Robert Redfield named CDC director – what does this mean for vaccines?

The Centers for Disease Control and Prevention (CDC) is America’s national public health institute – it is one of the most respected scientific institutions in the world. And the CDC Director, a presidentially appointed position, usually sets policy for public health in the USA, while they have considerable influence over public health worldwide. After the resignation of Dr. Brenda Fitzgerald in January 2018, President Donald Trump appointed Dr. Robert Redfield as the new CDC Director.

Despite the fantasies of the anti-vaccine religion and other science deniers, the CDC is staffed by highly educated and trained scientists, public health experts, physicians, and nurses, many of them are officers in the United States Public Health Service. These people are dedicated to the public health of Americans and often spend their lives keep all of us safe from harm from diseases.

The CDC’s main goal is to protect public health and safety through the prevention of disease, injury, and disability not only in the USA but also internationally. The CDC is an independent Federal agency whose dedicated staff stand at the front lines of infectious diseases throughout the world. The agency also focuses on non-infectious diseases, such as diabetes and obesity. Finally, they provide educational activities designed to improve health.

Of course, the CDC matters to me because they are the primary source of information about vaccines and vaccine-preventable diseases in the USA and the world. Though the CDC does not control vaccinations, they only set recommendations that states and certain parts of the Federal government (like the military and foreign service officers) generally follow. The CDC follows logical and scientific procedures to make these recommendations.

And now we have a new CDC Director, Dr. Robert Redfield, who at first blush appears to be a reasonable choice for the position. However, I am a scientific skeptic, so I never stop at the first blush.

How did we get here?

Before President Trump was inaugurated, he sent out a lot of signals that he was not a fan of vaccines. Considering Trump’s bromance with the cunning fraud Mr. Andrew Wakefield, many of us were concerned that Trump was going to appoint individuals to the Surgeon General and CDC Director positions who might not be supportive of vaccines. But to the extreme sadness of the anti-vaccine religion, Trump actually did the right thing and appointed relatively respectable individuals to those positions.

The first CDC Director appointed by Trump, Dr. Brenda Fitzgerald, was a fairly responsible choice. Although she had some odd opinions about alternative medicine, she was pro-vaccine. She even stood up to her fellow Republicans in Georgia with respect to the fact of evolution.

Unfortunately, Dr. Fitzgerald had invested in stocks that could have been influenced by CDC actions. Although she only had a small amount of stock, and she may have gained a few dollars in profits from favorable decisions, she resigned because of the conflict of interest ethical issues. It was the right thing for her to do. It’s ironic that other Trump administration members, who have much worse ethical issues, are still in power.

So about six months after we got a new CDC Director, we get another one.

Dr. Robert Redfield

On the surface, Dr. Robert Redfield is a sound pick for the CDC Director position. He attended Georgetown University (see Note 1) for both his undergraduate and medical school education. He joined the US Army in 1977 and did his residency in internal medicine at the Walter Reed Army Medical Center (WRAMC). After completing his residency, he did clinical fellowships in infectious diseases and tropical diseases also at WRAMC.

Redfield then continued his career as a US Army physician and researcher at WRAMC, focusing on virology and immunology. During the 1980s, the early years of scientific research into the AIDS pandemic, he led the research team that was first to demonstrate that the HIV virus could be heterosexually transmitted. He also developed the staging system for HIV/AIDS that is still used today by the World Health Organization and CDC.

He collaborated with most of the scientific teams that were at the forefront of AIDS research at the time. He has published nearly 100 key papers on HIV/AIDS. He was a pioneer in the early years of our understanding of HIV and AIDS.

Dr. Redfield is currently associate director of the Institute of Human Virology at the University of Maryland. This institute is arguably the leading, or one of the leading, institutions researching HIV and AIDS throughout the world. He co-founded the institute, and he works there with some of the leading researchers in HIV/AIDS. And as of late last year, he was an author and co-author of dozens of articles published while he was there.

Dr. Redfield was also a strong and innovative advocate for strategies to translate knowledge gained from clinical studies to the practical treatment of patients afflicted by chronic viral diseases. And there is no doubt that Redfield is a strong supporter of vaccines since he’s been involved with HIV vaccines for many years.

By any standard, Dr. Robert Redfield is a near perfect candidate to be CDC director. Unless you’re an anti-vaccine zealot, then you’re not happy.

But…there is always a but

Of course, Donald Trump couldn’t pick the perfect candidate for the position. According to numerous articles, there are some issues in Dr. Redfield’s background that will probably cause the anti-vaccine crowd to accuse him of a whole list of high crimes. But there are issues in his background that make me squirm.

Since the anti-vaccine crowd wouldn’t be happy unless some anti-science lunatic was appointed to the position, I’m going to stick with my own issues with the man.

First, and most problematic to me, he has (or had) a close relationship with a  right-wing AIDS organization known as the Children AIDS Fund International, once known as “Americans for Sound AIDS/HIV Policy.” The group was found by evangelical Christians, and it championed abstinence-only education to combat HIV. They take Federal grants, which occurred during the Obama administration, to push anti-choice and anti-gay nonsense. They have other pseudoscientific beliefs about HIV transmission and treatment that would be in utter conflict with Dr. Redfield’s scientific research into HIV and AIDS.

Moreover, Redfield has some views about HIV/AIDS that is just in opposition to current policy from many organizations, like his soon-to-be employer, the CDC. For example, he supported mandatory HIV testing for all incoming members of the military back in the late 1980s. This caused all kinds of issues such as privacy since those inductees who were HIV positive were segregated from other soldiers and sailors.

But there’s worse stuff in Dr. Redfield’s background. During the mid-1990s, he was responsible for a clinical trial at WRAMC for an experimental HIV vaccine. He was eventually accused of manipulating data from the trial (pdf) – he was held responsible for “sloppy or, possibly, deceptive” data analysis while overstating results in a number of talks and publications. Of course, as an Army officer, Redfield was subject to an official investigation which cleared him of misconduct charges. The US Army never quite explained to us how they reached their conclusions.

At the very best, he was sloppy and lazy with this important research – his research on HIV vaccines may lead to an actual vaccine. Let me remind the reader that rarely does one published article lead to established science – it takes repetition of a study several times before it’s accepted science. The amount of research in HIV vaccines is so large, it’s difficult to imagine any bad data from Redfield’s research getting accepted into the body of evidence for a particular HIV vaccine.

Of course, the anti-vaccine world has gone literally manic over Redfield’s background. Of course, I’m a bit troubled that I might actually agree with them. The right-wing AIDS nonsense is bad enough, but then he might have fudged data on an important vaccine? We have enough problems with the anti-vaccine religion inventing claims about vaccines, but now have someone who is in charge of our vaccine strategy who has that in his background?

And HIV/AIDS advocacy groups are, charitably, less than thrilled by Dr. Redfield’s appointment. In a blog post in POZ, a website for HIV-positive individuals, Sean Strub wrote:

Dr. Redfield has been one of if not their closest allies in government; he served on ASAP’s board and he still serves on CAFI’s board today. The Smiths, their organizations and their ultra-right “Christian” activism are largely unknown to the public, but they have been a powerful behind-the-scenes player, currying favor with HIV policy leaders in government in large part because of their ability to deliver evangelical/Christian Right votes in Congress for appropriations.

Well, that’s not good.

But….because there are always more buts

The journal Science, in a recent article, seemed to take a wait and see attitude toward Dr. Robert Redfield. They didn’t quite condemn the choice.

On the other hand, the Infectious Disease Society of America, one of the leading scientific societies for vaccine-preventable diseases, didn’t exactly endorse him when they wrote,

The Infectious Diseases Society of America stands ready to work with Dr. Robert Redfield as he takes the helm of the Centers for Disease Control and Prevention.

So what do I think? First, he is not an AIDS denier, despite his relationship to that right-wing group. But still, his association with that right-wing group is highly problematic for one of the top researchers in HIV science.

For me, his malfeasance with clinical research is a non-starter. Even if he was absolved of any wrongdoing by the US Army, the fact that we can’t read those documents is troublesome.

In the past, Presidents chose extremely competent CDC directors. They usually had a background in medicine and public health, which, admittedly, describes the experience and education of Dr. Redfield quite well. I realize that Trump is not known for his skill in hiring the proper individuals for agencies and departments of the Federal government. I’m only guessing here, but Dr. Redfield’s ties a right-wing Christian organization meant more to Trump than the actual credentials of the candidate.

Well, this article isn’t going to change Trump’s mind, so I hope Dr. Redfield does the right things for vaccines and other public health issues. And I hope he gets the CDC ready for the zombie apocalypse.

But there’s an update

I wanted to catch up on the story about Dr. Robert Redfield that might reduce my concerns about his appointment as CDC director. He gave what was described as an “emotional speech” to all CDC employees on 29 March 2018 that was reported in the Washington Post.

I think that there are a couple of important points that he made that lead me to think he might effectively lead the CDC. The jury is still out, but based on his speech, I’m less troubled.

Right out of the gate, he said that the CDC is “science-based and data-driven, and that’s why CDC has the credibility around the world that it has.” Despite the irrational and delusional  protestations of the anti-vaccine religion, this is why we respect and accept the scientific analyses of the CDC.

First, he didn’t address his previous support of policies that aren’t popular today, such as mandatory HIV screening, which not only AIDS advocates but also public health experts believe are not appropriate directions to take. However, during his speech, he strongly supported comprehensive prevention strategies and believed that the AIDS epidemic could be ended within three to seven years in the USA.

It is possible, and again, actions will matter, but Dr. Redfield may be our best HIV/AIDS advocate in the Trump administration, which hasn’t shown much kindness to the LGBTQ community.

Most importantly, at least to me, is that he forcefully spoke of the importance of vaccines and recounted a story from early in his Army career. He helped persuade military leadership to vaccinate “every individual in the armed forces” against hepatitis B. He said that, “that’s probably the most important thing I did in my life.”

It assuages almost all of my concerns about Dr. Redfield’s bona fides on vaccines with that one statement. But he says something much more important – he said that too many people do not understand the importance of vaccination. He said,

We have got to get the American public to understand that vaccination is important and needs to be fully utilized.

Yes!

Notes

  1. As an alumnus of Syracuse University, our hatred of all things Georgetown University is well known. It is a rivalry that goes back at least 40 years. I will try to refrain from any bias toward any individual who attended Georgetown.
The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!