Dr. Julie Gerberding has faced “one crisis after another” since becoming director of the U.S. Centers for Disease Control and Prevention in July 2002, she says. The CDC – the U.S. Department of Health and Human Services agency overseeing the health and safety of Americans – has addressed outbreaks of severe acute respiratory syndrome (SARS), monkeypox, West Nile virus, and avian flu virus. Before Gerberding took office, the CDC was criticized for its response to the anthrax attacks after 9/11 and spotty dialogue with health authorities and the public. Under her leadership, the agency has notably improved its communications, health crisis management, and outreach through global partnerships. A Harris Poll recently ranked the CDC the top U.S. government agency.
Gerberding has dealt with critical health issues her whole career. In the 1980s, as an intern and resident physician at the University of California, San Francisco (UCSF), she was at the epicenter of the AIDS outbreak. After completing a master’s degree in public health at the University of California, Berkeley, Gerberding joined the UCSF medical faculty as an expert on infectious diseases. In 1998, she became director of the CDC’s Division of Healthcare Quality Promotion and later was named acting deputy director of the National Center for Infectious Diseases.
In 2004, at 49, Gerberding was named by Forbes as one of the 100 most powerful women in the world. In 2005, Rotary honored her with its Polio Eradication Champion Award for leading the CDC in providing crucial technical and financial support to help end polio worldwide and for personally traveling to polio strongholds in Afghanistan, India, and Pakistan, which encouraged stepped-up efforts against the disease. She recently sat down with Editor in Chief Vince Aversano in her Atlanta office to discuss the partnership between the CDC and Rotary, the fight against polio, and the state of the CDC under her leadership.
You’ve said that while you interned in California in the 1980s, you were affected profoundly by the devastation of the AIDS epidemic. Can you talk about the specific impact on you?
If you were in San Francisco in the early ’80s, you couldn’t help being deeply affected by HIV/AIDS victims. We treated the very first patients, and the disease was a huge mystery and incredibly sad. Not just for our patients but also our neighbors, colleagues, friends, and families. The discovery that this was a transmittable infection, and the development of the science and medicine shaped me and everyone I trained with.
Since you took the CDC reins in 2002, have there been measurable improvements?
I joined the CDC senior leadership team 10 days before 9/11, so I was shaped by that day and the anthrax attacks that followed. When I became director, we had a host of emergencies – deadly viruses, a severe flu season, a vaccine shortage, a tsunami, hurricanes – so we had to become a more visible and effective entity in public health crises. Some gains are hard to measure. But we’ve provided support for some highly successful programs. We’ve seen the incidence of bloodstream infections drop by more than 50 percent. In some hospitals, staphylococcus infections dropped to almost zero in many patient populations. We’ve trained more than 9,000 clinicians to aid in detection, diagnosis, and reporting of emergencies. And we’ve learned that when you partner with others, you accomplish much more than you dreamed possible. But we have a long way to go as health care gets more complicated and expensive.
Polio has been eliminated from the United States for almost a generation now. Why should people here still care about polio?
In the United States, we’re just one traveler away from the reintroduction of this disease, so we have an enlightened self-interest in continuing to protect our own children. But we also, as humanitarians and people with hearts, need to know that children everywhere have the same benefit.
With polio almost eradicated globally, is it still a priority on the CDC’s agenda?
Polio remains the CDC’s number-one priority. Since 1991, we’ve provided financial and technical support that’s helped reduce cases by more than 99.5 percent in 122 countries. We’ve developed a network of multinational partners in affected countries now, including ministries of health, local and other volunteers, government agencies, philanthropic organizations, and the private sector – Rotary is certainly a leader there. Of course, the World Health Organization and UNICEF are critical parts of this network approach. We have years of commitment to the eradication goal, and we are doing everything we can to continue to strengthen and take this to its ultimate solution.
Do you feel that polio can be completely eradicated?
We’re seeing unprecedented reductions. And we’ve successfully eradicated one of the strains. But there are still cases in four countries – Nigeria, India, Pakistan, Afghanistan. So to meet the CDC’s goal of ending global transmission by 2008, we need to sustain the course.
Why does polio linger in those four countries?
The reasons are very complicated, and they vary from country to country. There is not a single common denominator, but we know we need to improve vaccine coverage for children, meaning effective campaigns in vulnerable areas. Also, we must continue to invest in vaccination in those countries and immunize in countries where polio’s been eliminated so we don’t create new opportunities for the disease to emerge and spread.
How would you describe the partnership between Rotary and the CDC?
The CDC and Rotary have the perfect partnership. We have all the right ingredients to bring our best together and create a whole greater than the sum of its parts. Rotary brings many strengths, especially passion and a long-standing commitment to get this done – also the experience, the incredible volunteerism, and the financial resources to help us win this battle.
What is the role of the private sector in public health matters?
We’ve recognized that it takes a network to efficiently protect public health. It takes responsible citizens who learn how to protect their own health and their family’s health. It takes clinicians aware of the value of prevention. It takes an enlightened business sector to recognize that health prevention is good business. It not only saves them money on their employee benefit packages; it decreases absenteeism, which increases productivity. Also, businesses are increasingly recognizing the value of investing in the communities where their employees live and work. I think that is the most exciting wave of the future: increased emphasis in the private sector on prevention as the first place to shop with our health dollars.
What can the CDC do to prevent a global flu pandemic?
The CDC, WHO, and other health experts have already provided test kits for hospitals to determine whether future infections are H5N1. And the federal government can take steps to help prevent and control it. But it’s not just a government issue. We need an involved network, including the business community, the clinician community, the education system, and everyone in the community with a stake in how people live, work, and play in the context of a public health emergency. The CDC’s role is to detect the problem and quench it as soon as it’s discovered. But we recognize that’s unlikely with an easily transmitted virus. Barring that, our job is to reduce the chance of introduction in the U.S. and slow its spread, to buy time to deliver a vaccine to our citizens.
How are we modernizing our vaccine production capacity to inoculate an estimated 20 million people in such a pandemic?
Our government has taken unprecedented steps to support vaccine manufacturers in the modernization process. Not only are we helping to build physical plants to scale up vaccine production, but we’re also on a fast track, importing the research and development to move from an egg-based vaccine system to a molecular-based technology. That will help speed the delivery of a vaccine to market. In a pandemic, weeks can save lives.
How did the network of global health protection do in the threat posed last year by the individual who traveled with a drug-resistant strain of tuberculosis?
When you have a patient with a drug-resistant form of tuberculosis, the first line of defense is the covenant of trust between patient and physician. In this case, that covenant failed. The second failure in the response was the lack of communication throughout the public health system to prevent the individual from traveling. This case demonstrated why all countries must collaborate more effectively to prevent people with MDR TB [multidrug-resistant tuberculosis] from traveling. We learned from this event. Since then, we’ve prevented other travelers with TB from traveling. It was a hard lesson, but it certainly informed the whole world.
If terrorism does strike here again, how would the CDC respond differently?
All of our agencies at the federal, state, and local levels have greatly improved their preparedness. But in the public health sector, we’re still decades behind in terms of the infrastructure. So we’ve had to crawl out of a deep hole. But recently, we’ve seen dramatic improvement in our pandemic disease preparedness in terms of detecting, responding, and communicating seamlessly between our network of clinicians and the media and public. But we need to do much more.
What are the CDC’s top priorities for 2008?
There’s still a big difference in the resources we apply to disease care versus prevention. Only about 3 percent of the health care dollars spent in the United States go toward prevention. So our top priority is to emphasize that it’s far better to promote good health and to prevent disease and injuries and disabilities, and prepare for emerging health threats, than it is to treat those problems once they’ve occurred.
After that, we want to increase our investment in many programs – our polio immunization efforts, with a goal of certifying polio eradication by 2012; our pandemic influenza preparedness activities; our Measles Initiative to reduce annual measles deaths by 90 percent by 2010; our Strategic National Stockpile [a national repository of lifesaving pharmaceuticals, medical supplies, and equipment that can be deployed anywhere in the United States within 12 hours]; our adolescent health initiative that promotes physical activity, healthy eating, and injury prevention through funding and technical assistance to 3,600 U.S. schools; our Vaccines for Children program that, in the past two decades, prevented some 20 million deaths from vaccine-preventable diseases; our HIV/AIDS testing initiative to reduce the estimated 250,000 HIV-infected persons in the U.S. who are unaware of their status; our National Breast and Cervical Cancer Early Detection Program; and our special pathogens laboratory capacity. But these aren’t just priorities for 2008; they’re part of our complex mission for the 21st century. Public health is at a tipping point. We’ve never had more challenges, but we’ve never had more opportunities.
Rotarians have been involved in trying to eradicate polio for 20 years now. What message would you give to the 1.2 million Rotarians in terms of finishing the job of polio eradication?
My first message to Rotarians is thank you, thank you, thank you for everything that you’ve done to bring us to this point. We are close to eradication, but close is not good enough in this case. And all of our science indicates that we really have to completely eradicate this virus, or we will have a long road ahead of us in terms of continuing to stamp it out where it crops up. So we’ve got to finish the job. We’re not quite done yet, but if we stick together and continue to apply ourselves, I’m very optimistic that we ultimately will be successful.