kangnam Sacred Heart Hospital, speaks during an interview with Korea Biomedical Review on Thursday.|
Question: What part of the announcement by the interior and safety ministry is not what you expected?
Answer: For the Disease Control and Prevention Administration (tentative name) to be genuinely independent to handle its budget and personnel, it has to have its research arm, along with policy and disease control. What was the most noticeable was that the plan to transfer the NIH to the health ministry. The plan also allows the health ministry to own a new organization, the National Infectious Disease Research Institute, mentioned by President Moon. This part was the most absurd.
Q: Why is it a problem to separate NHI and National Infectious Disease Research Institute from KCDC?
A: The KCDC played a crucial role in containing Covid-19 and is considered to have done the job well. So, the public opinion was formed that KCDC should be expanded into an independent unit, Disease Control and Prevention Administration. Not only President Moon but many experts said the nation needs to create the National Infectious Diseases Research Institute. Naturally, I thought that the new research institute would come under the KCDC’s NIH. Other experts also believed that KCDC would grow in size, and its research function would become more active.
However, the government announced that the health and welfare ministry would have a bigger NIH and a new national infectious disease research institute.
It would be as if the health ministry would take over the KCDC’s infectious disease research organization that the KCDC has endeavored to nurture so hard.
Q: The health and welfare ministry said the NIH should be independent of the Disease Control and Prevention Administration to become more professional. Ministry officials said the U.S. National Institutes of Health (NIH) is independent of the U.S. Centers for Disease Control and Prevention (CDC). What do you think about this?
A: The U.S. NIH is in charge of all research related to public health. Although the NIH conducts significant research that affects the industry and hands over the research outcome, it does not make policies for the healthcare industry. It focuses on research only and uses the results to promote public health. If the government wants to benchmark the U.S. NIH, it can change the Korean NIH into the National Infectious Disease Research Institute and put it under the Disease Control and Prevention Administration. To make the Korean NIH like a U.S. one, with functions that the health and welfare ministry wants, the government should integrate all the state-run research institutes studying bioengineering under the Ministry of Science and ICT and place them under an arm of the health and welfare ministry.
The health and welfare ministry said a transfer of the NHI would boost the R&D of public healthcare. The ministry said, “The KCDC’s role would be irrelevant to the development of technologies for genome-based medicine and regenerative medicine.” “We concluded that the NIH should take charge of functions such as technical support for fostering the bio-health industry, which the government currently focuses on,” it said.
Q: When mentioning the necessity of the NIH’s independence, the health and welfare ministry said the NIH’s disease control and research would be operated separately, given the international trend. What do you think?
A: The ministry is right, but it does not mean that the U.S. CDC does not have research functions. The U.S. CDC has its laboratory to analyze the cause of an infectious disease. The U.S. NIH does not carry out that task. The CDC has the National Institute of Allergy and Infectious Diseases (NIAID) to deal with an infectious disease. People say as if the NIAID is independent, but it belongs to the CDC.
Q: Rumors have circulated that the health and welfare ministry was opposing to the upgrade of the KCDC to an administration. Have you heard this, too?
A: I heard a high-ranking official of the health and welfare ministry say, “Do you think the KCDC will do better if it becomes independent? KCDC’s Covid-19 was good because the health and welfare ministry helped.” I directly heard from the official who said the KCDC could do nothing on its own if it gets independent. I think this is what ministry officials are thinking.
Q: Do you mean the health and welfare ministry’s negative stance on the KCDC’s upgrade was reflected in the interior and safety ministry’s plan to revise the Government Organization Act?
A: Yes. The health and welfare ministry has been trying to prevent the KDCD from getting independent. When President Moon held the ceremony to mark the third year of his office, he brought up the topic to give autonomy to the KCDC. Since then, the health and welfare ministry atmosphere has changed, and it could not oppose the plan anymore. That’s when they changed their strategy, I think.
Q: The interior and safety ministry said the KCDC’s management of organs, tissues, and blood would also be transferred to the health and welfare ministry, right?
A: Those areas are involved with chronic diseases and account for a large part of the public health market. The government wants to take them to the health and welfare ministry, too.
Taking control of organ transplants means the government would take away subunits under the KCDC. In the end, the Disease Control and Prevention Administration would be left with infectious diseases and chronic disease management. If the government’s plan goes as planned, it might take away the KCDC’s chronic disease management function, too.
Q: But the government’s announcement did not include any details yet, right?
A: To be honest, that’s more concerning. The health and welfare ministry said the KCDC’s size would grow in personnel and budget, even though its particle functions will be moved. But the ministry gets a research function, policy preparation, and policy analysis. The Disease Control and Prevention Administration will have only administrative infectious disease responding units. With reduced work, there is no way for the organization to grow. The government’s plan to create an infectious disease responding center in each region was more ridiculous. There will be less work, so they can’t increase the number of employees. To make the agency look bigger, they seem to try to increase the number of workers by establishing disease response centers in each region.
Q: In the wake of the Middle East Respiratory Syndrome (MERS) outbreak in 2015, didn’t the government upgrade the KCDC director's rank to the level of a vice-minister and increase the number of KCDC employees?
A: Yes, the KCDC director's rank got higher to a vice minister-level, and the KCDC could establish an emergency center. But, positions for department directors went up by only a few, and the number of epidemiologists went up from 30 to 60. That was it, and there was no more support.
After the MERS outbreak, Korea has been this kind of situation. People say the KCDC was doing an excellent job on Covid-19, and there is an online campaign going on to thank healthcare workers for their work on social media.
But if the government’s plan goes as scheduled, the situation will be barely different from those during the MERS outbreak.
Q: What do you think is the most desirable picture for the Disease Control and Prevention Administration?
A: If the KCDC becomes an administration, it needs to enhance the policy function. The new entity has to have a department in charge of proposing policies and a research institute to back up the department’s ideas. If it becomes and administration, its administrative function will grow. It needs to reinforce its administrative power to guarantee the execution of its functions.
The new body will need more workforce. Epidemiologists working at the KCDC are working for a limited period based on a contract, so they are irregular workers. The new administration should establish an epidemiology division to nurture epidemiologists so that they could dream about becoming the head of the Disease Control and Prevention Administration. In addition to policy research and analytical modeling related to infectious diseases, the function of mediator, disease mechanism research, and vaccine research should remain at the Disease Control and Prevention Administration. The administration should also handle basic immunological studies related to vaccine development.
Also, the administration should have regional offices so that the regional offices, instead of public health centers, could manage the function of infectious disease management. Local governments could handle public health centers’ job other areas. Still, infectious disease control should be governed by the Disease Control and Prevention Administration’s regional offices.
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