Georgina Peacock

Q: Today is Friday, February 24, 2023, this is Mary Hilpertshauser for the COVID-19 Oral History and Memory Archive Project, and I’m in Atlanta, Georgia, and I’ll be talking with Dr. Georgina Peacock who is with me here in the Stephen J. Thacker Library on the [Centers for Disease Control and Prevention] Roybal Campus off of Clifton Road in Atlanta [Georgia]. Dr. Peacock, do I have your permission to interview you and record this session?

PEACOCK: Yes, you do.

Q: Okay, can you tell me what your current position is at CDC [Centers for Disease Control and Prevention]?

PEACOCK: I’m the Director of the Immunization Services Division in the National Center for Immunization and Respiratory Diseases.

Q: Before we get into the details about your path to CDC and COVID, could you tell me a little bit about your family background and the community that you grew up in?

PEACOCK: Sure, so I actually grew up in lots of places, all over the world. I was born in England, my parents are English, and they were both—when I was born, they were in their PhD [Doctor of Philosophy] programs but became university professors and just picked different places to move around the world. They decided they wanted to—for us to see the world and so we moved to Hong Kong and then we lived in Australia and Canada and then moved to the United States, so we lived in Oklahoma and then moved up to Michigan.

Q: Those moves were precipitated by the fact that they wanted the family to see the world as you were growing up?

PEACOCK: Yeah, I think just an idea of exploring and understanding how different people lived.

Q: What makes up your family?

PEACOCK: I have –so my mom and dad and then I have two sisters and a brother, and I was the oldest.

Q: When you were growing up, what kind of things really interested you when you were a kid?

PEACOCK: What I learned from moving a lot was I learned how to interact with lots of different people and so I think that is something that I enjoyed, seeing different cultures, different ways people approach the world, different things like that. I don’t think I never did—went to a lot of activities probably because we moved a lot. I played the piano, I did some of the things that lots of people do, but I didn’t have one particular interest. But what I have always enjoyed doing and that I think moved into later in my life is traveling—the traveling and understanding how people live and the different ways they approach the world.

Q: Okay, so you landed in the Northeastern part of the United States during high school?

PEACOCK: Yes, so I was in high school in Michigan and then did my undergraduate degree at the University of Michigan in Ann Arbor.

Q: Did your family stay in Michigan while you were in the university, or did they move on and leave you there?

PEACOCK: Yes, they lived in Michigan for longer and then my siblings, who were much younger than me or some of them much younger than me, really spent their whole schooling almost in one place, which was really different than me and my sister. We had me and my sister and then a five-year gap and then another sister and brother and so they lived—their lives were very different than ours.

Q: Are you close to your sister?

PEACOCK: Yes, yeah.

Q: The rest of your family?

PEACOCK: Yes, yes, we talk quite often now on WhatsApp, probably like every day, yes, and a couple of them live close here and then others live other places.

Q: Okay, so what did you study at the University of Michigan?

PEACOCK: I studied cell and molecular biology, and I also studied German.

Q: So why cellular and molecular biology?

PEACOCK: I think I always thought I was going to be a scientist, and I had a very strong—we had a very strong science department in our high school, so in high school, I was actually able to take anatomy and physiology, genetics, botany. Those are the things that I remember, but it was amazing how many options of different courses we were able to take, and I really think that probably further solidified this interest in science. Both my parents were—they had PhDs in engineering, so they also were in that science, math side of things.

Q: But there was the other thing that you took in—when you were at the university, and that was German. What prompted you to study German?

PEACOCK: Well, I had taken German in high school, and I think I just picked it. You could pick German, French, or Spanish, and less people took German, so I took German.

Q: That was part of your curriculum?

PEACOCK: It was—

Q: Oh, in high school?

PEACOCK: —in high school, right, and so then I went to college, and the University of Michigan had something called the Residential College, which is a liberal arts college that’s a college within a college where you live and you’re—you live, and you take classes in the same dorm. One of the things they had was intensive language programs. When you did German for example, you did—when you did the first part of the language, you did an hour in the morning, you had a lunch table where you spoke in that language and an hour in the afternoon, and I don’t know. It seemed like a good balance to the science side of things, right? They were pass-fail, so you didn’t get grades in those classes, and I took really interesting classes. I took Six Philosophies That Changed the Human Mind, was one of the classes I got to take in there, and so I got this balance of taking hard-core science classes but then this other—

Q: Humanity?

PEACOCK: —humanities type thing, and so it was a nice blend.

Q: It is a nice blend, I like that. What is it that you loved about German then? I mean most people take Spanish or French, and German just seems like not the usual track.

PEACOCK: Yes, I don’t think there was any real reason. I did go—part of being in this Residential College is most people did a year somewhere else and so I did a year in Freiburg, Germany. I actually met my husband there who was also on the same exchange program but from another university, and so there were about sixty Americans there in this program. I don’t know that there was any reason that—about why German, but I definitely liked being able to speak another language. When I got there, I took classes that counted towards my major, but I also got a job in a bakery and again got to learn conversational German and meet the people, yes.

Q: This is also part of that where you were growing up, you were learning about other cultures, this kind of got carried over into your—

PEACOCK: Yes, I think so—

Q: —college career as well?

Q: Okay, so what happens after you graduate university?

PEACOCK: I applied to medical schools and ended up going to do a medical degree at University of Kansas in Kansas City.

Q: Why medicine?

PEACOCK: Well, why medicine? See because my—

Q: —because you were—

PEACOCK: —because my roommates were—so two things. My roommates were applying to—I came back from Germany, my roommates who I was living with, they were all applying to medical school. I also, at the same time, got a job in the lab [laboratory], so I was working in a cellular and molecular biology lab. And while I found the topics interesting, it—there, kind of, wasn’t enough interaction with other people and so I didn’t think I wanted to—I thought I would do a PhD in some kind of biological or chemical science or something like that, but it wasn’t something that I enjoyed. I don’t think it was something that I was—also excelled at. I think if researchers, bench researchers are—can do that, if you’re good at it, you can do that work really, really well, and I just don’t think I was that good at it and so I—but I still liked the—doing the science work. My mentor in the lab said, "I think you’re better suited to go to medical school." He had an MD [Doctor of Medicine] and a PhD, and then of course, my friends were all applying to med [medical] school too and so I thought, oh, I can do that too.

Q: Okay, well, it’s more of a people-related type of thing rather than just bench? Then you’re off to the school of medicine at the University of Kansas, and what happens there?

PEACOCK: Went to med school, had a daughter in my third year of medical school, actually got very sick in my fourth year of medical school. I had Hodgkin’s lymphoma and so I went through radiation and chemotherapy and surgeries and things like that, so ended up staying in Kansas for my—all of my training. I think a lot of that was because of the illness that I had in my— so it was the end of my med school so it—I had to take a—I took a break, a six-month break, so that I could finish that treatment and then my residency director had said, "You can start whenever you want to." I had a residency to start, and I think that was—we ended up staying in Kansas for fifteen or eleven years, yes.

Q: Wow, wow, is that the longest you’d stayed in one place?

PEACOCK: We’ve been in Atlanta now longer, so fifteen years, but, yes, until then, yes, yeah, yeah.

Q: During that time, you start to pursue developmental behavioral pediatrics, what made you take your practice that way?

PEACOCK: So I did pediatrics and had, I think, this influence of—so I had more children as well. I had a son in my second year of residency, and I had one in my third year of residency when I was also a chief resident and so I had this context of—I had lots of children, right? I also had this illness, and I, I think I wanted to figure out better how you work with children and families that are going through challenging situations. So I, in my residency met, two developmental pediatricians who said, "You should come do a fellowship." The way peds [pediatrics] fellowships work is you do three years of pediatrics and you become—you’re a pediatrician and then you can do a three-year subspecialty. They said, you can—it doesn’t take away from you being a pediatrician, you just add knowledge on, and you learn how to work with children that are facing adversity either because of the developmental disability or because of the life situation that they lived in. It sounded a good thing to do. I didn’t know exactly what I wanted to do. I thought about doing—becoming a hospitalist or becoming an infectious disease doctor. I had thought about being a hematologist-oncologist, but then when I went through that experience, I decided I didn’t want to do that because it was hard, and so.

And then the other thing in going into development—this developmental behavioral fellowship is they said, we’ll also pay for you to do a Master of Public Health [MPH], and that’ll give you some background on how you do child advocacy work or systems work around families. Very early on, my fellowship director said, "We’re going to put you on this state-level committee that is looking at how to increase quality of childcare in—increase the quality of childcare and the understanding of physicians about the importance of quality childcare." And you know, I sort of didn’t really make all those connections. This was a project that was being done at a state level, funded by a federal agency, probably funded by HRSA [Health Resources and Services Administration] to look at increasing quality childcare. It gave me that experience of how you work with stakeholders in—at different levels to improve something and so I think that was my—that was an introduction to public health. I don’t think I knew what public health was, I didn’t know what a Master of Public Health was going to be, but it fit really nicely with the clinical part of doing a developmental behavioral fellowship.

Q: Yes, so when you’re in the school of medicine and you’re becoming a doctor, it’s usually a one-on-one kind of situation. Whereas when you get into the public health, it’s more populations that you’re now serving, and it sounds like that interested you a lot better than just doing single?

PEACOCK: Yeah, and I think both, so I’ve never stopped doing clinical work. I do clinical work one—a couple of half-days a month, and I’ve always done that because it reminds you why you’re doing the systems work. Because you can’t figure out everything on an individual basis that is going to help that individual that you’re working with.

Q: Is that the best of both worlds in the medical field?

PEACOCK: I think so, I think it’s—if I had my druthers, I’d probably have a little more of a balance, so a little more clinical work than I do, just because it—I think it—I mean love doing that one-on-one—having those one-on-one interactions with families.

Q: Is it energizing?

PEACOCK: Yeah.

Q: Yes, how did you come to establish a developmental consultation and education program in Lima, Peru?

PEACOCK: I think I also had a bit of the same thing my parents had with wanting to see and do different things and so in my fellowship, I said, I—I’d love to do some kind of a broad—going-abroad experience. There had been a preexisting relationship with the University of Kansas and the Ann Sullivan Center in Lima, Peru, mostly through psychology, so school for children and adults with disabilities that a lot of the Kansas professors and things would go over and support.

So we went over there for a summer that—in the middle of my fellowship, and I did my capstone for my public—the—my Master of Public Health degree there. What I worked on there for that capstone was educating teachers and families and students about the importance of five-a-day, so eating different vegetables that were different colors and did that. But at the same time because I was a developmental pediatrician in training, we also—I also did consultation there. I came back, I finished my fellowship, and then right after I was done with my fellowship, the plan was that I would become a clinical professor at University of Kansas. But before I did that, we went back for—my family and I went back for four months and just did more of that work—did some developmental screening and also did more consultation of how—consultation diagnosis, things like that. And then for a number of years, continued to, I have some connection with them too, but probably—I haven’t been back since about 2010 but—

Q: Okay, can you explain just for the record what exactly developmental disabilities and that is, what it entails?

PEACOCK: A development disability is a condition that a—that someone has that develops during childhood. An example of that might be an intellectual disability or autism. Some people would characterize like learning disabilities or ADHD [attention deficit hyperactivity disorder] as developmental disabilities. Some of them maybe developmental conditions and some of them maybe a disability depending on, you know how intense the needs are. But then you can also look at it in a different way and say that there are certain syndromes that someone might have that are developmental disabilities, like someone may have Down syndrome, or they may have fetal alcohol syndrome, or they may have a genetic syndrome, something like that.

Q: Okay, and so there is developmental, there’s genetic, and then what about the ones that are in utero or that—is that part of it?

PEACOCK: It could be if you have a learning component to it. If you’re in utero and you have—I, think like a—well no, I think even if you had a physical disability, that would be a developmental disability like cerebral palsy is a development disability, so it’s something that happened. But if you were in a car accident, you—say when you’re eighteen or maybe even a little younger, and you might have traumatic brain injury, you might not be—it’s fairly technical, but you probably wouldn’t be told that you have a developmental disability. Because it was something that was acquired with—not when your brain was in that very early time of forming in the first five to eight years of life.

Q: It’s usually from in utero to maybe five or six or eight years old?

PEACOCK: It’s about eight. The CDC when they look at developmental disabilities, so when they put out prevalence numbers related to autism or intellectual disability, their measurement is of the eight-year-olds because the idea is when they looked at diagnosis, most children with a developmental disability are diagnosed by the time of—by the age of eight. It’s, yes, things that have developed or have been noticed in those first eight years of life.

Q: Typically, who notices those, are those teachers or are they doctors, pediatricians or—?

PEACOCK: Yes, yes, well, I think it’s a bit of both. If it’s early on, then it could be childcare providers or it could be your pediatrician, especially if your pediatrician is using some kind of developmental screener. Because we know that the screeners actually allow for some objective look at trying to find out where children are having challenges, because pediatricians may not have the time to ask all of those questions. If you’re in school, then you would expect that a teacher might notice that, and some things are maybe more easy to identify than others. If you tend to have a—something that’s disruptive, you may identified faster. If it’s something that is more like, say, it’s a reading disability or it’s anxiety or something like that, those are less easy—inattention but not with hyper—not hyperactivity, then they’re harder to identify or—in a big classroom, something like that.

Q: This is what you’re teaching as a clinical assistant professor at the University of Kansas?

PEACOCK: Yes, was all—doing that and then also, yes, doing the work of either the diagnostic clinics of young children. I also did some urgent care pediatric stuff too.

Q: There’s something that led you to childcare quality improvement?

PEACOCK: That was that project that I was doing in my fellowship, and it was just a— really kind of an extension of that. Because one of the ways you improve childcare, the experience in childcare for example is developmental screening and teaching childcare providers how to do that. And then the other thing that we did in our—in the program, so one of our jobs was to educate other pediatricians in-training. So I would take our pediatric residents when I was a fellow to childcares, and we would just sit and observe children. You’d pick a child in a classroom and then look at what they’re—the things that they were doing, were they behind in development, could you guess what age they were, things like that, just to teach pediatricians in training how to look at development and how to see whether children were progressing or not progressing.

Q: It sounds like you should be doing that, yes. How did CDC come into this picture now? What year are we? Let’s anchor ourselves in time.

PEACOCK: Yes, so we were in 2007 or ’06—in 2006, sorry. So, the first time I was in Peru, we—I had three children. The second time a year later that we went, we had four, so I came back to Kansas after our four months in Peru with an infant and then three other children, and so I guess the oldest was eight. Started on—in this faculty position, and I ran into some people in—at a—I don’t know, an anniversary dinner. They had been asked by the CDC to identify a developmental pediatrician who could come work on the Learn the Signs. Act Early program at CDC, which was a program to help identify children early with autism or other developmental disabilities, which is of course, what I was doing, right—in all of these other experiences. And I said, "I’ve never really—I just got my first real job,"—and I think I was, I don’t know, thirty-four, thirty-five, something like that—"my first real job, I’m not going to do another fellowship." They said, "But this is exactly what you do, and you’d write this." I talked to my husband, and he said, "Well we could do that." And so we moved to Atlanta for—so I did—I was on faculty for probably about six months and then we moved to Atlanta to—for me to do this fellowship at CDC, working as the medical lead in the Learn the Signs. Act Early program.

Q: Yes, is this the Act Early?

PEACOCK: Yes, yes.

Q: Can you explain Act Early?

PEACOCK: It’s called Learn the Signs. Act Early, and so the Learn the Signs part was really the health communications part, which is to educate healthcare providers, parents, and childcare providers about developmental milestones and then early warning signs of delay. And then the Act Early part was the part that I was privileged to develop, which was what we did was we had this project where we had these regional summits. We brought together stakeholders in states to form state teams and then we would have these regional meetings, and the stakeholders were different people involved in the early identification of children with autism or another disability. So they might be early intervention people, they might be people for the health department, they might be physicians, parents were involved, and they formed state plans to help with the earlier identification of children with delays.

Q: Were all state plans the same, or were they tooled to different populations?

PEACOCK: They were tooled to different populations and to different environments, how the funding streams came and things like that. What we did when we asked the—them to form the teams, is we did make suggestions of which types of stakeholders you should have there. You should have people from state government, you should have people from the education side, from medical side, things like that so that—because we knew that you needed all people in all of those systems to be working together in order to ultimately identify children early and get them into early intervention.

Q: Okay, and so was that a successful fellowship?

PEACOCK: Yes, well, and so I guess, so you’re—I don’t know. Yes, I mean it was I—

Q: What did that lead to?

PEACOCK: I learned a lot, so I ended up being in the fellowship for about eighteen months and then I became an FTE [full-time equivalent] and—

Q: What’s an FTE?

PEACOCK: Sorry, a full-time, a CDC employee, so I became a CDC employee really doing a pretty similar role but having some more responsibilities from like budget perspective and those kind of things and maybe supervisory perspectives and things like that. I did that for a few years.

Q: Was that a big leap for you to go from teaching to a government job?

PEACOCK: No—

Q: Or should I say a different mindset?

PEACOCK: Well, in my fellowship, what I was mostly doing was teaching. Because my whole job was going out and talking at conferences and working with different groups to help them understand the importance of doing this, so it felt very similar to that. There was, I didn’t think it would change when I became a CDC employee. I don’t think I knew what people did on the employee side of things, right. I did suddenly notice that, oh, it’s more—like I was doing more of the logistics of how to implement programs, right? Like the budget and the strategic plans and all of those kinds of things, which I think as a fellow—which would make sense, I wasn’t doing those things. That was an adjustment and so I think that’s an interesting question that you ask, because I was trying to figure out whether I would stay at CDC or not. I always thought I would go back to do clinical work in some way, or I wanted a better balance of clinical and public health.

And then the 2009, the H1N1 pandemic happened, and I got asked to come over and lead the first children’s health team. That made me realize, gosh, I can do lots of things at CDC and apply—I can apply what I know and what I do to completely different topic areas. When I lead the children’s health team, a lot of it was partnership work and working with stakeholders and educating about the importance first of making sure children got to care quickly and then once we had a vaccine, talking about how they should be vaccinated and things like that. It was working in H1N1 for those nine months that actually made me think, gosh, I’m going to have a career at CDC in public health. I don’t know that I was quite there yet for my—in those first couple of years.

Q: Okay, so you’re still adjusting to being part of CDC in those first couple of years, but it was really H1N1 that made you realize you will have—you’re doing the same thing but a bigger impact perhaps?

PEACOCK: And I liked it, it was fast, right? I was in the Emergency Operations Center [EOC], I got to work with lots of people, I got to see the public health—how epi [epidemiology] informed program and then we would look at seeing if whatever we were doing was affecting change and things like that. I got to see that happen really rapidly, and so that maybe was what I was missing a little bit in the program that I’ve been working with.

Q: Okay, so you were assigned to the EOC during the H1N1, which is the Emergency Operations Center?

PEACOCK: Yes.

Q: That gets activated whenever there is a—?

PEACOCK: An emergency or a public health emergency, yeah.

Q: Yes, and H1N1 just happened to be one of those, and this was your first epidemic?

PEACOCK: It was the first one and—

Q: Is it a pandemic or an epidemic?

PEACOCK: It was an epidemic and then a pandemic, yeah, yes. The reason I was asked to come was because I had both—I was a pediatrician, I had both clinical experience and public health experience, and they wanted someone who could bridge both of those.

Q: Yes, makes sense. What was it like in the EOC during that time? Let’s say, what did you do when you came to work and you sat behind your screen, what were you doing? Was it constant meetings, were you talking to partners, and when you say partners, who are those partners?

PEACOCK: Yes, so it was—and it was I guess different than what I’ve done recently in EOCs. The EOC was really busy, so there were a lot—there were—

Q: Describe what it looks like.

PEACOCK: Yes, well, it reminded me of that movie from a really long time ago called War Games that had like all the—it had the big TVs up in front of you where you’re seeing multiple screens and then lines of desks with telephones and screens and so part of what I did was actually man the desk. We actually got phone calls from people saying: "What are you doing to support children?” In fact, one day very early in that experience, I remember getting a call on a Saturday morning from one of the leaders in pediatric preparedness, Irwin Redlener I think is his name. Anyway, he called, and he said, "I need to talk to CDC leadership about what they’re doing to support children. This is going to be a big issue for—H1N1 is going to affect children disproportionally, and I need to know what your plan is right now."

At that point, I had been there for like two or three days, I’d never done an emergency response. Dr. Anne Schuchat was the—she was the chief medical officer, I think, and we patched the call through to her, and then she came back to us and said, "Okay, you all need to expand what you’re doing, and you need to—we need to figure out what this plan is because it’s going to—children are going to be affected in this pandemic and we need to know—I don’t know, what we’re doing."

Q: So, this is Children’s Preparedness [Unit]?

PEACOCK: It was, I mean so this was children in response and then what happened is that a couple of years later, I was asked to build a children’s preparedness team or unit. Because I think of the CDC experience of seeing that maybe we needed to have a focal point for what happens with children during a response.

Q: It was H1N1 that piqued that interest?

PEACOCK: Yes.

Q: Okay, all right. Can you describe what children’s preparedness after H1N1 and that team, what were you doing?

PEACOCK: Yes, so I first went back to doing Learn the Signs. Act Early, and then in 2011, it was called the Center for Preparedness Response at the time. Dan [Daniel M.] Sosin was there, and he contacted me and said, "We have these big issues related to preparing for disasters related to children, but we need someone to be focused on." The one particular issue that I worked on first was related to anthrax. There had been lots of planning over the last decade related to anthrax but not a whole lot had been done related to how an anthrax attack might affect children. One of the issues in anthrax is that you have to get medicine and then potentially vaccine to millions of people within a very short time period—like a couple of days. The medicine that is available for children was—you needed medicine in a liquid form and having the medicine in a liquid form in the Strategic National Stockpile was not necessarily possible to do in huge amounts. Because of the expense of it and because of, I think, maybe availability and things like that. One of the projects we worked on was how do you teach families how to take a pill, crush it in orange juice or chocolate pudding or something, and that would be what you would give as this prophylactic dose for the next ninety days.

It was all preparedness work; we created videos of how to actually do that. But you also then have to think about vaccines, and for children with anthrax because it’s never been—the anthrax vaccine has never been tested in children, you had to have an IND, which is an Investigational New Drug consent, which is actually—you actually have to do an individual consent of every person that takes it. We had to think through how would you administer—in the context of an emergency—how would you administer consent like that. And so we did a lot of thinking about that, so those are examples. I was focused on anthrax and first really in the children’s preparedness world, but a lot of the premise was the same. It was like things for children are not the same as everybody else, and it’s important for public health to think about how children are going to be cared for in a disaster. Which is not different in being a pediatrician you know? The theme I think through a reading I’ve done is how do we make life better for children, or children and families.

Q: Okay, and then there were other things that you responded while you were in this group there, there was Ebola, unaccompanied—

PEACOCK: Unaccompanied minors.

Q: Those are the minors and children are coming across?

PEACOCK: Very early on, yeah, yes.

Q: That’s a hard one and then Zika [virus]. Zika was something that you really worked a lot on. I think that’s when we first met actually was during Zika.

PEACOCK: Yeah, so Zika, I didn’t—I actually for Zika didn’t work in the Emergency Operations Center or really as part of that leadership structure. What I did was develop a study called the ZODIAC [Zika Outcomes and Development in Infants and Children] study, which was to look at the developmental outcomes in the toddlers who had been identified in the Zika—right at the beginning of the Zika epidemic.

What we were trying to do was understand whether the—some children with—that were born and had the Zika syndrome were neurologically devastated, so they had very, very significant disability. What we didn’t know is if there was a spectrum. I maybe, whether you got infected at a different part of pregnancy if that affected how much disability you would have or whether there were other factors that would affect that and so that’s what we were investigating. I actually went and worked with the ministries of health in Brazil and did this—we did this study over about a year time period.

Q: Yes, and so did the ministry of health have to—wanted to work with us and invited you to do that?

PEACOCK: Yes, yeah, so they—it was the ministry of—the Brazilian Ministry of Health and then also the—what they called the state—the state secretariat so the—in their provinces in Brazil that those state—of its equivalent of state-level government had to be onboard with this and then we worked with CDC Brazil as well. They helped broker a lot of that.

Q: Okay, did that transfer to other countries in that area, that Zika was prevalent at the time?

PEACOCK: There were similar studies going on in in different places. I know during that time I went down—I went to Guatemala for a couple days and worked for—at the CDC office there because they were informing some studies there. I think there was a lot. There was probably, the most of the studies were done in Brazil, and I think that’s because they had so many babies they were—that were affected by Zika, maybe more than in some of the other places.

Q: Okay, so what was the outcome of those studies?

PEACOCK: It’s interesting, we didn’t—

Q: Are they still going—?

PEACOCK: Well, no, they’re not still going, I’m sure that there are researchers that are still down there looking. And I think here at CDC, there’s still work that’s being done in Zika, I’m not involved in that. But it wasn’t as clear-cut. It was hard because the children and the families that were affected by Zika were disproportionately low socioeconomic status, so they lived in environments that have other risk factors for disability. One of the things that we noticed when we did this study was everybody, I think every child, whether they had Zika or not, had a high lead level. And they were in families where the—there were single moms and there were less education of the parents and things like that. It ended up being quite challenging to see if there was a spectrum of disease or if it was really—if you got Zika at a specific time in pregnancy, that you had these outcomes. We made some conclusions, they weren’t super strong conclusions, that there may be some spectrum of disease, but I think it—I wouldn’t call it a definitive study. I think it contributed more, and I know there’s a lot more studies that are out there now that are trying to identify what’s going on.

Q: Did ZODIAC help with health equity in that country?

PEACOCK: I think to a small degree. This was a relatively small study when you look in the big scheme of things. But what we were able to do by going—partnering with these state health departments is we actually helped them improve their early intervention systems of care. So depending on where you were, some places had pretty good early intervention systems and some really hadn’t something that wasn’t existent—in existence, but we were able to maybe talk with pediatricians. We were able to talk with the state feds and saying, "This is really important that we get these children into early intervention. Even if they have very significant disability, we can help children avoid further contractures of their limbs for example if you have physical therapy or improve eating or feeding techniques so that they don’t get pneumonia," things like that. I think there was a value beyond doing the study in helping educate the pediatricians and families about what can be helpful as far as early intervention.

Q: Okay, great, so now you have moved on, and you’re now director of the Division of Human Health and—Human Development and Disability, is that correct?

PEACOCK: Yes, so in—

Q: This is in 2014?

PEACOCK: Fourteen, so, I mean it was during some of this—so during some of this—Zika was when I was already a division director. I don’t remember exactly the timing, but as I moved out of running the Children’s Preparedness Unit. That stayed in my division and so I was still involved in that to some degree, but I became the director of the Division of Human Development in 2014.

Q: Was that a new division?

PEACOCK: No, it had been around, it’s a small division, and I think it had been around since the early 2000s. It’s part of the National Center on Birth Defects and Developmental Disabilities, and our division was and is still focused more on—well, two areas. So, the early identification work, so under—Learn the Signs actually was in the division. It hadn’t been when I was part of it, but it got moved, so the early identification, human development part, but then also the living with the disabilities. The disability public health programs were there, the early hearing detection and intervention program is there, the autism program is there, those are some of the bigger programs.

Q: Is folic acid in there?

PEACOCK: No, that’s in the—

Q: That’s maternal?

PEACOCK: It’s in the same center, the National Center on Birth Defects and Developmental Disabilities, but it’s in the Division of Birth Defects and Infant Disorders, so it’s just a different division, and the split is really related to what we talked about at the beginning. There’s a division focused on congenital and birth defects and then there’s a division that’s more developmental disabilities.

Q: Okay, great, well, that makes more sense now, thank you. All right, so let’s bring us up to COVID, and what were—how did you first hear about COVID? I put Amanda [Cohn] down because I’m not quite sure who Amanda was. We talked about this—

PEACOCK: Yes, yes, yes—so Amanda Cohn was the chief medical officer in NCIRD, National Center on Immunization and Respiratory Diseases. My center director, Coleen Boyle retired, and Amanda Cohn was asked to come be the acting center director while they did a search for a new director. Amanda happened to also be one of the few people that was involved in the very early work that was done, even before the Emergency Operation Center was activated for COVID. So working with the reports that were coming out of China and things like that. She is a very well known—a well-respected person at CDC who had been involved in that. She came over to the center and I said, "I haven’t done emergency work for so long, I really—" they opened the Emergency Operations Center for COVID, and I said, "I really want to go help," and she’s like, "I know exactly." She said, "What are you going to do?" and I said, "It doesn’t matter, just where would I be helpful, you know what skill set that I have." At the time, the thing that they really needed help with was this patient under investigation call center, and so it was a call center that was set up that was running twenty-four hours a day, staffed by clinicians. Almost all the clinicians were [US Public Health Service] Commissioned Corps officers, and I’m not, but I still am a licensed physician.

We were answering calls from health departments and from emergency room doctors about whether—when they were seeing a patient, whether what type of—like should that patient be tested for COVID or should they not? I remember we had line listings on the whiteboards. I remember the number forty-six, so that was the forty-sixth person that was identified as possibly having COVID in the US. That just gives you an idea of how early on that was, you know?

Q: Yes, forty-six, wow. What were the questions coming in? Were they like, well how do I gown up, how do I treat them, how do I—how infectious is this?

PEACOCK: It was more symptoms, and so it would be a quick medical history, "This person—" they were almost all travelers or related to a travel to—from China at that point because it was super early. And you know, "This person had this—" So it was about what contact that they had and then what symptoms they had. So I had a form that had been developed where I was checking off, running through a protocol, asking questions, and then my job was to determine whether I should suggest that this person get tested or not.

We were pretty conservative in the beginning. We weren’t—well very initially, I think you had to have a travel history in order to move you to testing and then that broadened a little bit because then we knew that people might have contacts that they didn’t know had traveled or something like that. It wasn’t a really neat system. We had a physician that—in the front of the room who was the person in charge, and so if we had a conversation with a health department or an emergency room doc [doctor] and didn’t know what we should do, we had lots of ability to ask other people. I didn’t do it long, I did it for a few weeks because I was still doing my division director job. What I was doing was coming over in the evening or overnight and doing shifts because that’s where it’s hard—I mean that’s why they needed help and then I was able to keep my other program running.

Q: When did you sleep?

PEACOCK: Well, not a lot, but that—that’s a common theme in my life so that’s—

Q: I see that, yeah. Was there a case definition at the time or was that the protocol kind of thing?

PEACOCK: I think that helped form probably the case definition because it was so—we were trying to collect information on what the—you know? So, there may have a case definition, but I think it was being refined quite a lot by this—the—the recording of symptoms.

Q: Yes, this is a very fascinating emerging infectious disease, we hadn’t—no idea really anything about, and so you probably were using some protocol from another respiratory infection protocol?

PEACOCK: Yes, yes, I think a lot of—I didn’t do that, although that I think a lot of what we were initially using was things that had maybe then developed with flu in mind like a flu pandemic.

Q: Okay, and so then you moved on to another thing for the COVID, which is Community Interventions At-Risk Task Force, which is in March?

PEACOCK: Yes, so I went—after I did—

Q: You went back to your division.

PEACOCK: Yes, because I never stopped doing the division stuff, but then Amanda again said it—you know— by that time, there were lots of people with infection and there were lots of people and—

Q: Also, we’re about to go into lockdown if you’re starting in March. March seventeenth is when we went into lockdown.

PEACOCK: Right, so just before then and it was clear that some—and I think there were probably lots of deaths too, and so, and the people that were dying were older adults and people with chronic conditions. And interestingly because our, I think, last big response, which had been H1N1, which was a lot of children and pregnant women that were affected, you know, the very initial thought was maybe, that they would be the populations that needed a lot of focus on. But it was kind of clear when I came in that we maybe weren’t doing enough work thinking about the implications of this affecting older adults, the potential of shutting down, which is what ended up happening. Shutting down nursing homes to the outside and what does that mean when you have people living in nursing homes, they may have some cognitive disability, cognitive decline, and suddenly, you know they have no visitors. Issues like that. Or you have rheumatoid arthritis and so you’re on immunosuppressants, and that might put you at even greater risk for complications from COVID. And so that’s the type of work that I was asked to do was think about those that were at highest risk for complications and what interventions those should be.

And so a lot of that was education. I was doing a lot of webinars, talking to professional groups, and over time, over those next couple of months, we really expanded, and so we had people focused on prison populations or people experiencing homelessness or rural populations, different things like that. And then about halfway through my time on the task force, there were a couple of things that happened. There was a merger of the At-Risk Task Force, which was what I was leading, and the Community Interventions Task Force, and we became the CICP, so the Community Intervention Critical Populations Task Force. It was the idea of combining the places where people were getting lots of COVID, or that had special issues like schools or—

Q: Nursing homes.

PEACOCK: Yes, different things like that with the people who were at higher risk so that there could be a blending of that work, and so that happened while I was—had been leading the At-Risk Task Force.

Q: Okay, kind of a different population than you’re used to.

PEACOCK: Right, yeah, completely different because we actually didn’t—there eventually, there were, there was more focus on children, especially with MIS-C [multisystem inflammatory syndrome in children], which is—you’re going to want me to know what that abbreviation stands for —multi—I don’t know—MIS-C. It was the complication that we saw more in children from COVID. But early on, we really weren’t seeing children being—they were not the focus, right, they were not the population that was most affected. But again, I think throughout my career you apply those basic public health tenets or whatever and you just apply it to a different population. We were still doing the same types of things, educating people, making sure that you have the right stakeholders in the room when you’re discussing particular issues, and so yeah, it was different though because it was in children.

Q: I think it was harder for a lot of older populations to understand how to even get a vaccine because a lot of the stuff was done online and through that type of environment, which—I’m just speaking for my own parents—they could not navigate.

PEACOCK: Yes, yes, and we weren’t even—at that point, we weren’t even thinking about a vaccine. I guess we knew it was coming but it—

Q: But not so fast?

PEACOCK: Right, right.

Q: But we’ll get to that later, and then you went on to become a team lead at the Navajo Nation, which is—? Tell me how you got involved in that.

PEACOCK: Yes, so I was still leading the Community Interventions At-Risk Task Force. I was one of the co-leads, but there was this identified need that—I mean another population that were having disproportionate deaths and hospitalizations were American Indian populations. I think because of the work I had already been doing in the At-Risk Task Force, they—I was asked—there had been almost like a team that went out to Navajo and to—did a needs assessment to see what was going on. Then there was a determination while they were out there and a request from Navajo Nation that there—they needed help. They needed help to think about contact tracing and mitigation strategies and all of those kinds of things.

So, I was asked to lead a team, and I think we were a pretty big team, the first team that went out. I feel like it was somewhere around ten to fifteen people. And we ended up splitting into two different groups, so one—three different groups actually. One group went to a part of Navajo Nation. So, Navajo Nation is really large, I don’t know how big, but very large and then also is the largest—I think the largest American Indian population, so there’s about two hundred thousand people in Navajo, not all on the reservation but part of the Navajo Nation.

So, we sent a team down to one of the—I think it was called—Kayenta, where there very, very high numbers of deaths and lots of disease that was happening. One team went down there and looked at their contact—setting up and helping them with their contact tracing because they were something like fifteen hundred cases behind in investigating. Obviously, you’re trying to investigate, but the days are getting longer, and so eventually, that contact has—

Q: Moved on.

PEACOCK: Yes, it was done and then there’s been this huge spread and blending. There were a group of epis [epidemiologists] and other people that went out and did that and so that was one team. I stayed in Window Rock [Arizona], which is where their headquarters is, it’s the capital. They had an emergency operations center, and so I was sort of, more in—working with the leadership of Navajo thinking about different things, thinking about how we could help people that had COVID stay in their homes so that they didn’t have to leave their home to go get water where—and then they would infect someone. Because a lot of houses don’t have running water, and so they would go once a week and pick up water and then other people could get infected, you could spread COVID. You know we worked with—I think FEMA [Federal Emergency Management Agency] was there as well. We worked with groups to have more trucks that had water that you could go fill up that were closer to home, or there were care kits that were actually delivered to the homes. One of the things and—that they were working on as I was leaving was also having clothes washing—portable clothes washing places basically, so that you didn’t have to go to the laundromat. Because again, the way that COVID was being spread was when people congregated, and if you don’t have water—you have to have water and so that we were trying think of ways to make sure the water came to people as opposed to people going and spreading COVID.

Q: Who were some of the—besides FEMA—that were there, do you remember anybody else? Was IHS [Indian Health Service] involved in this?

PEACOCK: Yes, and so IHS, Indian Health Service, was very involved because they do a lot of the clinical run—do the clinical work. At Navajo, they were part of the emergency operations senior team, so they were represented within that, along with the Navajo public heath folks that were there, so it was kind of a collaborative.

Q: Is there some type of or is there some sort of diplomacy that you need to have when you’re working with a sovereign nation like Navajo Nation?

PEACOCK: Yes, and when we came—when we first arrived, actually, they did a very nice job of introducing us to Navajo before we even set foot in the EOC or before—we got an orientation from the tribal leaders. Just like actually when we go to the states but particularly when we went to Navajo, I remember there we are advisors, and not to tell people what to do. I think that was really important to establish early that we’re there. One of the things I needed to do as the team lead was say, "We may think something should happen a certain way, but we’re here—we’re invited here to help with certain things and provide advice, we’re not the decision makers." I think that’s hard, we—we’re used to being decision makers and so when you go out to a tribal nation, you have to—the most important thing is you can—you need to listen and figure out where—we have the privilege at CDC of having immense amounts of resources, right, and so we can help guide whoever we’re going to support on how to they may access some of those resources, but it’s not our job to tell them how to run the EOC in Navajo.

Q: Yes, but there are sometimes a lot of trust issues when sent down in another—when the federal government is sent down into a tribal nation. Just based on history and what’s gone in the past, there’s not a lot of trust, so—

PEACOCK: They were pretty welcoming, I think they needed help, a lot of people were dying. But I do remember having a conversation with some other federal agencies that were there, and we were making the case as the public health people, so we were from CDC. We actually had a group of people that were from the—I don’t know what the name is, but the people who work on clean water at CDC, so they were there as well. We were having a conversation with another agency, and we said, "It’s really—we need to work on solutions for clean water," and the response back was, "Well, they haven’t had running water before so that’s not part of this emergency." We said, "Well, but it is because this is a respiratory emergency and it’s being spread—and airborne and therefore—and people have to have access to clean water, so they can wash their hands." And also, the whole issue I was talking to you about earlier that people are leaving their homes and having to go get bottles of water. So I think there was not always understanding by everyone that was out supporting tribal nations about what our role was, which is to follow their lead but bring our resources and expertise to bear.

Q: I know there was a project to get more water point stations created.

PEACOCK: Yes.

Q: I think the clean water people at CDC really took that upon themselves, yes.

PEACOCK: Right, right and so they—I was—and I didn’t—I’d never—that’s one of the fun things about working in emergency response is you meet all these people across the agency that—

Q: You never would have.

PEACOCK: —you’d never worked with, you know?

Q: Exactly, what was the cause of most of the outbreaks and deaths in Navajo Nation, was it proximity?

PEACOCK: I think that’s what the spread was, so, because people live in fairly close quarters, I think once someone had COVID, it spread quite quickly.

Q: Where did it come in, did it come in from—?

PEACOCK: I don’t know, I mean it would have come in from outside, but I don’t know. My memory is that it came in—they think their case zero was in Kayenta where—I was talking about, which is super remote, I mean like our cellphones didn’t work while we were down there, we needed satellite phones, the internet was kind of patchy. I think that that’s where their first—someone who lived on the reservation but had been somewhere else and came home and had COVID I think.

Q: Okay, then you went on to be a team lead at White Mountain Apache Nation—

PEACOCK: Yeah, so—

Q: —like just a couple of months.

PEACOCK: I know, it was—so at the end of May, I was done with my Community Interventions At-Risk Task Force work, which included the Navajo experience. And so, I went back, and I really was intending to be—all summer to be in—doing my regular job, which was being the Division Director of Human Development and Disability and then got a call, a fairly quick call, and they said, "We have some issues in another tribal nation and because of the work you did in Navajo, we’d like you to come back." It was really diplomacy, right? They really wanted someone to come and sort out how we could be supportive.

What I was told before I went out there was there’s lots of disease, there’s lots of hospitalizations, deaths, and it’s different than the rest of Arizona. We’re really worried about the population and then we’re also really worried about spread. When I got there, I actually was really, I don’t know, pleasantly surprised. It was a really well-working machine, so that the Indian Health Service at Whiteriver—so the main town is Whiteriver. White Mountain Apache is way smaller, it’s about sixteen thousand that were in the tribe, and so Indian Health Service had this hospital at Whiteriver. They worked very collaboratively with the tribe, and there was a lot of collaboration back and forth, and I think there is general, I think there’s a good working relationship.

One of the really unique things that they were doing, collaboratively, was when someone who was considered a high-risk person for COVID complications, like they had a chronic medical illness or they were older or something like that, they—and they got COVID, they were visited or called every day. So about every other day, you either got a phone call or you got a home visit by someone on the team, and there was also a representative of the tribe on the team. So, there would be a healthcare provider, usually either a nurse or a physician—with a tribal member that’s probably in a role of like a case worker or a social worker, something like that. When they went out to the home, the things that they were doing is—so if you were in this kind of home visiting program, they sent you with a—home with a pulse oximeter, so that you can monitor your oxygen saturation in your blood, and there were instructions to call if it went below a certain amount. But then when they went out every day, or they talked to you on the phone, they also could take a reading of that. They took oxygen with them, and so if you were at a certain level, you got oxygen there, and they tested anybody else who had symptoms in the house. And if they identified someone else who was positive, then they put them on the list, and they had them there. They avoided— they really kept lots of people out of the hospital and I think had—if you look at their death rates and their hospitalization rates compared to the number of people that they have that have high-risk conditions, they really were much lower than in other parts of the country—because of this intensive case management. They wrote it up, it was published in the New York Times and in the New England Journal [of Medicine], and I think it worked because of this relationship with the tribe and the IHS just working so well together. That actually was underway and happening when I got there, so clearly, I don’t know, I—they didn’t really need help with that.

What we ended up doing a lot while we were out there—and we were out there for a couple of weeks—was helping them think through school plans, like how they were going do schooling in the fall and reopening of different activities. They had essentially shut down the whole thing, and you couldn’t go hunting and fishing, you couldn’t—you weren’t in school, you—they had very strict rules about when you could go to the grocery store, and who could go to the grocery store and so really people were in a total lockdown. I worked a lot with them on thinking as what would be the triggers to reopening and then what would be the parameters to close again and then what mitigation did you have to have in place, say, if you reopened a school. So that’s what we did quite a lot of while we were out there.

Q: Is testing a big part of that too?

PEACOCK: Yes.

Q: Yeah, so testing had become more—now, you didn’t have to go anywhere to get tested or you—

PEACOCK: It was pretty—yes it was pretty prevalent. They could test people like when they went out to homes, you could test in the hospital, and then there were mass testing sites too that we helped run, and those were happening pretty frequently. They were getting help from the National Guard to do that—at least with that population, it seemed fairly accepted. I know that in some places having people in uniforms was not something that people—that wasn’t real comfortable for people, but in this particular case, the—when I went to some—we helped with some mass testing sites, and there didn’t seem to be any issues related to that. One of the things that they did do when we did this testing is you—there’s often some kind of reward or incentive that you got and so they gave out actually lots of fresh vegetables, like groceries. So, you get tested and then you get a big bag of potatoes or broccoli or whatever that was, and then they also, if you got diagnosed with—the other thing with—in this intensive case management that they were doing is you would get food and other supplies delivered to your house. The idea was you cocooned in place essentially, and it’s really remarkable. In fact, so remarkable, I formed a really amazing relationship with them, and I’m going back in June to do autism diagnosis for about thirty of their patients that can’t get services right now. I’m going to go out there and help them work through that.

Q: Relationship building.

PEACOCK: Yes.

Q: Great, okay, I know testing is something that we are so familiar with right now, but why at that time was testing so important?

PEACOCK: Well, testing could help avoid—decrease spread. If you knew someone was positive, then you could isolate—they could isolate. One of the other things—and I didn’t remember that, but the other thing that I helped with while we were there is thinking about places people could go. Because you lived in these very close quarters, some people didn’t have anywhere to go stay and so—

Q: If they were positive?

PEACOCK: —if they were positive, but they weren’t sick necessarily. They took the casino because the casino wasn’t open because of COVID, it was part of the lockdown. All of the hotel rooms that they had, they converted to these places that people could stay while, they were positive. They had food, and they also had some access to care, so they could—I think they checked the pulse ox [oximeter] every day, and if someone were to get sick, then they also could help transition them to a hospital or whatever might need to happen. That wasn’t for a huge number, but they did convert these different places. The casino is one place, they had some other—I don’t remember what the settings were, but they had other places where people could go stay if they didn’t have anywhere to stay and were able to isolate.

Q: Let me just describe, the pulse oximeter is that little device that you stick on the end of your finger like a little clamp-type thing, and it measures how much oxygen is in your body?

PEACOCK: Right, right, yes.

Q: All right, ah, where would people go if they did come down with COVID?

PEACOCK: In White Mountain Apache?

Q: Yes.

PEACOCK: They went to the hospital.

Q: There’s a—they had that—

PEACOCK: Yes, they had—at Whiteriver, yes, yes.

Q: Okay.

PEACOCK: There’s also some satellites—satellite clinics, so they would either go to their outpatient clinic or they’d go the hospital.

Q: Okay, all right, so then you go back to your division again, do your job, and then you’re tapped for another duty? This is totally different than what you have been working on before, and this is Operation Warp Speed.

PEACOCK: Yes.

Q: Which is?

PEACOCK: Yes, so interestingly, there was—and I forgot to tell you when we met before between that and what got me closer to working with the Operation Warp Speed and the Vaccine Task Force [VTF] was that there—now we knew there was a vaccine coming, right? And that was a super exciting thing because it was going to change our whole prevention strategy because we would have a vaccine. There was this intensive planning that was starting to happen for all different kinds of people. The tribal support unit was focused on how they were going to work with Indian Health Service and tribal nations to deploy vaccine and get vaccine to those populations. In about October of 2020, they asked me to come in as a special advisor to help—as a liaison between the leadership in the—at CDC and other places and represent what the needs of the—that we were finding out from the tribal nations. I came to do that, and that was all around planning for the soon—the vaccines were coming soon and so I was doing that. I was only doing it about part time because I really, really felt like I needed to do my job, my division director job. I felt bad, I had been gone for—I’ve been gone for a year almost with these little things and I had—I felt bad for all the people that were doing the job that I was—

Q: Were you still doing—

PEACOCK: —supposed to do.

Q: —clinic work?

PEACOCK: No, because the—wait, I did a few telemedicine visits.

Q: I was going to say did you revert to telemedicine, and how did that feel as a clinician, but we’ll get to that in a minute.

PEACOCK: Yes, yes, so I wasn’t really doing clinic, just very, very little bit of clinical work. One of the clinics I had been working in shut down completely. I had been working at the Dekalb County Refugee Clinic working with kids with disability. No refugees were coming in so—and I mean that clinic completely shut down and actually has not reopened in the same way. My other developmental clinic, we just—we didn’t take any new patients unless I—we did a little bit of follow-up by telemedicine.

Q: Yes, how was that to work through telemedicine I mean?

PEACOCK: Telemedicine is okay I think if it’s a follow-up and you thought of—you—connection with the family. We tried it a couple of times, doing a developmental diagnosis kind of clinic that usually takes an hour, an hour and a half with a patient, we just couldn’t do it. Because you can’t really see and do things with the child, and you can do that history part, but we did the best we could, but it wasn’t ideal.

Q: Okay, yes, I always wondered about telemedicine, and well, do you think that will continue?

PEACOCK: I think there’s a huge role. I mean for follow-up when you have a child with a disability that’s either—maybe has anxiety about going to the doctor or they actually are in a wheelchair or they have—it’s hard to get there, having an option to do a telemedicine visit I think is great. I don’t think it can replace having in-person visits too.

Q: Yes, okay, all right, so the vaccine is coming?

PEACOCK: Yes.

Q: Who were the partners that you were working with during this period of time?

PEACOCK: When I was the deputy for the Vaccine Task Force? Well, I guess we had two sets of main partners. We were working collaboratively with Operation Warp Speed, which was the [United States] Department of Defense [DOD] folks. They were really talented logisticians who—many of the people that we worked with were in their other jobs. They’ve been hospital administrators, or they’ve been lead nurses in the army or they’d been—or they had actually worked really with supply chain and logistics, so getting things places. Most of them had worked in the medical field in some way and then we had a complementary group. They were divided into regions, so you had a DOD or an Operation Warp Speed lead for each of the Health and Human Services [HHS] regions. We had complementary public health CDC people who were regional leads as well. Many of those people—we had some people from the Immunization Services Division, which is where I am now, and then we had a lot of people from the Global Immunization Division, because they couldn’t—they were doing their global work, but they knew a lot about vaccine implementation. We had this—these complementary groups of people that worked in teams to—and then I said we had lots of partners. Our other partner, of course, was—were the jurisdictions, so the state health departments and then federal entities. The federal entities, an example is Indian Health Service or Department of State or the VA, Veterans Administration.

Q: Was FEMA involved?

PEACOCK: Not so much in this. FEMA was very involved in running mass clinics once we had that, but they weren’t as involved—

Q: It wasn’t the vaccine part. What about EPA [United States Environmental Protection Agency] or—?

PEACOCK: No, I don’t think so. FEMA was involved in vaccine delivery in some places, like I remember Puerto Rico had a lot of—actually that was National Guard. I don’t know, I don’t know that FEMA had a large role but—or it wasn’t something I interacted with. They may have had a role, but it wasn’t—

Q: And the FDA [United States Food and Drug Administration] wasn’t there?

PEACOCK: Yes, not in implementation. My part of the Vaccine Task Force was thinking about how to implement the program, so distribution and then administration. The other things that Vaccine Task Force was doing at this time because we didn’t have any vaccine was preparing for looking at safety and effectiveness and then, of course, all of the authorizations. There were lots of people that were—the people working with ACIP, the Advisory Committee on Immunization Practices, which is CDC’s advisory committee on vaccines along with the FDA advisory committee and the FDA staff people. I didn’t do that work, but that work informed what we did. When the first vaccine—the authorization happened in the middle of December, we worked with our partners in Operation Warp Speed so that there had been—General [Gustave F.] Perna was the lead of Operation Warp Speed, and there was a decision made that within twenty-four hours of authorization, they wanted to have vaccine in the field, in place. What has to happen for authorization is FDA has to authorize it, ACIP [Advisory Committee on Immunization Practices] at CDC has to meet and make recommendations, and then of course you have to have the shipments happening, or getting ready to happen. You’re not allowed to let anything out of the warehouse, so we had—vaccine was coming in two different ways. Pfizer [Inc.] direct shipped from their factories, Moderna [Inc.] came out of our distribution depots that we usually use for the Vaccines for Children [VFC] program. The framework for delivering vaccine was built on our routine vaccination framework that we use routinely to get vaccine out to fifty percent of children in the US for routine vaccinations.

So, we were preparing, as we knew all of the authorization and recommendation was happening, we were preparing to get vaccine out, and we had spent November—the month of November working with states on readiness. Are you ready, do you have plans for when this vaccine shows up, we think we have an idea of how much you’re going to get because we weren’t going to have a lot to begin with, but then we were going to have more. How are you going to reach the priority populations, do you have enough COVID providers enrolled so that you can get that out? We actually did some ranking of readiness related to the jurisdictions so that we could give more intense help to places that we didn’t necessarily think were ready to receive vaccine and start getting it out to everyone, to all the providers. In some cases, we actually sent like a project officer—we sent someone out to help—to kind of embed it on a deployment in a health department to help them with getting ready for some of these things because there were lots of logistics that were involved. You had to have very cold freezers, you had to have—you just had to do a lot of planning. You had to know if you’re going to vaccinate a thousand people in a day, how are you going to do that and how are you going to keep people from spreading COVID while they’re there. That was a huge logistical effort, and I think the fact that we had people from totally different perspectives working on it, I think that—part of what contributed to the success. We did end up having vaccine in all of the jurisdictions maybe, with an exception of like some of the very distant island territories because it just takes a long time to get there, we had it in twenty-four hours. I mean there was vaccine distributed—which is amazing.

Q: Was it flown, was it trucked, was it—how did it—how many distribution centers are there?

PEACOCK: —like—actually I should know that. That’s why you need to talk to Jeanne Santoli. There are a couple of distribution centers, and I think it was done through a combination of planes in some cases, but I think mostly driving. I think it was mostly—

Q: Trucks—

PEACOCK: —trucks.

Q: —and trains?

PEACOCK: I don’t think trains. I mean mostly trucks, but actually I don’t remember, yes, that would be a good Jeanne question.

Q: Okay, I will ask her. Is there an individual or a partner that comes to mind that—when you think about that time that really stands out to you?

PEACOCK: I think there are a few. Nancy Messonnier was the head of the—I don’t think she was the lead of the Vaccine Task Force. She was even above that, and she was incredibly passionate about making sure that states were prepared to implement this vaccine program. And I think she really—she tracked all the details, and she was incredibly passionate about the role of CDC in this whole operation. And I think really wanted to make sure people understood that there was—yes, we needed to get vaccine to places. But then the public health work started, which was figuring out how to administer all the vaccine, reach all the special populations, reach people in senior living centers, and people who were experiencing homelessness, and people that were home bound, and all of those different things. She’s someone that stands out.

What was amazing during that time was just working—I had never worked in the vaccine space, so I was working with all these people who typically, in their day jobs, either are doing global immunization work or they’re administrating the Vaccines for Children program. Essentially what we were doing was building on the foundation of that really successful health equity program, the reason Vaccines for Children was put into place almost thirty years ago was because there was a realization that not all children had access to vaccine. This program built on all of that knowledge of it and expertise. It was amazing.

Q: Yes, yes, it was amazing, CDC’s been working on health equity long before it became something we talk about all the time now.

PEACOCK: Yes.

Q: All right, can you explain, and I know—well, I don’t know. Vaccine came out very quickly, I mean we’re talking December 2020 when it started to be—

PEACOCK: Yes.

Q: That’s a very short time when usually it takes about two years. Can you explain why?

PEACOCK: Again, I wasn’t totally involved in that so that I’m sharing what understand—my impression of what happened. Essentially, the US government invested in I think eight different vaccines, so eight different potential vaccines, and said, "We are going to—you know." Normally what you would do is a company would make a candidate vaccine, and they’d take it through the clinical trials, and then if it looked like it was good, it would go to the FDA. The FDA would approve it or might do an emergency use authorization and then it would be released. We didn’t have time for that, so I think at NIH, National Institutes of Health, they looked at all the—they identified a number of candidate vaccines and said, "Okay, we’re going to invest in all of these. We know they’re not all going to make it to market, but we can’t wait, and we’re going to start clinical trials right away. We’re going to use all the safety and efficacy strategies and framework that we always use, but we’re going to invest a huge amount of resources so that we can get to the outcome faster." Meaning if you have more funding, more resources, you can enroll more people in a clinical trial at the same time, right, you don’t have to—that’s how we got vaccines faster was because of the huge investment. And just saying we know that some of this investment is going to result in a vaccine that isn’t going to come to market, but we have to do that because we don’t know which one is going to make it.

Q: After your time on the vaccine, what were you doing then?

PEACOCK: I went back to my job, I said, "I have to go back to my job." I am division director. Probably because I ended at the end of December, and I probably took a few days off and then I went back in January, and about two weeks after I was there, I got an email from Anne Schuchat. She said, "I’m sure you don’t have time to do this because everyone’s really busy, but you’ve been asked by the health commissioner in the state of Georgia to come over them and help them with their vaccine program." I said, "Well, I mean there’s lot of people that can go do that, and I’m supposed to do my job," and they said, "Well—they—I think all your work that you’ve done with at-risk populations is what is needed in Georgia.” There’s—and I think it’s in our backyard right? A lot of times I think that we—backyard of CDC. I talked to Kathleen [E.] Toomey, Dr. Toomey, the health commissioner, and she said, “What we need is we need a chief medical officer to come over and really help us roll out our vaccine program to a high-risk population." I think throughout my whole career, like I don’t know, if you get an opportunity, you should take it, so I did. I said, "Well, I can come for nine—" We negotiated that I would come for ninety days. My boss Karen Remley, who’s the center director, she had become the permanent center director, was supportive and said, "Yes, if this is where you’re needed, then you should go."

It was an amazing experience because what I was able to do was sort of—having been on the planning for distribution side of things and also had the at-risk experience before I got there on the mitigation and testing side, now we were trying to figure out how to vaccine high-risk populations. We implemented programs for seniors in senior living centers. We figured out how to get vaccines to sailors that were coming into the port down in Savannah [Georgia]. They were only on there for eight hours and they would leave—so we had worked with the local health departments so that they could be vaccinated.

We did a lot of this with the organization called CORE [Community Organized Relief Effort], which was a philanthropic organization or a public health organization that the State of Georgia contracted with so that we could do these really community-level vaccination events, so they would hire people in the community. Another example is they did vaccinations of migrant farmers before the shift started at four in the morning on the farms or in the carpet industry in the carpet companies. We even did vaccinations at breweries and restaurants and for the clientele, but also for the workers that were in—offered it. I remember looking one week, and we had about 150 of these community events happening all across the state of Georgia to try to increase vaccination because vaccination wasn’t necessarily very popular in a lot of parts of Georgia.

Q: I was going to ask that.

PEACOCK: But I think through some of these efforts, we—when I got there, I think Georgia was ranked forty-ninth in its vaccinations and by the end—I ended up staying five months not three—but we were forty-third. Compared to people who were first or second or whatever, maybe we weren’t there, but we definitely, I think did things to provide access to vaccine that allowed us to vaccinate more people than you would have predicted had we not done it.

Q: So, you made a bigger impact?

PEACOCK: I think so.

Q: I think including the local community always helps a program like that because nobody wants to just trust the federal government—air quotes around that—they want to trust their neighbor you know?

PEACOCK: Right, right, and then for some people, the mass vaccination clinic was the best thing, right? It was run by the National Guard, and you could—you didn’t even have to get out of your car. You could drive through, and they gave you—and then other places, no one came to the mass clinics and then—and that you—worked with churches and did it in a church, or you did it in you know a doctor’s office or whatever. What was fun about that deployment was that I’d never really done public health like that—that was at the individual level, right? Where you’re actually—I was going out to some of these events, and I didn’t do any vaccinating, but observing and things like that. Really at CDC, what we do is more direct and provide money and resources and people, but we’re not in it and so that was fun too. And to see—I mean I live in a part of Georgia that is very different that most of Georgia as far as very urban, and maybe there’s a lot of access to a lot of things. We have a lot of things in our community, and not everyone has that lifestyle and those resources.

Q: Yes, when did you get your vaccine? I’m assuming you’re vaccinated.

PEACOCK: I am vaccinated, yes, I’ve had—I don’t know, I’ve had all the ones we were supposed to have. I got vaccinated in January so because—

Q: Oh really?

PEACOCK: —yes, because I was a healthcare provider and I was also doing some deployments, I think I was sort of in that list, and so. My sister is an emergency room doctor here in town and my other sister is a chaplain and so they had gotten their vaccines in December and then I got mine early January.

Q: Yes, how’d you feel when you got your vaccine?

PEACOCK: Yes, so I was a little tearful. Like it was—you know, I mean it was—and I think from the few perspectives, like thinking about all the work that we had done to get there, and then to see it working. I went to the Dekalb County and got my first vaccine in a drive-through and then I think my second one, I got at CDC. But just to see all that working was amazing, right? That we had something that was going to be, life changing—and I think it has been life changing. I think there have been millions of lives saved because of the program.

Q: Yes, how do you feel about the people who didn’t want to take the vaccine?

PEACOCK: You know I think—I do think it’s a choice. Sometimes what I worry about or what I—what does concern me, is I think sometimes people make the choice based on bad information, and that’s not fair to them. Ultimately, I don’t think you should necessarily tell people that they need to be vaccinated, but the exception might be—I do think there’s maybe an obligation of healthcare providers to be vaccinated if you work in a hospital. I think it’s reasonable to require people to get vaccinated when you can expose people that are really, really vulnerable. But other than that, I do think it’s a choice, but I hope people can make that choice with lots of information and good information, and I don’t know that that’s always happened. I think there’s sometimes active attempts to mislead people and that I don’t—it’s not—it’s really unfortunate, because vaccines really are a cornerstone to public health, it’s—

Q: Well now that we’re on that subject of information, I know CDC had a high profile during the pandemic and for—some people would use that against us and use that for us, but what are your thoughts on how CDC was perceived during that period of time? When you were deployed, people really seem to enjoy your presence, but not everybody did in other places.

PEACOCK: I think on the very individual level, I had never—I didn’t experience, except maybe one time someone’s saying, "Gosh, you’re from CDC, you all are doing a bad job." But you definitely saw it in the media, you definitely saw it on a broad level. But the information was confusing, and whether we could’ve made it less confusing, I don’t know. I know there were lots of people that were working really hard to put out information, change information when the information needed to change, and that in and of itself is confusing, right? We still don’t know everything about this disease. We read in the newspapers even now, or not newspapers, but on the internet that we see all of these, the higher incidence of heart attacks, and it’s probably related to something to do with the vaccine—sorry, but with the—

Q: Virus.

PEACOCK: —virus. We also do see it related to vaccine, but I think that’s misinformation or disinformation but—so we’re still learning about COVID.

Q: Right, it’s a new and emerging virus. It almost reminds me of when people were talking about AIDS [acquired immunodeficiency syndrome] early on and how misinformation was crazy then too, and the stigmatism that went with all of that as well.

PEACOCK: Yes.

Q: It’s just learning to know how much information you need to put out and how many times you need to change that information. Maybe we over shared sometimes, but had we not shared—

PEACOCK: Then people wouldn’t have had that information. Yes, so I don’t know. I’m sure there are things we could’ve done better, but I think the intention of people at CDC was to get information out to people. People worked really hard to make sure people had what they needed, whether or not that’s what resulted or what they heard.

Q: How did you respond do that person who said CDC is not doing a good job?

PEACOCK: That particular case, and I think what it highlighted to me was how complicated all of our positions and all of our—what we do is, especially in the middle of the pandemic. This happened while I was visiting a rural county in South Georgia, and we wanted to talk to the farmers because we wanted to vaccinate the farmers, but also the migrant workers. And they did not want to talk to the federal government. They didn’t want to talk to CDC. The reason they didn’t want to talk to us, is because there had been a delay in the farmworker program that happens every year. So they work with this farmworker program where workers come from South and Central America to harvest the blueberries. They were late because they had been delayed or detained, outside of the US due to something related to COVID and quarantine and something like that. So really, they were, they weren’t mad—this particular case, they weren’t mad at CDC, they were mad at the government as a whole because we were potentially—we globally were potentially affecting the livelihood of the farms, the—you know. And the workers wanted to come, but the workers couldn’t come because of some of the rules that were in place, and they were eventually coming, but there was this delay. We wanted to talk to them about how to vaccinate the workers, and they just didn’t want to talk to us because—and I mean it was reasonable, right? It was—you know? We represented outsiders that were making a complicated life and a difficult life even more difficult because the pandemic, I do think, made life difficult for all of us, many of us, yes.

Q: Well on so many levels, I mean you have the economic, you have the health equity, you have the isolation, you have the exposure of frontline workers, not even frontline workers who we’re thinking would be doctors and nurses and clinicians. But you had the grocery store workers, you had the people who were doing your garbage, things you wouldn’t even think about and that were frontline workers.

PEACOCK: Right.

Q: Those were people that still had to go to their jobs; they couldn’t telework.

PEACOCK: Right.

Q: There’s that whole other economic part to that of the—is the shutdown and all of that happening and how many businesses have closed since the pandemic.

PEACOCK: Yes, yes.

Q: There’s just going to be a lot of that out there, but let’s go back, to your experience. Teleworking let’s get to teleworking because we just went off on a little bit. Was it hard for you to telework? We all were shut down and told to go back home for a couple of weeks in March of 2020, just do a couple of weeks, we’ll be back, don’t worry.

PEACOCK: Well, so I couldn’t necessarily do that right away because I was working on the At-Risk Task Force and so we were allowed to work in the EOC. We didn’t have to, eventually they did—there were much fewer people, but I worked all the way through that time on the At-Risk Task Force in the Emergency Operations Center. So I did telework on those few times that when I went back to the division, but for the majority of the time, I didn’t telework, but I think it was partly because I didn’t want to. I think that probably drove my interest in continuing to be deployed places really because I—it was hard to be at home. I had teenagers at home, that schooling was not easy. They were high schoolers, they didn’t want to get out of bed, they didn’t want to—you know? Also, I think teleworking especially, if you’re doing something, an intense job, you never ever stop working. So, you wake up in the morning, you look at your phone, you start seeing emails, you get on your computer. You might go take your computer downstairs while you’re getting something to eat or and then—and continue. I remember not finishing things till ten o’clock at night and so you just never stop working. So, for me, teleworking, what I learned is that I actually could do it. I didn’t ever know that I could, I always was not someone who wanted to telework, but I didn’t like it for me. I mean I saw that there were advantages to it for some people, but I didn’t like it, and I didn’t do it that much.

Q: Yes, what did you miss, what was the in-person thing that you enjoyed—

PEACOCK: I mean I enjoyed—I enjoyed the interaction with colleagues, and I think sometimes you can connect with people easier when you’re in-person. I found it really hard to be on Zoom meetings all the time. One of the things I started doing was while I was on the Zoom meetings, I started knitting washcloths. I called them my pandemic washcloths, and I could make like one or two washcloths a day because doing something with my hands allowed me to concentrate better.

Q: Okay.

PEACOCK: Actually, for me, going home at the end of the day and having that transitionary time even if it’s twenty or thirty minutes in the car and you’re listening to music or whatever that is, is really important. It changes my mindset and then I can—even if I start working again later at night, there’s a break, and I didn’t have that when I was teleworking.

Q: Yes, there’s a whole mental health issue that comes up when we talk about teleworking and the isolation of that for people who didn’t have families or who—people who have—were families that were just stacked on top of each other and couldn’t get away.

PEACOCK: Right, right, I mean that was hard too, right? Dogs and cats and husbands and children and all of that, it’s hard when you’re trying to do a job that’s pretty intense, and, yes, so that’s hard too.

Q: Yes. On the other hand, I’ve interviewed an EIS [Epidemic Intelligence Service] officer who used to bring his baby to all his Zoom meetings, a newborn, so just like—really nice.

PEACOCK: Yes, I mean it’s very different, right? Depending on what your other obligations in life were, there are some advantages to teleworking as well. The flexibility is important, and you mentioned isolation. I think one of the things that I worry about is all of our really junior staff and fellows that started in the pandemic that never really met anybody. I think that must be one of the hardest positions to be in is just starting out a job and not knowing—you only know the people you see all day, but you didn’t know anyone extraneous to that, right, that you might have met in a breakroom or might have—whatever.

Q: Yes, it is isolating and then sometimes—I mean it gives you the flexibility sure, but you need to have that inability to stop working because there’s no break, there’s no I got to get in the car and go pick and go home. I wanted to bring up a few things about—I know you talked about that you were never afraid of getting sick.

PEACOCK: No, I wasn’t afraid of getting sick. I was respectful, I feel like, of the disease and so I, I didn’t necessarily put myself in positions, I don’t think, where I was around a lot of people so that—I felt like if I was careful? And that I wore my mask when I was going into places where there was a lot of risk or if there was a lot of disease in the community at the time wearing a mask that I’d probably be okay. I remembered when my parents came to visit, we, often in our family, have dinners together on Sunday nights, and we stopped doing those because—mostly because of their—exposure to them and not wanting them to get sick. And then of course I had a sister who’s an emergency room doctor and another sister working in the hospital, so they were super high risk. And so we were careful. I would meet with them, but we might meet outside on the porch, or we might do something like that.

Q: Socialization was everybody was trying to do things through Zoom, and that was not satisfying—

PEACOCK: I tried that, that didn’t work. I have a book club that meets once a month of just women in the neighborhood, and we did one book club on Zoom, and then we just started doing them outside. We have like a really, really big circle, and I remember doing one. It was so cold—it was like thirty-six degrees and so we all brought—we sat in sleeping bags. But we still sat and had our book club because that was—it was so important to connect with people, and so. We wore masks and we were outside and so I think we were safe, and I don’t think I got—in fact interestingly, I don’t think I got COVID until a couple of months—like about a month I got COVID for the first time.

Q: Oh really? Okay, do you think you can pinpoint where you got it from?

PEACOCK: I think I got it on the airplane, yes.

Q: Okay, yes, yes, it’s hard to know now when to mask and when not to mask.

PEACOCK: Right.

Q: Yeah, so did you have any worry for the rest of your family, your kids before they were vaccinated?

PEACOCK: Not worry. It was definitely hard to control teenagers, and I think they were probably in situations where they had much chance—higher chances of exposure. I did make sure that they got vaccinated as soon as they could, and they actually embraced that because they saw it as like a ticket to freedom you know? The people I worried about I think were my parents, I mean my parents, but otherwise, maybe not. I didn’t want people to get it through either, I mean I—

Q: Did you know anybody who got it and didn’t recover?

PEACOCK: Not firsthand, no.

Q: Okay, good.

PEACOCK: Yes.

Q: Okay, so let’s go down to just a couple of reflective questions. We talked about how COVID interrupted all of our lives for a really long time there, how do you think it’s going to reverberate into future generations? I think back on when I read old historical documents from [the] 1918 [flu pandemic] and how people had lost a caregiver, a parent, a loved one, and how that reverberated down into their childhood and really formed their future. I’m thinking this is—our children have lost many milestones that they didn’t get to celebrate, things that they couldn’t do, and never can do again, and people who have lost parents, and the orphans that are now out there. I’m just wondering if you have any thoughts on that?

PEACOCK: One of the biggest things that I feel like is—I think that this affected many, many ages and many different populations. But I worry the most about our teenagers and young adults because I think of—just I mean there’s—there are so many mental health challenges that we’re hearing about. I think there was just a publication from CDC on anxiety in girls.

Q: And suicide.

PEACOCK: And actually, speaking of suicide, there were a number of suicides in our community, and it felt like there were more than usual, I mean I didn’t look at the data, but just like how is that going to—I don’t think we know how this collective sort of anxiety, depression, challenges at that pivotal time in your life affect you forever. I think we’re seeing it in our schools now, we’ve got children that—or in our colleges in different places. They didn’t do those things that you do, whether it’s as a senior in high school or a freshman in college. We had freshman in colleges that they did their whole freshman year maybe even from home or from a dorm room, or they didn’t get to play baseball on the varsity baseball team, or whatever that might be. I know in isolation, those seem like, oh well, maybe that’s—it’s just a life event, but it’s a collective life event through all of these children across the world, you know? I don’t know what that will do, but I think it will have a dramatic impact, I just don’t know what the impact is.

Q: Fair enough. What’s been the biggest professional or personal challenge for you during this time—during COVID, not this time?

PEACOCK: The challenge is how to navigate what we’re calling like this hybrid environment or telework environment or remote environment and thinking you know—I led a division before the pandemic and now I’m leading a different division. And a lot of those things that I did to bring people together before and have cross-collaboration and things, I can’t do in the same way now. I do think we have to think about how to work differently. We are different, right? There’s different expectations, there’s different—and people have very strong opinions about what that—how that should work. I think it’s a challenge because I don’t necessarily know what all those answers are, and I’d figured a lot of things before about how to move an organization on, and I’m not sure I know all of those now.

Q: It does feel different. I think I just want to stop right now and say is there anything else you want to say or cover that we haven’t covered during this period of time, you’re—?

PEACOCK: I don’t think so. It’s been it’s been a great opportunity to reflect of all the things that happened. I would never have thought that I would be the Director of the Immunization Services Division. And I think being given the opportunity to move the Domestic Immunization program into the future based on what we learned with COVID is an amazing opportunity.

Q: Thank you, that’s a wonderful stop there.

[END OF INTERVIEW]