Global Health Chronicles

Dr. Timothy Dondero

David J. Sencer CDC Museum, Global Health Chronicles
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00:01:15 - Early beginnings

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Partial Transcript: To start, can you tell us a little bit about where you grew up and about your early family life?

Segment Synopsis: Dr. Dondero briefly describes the small Connecticut town where he grew up, and his unusual route into pathology by way of engineering and agriculture as well as his fellowship in Malaysia on filariasis. Dr. Dondero explains his work in the Army at the Medical Research Unit in Kuala Lumpur mapping malaria and drug-resistant malaria throughout Malaysia.

Keywords: Army Medical Research Unit; Berry Plan; C.P. Ramachandran; Calcutta, India; Connecticut River Valley; Haddam, Connecticut; J. Gallo; Kuala Lumpur, Malaysia; Middletown, Connecticut; maintenance engineer

Subjects: Army Medical Research; Cornell University; EIS [Epidemic Intelligence Service]; Great Depression; Indonesia; Johns Hopkins University; MIT [Massachusetts Institute of Technology]; Malaysia; Merchant Marines; Middlesex Memorial Hospital; NIH [National Institutes of Health]; South America; States; University of California San Francisco; University of California, San Francisco; Vietnam War; WHO [World Health Organization]; West Africa; filariasis; malaria; pathology

00:08:00 - EIS assignments

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Partial Transcript: How did you hear about CDC’s EIS Program?

Segment Synopsis: Dr. Dondero discusses his unprecedented interview location for his admission into the EIS Program. He recounts his EIS assignment to the Tennessee State Health Department and while there, pinpoints the cause of Legionnaires’ disease. Dr. Dondero describes his next assignment working within Quarantine Division coordinating new epidemiologist’s assignments as they responded to the Southeast Asian refugee crisis. Assigned to Africa for two and half years, subsequently Dr. Dondero returns to headquarters and joins the AIDS program in 1985.

Keywords: Atlanta, Georgia; Bristol, Tennessee; Cambodians; D. Heymann; Dhaka, Bangladesh; EIS Officers; International Health Program Office; Kingsport, Tennessee; London, United Kingdom; Memphis, Tennessee; P. Brachman; Philadelphia, Pennsylvania; Quarantine Division; S. Foster; T. Weller; Vietnamese boat people; Virginia; air conditioning; auxiliary cooling tower; cholera epidemic; flood; humidity; refugee camps; refugee islands; refugees

Subjects: AIDS [acquired immunodeficiency syndrome]; Aboriginal hospital; Africa; CDC [Centers for Disease Control and Prevention]; Cameroon; EIS Program; Ebola; Harvard University; Langmuir Prize; Legionnaires’ disease; Malaysia; New England Journal; Nobel Prize; STDs [sexually transmitted diseases]; Southeast Asia; Tennessee State Health Department; Thailand; United States Army; University of California, San Francisco; WHO

00:18:58 - AIDS Task Force

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Partial Transcript: How is it that circumstances arose that you made your way to the AIDS Program?

Segment Synopsis: Dr. Dondero explains that he needed a change from the International Health Program Office, thereby allowing him to take a management course where he became friends with the AIDS Program management officer, leading Dondero to interview with Doctors’ Jaffe and Curran.

Keywords: Chief of the Surveillance Branch; F. Porcher; H. Jaffe; International Health Program Office; J. Curran; M. Morgan; Public Health Advisors; W. Rushing; antibody test; blood banks; civil wars; disaster relief; droughts; female sex workers; lead epidemiologist; sentinel surveillance

Subjects: AIDS; AIDS Program; Africa; MMWR [Morbidity and Mortality Weekly Report]; Surveillance

00:24:11 - Serosurveillance

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Partial Transcript: Indeed, about the time you became Chief of the Surveillance and Evaluation Branch in June of 1986 that was coincident with the Public Health Service Conference that was held at Coolfont, West Virginia.

Segment Synopsis: Dr. Dondero describes how members of the AIDS Program used an unusual way to track their start dates in the program. Dr. Dondero goes on to explain how his connections at Walter Reed was helpful for HIV serosurveillance using existing specimens.

Keywords: Walter Reed Unit; blood donors; drug user; sentinel surveillance; veterans

Subjects: Africa; Army; CDC; Eastern Equine encephalitis; Malaysia; Rocky Mountain spotted fever; Tennessee; Walter Reed [National Military Medical Center]; measles; the Job Corps

00:29:13 - Political Brouhaha

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Partial Transcript: So, in your early discussions with colleagues at Walter Reed, is this where the initial brokering [took place] of an arrangement where the military would share its seroprevalence data with CDC?

Segment Synopsis: Dr. Dondero explains that his past military connections allowed his team to use serosurveillance data from Walter Reed Army Medical Facility, using passive surveillance, and harvesting existing data to confirm transmission patterns. Dr. Dondero also explains how the Reagan administration thought that the AIDS case projections were inflated.

Keywords: AIDS epidemic; Coolfont; Gallup-type survey; J. Curran; President [R. Reagan]; R. Redfield; U.S. epidemic; blood specimens; conservative; gay community; gay male population; median; passive surveillance; political side; serosurveys; ten years; undue political clout; “Family of Surveys”

Subjects: AIDS; American Red Cross; Army; CDC; HIV [human immunodeficiency virus]; Job Corps; NCHS [National Center for Health Statistics]; University of Maryland; Walter Reed

00:35:05 - Family of Surveys

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Partial Transcript: Let’s talk about the “Family of Surveys.” All of the surveys, and we’ll talk about some of them, I think, in a little bit more detail, were done in an anonymous and unlinked fashion.

Segment Synopsis: Dr. Dondero describes the issues faced using specimens that had already been collected while eliminating any personal identification and linkage to the person from whom the specimen was collected. There was international reluctance to use specimens without permission from the donor, and ethical discussions began. Dr. Dondero explains that alternate testing sites began and describes the early AZT treatment drugs.

Keywords: AIDS activists; J. Levi; R. Bayer; ethical debate; ethicists; gay activists; legal discussions; mother-to-child transmission; participation bias; quarantine camp; tissue banks; “alternate test sites’

Subjects: AZT [azidothymidine]; CDC; Columbia [University]; FDA [Food and Drug Administration]; HIV; Holland; IRB [Institutional Review Board]; Legionnaires’ [disease]; Second World War; treatment drugs

00:43:21 - Survey implementation

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Partial Transcript: Let’s talk a little bit about the logistics of implementing the surveys. The first one was--

Segment Synopsis: Dr. Dondero relates using his early public health experience to choose survey populations for AIDS. He describes finding hospitals and patients who didn’t fit the traditional AIDS risk factor outline to avoid oversampling.

Keywords: E. McCray; H. Gayle; HIV infection; M. Morgan; PI [Principal Investigator]; STD Clinics; college students; drug overdose patients; drug treatment centers; infection control nurse; men who had sex with men; mother’s antibody; nontraditionals; pneumonia patients; public health advisors; undergraduates

Subjects: AIDS; Africa; CDC; Job Corps; Metabolic disorders; Tennessee; infectious diseases; sentinel hospitals; sentinel surveillance; sexually transmitted diseases

00:49:56 - Job Corps

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Partial Transcript: Can you explain a little bit about what the Job Corps was about?

Segment Synopsis: Dr. Dondero provides a quick glimpse into the Job Corp organization and how, entrants into the Job Corps program were being tested for AIDS. Using the data from the Job Corp organization they were able to find how sharply AIDS was effecting the minority population.

Keywords: disadvantaged; poor, young people; poverty; racial and ethnic differences; sober; training program; young people

00:53:02 - Sentinel hospitals

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Partial Transcript: By September of 1989, so roughly about a year, a year and a half, after things started rolling out, sentinel surveillance for HIV was going on in 41 states, the District of Columbia, Puerto Rico and 38 metropolitan areas.

Segment Synopsis: Dr. Dondero discusses how he and his team started the sentinel hospital AIDS case surveillance system.

Keywords: AIDS case surveillance; Army data; E. Starcher; L. Peterson; M. Morgan; Preventive Medicine resident; W. Rushing; computerized; institutional resistance; public health advisors; reporting systems

Subjects: CDC; Connecticut; Serosurveillance; sentinel hospitals

00:57:01 - Media training

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Partial Transcript: So, two years-- after finishing the EIS two years, many went on to do a third year.

Segment Synopsis: Dr. Dondero discusses his experience on the AIDS Task Force and how, in order to get the public health message out to the public, Task Force members had to take media training courses. Doctors’ Curran and Darrow deemed it necessary that all members be able to talk to the press at any time since AIDS was a prevailing media topic.

Keywords: B. Schwartlander; Building Six; D. Trump; EIS Officer; German intern; I. Onorato; J. Curran; Ph.D. in theatre; R. Janssen; W. Darrow; clinic based surveys; drama training; media training; “Project Iceberg”

Subjects: 60 Minutes; Tennessee; Yale School of Drama

01:00:19 - Two Branches

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Partial Transcript: Now, as you touched on earlier, it was soon after the surveys got up and rolling, this is when AIDS case surveillance and seroepidemiology formally split into two branches.

Segment Synopsis: Dr. Dondero explains the creation of two branches, AIDS case surveillance and Seroepidemiology, to handle an increasing workload resulting from ongoing studies.

Keywords: R. Selik; Seroepi; reporting systems

Subjects: Seroepidemiology; Surveillance

01:01:16 - Infant testing

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Partial Transcript: To start us off, can you expand a little bit on your earlier comments and describe in general how was this survey conducted and what was actually being measured?

Segment Synopsis: Dr. Dondero discusses how the survey of childbearing women created new data on the non-MSM population and showed how prevalent HIV/AIDS was in young, childbearing women. Dondero and his team showed that the mother’s antibodies were passively acquired by the baby unless treated with prevention intervention, such as AZT.

Keywords: C. Schable; Clinical Trial 076; Division of HIV/AIDS Prevention; Factor VIII concentrate; HIV antibody; J. Chin; STD clinics; Washington [D.C.]; biomedical intervention; blood; blood products; diagnostic testing; early 20s; ethical side; family of surveys; heel-stick blood specimen; infants; infection prevalence; metabolic disorders; mother-to-child transmission prevention; mother’s antibody; newborn prevention; non-MSM [men who have sex with men]; passively transmitted antibodies; post exposure prophylaxis; routine; younger childbearing-age women population

Subjects: AIDS; AZT; Army; CDC; California; East Coast; England; Global AIDS Program; HIV; Hooper Foundation; Job Corps; Malaysia; Massachusetts; New York; Scotland; University of California San Francisco; Wales; World Health Organization; blood banks

01:17:45 - MMWR supplement publication

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Partial Transcript: You were the lead author for a December 1987 MMWR supplement publication called “HIV Infection in the United States: A Review of Current Knowledge.”

Segment Synopsis: Dr. Dondero looks back on his experience writing and presenting his report to the President of the United States and the Domestic Policy Council, and describes how during his presentation he felt that some members of the council did not understand the severity of the AIDS epidemic.

Keywords: Attorney General; Domestic Policy Advisor; E. Meese; G. Bauer; disapproval; line-list

Subjects: AIDS epidemic; Domestic Policy Council; EIS; President of the United States; White House

01:20:32 - Family of Seroprevalence Surveys

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Partial Transcript: Before we finish up, I must ask you about the moniker, “The Family of Seroprevalence Surveys,” that’s how the program became popularly known.

Segment Synopsis: Dr. Dondero explains choosing the name, “The Family of Surveys.” Mathematics and biochemistry had their own “families”, and the program wanted to catch the attention and support of the Reagan Administration, which was promoting their own family-friendly agenda.

Keywords: Division of HIV/AIDS Prevention [DHAP]; EIS Officer; H. Gayle; Health Commissioner; I. Onorato; J. Mason; J. Mermin; L. Peterson; M. Gwinn; The [Reagan] Administration; White House; budget; leading economic indicators; line-item budget; mathematics; midwife; very family friendly; “Family of Surveys”

Subjects: AIDS; Army; Biology; CDC; HIV; National Center for Health Statistics; Public Health; STD Clinics; Uganda; Utah

01:26:04 - Closing thoughts

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Partial Transcript: Have you ever reflected back on how these years that you’ve spent working on AIDS have affected you professionally and personally?

Segment Synopsis: Dr. Dondero describes his appreciation for AIDS work moving him back into an international domain. He concludes his oral history with his belief that public health work, especially surveillance, is “never fun, but it’s essential.”

Keywords: EIS Officer; H. Gayle; cholera epidemic; data tables; death surveillance; family connections; international activities; refugee camps

Subjects: Africa; Canada; HIV; Madagascar; New England Journal; Peace Corps; Tennessee; Vanderbilt