‘When the Event Doesn’t Follow the Playbook’.

Anne Schuchat always wanted to be a doctor. But after graduating from Dartmouth Geisel School of Medicine and completing her residency and chief residency in internal medicine at New York University’s Manhattan VA Hospital, she was unsure of what to do next.

“I had heard of the disease detective program at CDC, the Epidemic Intelligence Service,” she says. “That sounded kind of cool, and I thought it might be a fun way to spend two years before I went on to spend my life as a clinician.”

Instead, Schuchat has spent the last 30 years at the Centers for Disease Control and Prevention (CDC), playing key roles in emergencies including anthrax bioterrorism in 2001, the 2003 SARS outbreak, the 2009 H1N1 pandemic, the Ebola epidemic in 2014, and the ongoing Zika epidemic. She was promoted to rear admiral in the Commissioned Corps of the United States Public Health Service in 2006, and earned a second star in 2010.

Schuchat is now principal deputy director of the CDC, a role she assumed in 2015, after nearly a decade as director of the National Center for Immunization and Respiratory Diseases. She served as acting CDC director from January to July of 2017, and again from January through March of 2018.

Schuchat will share lessons learned from the CDC’s previous engagements at a Public Health Forum titled “Crises, Calamities, and Chaos: How Public Health Can Improve Response to Emerging Threats Wherever They Arise” on April 30.

Ahead of the event, Schuchat discussed why preparation is so important, the most difficult part of her 30-year career, and what motivates her as new challenges arise.

What is the overarching message you want to get across with your upcoming talk?

The last few years have made it really clear that public health needs to be ready for pretty much anything. We have to be able to anticipate and respond to the unexpected.

The Zika outbreak is a good example. We never would have imagined that a mosquito bite could lead to a birth defect that is tragic for the child and the family, and often the community in a hard-hit area. We wouldn’t have imagined that a mosquito-borne virus would also be sexually spread, but we got both of those surprises in the Zika outbreak. We also weren’t expecting that a virus that had been known of for decades would be linked to this devastating syndrome. Zika’s spread across the Americas, and the learning that we had to do with our response, is emblematic of the challenges that we have today.

We’ve also had a year with a number of really terrible natural disasters, including the hurricanes in Texas, Florida, Puerto Rico, and the US Virgin Islands, and then these wildfires in California.

Public health has an important role in all of these events. What I would like to do is talk about what we have learned from some of them, and how every kind of public health student in every discipline really has a role to play in our response and resilience.

What sorts of efforts are needed to strengthen response and resilience?

Planning, exercises and drills, and protocols are all important, but when the event doesn’t follow the playbook, flexibility is the key.

Having good data is also essential. It’s not always that easy, but the better the information that you have, the better your response can be. Early detection can often lead to a simpler response and a more effective response. Prevention, whenever possible, is a lot better than even the best response.

Finally, the kind of emergent threats that we’re facing these days need multi-sector solutions. The complexity of the issues we have to deal with is daunting, but the tools and the commitment that we have right now are motivating. The abilities we have now, whether it’s through technology or other means, to connect across geographic areas and across disciplines is pretty impressive. When I got to the CDC 30 years ago, we didn’t even have fax machines. We’re in a whole other world now. We’re more interconnected than ever, and that can make the pace of change very, very fast. It also means a threat anywhere is a threat everywhere.

What threats are you particularly worried about right now?

One thing is the opioid epidemic. It’s following a pathway that looks more like an infectious disease than anything else. We’ve seen life expectancy get shorter instead of longer, and the last time that happened was in 1993 during the AIDS epidemic. It’s a complex, very fast-moving, dynamic epidemic, and we need accurate, timely information shared across disciplines and across geographic lines to get ahead of it. We’ll need public health, health care, law enforcement, public safety, and social services—we’ll need everybody and their brother to help us get ahead of it.

A second area is antimicrobial resistance. This one has the chance to threaten modern medicine, not just from infections that you can’t treat anymore, but many of the things we take for granted, like being able to have a straightforward surgical procedure, or dialysis, or chemotherapy. Some of those things will become quite risky in an era where the bugs that are spread in those contexts can’t be treated with regular antibiotics. It’s very much an urgent issue that we need public health attention for.

What was the hardest moment in your career so far?

One of the most difficult projects was the 2014 Ebola outbreak, where I was asked to see whether the CDC could test a vaccine or could help accelerate getting a vaccine for Ebola. I ended up leading what eventually formed into a study called the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE). The task was to lead a team in the middle of an emergency, identifying partners on the ground and people within the country, to pull together an experimental trial of a vaccine that hadn’t been given to a whole lot of people, in a context with very, very limited infrastructure, and with a real need to respond to the outbreak first.

That was a very, very, very gratifying partnership. Every day was a challenge. Every day we learned. We felt very good about the work that we did and the capacity that was built in the effort—but on any given day it seemed completely impossible.

What was your proudest moment?

I don’t know if I have one, but I’ve been here long enough that I’ve been able to supervise or mentor a lot of people, and seeing those people go on to do great things is always a source of pride and joy.

How has the experience been of serving as acting director of the CDC twice in the last year?

It was an incredible privilege to get to serve as acting director in 2017, and an unexpected privilege to get to serve again this year. I’ll have been with the agency 30 years in July. I care tremendously about our mission and our people and our effectiveness, so the ability to help smooth a transition that was more extended than people were expecting was an honor. We’re thrilled to be welcoming our new director and settling into the next phase for the agency. I believe in what we do, so the opportunity to help in a different way was very welcome.

—Michelle Samuels