A Unified Front Against AIDS
and resources. Along with a rapid response, the public health system should avoid duplicating research, and should employ the knowledge available in both the public and private spheres of research. These necessities in a health crisis require coordination. This level of coordination seems impossible under the current system for three integral reasons: assigning roles is contrary to the American scientific spirit, the identification of a crisis proceeds at a slow and haphazard pace, and, most importantly, a lack of central authority prevents the flexibility and fluidity necessary to maintain coordination throughout the shifting environments that an expanding health crisis creates.
As discussed above, a certain chaos exists inherently in the scientific process, especially when little initial information is available to direct research. Even when information becomes available, however, scientists are often unwilling to accept assigned research tasks. Scientific freedom serves as a major attraction in becoming a scientist—individual interest dictates research. Under the structure of the current system, if a scientist did, for some reason, want to abandon a project already in progress for one more integral to the cause, the transition of funding and laboratory configuration becomes enormously difficult logistically. New funding, usually in the form of grants, must be approved, and new facilities must be configured to support the new research objective. This clearly points to a lack of a central coordinating authority, which would ease the transition. Even with the facilitation of research objective transition, the decision to change remains in the hands of the individual researcher. The debate may come to an impasse at the point where the struggle balances between personal scientific freedom and the public good.
The lack of central authority greatly slows the process of crisis identification. The collection of disease data operates primarily on an anecdotal system. Only individual states can make a disease “reportable.” In other words, the state must request that physicians, laboratories, and hospitals in that state report every case of a certain disease they come across to state officials, in order to facilitate its tracking and future research. The CDC, NIH or any other federal body cannot demand any data, or even the collection of data. At most, the federal institutions can merely request the report of data. These requests, even though they originate from a federal body, are rather toothless. If requests are not honored by the states or private institutions, the CDC and NIH have no sanctioning power, no punitive recourse against the private sector. One inherent problem that results is that fifty states have fifty reporting procedures, further complicating and slowing the collection of information. Another involves the fact that a private health care organization rarely knows the prevalence of the disease unless it is given broader statistics from a more central source which has compiled them. Circuitously, it is these private institutions that initially notify the state that a disease is worth reporting. Not only does this circular and anecdotal method of reporting slow the process of potential crisis recognition, but so too does the weak relationship [next page]