Robert Redfield Jr., the new director of the Centers for Disease Control and Prevention, gave a deeply personal agencywide address Thursday in which he repeatedly underscored the importance of science and data and said the CDC's most critical public health mission is to protect Americans “from that which we don't expect.”
The 66-year-old Redfield, a longtime AIDS researcher appointed to the job a week ago, was overcome by emotion twice during his brief remarks and a question-and-answer session. The University of Maryland medical professor had sought the top job at the CDC and the National Institutes of Health for more than a decade.
About 30 seconds into his address, he choked up and then regained his composure. He spoke of the honor of leading the best “science-based, data-driven agency in the world. I've dreamed of doing this for a long time.”
The 45-minute session at the CDC's Atlanta headquarters, which employees were able to watch or listen to from locations across the United States and around the world, was well received by employees. Katherine Lyon-Daniel, CDC's associate director of communications, asked him questions she said had been submitted in advance; they didn't include any controversial topics.
Redfield came across as knowledgeable and well briefed.
“I'm a little nervous. I'm an outsider,” he said. “I didn't grow up here in CDC, but I hope you accept me as a member of the family and accept my wife, because we're here to serve side by side with you.”
Several staff members noted his strong embrace of science and said they were especially gratified to hear him say that if the CDC has evidence to support a public health intervention, the intervention should be applied.
The Maryland clinician has moved quickly to take the helm of the CDC. He was sworn in Monday in Washington by Health and Human Services Secretary Alex Azar, flew to Atlanta and met Wednesday with the directors of the CDC's individual centers.
Redfield’s main career focus has been chronic human infections, especially HIV/AIDS. He headed clinical care and research at the University of Maryland medical school’s Institute of Human Virology. He also oversaw programs caring for 6,000 patients in the Baltimore-Washington region, as well as for more than 1.3 million patients in Africa and the Caribbean as part of the President’s Emergency Plan for AIDS Relief, known as PEPFAR.
His appointment had drawn criticism because of his once-controversial positions on HIV testing during the first decade of the AIDS crisis, his ties to conservative AIDS organizations that supported abstinence-based prevention and his lack of experience with governmental public health organizations.
He takes the agency's helm at a time when scientists and public health experts are concerned about the commitment of the CDC and HHS to science- and evidence-based research. Just three months ago, CDC employees were advised to avoid seven words or phrases in narratives in preparing the fiscal 2019 budget. Some “words to avoid” were spelled out in an HHS style guide, and instruction about others, including “evidence-based” and “science-based,” were given verbally by a CDC official. Department officials have provided different accounts of how that verbal guidance took place but said it was not official administration policy.
The agency is “science-based and data-driven, and that's why CDC has the credibility around the world that it has,” Redfield said Thursday, before choking up again as he talked about the chance to work there after a 20-year academic career. “Academia does not solve problems. Academia is not a service organization.”
Redfield didn't address some of the criticism over policies he supported decades ago, such as mandatory HIV screening, that some AIDS advocates said were not sound public health approaches. But in talking Thursday about ways to end the AIDS epidemic in the United States — which he said could be accomplished within three to seven years — he voiced support for comprehensive prevention strategies.
“I've never been an abstinence-only person,” he said. “Just ask my wife,” he added, prompting laughter from the audience. “I believe in every measure we have scientific evidence for, including condoms.”
He also spoke of the importance of vaccines and recounted how as an Army doctor in the early 1980s, he helped persuade military leadership to vaccinate “every individual in the armed forces” against hepatitis B after a young soldier for whom Redfield had cared infected his wife and newborn child. “That's probably the most important thing I did in my life,” he said.
Too many people don't understand the importance of vaccination, he continued, mentioning the 130 children who have died this flu season. “We have got to get the American public to understand that vaccination is important and needs to be fully utilized.”
Redfield said the opioid epidemic is “the public health crisis of our time” and agreed with Azar that it is a medical, not a moral, problem on which the CDC will help lead the government's response. He also likened the stigma around addiction to that during the early days of AIDS. Redfield, who has five children and nine grandchildren, has close personal experience with the opioid crisis.
“If any of you have tried to access care for addiction in this nation, I can guarantee you it's complicated,” he said. “It needs to not be complicated.”
Although his supporters point to his strong background in infectious disease and global health, public health experts inside and outside the agency say one of his biggest challenges will be his limited governmental public health experience, especially involving emergency responses.
Redfield spoke about organizing a relief effort during the 2010 Haiti earthquake and about his experiences working in Africa on the PEPFAR program. But he acknowledged that the CDC's most important mission is to protect Americans from emerging health threats, whether they are naturally occurring diseases or bioterrorism.
“I pray it doesn't happen on our watch. But I want to make sure we're all prepared, whether it's flu — my biggest fear — or MERS or something else,” he said, referring to Middle East respiratory syndrome, an acute viral respiratory illness. “I respect the mission we have, which is to be prepared for what we don't expect.”
Redfield said he has gotten a list of 57 items from his wife about what he should do. “Number one, listen. Number two, don't interrupt. Number three, listen.”
The job heading the country’s foremost public health agency had been vacant since Jan. 31, when former Georgia public health commissioner Brenda Fitzgerald resigned after serving only half a year. She was unable to divest from “complex financial interests” in a “definitive time period,” according to an HHS statement. Fitzgerald had also purchased shares in a tobacco company shortly after becoming CDC director. Azar accepted her resignation two days after he was sworn in.