Inside the Outbreaks

Ronald Reagan once said (paraphrasing) that the government is populated by mediocrity because if the employees were any good they would be working for private companies for more money. (I tried to find the exact quote, but sifting through Google searches of “Reagan quotes” is depressing.) This sentiment is echoed by many in today’s political climate who see all government employees through the Department of Motor Vehicles lens. It was a breath of fresh air then to see the cover for Mark Pendergrast’s Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service portraying government scientists as super heroes. Look! It’s science man!

Inside the Outbreaks is a history of the Center for Disease Control and Prevention’s (CDC) Epidemiology Intelligence Service (EIS). The EIS is an elite training and surveillance division of the CDC that provides “boots-on-the-ground” scientists to investigate outbreaks of disease. As one scientists notes, “A disease outbreak is a sign that something has gone wrong…it’s like a giant arrow pointing, PROBLEM HERE!” The EIS’s job is to figure out what the problem is and solve it.

Members of the EIS have helped to eradicate smallpox by chasing it to the far ends of the earth. EIS scientists performed the “shoe leather epidemiology” necessary to identify HIV/AIDS. (The group’s unofficial logo is a shoe with a hole in the sole over a globe.) Polio is a thing of the past in the US thanks to EIS efforts. They’ve been on the front lines of Ebola, SARS, flu epidemics, and other emerging diseases. You can bet that they are in Haiti helping to contain the current cholera outbreak there. It sounds like an incredibly rewarding job to a science nerd like myself, but it’s not all glamour as evidenced by this tidbit on a EIS scientist involved in the smallpox effort:

Six-foot-tall Jordan had lost 60 pounds, down to 134. An American lab identified seventeen kinds of parasites in his stool.

Yikes. It would seem that the EIS’s work would enjoy wide bi-partisan support. Pendergrast shows that this is not always the case.

…the 1956 [polio] epidemic in Chicago was concentrated in the black ghett0, where the children were not getting vaccinated. The American Medical Association had fought free immunization as “socialized medicine.”

Ah, the more things change… The CDC also ran into opposition when they started to treat gun-related deaths as an epidemic that could be investigated using proven epidemiological techniques. The Republican-led Congress at the time was so outraged that they passed a law that specifically prohibits the CDC from issuing recommendations for curbing gun violence. That prohibition remains in place today.

Administrations on both sides of the aisle have also made cuts or reallocated the CDC’s funding over the years, which can have direct impacts on national and international public health efforts. To help insulate itself from changing political winds, the CDC Foundation was formed. The CDC Foundation is a non-profit organization that “helps the Centers for Disease Control and Prevention do more, faster by forging effective partnerships between CDC and others to fight threats to health and safety.” Even though I live in Atlanta, the headquarters of the CDC, I hadn’t heard of the CDC Foundation until reading Outbreaks. It’s a fascinating approach to a real problem for government agencies with long-term missions.

It tackling the history of the EIS, Pendergrast interviewed hundreds of EIS graduates. If Inside the Outbreaks has a weakness, it’s that the material to cover necessarily limited the amount of space that could be spent on what are individually fascinating topics in their own right. And the fascinating topics Pendergrast briefly hits upon are legion. Indeed, there are a number of prize-winning books that are entirely dedicated to topics that get only brief mention here - Polio: An American Story (Pulitzer) and And the Band Played On come to mind. Laura Garrett’s doorstop The Coming Plague covers the emerging diseases aspect of Outbreaks in great detail and the best seller The Hot Zone delves more deeply into Ebola and other “sexy” diseases. If you’re looking for a nice overview of the history of a largely unknown group of government scientists that are tops in their field, Inside the Outbreaks is the book for you. However, if you’re looking for detail on a specific disease or outbreak, you’ll need to look elsewhere.