Julie Gerberding





Director of the Centers for Disease Control and Prevention

Born Julie Louise Gerberding, August 22, 1955, in Estelline, SD; married David Rose (a computer software engineer); children: Renada (stepdaughter). Education: Case Western Reserve University, Cleveland, OH, B.S. (chemistry/biology), 1977, M.D., 1981; University of California, Berkeley, M.S. (public health), 1990.

Addresses:

Office— c/o Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.

Career

Director, University of California, San Francisco, Epidemiology Prevention and Interventions (EPI) Center, 1990–98; director of healthcare quality promotion, Centers for Disease Control and Prevention (CDC), 1998–2001; acting deputy director, National Center for Infectious Diseases, CDC, 2001–02; director, CDC, and administrator, Toxic Substances and Disease Registry, 2002—; associate clinical professor of medicine, Emory University, Atlanta, GA, and associate professor of medicine, University of California, San Francisco, CA.

Sidelights

Barely six months after she took over as the 13th director of the Centers for Disease Control and Prevention (CDC), Julie Gerberding found herself faced with an ominous threat to public health—a potentially fatal viral infection labeled severe acute respiratory syndrome, or SARS. No stranger to the

Julie Gerberding
front lines of the war against emerging diseases, Gerberding is a specialist in infectious diseases who first earned her stripes two decades earlier in the battle against AIDS, a scourge she still considers the major worldwide public health issue for the next decade. Under Gerberding's direction, the CDC moved promptly to prevent the spread of the disease (which appeared to have originated in eastern Asia) within the United States. By mid–2003, the SARS epidemic appeared to have been largely contained—at least temporarily—but Gerberding and her colleagues at CDC were taking no chances. In the event that SARS may reappear on a seasonal basis—much like influenza—the CDC drafted a plan to cope with a possible return of SARS. Gerberding, quoted by the International Herald Tribune, said her agency would focus on "detecting cases, responding to WHO's [World Health Organization] call for technical assistance or field team assistance in various parts of the world, and having reliable diagnostic tests available where they are needed. It would be foolish to not have that kind of plan available for us."

Even before the frightening SARS headlines had disappeared completely from the front pages of United States newspapers, Gerberding was confronted by yet more frightening medical news, including an American outbreak of the rare monkeypox disease and the return of the seasonal threat from West Nile virus. Fortunately, the monkeypox scare, tentatively linked to the infection of pet prairie dogs exposed to infected giant rats from Africa, seemed to be quickly brought under control. In late June of 2003, Gerberding told the Center for Infectious Disease Research & Policy (CIDRAP), "I think we have optimism that this particular outbreak of monkeypox can be contained. We have so far been able to link human cases to affected animals, and they directly link back to the source that has been described already today," in a reference to the African rodents.

Potentially far more problematic for Gerberding and the CDC was the return of the summertime threat of the West Nile virus, which was first detected in New York in 1999. In mid–June of 2003, according to Agence France Presse, Gerberding told reporters, "We have documented West Nile virus activity in 24 states. We have not documented human cases yet. It is too soon to predict if it will be better or more severe than last summer." The disease, spread mostly by mosquitoes although it has also been transmitted through blood transfusion and organ transplants, in 2002 infected 4,156 Americans, 284 of whom died, for a mortality rate of nearly 7 percent. A number of health experts have predicted more cases in 2003, largely because of the heavy rains that hit much of the eastern United States in the spring. Most susceptible to the West Nile virus are people with weak immune systems, most notably the elderly. Ironically, one of the Americans infected with West Nile virus in 2002 was Gerberding's husband, computer software engineer David Rose. When the couple found a dead bird in the backyard of their Atlanta, Georgia–area home, Gerberding promptly reported the finding to local health authorities. She later told CWRU (Case Western Reserve University) magazine, "I have a fair amount of experience with a lot of different viral agents. I was not surprised with the test results and was very thankful that it was just a mild case."

A native of Estelline, South Dakota, where she was born on August 22, 1955, Gerberding is the daughter of the town's police chief and his schoolteacher wife. By the age of four, she had decided that more than anything she wanted to be a doctor when she grew up. In pursuit of that goal, Gerberding enrolled at Cleveland, Ohio's Case Western Reserve University, earning her bachelor's degree in chemistry and biology in 1977. Four years later she received her medical degree from Case Western. In an interview published in the Spring 2003 issue of CWRU, she discussed the selection of the school for her studies. "I did a lot of research about where I wanted to go to medical school. I was extremely impressed with the concept at Case that you were there to learn and the emphasis on the organ system curriculum, the problem–oriented curriculum, and the early exposure to patients. I was interested in going to Case as an undergraduate, because I wanted to go to medical school there." She served her internship and residency in internal medicine at the University of California, San Francisco (UCSF) and in 1990 was named director of the school's Epidemiology Prevention and Interventions (EPI) Center. Her years in San Francisco coincided with the emergence of the AIDS epidemic, which struck particularly hard in that city. Against this backdrop, Gerberding developed a passionate interest in combating infectious disease.

Of her involvement in the battle against AIDS, Gerberding told CWRU, "I started my training at UCSF at the very beginning of the AIDS epidemic and took care of the earliest patients there, who, in retrospect, we recognize had AIDS. My clinical training really evolved with the AIDS epidemic, and it was natural to get started in the infectious disease area during that time." While at UCSF, Gerberding helped write guidelines to protect hospital workers from contracting the disease, winning recognition for her pioneering efforts in this area of the war against HIV infection.

Julius Krevans, chancellor emeritus of UCSF, told Anita Manning in USA Today that Gerberding was "considered one of the bright stars" almost from the outset of her years at the institution. The early emergence of the AIDS crisis coincided with research Gerberding was already conducting into the nature of hospital infections and how best to prevent their spread. Under the circumstances, it was logical that she would broaden her research to include this new mystery disease and how it might be communicated from patients to hospital personnel. According to Krevans, research conducted by Gerberding and her colleagues helped to establish ground rules for ways in which large institutions—including hospitals and large corporations—could deal with HIV–infected people in the workplace.

The guidelines developed by Gerberding and her colleagues were adopted by major Bay Area companies, including Levi Strauss, and eventually by the San Francisco Chamber of Commerce as well. Of Gerberding's contribution to the early battle against HIV/AIDS, Krevans told USA Today 's Manning, "From the beginning of her career, she had thrust upon her a responsibility to think through something that affected not just an individual patient, but something that affects a community, the larger society." Dr. David Bangsberg, who succeeded Gerberding as director of UCSF's EPI Center, was interviewed by the Atlanta Journal–Constitution about his predecessor's research: "She quickly became a leading authority in establishing that the risk of HIV infection was low among health care workers and that the risk could be further reduced" through the use of post–exposure drugs.

In 1998 Gerberding joined the CDC as director of its healthcare quality promotion division. In that position, she continued to pursue her research into the area of hospital safety, focusing in particular on medical errors and drug–resistant infections. Three years later, Gerberding was named acting deputy director of the CDC's National Center for Infectious Diseases (NCID). Her new position put Gerberding at the center of the CDC's response to the anthrax terrorist incidents of late 2001. It was Gerberding who helped to quiet the widespread panic that gripped the United States in the wake of a handful of anthrax cases traced to disease spores sent through the mail. By mid–November of 2001, when a couple of weeks had passed with no further anthrax–tainted letters, Gerberding shifted the focus of the CDC's response to specific target groups. The CDC's recommended 60–day regimen of preventive antibiotics was aimed specifically at postal workers, media representatives, and congressional staff members, all of whom had been among the handful previously exposed. In explaining the agency's rationale, Gerberding told United Press International, "The circle of people who need to be treated has narrowed substantially," adding that the federal agency was cooperating with state and local health organizations "to do everything possible to promote adherence to the antimicrobial regimen."

When CDC Director Jeffrey Koplan stepped down in the spring of 2002, it soon became apparent that Gerberding was prominently featured on the short list of candidates to replace him. In late June of 2002, the race had been narrowed down to Gerberding and Dr. Robert Redfield, an AIDS vaccine researcher based at the University of Maryland, both of whose names were submitted to President George W. Bush. Speaking out in support of Gerberding's candidacy was Dr. James Curran, dean of the Rollins School of Public Health at Atlanta's Emory University and the former chief of HIV/AIDS programs at the CDC. Curran told the Atlanta Journal–Constitution, "She has been given increasing responsibility quickly, which is a sign of the confidence that people within the CDC have in her. She is a solid scientist, personable and reasonable, and she's knowledgeable about infectious disease at a time when that has the attention and concern of the American public and the administration."

In the end, Gerberding got Bush's nod, influenced in no small part by strong support from Secretary of Health and Human Services Tommy Thompson. In announcing that the Bush administration had decided to go with Gerberding, Thompson told reporters, as quoted by Mike Fleming in the Washington Blade, "I can think of no one better equipped to take the helm. Dr. Gerberding knows public health, she knows infectious diseases, and she knows bioterrorism preparedness." For her part, Gerberding pledged to do all that she could to see that CDC pursued the priorities of both Thompson and Bush. According to Fleming, she said, "Most importantly, I intend to listen to voices that may not have been heard, especially those from external constituencies in communities, academic environments, and the private sector, whose input—sometimes painful input—is absolutely essential to our success."

The first woman ever to serve as director of the CDC, Gerberding faced a number of daunting challenges in her first 18 months on the job. In addition to the emergence of SARS, an outbreak of monkey-pox, and the continuing battle against HIV/AIDS, she also faced an internal CDC debate about the magnitude of the agency's vaccination campaign to protect key groups against a possible smallpox bioterror attack. Originally targeted at health care workers, the vaccination program was later expanded to cover other first responders, including police officers and firefighters. Citing the incidence of heart inflammation and heart attack among vaccine recipients, the CDC's Advisory Committee on Immunization Practices (ACIP) in June of 2003 recommended limiting vaccinations to health care workers. However, Gerberding came down in favor of the broadened approach to smallpox vaccination, telling the Atlanta Journal–Constitution, "We respect the ACIP perspective, but we also recognize that we still have work to do, including ongoing immunization."

As director of the CDC, Gerberding has been forced to follow a grueling schedule, flying frequently between the CDC's headquarters in Atlanta and the nation's capital to confer with Thompson and other federal health officials. The demands of her job have forced her to be creative in carving out time to spend with her husband, stepdaughter Renada, and the family's three cats. As she told USA Today 's Manning in June of 2003, "We've only been married less than three years. This is not exactly how I'd recommend spending your honeymoon."

Sources

Periodicals

Agence France Presse, June 19, 2003.

Atlanta Journal–Constitution, October 19, 2001, p. A1; June 29, 2002, p. A1; July 3, 2002, p. A1; June 20, 2003, p. A11; June 27, 2003, p. A5.

CWRU, Spring 2003, pp. 28–31.

International Herald Tribune, June 23, 2003.

National Journal, October 10, 2002.

United Press International, November 15, 2001.

USA Today, June 12, 2003, p. 4D.

Washington Post, July 3, 2002, p. A21.

Online

"AIDS Expert Named to Head Federal Health Agency," Washington Blade, http://www.aegis.com/news/wb/2002/WB020705.html (June 29, 2003).

Biography Resource Center Online, Gale Group, 2002.

"CDC Director Confident of Monkeypox Containment," CIDRAP, http://www.cidrap.umn.edu/cidrap/content/hot/monkeypox/news/june2003mo keypox.html (June 29, 2003).

"CDC 'Very Concerned' SARS Could Spread in Workplace," CNN.com http://www.cnn.com/2003/HEALTH/04/10/sars.virus.us.ap/index.html (April 11, 2003).

Don Amerman



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