In 2005 you transitioned from a long career at the CDC to your new roles at Emory University. Why the move to academia? Does the move reflect a change in your personal scientific or public health goals?
No. It reflects the fact that I spent 31 years at the CDC and had served as Director of the National Center for Infectious Diseases for 13 years. All this time the clock was ticking, and I came to realize that as much as I enjoyed doing what I did at the CDC, if I was ever going to do something a little different, I needed to do it now and make way for younger people in the leadership chain at the CDC. Once you’re in a job for 13 years, there’s still more to do, but there comes a time when it’s right for someone else to assume that leadership role.
Another reason for the move was the gradual decrease in contact I had with the younger staff members at the CDC. I thought in academia I would have more chances to do some teaching and mentoring of younger folks.
One of your recently published studies examined barriers to flu vaccination. Can you ever hope to change people’s minds about accepting an immunization?
I think you can hope to change many people’s minds, but there will always be a refractory core. We need to do what we can to remove barriers to immunization and improve our communication skills.
Some of the work I’ve been involved in since coming to Emory explores approaches to increasing adolescent immunization coverage in rural and urban Georgia. I’ve been surprised at the level of awareness among students—it’s higher than I would have guessed. The teachers we’ve worked with have been supportive of introducing immunization information to science classes. I’ve seen evidence of the effectiveness of educating young people by raising their knowledge about immunization, and perhaps altering their interest in the topic.
I see that you were named one of the “Top 100” Irish Americans of 1999 by Irish America magazine. How Irish are you?
That came out of the blue. I have Irish blood, but I wouldn’t pass muster as a green-blooded Irish American. I was flattered by the recognition. I did visit my ancestral area in the Republic of Ireland while in medical school and look forward to returning someday.
I probably should take that off my CV.
In 1996, you authored a perspectives piece titled, “Emerging pathogens. An epidemiologist's perspective on the problem and priorities for the future.” A lot has happened since then, including: SARS, bird flu, and swine flu outbreaks. How has your personal view of the threat of emerging pathogens changed since 1996?
I think they’re more of a threat now, in part, because of globalization and also due to the many changes the world is experiencing. The trends in almost all factors contributing to disease emergence favor the pathogens. Examples of this can be found in globalization, as well as the lack of political will to make the investments that detect and respond to the problems. Drug resistance, for instance, is obviously a major problem and a good example of a problem that has gotten worse. The drug development pipeline has dried up—the introduction of new antibiotics has markedly declined. Research by pharmaceutical companies has not kept up with these needs.
Where do you see your field in 10 years?
I think there are going to be a lot of surprises. We’re going to continue to see new and reemerging infectious diseases, diseases caused by previously unrecognized organisms, and diseases in new parts of the world. We will experience more problems with antibiotic resistance, but I hope we see the market failure resolving and the innovation gap decreasing.
I hope we see more collaboration between people involved in human medicine and public health and those in veterinary medicine and public health on issues contributing to cross-species transmission.
There are threats, and they are persisting, but there are more and more tools available to combat these threats. There’s also more commitment and more willingness to work across disciplines to bring an expanded array of areas of expertise to bear on many of these problems. Research focused on the microbiome, systems biology, and application of whole genome sequencing, along with other cutting edge tools, will identify new prevention opportunities.
If you had to change careers today and you could do anything, what would you do?
I don’t have any regrets about having done what I’ve done—it’s not something I ever planned, but I’ve thoroughly enjoyed it.
Having said that, I was a history major in college and I have maintained a historical perspective and interest. I have watched what others have done with medical history, and if I were starting over I might consider getting into that area.
What’s your favorite science book?
I read a lot on the job, and I don’t read a lot on the side. But one book that I did read was The Hot Zone by Richard Preston—he writes the best first chapters. It touched on a number of the issues we’ve worked on at the CDC over the years.
What is your favorite organism?
My favorites would be the ones that make up the normal human microbiome—because they’re good for you.
But from the standpoint of my years at the CDC and the challenges we faced there, the Sin Nombre virus is my favorite. It’s the hantavirus that was identified in an outbreak of severe acute respiratory disease initially recognized on the Navajo reservation in 1993. When the virus was discovered at the CDC, the tradition had been, historically, to name a new virus after a location where the patient, who was the source of the virus, was identified. The name initially proposed happened to be a sacred site on the reservation. The Navajo, understandably, weren’t enthusiastic about that proposed name. This experience highlights the stigmatization that often occurs during outbreaks caused by emerging pathogens.