Dr. Bruce Weniger

Bruce Weniger

MILLER: This is Dr. Bess Miller, and I'm here with Dr. Bruce Weniger. Today's date is May 22, 2017, and we are in Atlanta, Georgia, at the Centers for Disease Control and Prevention. I am interviewing Dr. Weniger as part of the Oral History Project, the Early Years of AIDS: CDC's Response to a Historic Epidemic. We are here to discuss your experience during the early years of CDC's work on what would become known as AIDS [acquired immune deficiency syndrome]. Dr. Weniger, do I have your permission to interview you and to record this interview?

WENIGER: Certainly.

MILLER: Bruce, you have been a global leader in epidemiology, public health program implementation and operations research, and vaccine safety, in fields including HIV [human immunodeficiency virus], sexually transmitted diseases, and influenza throughout your career. You have also been a leader in training and education and operations research and public health practice, particularly in 00:01:00collaboration with the Field Epidemiology Training Program, the so-called FETP, based on CDC's EIS [Epidemic Intelligence Service] program in Thailand. For this oral history of AIDS at CDC we are focusing on the early years, beginning in June 1981 with the publication of the first Morbidity and Mortality Weekly Report [MMWR] on the five cases of Pneumocystis carinii pneumonia among homosexual men. But the story of CDC's work on AIDS in Asia began several years later. You served in critical leadership roles in CDC's work on HIV/AIDS in Asia, specifically in Thailand, initially from 1983 to 1986 as a medical officer assigned to the World Health Organization and the Ministry of Public Health in Bangkok, then as Medical Epidemiologist in the international activity of the Division of HIV/AIDS at CDC, and later from 1990 to 1993 as the founding 00:02:00director of the Thailand Ministry of Public Health-US CDC HIV/AIDS Collaboration. Let's begin with your background. Can you tell me about where you grew up, your early family life, and then where you ended up going to college?

WENIGER: Let me just start by thanking you for this opportunity to collect some memories before they all disappear. I like to say that the gray hair on the outside represents transmigration of similarly colored matter from the inside. I'm a native New Yorker and grew up on Long Island, although for some reason people say I don't have a New York accent. That may have been because my parents didn't have New York accents. Eventually I made my way to UCLA [The University 00:03:00of California, Los Angeles] School of Public Health and School of Medicine. I started out in the School of Medicine, and in that first year I got interested in public health, for which where you weren't just taking care of one patient at a time; you were taking care of the health of the community, a huge number of patients at a time. That's where I first got involved with public health activities and interest in CDC.

MILLER: What led you to CDC, first as an EIS officer in 1974 to 1976?

WENIGER: I think you have the years wrong. I was an EIS officer from '80 to '82. In my freshman year at the UCLA School of Medicine, that was basically 1974, 73-74, at that time the smallpox eradication program was under way all over the 00:04:00world, but mostly then in India and Bangladesh, cases having recently been eliminated in Africa except for the final Somalia case. There were increasing cases in Bangladesh that led [Dr. Stanley O.] Stan Foster, who was leading the smallpox eradication program in Bangladesh, to need a lot of expatriate epidemiologists to help solve the problem. So the word went out to people around the world: "We need a lot of warm bodies who know a little epidemiology." [Dr.] Davida Coady was one of the recruiters. She was a former WHO [World Health Organization] smallpox epidemiologist who was teaching part-time at UCLA, and she recruited a number of people affiliated with the UCLA School of Public 00:05:00Health: [Dr.] Peter Drotman, myself, [Dr. Robert] Bob Perry, and others. We flew off in the summer between my freshman and sophomore years at UCLA School of Medicine to become epidemiologists in the eradication program in Bangladesh. I did another oral history a few years ago with [Dr.] David Sencer, interviewing for the Global Smallpox Chronicles [Global Health Chronicles -- Smallpox], where I talked about that experience. So that [Bangladesh] exposed me to Stan Foster and [Andrew N.] Andy Agle, the administrative officer who would give us stacks of Taka [currency] bills to pay workers in outbreak surveillance and containment activities. That got me interested in public health in general. I met people from CDC, and then afterwards there was another role model there [at UCLA]. I think his name was Sander Greenland, but I have to check -- my memory is beginning to fade -- who had been an EIS officer, and I became interested in 00:06:00EIS. But I knew I had to finish medical training and at least internship and maybe some residency. So I ended up going into pediatric training at the University of Utah. There I think [Dr.] Harry Hull was also on the faculty, and he had been an ex-CDC person. Finally, after two years of residency there -- one year in internship and one year of residency, I decided clinical pediatrics was not for me. I applied to the EIS program and was accepted and went into the Parasitic Diseases Division as an EIS officer.

MILLER: What a great medical school experience.

WENIGER: Well, I must say I was paid a standard per diem by WHO for my three months. I remember Stan Foster was a little angry at me because he wanted me to extend beyond three months, but I had to get back to school. School was starting in a few days, and I had to get on an airplane and leave. So he eventually forgave me. In fact, even though I was not a CDC employee at the time working on 00:07:00smallpox, he was kind enough to give me one of those ribbons that we wear on our uniforms indicating we were smallpox campaign workers.

MILLER: That's terrific. So you landed in parasitic diseases. What did you work on? At that point were you touching on some of the early, early HIV work?

WENIGER: Well, my main assignment was with creepy crawly critters, as I like to call them: worms -- helminthic diseases, schistosomiasis surveillance and things like that, although there was an epidemic of amoebic encephalitis at Disney World that I got involved with, writing up the MMWR article. In relation to the purpose of this oral history related to CDC's AIDS history, I do recall it was a 00:08:00small group: [Dr.] Mike Schultz, Myron Schultz was the director, who passed away not long ago. [Dr.] Dennis Juranek was the deputy director. [Dr.] Peter Schantz was a staff member, and the EIS officers at that time [were] [Dr.] G. Alexander or Sandy Carden, who became an infectious disease specialist in Florida, and [Dr.] Isabel Guerrero, who went on to work at the New Jersey Department of Health, and myself. We used to take turns handling phone calls for the Parasitic Disease Drug Service. At that time the clerk involved with the Parasitic Disease Drug Service was Sandy Ford, and she's become famous in all the history books about the AIDS epidemic. I do recall every four or five or six days we would take calls, either during the day when calls came in, or at night when the CDC switchboard would call us and say, we have a doctor somewhere who's got a patient who needs one of these drugs. We used to carry these forms with us or 00:09:00have them at our desk. I remember they were pink forms, and on the form we'd fill in the name of the doctor, the institution, the hospital where the patient is, who were the patients, some demographic background, and what disease they had that needed the various drugs of such rare use in the U.S. that no drug company bothered to take the time and effort to get them licensed in the U.S. We had these drugs under investigational new drug applications that we [CDC] can provide. I do recall over a period of several weeks, maybe some months, beginning to get patients who needed Pentamidine for Pneumocystis carinii pneumonia. We'd get through the form and then check off pneumocystis, check the box and what was the underlying diagnosis, and we had several [boxes for] cancer treatment chemotherapies, immune suppression from steroids, and so on. I do recall getting a doctor saying, the patient doesn't have any of those. I didn't 00:10:00think anything of it. I just wrote in the margin "none" or "not known" or "unknown" and called the corresponding U.S. Quarantine Station to ship off the drug right away. The next day we'd drop it [the form] in Sandy Ford's box. I maybe had 3 or 4 like this over a period of time, I can't remember, and the others in the office began to do that. It was only Sandy who recognized that something was going on. She called Mike Schultz, and that's what led -- at the same time we were starting to get reports from New York and San Francisco of physicians who were seeing patients with this opportunistic infection, and that eventually led to the article that Sandy Carden I think was involved in: the first article about these cases of Pneumocystis carinii with unexplained, unknown underlying conditions that led them to have these opportunistic infections. I regret that my index of suspicion was so low; when the doctor said he doesn't have any of those, I just checked [the box] and didn't think anything of it and put it in the box.

MILLER: Good for Sandy Ford. I had worked with her in tuberculosis. She has 00:11:00since passed, but yes, that was great epidemiology. Let's move on to your Field Epidemiology Training Program [FETP] assignment in Thailand. So this was soon after EIS, 1983 to 1986. How did that all happen? How did you wind up getting this FETP assignment in Thailand?

WENIGER: The second year of my two years in the Parasitic Diseases Division as an EIS officer, I signed up for the Preventive Medicine Residency [PMR] Program, which required a third year. So from '82 to '83 I went out to the state health department in Oregon, which was required. If you were Atlanta-based you went out to the field or vice versa for the PMR program. During that period of time, [Dr.] Philip Brachman, who had started the Global EIS Program, had arranged with 00:12:00the government of Thailand, the Ministry of Public Health there before I was involved, to start a -- in a sense -- son or daughter of EIS. At that time it was called the Global EIS, although that name was changed for not being very politically correct. They were looking for someone to replace the first CDC advisor, [Dr.] David Brandling-Bennett, who went on later to be a deputy director at PAHO [Pan American Health Organization] in Washington and then later moved on to the Gates Foundation. He might still be there today; I'm not certain. So in looking for someone to replace him as the second FETP advisor to be detailed to the WHO, which was officially sponsoring and funding the [Thailand] program, is how I ended up in Thailand from '83 to '86.

MILLER: What about you? Did you have the travel bug, or what made you go ahead and decide to do that?

WENIGER: I think having worked in medical school in the smallpox program, and then later on in medical school I did a summer of parasitology -- I guess you 00:13:00might call it a fellowship from the International Centers for Medical Research and Training in Costa Rica, where I worked in a laboratory at the big public hospital doing stool specimens and looking for eggs of various parasites and had become a parasite fan or interest.

MILLER: Often in international [work] we find people [whose] parents were missionaries or a variety of reasons that people -- was there anything in your background that would suggest you would be so interested in international work?

WENIGER: Interestingly, not in a family sense. But years later I was looking through some old papers I saved from my application to Brown University when I was a high school student. You know the one-page essay you write? Completely 00:14:00forgotten about it. I pulled it out of the filing cabinet along with other memorabilia and saw I wrote that I wanted to go into the Foreign Service and I was interested in international affairs and my goal was to be in the Foreign Service. I completely forgot about that. Maybe there was something about the exotic nature of going to other cultures and so forth. But I also had had an overseas experience in Costa Rica prior to the medical one, when I volunteered for a summer project at Brown University to work in Costa Rica to be assigned to a Peace Corps volunteer in the bush, in the mountains, and that was another positive experience in a small village. I brought my family back decades later to visit. In my early photographs, from which I made new prints, children who were 5 or 6 were now in their 30's and 40's and having their own children. So it was a great experience.

MILLER: So you get to Thailand in 1983. What was the working environment like 00:15:00for you in this assignment? Who was your supervisor, and were you beginning to get a sense that you might be focusing on HIV at all in the early years?

WENIGER: The FETP program was modeled on the CDC [EIS] program, although it didn't have the depth of expertise in other parts of the Ministry that we have here in the U.S. CDC. The EIS officers, numbering 50, 60, 70, are assigned throughout the agency, working under more senior staff, often themselves EIS alumni, to learn the ropes doing on-the-job epidemiology. That's the way it worked there [in Thailand], but there were only 5 trainees per year. We had a course that instead of having only Ministry faculty to teach statistics, epidemiology, all the related components of the course that's taught here, we 00:16:00recruited people from the major medical schools, the preventive medicine departments, community medicine departments in Bangkok to come and teach them. Basically it was similar to the CDC. We'd get a report of a problem, diphtheria in Yasothon Province or other usually infectious diseases occurring of various types. Sometimes I'd go out with the trainees, sometimes they (the trainees) would go out on their own. The difference was, though, that in the U.S., telephone communications were quite easy. We didn't have cell phones in that era, but you could get on the phone at your motel that night or in the local health department and call back to your supervisor in Atlanta. Not so easy to do that in Thailand, to make those long-distance calls.

MILLER: So you were doing mentoring and teaching. As you were there for several 00:17:00years, during the later years, there was the beginning of seeing AIDS patients in Thailand. What did you work on initially on that?

WENIGER: That era, '83 to '86, was when the first AIDS cases -- before I left CDC in '82, of course, we were already getting reports of this strange new disease of unexplained opportunistic infections. In the '83 to '86 period, the causative organism had been discovered, and eventually by, I guess, it was '85, we had a laboratory assay to test people who were asymptomatic but infected. I remember on one of my visits back to HQ [headquarters] here in Atlanta related to the FETP, I went over to see [Dr. James] Jim Curran, who had been placed in 00:18:00charge of the -- I think it was called the Task Force on Opportunistic Infections. I may be getting the names --

MILLER: That's it.

WENIGER: -- not corresponding to the appropriate year. The Abbott test kits to detect HIV had just been licensed and were just coming out, but not widely available. I said, we have a lot of [HIV/AIDS] risk categories in Thailand and there might be infections there -- no cases yet -- and shall we get some of these kits? If you send them to me, we'll run them. So he sent us, through the diplomatic pouch or the APO [Army Post Office], which uses the same facility, enough Abbott tests to run 600 specimens.

MILLER: What group did you pick to do your first testing?

WENIGER: We did this through the FETP. Dr. Yongyuth Wangroongsarb, one of our trainees, became the principal investigator, and we rounded up 6 groups: about 00:19:00100 blood donors, 100 male prostitutes, 100 female prostitutes, 100 men coming to STD [sexually transmitted disease] clinics because they had an STD, and then another 100 thalassemia patients who had received frequent blood transfusions. We figured out if it was in the blood supply we might pick that up. There was one more risk group I'm forgetting [intravenous drug abusers, http://bit.ly/HIV-prev-Thailand-1985b]. Of those 600 specimens we found one positive, who was a male prostitute.

MILLER: What was the thinking right from the get-go? That's so amazing that you were there at that earliest moment, after we're already seeing this rapid 00:20:00upswing in the U.S., in Africa. We're already knowing -- what was the thinking among the Thai public health leadership?

WENIGER: At that time Asia, most of Asia, was considered a so-called "pattern 3" country, where there were very few cases, mostly imported ones. I think what we saw doing that survey may very well have been the first detection of HIV infection in Asia. By that time there were cases of AIDS reported in Japan, and around that time we also had our first AIDS case reported in Thailand. But we didn't know what was going on in the general population, [what was] in the blood in the population; whether the virus was sitting there. I think we guessed that it could be several years or many years before AIDS became a patent, symptomatic illness, and we wanted to find out. So I think that may have been the very 00:21:00first, because we got the kits before they went elsewhere in the world, that were just being distributed by Abbott.

MILLER: Was there a sense of relief in terms of just seeing one, or was it a sense of doom? What was the response?

WENIGER: I think everyone was expecting it, that it wasn't going to stay in North America and Europe. One positive thing about my counterparts and colleagues in the Ministry of Public Health of Thailand, unlike many of the other countries in Asia, there was not an attempt to hide it, and they were very open about doing the research, allowing it to be published that we had these cases. For a number of years after that, other countries were fighting -- epidemiologists in other countries, ministries of health, were struggling with politicians who didn't want to reveal that they had this problem. Because, of course, everyone denies they have the risk behaviors and categories that lead to it. Sometime, I think about 1985, the Epidemiology Division at the Ministry of 00:22:00Public Health in Thailand, where the FETP and I were based, received our first notification of an AIDS case in Thailand. It came from Dr. Anuwat Limsuwan, an infectious-disease specialist at the nearby Ramathibodi Hospital of Mahidol University. It caused a lot of excitement because everyone was waiting for when it was going to come to this country. I recall there must have been 10 or 12 people, senior staff of the Epidemiology Division, mid-level staff of the Epidemiology Division, the FETP trainees [equivalent of EIS officers] and myself, getting into vehicles to drive them a mile or two to the hospital and surrounding this patient's bed, very politely and calmly asking him questions. It turned out he had been a Thai student at one of the two universities in 00:23:00Louisiana, either Tulane or LSU [Louisiana State University], I forget which one, I can probably look it up. He had been actually diagnosed in the United States, and he was basically coming home to die because in that era there were no treatments. The staff were asking him questions and what-not. That became the very first case, Then, before long, we had a few more. Later cases had never been out of the country. Those were the indigenous [autocthonous] cases, as we say. They acquired the infection somewhere or somehow in Thailand from somebody else.

MILLER: As an aside, I'm aware that you have a Thai wife. Did you meet your Thai wife during this period at the FETP?

WENIGER: Yes. As I was mentioning earlier, I had the opportunity to accompany a Vietnamese refugee from Thailand to the United States, along with her family and 00:24:00maybe a few dozen others. She was an elderly woman with a heart condition, and they wanted a doctor to go on the flight. The head of the medical operations at the IOM, International Organization for Migration, I think they may have changed their name --used to be ICM, International Committee for Migration -- was [Dr.] Roland Sutter. I had known Roland Sutter as another physician in Bangkok at that time, and he asked me if I'd like to accompany this woman. I said, sure, there's an epidemiology conference in Vancouver around that time. I could use it to get a free trip to the United States and get administrative leave or personal leave, I can't remember which I used. So I accompanied her, and we took her to her family picking her up in Orange County, California. At the John Wayne Airport, 00:25:00waiting for the family to show up, all the young women in the family on the airplane had put on their traditional Vietnamese dresses to be prepared to meet previous relatives who had escaped on boats 5 or 10 years earlier and had already been established in California. Then I flew up to Vancouver, where I met my wife. Someone pointed out, "that woman over there is from Thailand." She had been getting her Ph.D. in Germany and was presenting at the [International] Epidemiology Association Conference. And one thing led to another.

MILLER: That's great. So you met your Thai wife in Canada.

WENIGER: I shouldn't say "Vancouver," because that's one of my secret questions on websites, you know, "where did you meet your wife?" Hopefully no one watching this will use that information.

MILLER: So then you came back briefly to Atlanta, and you worked in the 00:26:00international activity of the Division of HIV/AIDS. With your supervisor, Dr. [William] Bill Heyward, you set up the HIV/AIDS field research center in Bangkok as a collaboration between the Thai Ministry of Public Health and CDC. So how did this come about? Why Thailand?

WENIGER: Jim Curran was still running the HIV/AIDS program at CDC, and he asked Bill Heyward, William Heyward, to set up some international field sites and become his point person for international activities regarding HIV/AIDS. He had had some difficulties trying to find sites around the world to do that. I think the fact that I had the previous experience in Thailand, getting to know a lot of the officials in the Ministry of Public Health, and the early trainees were now moving into positions around the Ministry of Public Health, he brought me 00:27:00onboard his program with the primary mission to set up a program. It probably took about a year, maybe 18 months of going back and forth and talking to people at the Ministry of Public Health that "the CDC would like to work with you" to set up a collaborative program. As I mentioned earlier, the Thais were quite open and receptive to research, and were enlightened about solving this problem and studying this problem and getting the assistance of CDC. So we eventually formally started this project. I think I showed up in September of 1990, and I was the only American at that time. I was soon joined by Nancy Young, the only other expatriate during my entire term there, who was assigned to Thailand. She became the director of our laboratory. I must say that once we got the green light, "Yes, you can set up a program," we faced the inevitable problem in all 00:28:00governments -- space. I remember going from one department of the Ministry to the other, saying the Ministry would like to have a joint research program, but we need some space.

MILLER: So CDC was now moving into more international work. Was the Office of the Director of CDC supportive of these field stations? There had been one in Zaire, which right around then had to be closed down, and then also in Abidjan, Côte d'Ivoire. But now we're moving into Asia, which didn't yet have all that much HIV. Did you have the support both of the OD and also from Washington to do this?

WENIGER: As the assignee negotiating this and writing up a multipage agreement, memorandum of understanding, I presume Jim Curran took care of that with his 00:29:00boss at the time. Was it [Dr. William F.] Bill Foege? I can't remember who was the head of CDC from '90 to '93, but I wasn't really involved with his communications to the higher levels. The funding was there, the interest was there, the will was there, and so I was basically dealing with writing up the agreement that the Thais would sign and the CDC would sign. In fact, a few months after we started, Jim came to Thailand with [Dr.] Helene Gayle, who was then his international activity point person. We had a lovely ceremony, and he signed the agreement and we were off. But as I was mentioning earlier, I had to go searching for space. I didn't want to rent private space. We probably had the funds to rent commercial office space in a building near the Ministry but --

MILLER: And in those days you could do that.

WENIGER: In those days you could do that, I suppose, and now everything is more complicated. But I thought if it was really going to be a joint project, and we 00:30:00really wanted to emphasize it wasn't just CDC setting up an outpost, so we hired as our -- or had assigned to us as our Thai Director, Dr. Khanchit Limpakarnjanarat, who had been not only a graduate of the Thai FETP, but he had been brought into the U.S. EIS, where he did that two-year program. So he had experience of both worlds, and he became the co-director, the Thai director, of the program. So we finally found at that point in time the Ministry had moved from a very crowded campus on the river in downtown Bangkok up to the suburbs, where they had what must be hundreds of acres of land, far larger than this campus on Clifton Road at CDC. They built all these amazing, huge buildings for their far-flung organizational chart activities. It turns out that one of the buildings had a lot of empty space. So the director of the Department of Medical 00:31:00Sciences, which was responsible for laboratory research, said, "You can have this floor over here, but there's one requirement. You pay your own electric meter." And we said, fine. So we eventually contracted through the Embassy to build all the walls and the partitions and the plumbing and everything to have a laboratory on one side and the epidemiologists on the other.

MILLER: At that time, Thailand was still pretty much of a lower-income country. It's advanced quite a bit over the last few decades, but tell us a little bit about the government of Thailand or the Ministry in terms of their role in this, their expectations, and other international work. CDC has had to do quite a bit of negotiating in terms of being accepted and clarifying who does what. What was it like in Thailand?

WENIGER: As I mentioned, space in all government agencies, whether it's CDC or 00:32:00the Ministry of Health in Thailand, was always at a premium. We were lucky to find some space. Another difference, I think, between my experience in the U.S. Government and my experience over there, is that each of the departments of the Ministry there were like sovereign entities. Here, we have the center for this, the center for that, and the center for something else. But if the big boss at the top says you're going to do something, and these two centers are going to work together to do something, it gets done. But there, every department was like its own sovereign silo, and sometimes there were difficulties getting cooperation, because they were always defending their resources and their turf and so forth.

MILLER: Were the Thais putting financial resources into this?

WENIGER: They were putting in the salary of Dr. Khanchit [Limpakarnjanarat] and 00:33:00others. But most of the electric bill, the construction of the project [was paid for by CDC], and they were not charging us rent. So they were basically contributing facilities. When things needed to be done, cooperation to do studies around the country, local and regional health departments were helping out. So they were contributions in kind, as they say. Now, I do recall one experience in setting these things up, is that previously in Thailand, and still remaining today, a major U.S. Army medical research facility had existed for decades. [It was formerly known as the Southeast Asia Treaty Organization or SEATO Lab (became the Armed Forces Research Institute of Medical Sciences) with a U.S. component of the U.S. Army and other services researchers, and a Thai component, working in the same building or next door. We were CDC coming into that turf as a bit of an interloper, a bit of a new one on the block. I think 00:34:00when we first began the project -- we had courtesy calls with them and were explaining what we were going to be doing -- and I think they were a little bit hesitant that there were now going to be two U.S. Government agencies doing medical research. They were doing everything from dengue, hepatitis [to] Japanese encephalitis, and we were going to be focused on just one, HIV/AIDS. But we did cooperate and avoided [duplication] and collaborated in some ways. In fact, previously when I had been the FETP advisor, the AFRIMS [Armed Forces Research Institute of Medical Sciences], the U.S. Army Laboratory, was of tremendous help in running laboratory tests. There would be an outbreak of hepatitis, and the trainees would go out and collect a bunch of specimens, and if either the ministry didn't have the resources or the time to be able to run those specimens, AFRIMS was happy to do that. So they were really a great 00:35:00resource for the country and the Ministry in that respect.

MILLER: So in 1990, it's clear that the HIV/AIDS epidemic in Thailand and Asia overall, like Africa, is primarily a heterosexual epidemic, and the risk groups were injecting drug users, female sex workers, their clients and so on, and then into the blood and blood product recipients. According to an AIDS in the World survey, in 1987 there were less than a thousand adults with HIV in Southeast Asia. But by 1990, when you get there, [there were] about 138,000 and by 1993, 1.5 million infected adults in Southeast Asia. So you were there during this explosive rise of HIV in Thailand. Can you tell us a little bit about the 00:36:00changing view of HIV and the Ministry and among academicians in Thailand? Now they're starting to see this explosive epidemic. Was there fear, was the stigma, or was there intellectual curiosity, I'm sure?

WENIGER: If I can diverge a little bit from the question, I think Jim Curran and Bill Heyward starting the joint collaboration with Thailand was very prescient, because we [The HIV/AIDS Collaboration] were fortunate to be in place and working closely with the FETP and the Epidemiology Division [of the Thai Ministry of Public Health] in the next building, which was continuing to do sentinel surveys. We were able together to basically document the entry -- and explosive growth -- of HIV infection in Thailand, in real time -- to use that expression. In '84, '85, '86, there had been a few serosurveys that didn't find 00:37:00much of anything, until we found that one patient out of a hundred male prostitutes had the infection. Then, all of a sudden, the epidemic curve just went like this [moves hand diagonally upward], in early 1988, where it went -- I don't recall the exact numbers, they're in the review articles -- went from close to zero to like 20%, 30%, 35% in injecting drug users. The Thanyarak Hospital of the Ministry, which was a drug abuse treatment hospital, was testing every new and readmitted patient coming in for drug treatment. They had tens of thousands of results, and the numbers were just remarkable. Then the Ministry of Public Health began sentinel surveys in various provinces of different risk groups. We could watch the epidemic go from the first wave in drug users, and 00:38:00then all of a sudden to female prostitutes working in low-cost brothels. The curve was rising rapidly over a period of just months. And then [there was] a third wave in male STD patients, and then eventually a fourth wave where the men who had been visiting prostitutes would bring infections home to their wives, and we'd see an increase in infection rates among women, the general population of women, coming for antenatal care because they were pregnant. And then eventually the infants of these pregnancies where the mothers had been infected. So it seemed to go from one wave to the next, although we later learned from genetic analysis by Chin-Yih Ou at CDC -- the laboratory researcher who had 00:39:00worked on the Florida dentist case and proved by genetic analysis that the dentist had given the infection to one or more of his patients -- that the virus that caused the outbreak that was infecting male homosexuals was not the same virus that was infecting heterosexuals. It was almost like two epidemics occurring in parallel, but not caused by the same virus. That segregation was sort of unusual because I myself had presumed, well, the drug addicts had sex with women and then that's how it got into the prostitutes. But they were two separate viruses. We called them subtype B, similar to the MN and SF strains from the United States and Europe, and then this new one that we called subtype E, which now is called "AE" because it's sort of a mixture of A and E. That segregation continued for quite some time. Now E is the most predominant strain 00:40:00in the country, and it spread into Cambodia, into Southwest China, into Myanmar, into Northeastern India.

MILLER: Even though that wasn't the predominant one in injection drug users, or was it?

WENIGER: That was also -- yes, injection drug users had B, probably because they acquired it in prisons, and the prisons had been infected by foreigners who were arrested -- we're presuming that, because we knew before the great annual pardons of prisoners that there had been HIV in prisons, from studies that had been done among prisoners.

MILLER: So at this point, again, there's still no treatment, but was there a sense of panic, of an emergency, that we need to do something? How did the sense of policy respond early on? We know later on Thailand was a real leader in terms 00:41:00of how it responded, but at this early phase -- .

WENIGER: I think the public in Thailand pretty much reacted as the public did in many other countries: fear, isolation, turning AIDS cases into pariahs. Thailand experienced that as well. What did help, though, was that fairly early on the Ministry, or the government, basically, established a National AIDS Committee. They put some really remarkable people in charge of it: the famous Mechai Viravaidya, the family health planning, family planning guru of the country, became involved in HIV prevention as well; and the infectious-disease specialist [Dr.] Prasert Thongcharoen was appointed to this committee. They became involved 00:42:00in getting all the components of society, the press, schools, all the ministries, to get to be involved, in terms of public education and risk reduction and so forth.

MILLER: A lot of what was done during all of these years relied on the foundation of a strong surveillance system. Can you talk a little bit about that? What was the infrastructure like, and what was the quality of the surveillance system that did so much important work during those early years?

WENIGER: When I was the second FETP advisor in the early 1980's, the Division of Epidemiology had a fairly good surveillance system, and [published] basically a similar product as the MMWR. They called it their Weekly Epidemiological 00:43:00Surveillance Report. One of the things I mentioned to the trainees that were under my tutelage was that surveillance is a two-way street. It's not just collecting information from the periphery and bringing it to the center and keeping it there, but turning it around and sending it back out -- so that the people at the grassroots and provincial or regional health departments can see that when they report, something happens, an epidemic gets investigated. They report an epidemic, it gets investigated, they see their numbers on the chart. By the time I got there in '83, they'd already set up a computerized system for reporting cases. I think the cases came in on paper, but they were computerized at the central level, and they would publish a weekly epidemiological surveillance report similar to the MMWR. So with that, more and more reports 00:44:00would start to come in, and the trainees, as their staffing levels permitted, would be able to go out and try to work up these problems.

MILLER: That's very impressive.

WENIGER: They were not hiding the AIDS cases. Every few months there'd be a summary of AIDS cases or HIV infections detected by the serosurveys, which was quite [a bit] more enlightened than many other countries in that part of the world, in terms of the early epidemic.

MILLER: Were you involved at all in doing validation studies of surveillance systems? How did you, as a CDC leader, interface with priorities along this line?

WENIGER: I don't think we had the time to get involved in that. We were doing 00:45:00sero -- we were involved in a number of areas for research and higher-level assessments of how the Ministry was doing surveillance. The HIV/AIDS collaboration itself was not doing surveillance. We relied on our colleagues and partners in the Ministry to do that. One of my initial goals, and I was basically prompted by [Dr.] Roel Coutinho, who had been an organizer, I think it was of the 10th International AIDS Conference in Amsterdam. The point I recall him making in one of the key speeches there was, don't just do "me too" epidemiology. We already knew how HIV was spread, what the risk factors were. Don't just do one more study that shows, yes, it's spread by this risk behavior or that risk behavior. We already have that information from North America and Europe and other countries. Do something that would make a difference in the 00:46:00epidemic. So my priority was to set up the cohort studies, the infrastructure that would allow [us] someday to do vaccine trials. So we went to the northernmost province in the country, where female prostitution was quite ... -- well, it was prevalent everywhere, but we set up relationships with the local prevention health department and set up cohort studies to see how well we could follow these women, test them periodically, and give them counseling to try to discourage them from being in this business. Those infrastructures of staff and communications and health workers and epidemiologists, [were] Thai nationals working with a few expatriates, so that when it came time that we had an intervention to test, we'd have a cohort of high-risk people that could be 00:47:00tested. So those were the hardest studies. I think one of the advantages that CDC had over our colleagues and counterparts at the NIH [National Institutes of Health] is that, as the U.S. Army had done before us, they have the long-term commitment. They don't work on three-year or five-year grant cycles where they build up this infrastructure with funding given to American universities, they go overseas, they set up all these projects, and five years later the money stops and all the people get fired. But the Department of Defense and the CDC can make a long-term commitment. We started the HIV/AIDS collaboration around 1990, and it's still in existence. I'm thinking of a number of NIH programs -- for example, the PAVE program for accelerated vaccine something or other. How 00:48:00many programs are in effect for a few years and then the researchers, the RO1 [Research Project Grant at National Institutes of Health] researchers lose their grants or lose their contracts and it all has to be rebuilt again. I think that's the great advantage of CDC. We can make a commitment for long-term funding and long-term support, because you need this kind of infrastructure to do the kind of studies that will help produce studies that will determine: does this intervention work or not? Does this vaccine work or not? Does this prevention of mother-to-child transmission work or not? Because you can make that long-term commitment that's longer than the assignment period -- the tours of duty -- of individual researchers.

MILLER: We've talked a little bit about the serosurveys, and you've mentioned some of these, but can you tell us a little bit more about the cultural aspects 00:49:00of these different epidemics in Thailand? For example, what are the theories of what drove the injection drug use epidemic, this incredible rise in the course of a year or two?

WENIGER: One theory I have, that got published in an editorial for a paper by Kenrad Nelson and colleagues in the New England Journal, was that in the early days opium was the drug of choice, and, of course, opium is grown and cultivated in that famous Golden Triangle where Myanmar and Laos and Thailand meet. Then it's transported along smuggling routes to go to other parts of the world. But smoking opium doesn't transmit HIV, and one of the theories, and I had some 00:50:00references to justify this, was as drug suppression efforts became more successful, opium smuggling was replaced with heroin production. Instead of producing the heroin from the opium in Bangkok or other parts of the world, there were refineries located closer to the sources of the opium poppies, so that there would be less volume of drug to smuggle and transport. So what was being transported was then heroin, which is injected. Thus shared needles can result in HIV and other infections going from one person to another. So ironically the success of drug suppression helped increase the risk of 00:51:00transmission of blood-borne diseases like HIV, because now the only way to administer these drugs along the routes required sharing needles. Another observation I had was that under communism, prostitution was suppressed in China and Cambodia and other countries. As these countries industrialized, including non-communist countries like Thailand, people moved from their villages, where premarital sex was uncommon and most of the men would use a small group of prostitutes for sexual services. As industrialization took place, factory towns 00:52:00would be set up, and young people, to escape from their villages where there was not much work, would move to these factory towns where they lost the influence of the village and the family about premarital sex. So more females were engaging in premarital sex than in the villages, and this is another factor that can lead to greater transmission of heterosexual diseases. Of course, under communism, sex was, the sex business was suppressed. As countries like China opened up to capitalism, there was less control of this kind of thing, and commercial sex became more overt. I think that was another explanation of how 00:53:00the epidemic was facilitated -- by these social political changes occurring in countries that industrialized.

MILLER: We heard a lot about brothel-based female sex work in Thailand. That was a big tourist draw; the brothels in Bangkok were well known. We know that that initially contributed. How did that impact on the dramatic rise? Was that a big factor in terms of the increase of HIV in Thailand?

WENIGER: Let me just provide this disclaimer: that I've been away from the HIV/AIDS field for quite some time, and the terminology that we used then and now is not the same. There's a lot of political incorrectness or correctness 00:54:00that's enforced. So if I use the term "commercial sex worker" now, there may be new terms to replace this that are considered less pejorative. So excuse me if I'm using the terms I recall from that era. We found that there were really two types of female sex workers. The brothel-based ones were the ones that were very low cost, $3, $5, $8, and working in establishments. They would call them tea houses or brothels. Then there were more freelance workers who might work in bars, meet customers, go to a short-stay motel around the corner or high-class places even. The rates of HIV were different in those places. One of the major contributions I think of Thailand prevention programs for HIV was generated by an FETP graduate named Dr. Wiwat Rojanapithayakorn, one of the early graduates, 00:55:00who was working in Ratchaburi Province facing the epidemic. He came up with this 100% Condom Only campaign, where although prostitution was technically illegal, the police knew where these places were and people sort of ignored it. Working with the police, he went to these places and set up a program where they were required to use -- the owners of these establishments were mandated to require their employees to always use condoms, and if their customer refused, to explain to the employee "don't have sex with this person." Whenever a case of an STD occurred in a woman from one of these establishments, they considered it prima facie evidence that the owner did not enforce that rule. The police would punish them, close them down for some period of time to enforce it. This became a 00:56:00nationwide policy that had a tremendous effect. I can't remember the exact numbers -- they're in the review article -- that led some years later for Dr. Wiwat to be awarded the Prince Mahidol Award of Thailand, which is considered like the Nobel Prize in Asia for public health, for [his] having established this program of working with the police and the provincial authorities to enforce this rule.

MILLER: Was it easier to control the epidemic in the brothel-based versus the bars or the higher-class quote-unquote settings?

WENIGER: I'm not sure I can answer that question. I think in the early years of the epidemic, one phenomenon I noticed was that you can't get people to change their behavior, whether they're young men going to prostitutes or others 00:57:00engaging in sex or sharing needles, or whatever the risk behaviors are. You can't get people to change their behavior until they perceive themselves to be at risk. You know, they see it on television, they see public service ads, and they see educational programs in the schools. I have a picture of Jim Curran and Helene Gayle and Dr. Khanchit Limpakarnjanarat in the hospital in Chiang Rai when they visited Thailand, [standing] next to this big mock AIDS devil. That kind of -- you know, some ugly-looking, red papier-mâché figure that represented the evil AIDS. I don't think people really pay attention to that until they experience the disease themselves; their son, their daughter, their brother, their sister, their cousin, a neighbor in the town gets this disease, and within six months of being symptomatic they're gone. So I think when that 00:58:00began to happen in Thailand -- and at a certain point in Thailand 2% of the pregnant women in the country were HIV positive. So this was a random sample of women going to public antenatal clinics. That's a large number. When people begin to see how this disease is affecting their families, their friends, their community, because people are dying down the street or in the same home. In fact, we've lost our own Thai relatives, at least one in Thailand from this disease. When you finally see that, then I think you recognize that it's time to follow the suggested protective behaviors that you see on television, because you now know you are at risk. So that's my little theory, and I think we saw that in Thailand.

MILLER: What about the foreign tourists? Did it affect the business of Thailand? 00:59:00Was that maybe part of the motivation of controlling it?

WENIGER: There is sex tourism in Thailand and many other countries. I think, though, it's fair to say that, although it gets a lot of publicity and a lot of coverage in the Western press, in terms of prostitution, it probably represents a very small proportion. I think most acts where money is exchanged for sex in Thailand, and most other countries, are not involving foreigners. Although sex tourism occurs and continues to occur, it's probably just a small proportion of prostitution in Thailand and other similar countries.

MILLER: You talk about the very impressive Thai response of 100% condom use. Can 01:00:00you talk a little bit about an area that's certainly been very difficult in the United States, but elsewhere as well, and that is the approach to the injection drug users, needle exchange programs. What was the Thai view of that? Was it implemented and successful?

WENIGER: I'm not sure I can really comment with direct knowledge of how that goes. I must say that we did have problems because the law enforcement authorities were often not so cooperative with the drug treatment authorities. In fact, we did studies trying to estimate the size of the drug-abusing population in Bangkok by doing capture-recapture studies, where we would have, 01:01:00with the cooperation of the drug treatment clinics in the city, the names and dates of birth of individuals under treatment at a certain point or period of time. Then working with the National Drug Control authorities or the prisons, we'd have a list of people in jail for drug use, and by cross-linking those two populations to see how much overlap there was, we could calculate the number of drug addicts in Bangkok. I think the number was somewhere between 30,000 and 40,000 at a point in time. The problem was that if police are looking for people to arrest for drug use, the likely place is to stand outside the drug treatment clinic as they're walking out or walking in. These types of things I'm sure occurred in Thailand and probably occurred in the United States, too. Willie 01:02:00Sutton was famously quoted [when asked] "Why do you rob banks?" "Because that's where the money is." If you want to arrest drug users for your quota of needed arrests, you go to the drug treatment centers or nearby. So I'm not sure I can comment on trends in that area. I've been away too long from the country, and although I go back and work there part-time now, I don't really follow this issue very much.

MILLER: I know in many countries in Asia or Southeast Asia, there was a great stigma against drug users. Was that similar in Thailand?

WENIGER: Oh, yes.

MILLER: There were a number of very important areas of research that were conducted in this Thai field station. I know one area you worked on was 01:03:00molecular epidemiology and the different strains of HIV in Asia. Can you tell us a little bit about that, and what's the significance of knowing all that?

WENIGER: I think I mentioned earlier the discovery, to everyone's surprise, that there were two strains of HIV, both HIV-1, that were circulating in Thailand and segregating by risk category. That [discovery] was only made possible by doing the genetic analyses. We worked with Sharon Cassol from Canada on collecting blood from some neighboring countries, Myanmar, Thailand, China -- I may be forgetting [all] which countries we worked with -- and India, where they would send us blood samples from infected persons, dried onto filter paper. 01:04:00Surprisingly, when the blood is dried onto filter paper, and you keep the flies off of it and put it in a glassine envelope, it doesn't need to be -- it's thermal stable, you don't need to refrigerate it. So we were able to bring that to Bangkok and then send it off to Chin-Yih at CDC and see what the strains of HIV were in the other -- they were able to get through the genetic analysis on these filters and see what other strains of HIV-1 there were in other countries. That's what led to the conclusion that the strains of HIV in Thailand, as time went on, were moving into Cambodia, moving into Southwest China, where they do have an injecting drug use problem in that area, in Myanmar and other neighboring countries.

MILLER: What was the practical or programmatic significance of that? I think at 01:05:00one point you mentioned, in thinking about vaccine trials, other aspects. I think it was interesting intellectually, but how did it impact on program?

WENIGER: I'm not sure at that point it impacted on program. I think, though, that now that these genetic studies have continued, the main target for vaccine studies, vaccine intervention trials, of which there was a famous one conducted by the U.S. Army that for the first time found an effective AIDS vaccine. In its first year after vaccination, it was 60% effective, but as more follow-up went on, the immunity wore off, and it was only around 31% effective. That was a major event for the world, and I'm very proud that Thailand was home to that. I think the U.S. Army, working with the Ministry of Health that conducted these huge trials, with 16,000 vaccine recipients or placebo recipients, really 01:06:00deserves a lot of credit for finally showing that it was possible to have at least a partially effective AIDS vaccine. We think of how poorly some of our influenza vaccines do in some years, 60% or 50% efficacy, having 60% one year after vaccination was not so bad, and going down to 30% is certainly -- it's not a home run, but it's at least a double to second base. I'm proud that they did that, and knowing what the strains are in the country that are circulating, what the targets might need to be in the vaccines to be tested is important. There's another area that slipped my mind. Ask another question and I'll comment on that.

MILLER: I think, certainly from my understanding, some of the work on prevention 01:07:00of mother-to-child transmission that took place in Thailand was a watershed in many ways for prevention of mother-to-child transmission in developing countries. But it was not an easy component. There were several components to this so-called AIDS Clinical Trails Group 076 study. Can you mention a little bit about that in Thailand, and the ethical questions associated with doing a placebo-controlled trial. Much has been written about that since.

WENIGER: My involvement in that from '90 to '93 was pretty much, as I mentioned earlier, setting up the infrastructure. While I was there, we only had two Americans: myself and the laboratory director full-time, and maybe a dozen Thai national employees who were working on various projects. What we did to solve 01:08:00this problem of needing more epidemiologic expertise [was] we'd bring short-term consultants from Atlanta, so we had [Dr.] Nathan Schaffer and [Dr. Robert J.] R.J. Simonds. I recall being involved in the maternal-to-child transmission studies, but while I was there we were making arrangements with the Rajvithi Hospital and various hospitals around town to start these cohort studies, working with the staff at those hospitals to test mothers and be ready to do the intervention trials. Those trials took place after I was no longer in Thailand. They did, of course, find that, yes, you could prevent maternal-to-child transmission with drugs, and that was wonderful. It only occurred because we had these wonderful relationships with obstetric programs in the city at the major 01:09:00teaching hospitals that made it possible. That's another example of having these long-term commitments to maintain salaries and subsidies and staff to do research. Even before you register for the intervention, just do epidemiological research on the proportion of mothers who were infected, and what their clinical aspects were, and how often the kids were getting infected, until we were ready to do these trials. So long-term commitments are necessary, not short-term and medium-term grants that run out.

MILLER: It's phenomenal how wonderful the relationship really sounds like from the perspective of the Thai and U.S. collaboration. Any thoughts you have on why that was so good? In other countries, it's not been quite as easy. Is it the Thai people? Is it the long relationship that they originally had with the U.S. Army?

WENIGER: I think in Asia in general, in Thailand as well, personal relationships count for a lot. I think the reason we were successful in starting the HIV/AIDS Collaboration -- now it's called the TUC [Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration]-- it's changed its name-- was because we had been there before with the FETP. Philip Brachman arranged to start the FETP. I was not there at the time. So personal relationships and trust have a lot to do with it. In fact, that brings up a subject that I hope we'll have a chance to talk about, which is scientific competition. In my experience there as the founder and runner of this research activity, I saw the negative aspects of hypercompetitive scientific work. I 01:11:00mentioned earlier that the U.S. Army research facility there, the AFRIMS medical research facility, was a little bit uncomfortable with this new player on the block from CDC that was going to focus on HIV and AIDS. But they went along with us and helped us out and gave us advice. But once I was there, I noticed coming from both certain individuals at CDC and elsewhere, how scientific competition can do a lot of damage. My philosophy in working in Thailand was that we always had to remember we were their guests, and our host was the country of Thailand, the people of Thailand, the Ministry of Public Health. We were not little colonial outposts doing our own thing. I noticed when another research group was working in the country or coming into the country, whether it was Harvard University working with another hospital across town that we were not involved 01:12:00with, I thought this was fine. I didn't think that we should claim that they should stay away and not get involved. There are plenty of provinces and plenty of diseases to study. My only suggestion would be let's use deconfliction, as it's now being used in Syria. We're working, someone else is doing work in Chiang Mai, and Chiang Mai is a lovely place to work, and that's why I spend half the year there now. But there were other research groups working in Chiang Mai. So I say, when we set up our project of female sex workers, a cohort, let's do it in a different province. Fortunately, Dr. Khanchit Limpakarnjanarat [Thai Director, HIV/AICS Collaboration] originally came from Chiang Rai province, not far from Chiang Mai. So we went up there. My only suggestion was, let's avoid trying to be competing over the same patients in the same hospital or the same province, but work together. So we would often welcome visitors from other 01:13:00research universities or programs that wanted to do research in Thailand, meet with them, make suggestions and so forth. Say, "why don't you try over there, there's nobody involved over there." But I did notice a lot of a different attitude coming from even some people in Atlanta, that we don't want those -- we want to be first to discover something, we don't want them to discover it first, so let's not cooperate. In fact, I remember we had been working with the Thai Ministry and their regional and provincial health offices to collect specimens of various types. Those specimens eventually were sent to Atlanta with the cooperation of the Thais for storage and study and analysis. Then the Japanese wanted to get some of these specimens, and so we worked out what we thought would be something called a Material Transfer Agreement [MTA]. The Thais said fine, because the Japanese had built the Thai National Institutes of Health next 01:14:00door to our offices, and that's where most of the laboratory work was being done. They would send their researchers over there. [Dr.] Yutaka Takebe was one of those researchers, and we got along fine with him, we worked together on some manuscripts. But when his institution in Tokyo wanted to get some specimens that we had processed -- they were Thai specimens we had sent to CDC --we drew up a Materials Transfer Agreement, and there were certain personalities back in Atlanta in the lab that didn't want to send those specimens to Japan. Why? They weren't their specimens. They belonged to the Thai people and the Thai government. So that MTA never succeeded, and I thought that type of competitive "we're not going to share our specimens" is not the way science should be working. Science works best when people publish their results and help out other researchers in the same field and not be constantly struggling to be the first 01:15:00and freeze out their competitors in that respect.

MILLER: Very interesting. I still wonder what the community response was to this horrible epidemic, the illness, the deaths. Can you talk a little bit about that? What was your own response? This was such a crippling disease even in the early 90's, certainly in Asia.

WENIGER: Not having experienced clinical AIDS institutions in America, because when I came back from working in Thailand on this AIDS program, I moved to 01:16:00vaccines. So I'm not sure I can say things were that much different. There was the initial resentment, fear, anger, segregation of patients with AIDS or HIV infection in Thailand, as we had here. Remember all those horror stories. But as time went on, more enlightened policies went into effect, and Thailand even developed its own AIDS activist groups that would lobby and demonstrate and so forth. Now Thailand, through government funding, provides antiretroviral drugs to people who are HIV infected. It's not a big deal --people are surviving longer than they did in those early days. So I'm not sure I can give you 01:17:00examples or anecdotes of how things were different there than here. I think most societies face the same evolution, from horror and fear to acceptance and understanding, that if they didn't engage in risky behavior they weren't at risk from someone sitting next to them in the classroom and so forth. I think, though, that Thailand was unique among its neighbors in that region in being more open and willing to publish their results and to make their situation be known. Only when you convince people that you have a problem, are they willing to spend the money and make the effort to solve it. If you don't reveal that you have a problem, it's not going to get solved.

MILLER: That's very impressive. Anything to say about the Thai people and the Thai society?

WENIGER: I think I'm biased. I now work part-time at a university in Thailand, and I think the hospitality of the Thai people is inborn. You don't have to go to hotel school or restaurant school to learn hospitality. The Thai people host a number of regional offices of various groups, because quality of life is relatively good. It's a relatively safe country to work in, and I think that made it an advantageous place. It was also probably the beachhead, at least as far as we can tell from the early serosurveys, of where the virus first got into the Asian population and began spreading.

MILLER: What about the beachhead?

WENIGER: I use a military analogy, in the sense that Thailand was probably, in 01:19:00terms of what we know from serosurveys, the first place where HIV came into the country in the bloodstream of either a foreigner or a Thai national returning from overseas. Then because the conditions were ripe, given risk behaviors, needle sharing, unprotected sex and so forth, it could spread rapidly.

MILLER: Before we close, is there anything else you would like to mention about your experience there? This has just been fascinating. You are the only, or certainly one of very few [interviewees], that is telling us about the epidemic in Asia, and it's incredible.

WENIGER: It's now been, what, 35-plus years since I first went to Thailand in 1983. I have to do the arithmetic. I think the longer I have experience in 01:20:00living, visiting, working in Thailand and knowing the Thai people, I see the benefit of the FETP. A few years back when we had the Avian influenza pandemic, I remember sitting in my kitchen in Atlanta, and the BBC [British Broadcasting Corporation] or one of the major news organizations was interviewing one of our early graduates from the FETP, Dr. Supamit Chunsittiwat. [He was] a really remarkable fellow who was eloquently explaining to the reporter how Thailand was working on this problem that had been found in Thailand and other countries in Southeast Asia. I thought, this is the fruit, the payback, from all those 01:21:00efforts starting with Dave Brandling-Bennett in 1980 with five trainees. Now they have hundreds of them. Some of them don't work in epidemiology, some of them maybe went into clinical practice, and many of them remained in the ministry. They're now reaching the highest levels of the civil service, where they're now running departments and running divisions and running various parts of the public health system We're getting the benefits of that training of the FETP, because, in a sense, I consider epidemiology to be the science of health. It's the queen of research methodology. It's basically epidemiology as the application of the scientific method to health problems. Now we're seeing the 01:22:00payback from that investment. CDC, off and on over this 35-plus years, has sent staff, has sent some funds, has sent short-term consultants and long-term advisors, to work with not only Thailand but other countries around the world, and the payback is there. This has nothing to do with my own experience. But when I saw in the press what CDC had done, was doing, to stop the Ebola epidemic, pandemic, or epidemic in Africa, it made me very proud. There must have been literally thousands of person-months of CDC people going there, making their families worried to death about the danger they faced. But when I think of how close this world came [to disaster] if that virus had gotten out of that 01:23:00region ... . Nigeria did a wonderful job keeping it from spreading to that major metropolis .... If it had gotten into other parts of the world and Asia or South America .... The world really just missed a terrible tragedy, and I think CDC gets a lot of credit for that. The people in Nigeria who stopped it were epidemiologists in training, and I thought this was proof of what Phil Brachman and others started way back when they began taking the original EIS model overseas. It made me very proud that this agency had been very much involved in helping stop what happened in West Africa with Ebola. Whew! We came very close 01:24:00to a disaster if it had ever gotten out of that region.

MILLER: I'd like to close with just a few questions about the personal aspects of your work. You've covered some of them. Did you worry about becoming infected yourself or about your safety or your family's safety during these early years?

WENIGER: Not really, because I think by that time we knew how this disease was spread and we knew what precautions to take. Don't share needles, don't engage in certain behaviors. So I wasn't really concerned. Of course, we had a laboratory, and we had to make sure the lab people were protected. But no, that wasn't really an issue. I tell people that in some countries there's civil 01:25:00disorder, unrest, and risks, and certainly many CDC people are in parts of the world that are very dangerous. I worry about those still working in polio eradication in some very dangerous places for political reasons. But I tell people in Thailand the most likely thing that's going to cause a tragedy is automobile vehicles and trucks. I tell anyone who goes to Thailand, look both ways when crossing the street, because you never know, there's a lot of people coming down the wrong way on a one-way street. In fact, I tell my family this story: about a week or two after first going to Thailand in 1983 with the FETP, I was crossing a major one-way road with four lanes in one direction, and the traffic was stopped by a traffic light. So I was about 50 meters ahead of the 01:26:00vehicles all stopped, and I was going to quickly jaywalk across the street. There was a policeman on the other side of the street and he shook his head. I was about ready to step into the street to get across before the light turned. I thought to myself: you know, I just got to the country a week or so ago, I don't want to get arrested for jaywalking; I need to be on my best behavior.Just at that second, when I decided not to step into the street -- they had a one-way bus lane, just for buses going the opposite way on the one-way street -- [a bus] went right in front of my nose. There's no question that if that policeman had not been there, I wouldn't be here. So I tell everyone I know going to Thailand: look both ways, all the way across the street, not at your cell phone. I think that's the most practical advice I can give.

MILLER: Thanks very much. It's been terrific.

11