Dr. Andrea McCollum

Dr. Andrea M. McCollum

Q: This is Sam Robson, here with Andrea McCollum. Today's date is March 15th, 2016, and we're here in the audio recording studio at CDC's [Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. I'm interviewing Andrea as part of the Ebola [Response] Oral History Project and we'll be discussing a little bit of her life and career and especially digging into her response to the 2014 Ebola epidemic. Andrea, for the record, could you please state your full name and your current position with CDC?

MCCOLLUM: Andrea McCollum, staff epidemiologist, CDC.

Q: Thank you. Can you tell me where and when you were born?

MCCOLLUM: I was born in Charleston, South Carolina, in 1978.

Q: Where did you grow up?

MCCOLLUM: I was in Charleston for about four years and then my parents moved back to their hometown, which was Greenville, South Carolina, three hours upstate.

Q: Is that where--

MCCOLLUM: That's where I grew up and that's where I went to school, high school, 00:01:00and then left after there to go to college at the University of Georgia, where I received a bachelor's in genetics and then I continued for my master's at UGA [University of Georgia] also in genetics. After that I joined a PhD program at Emory University in population biology, ecology and evolution, which is just a long way to say genetics [laughter]--another version of population genetics. And I was fortunate enough to actually do my dissertation research in the malaria labs [laboratories] at CDC. I officially started work at CDC as a grad [graduate] student in 2003. I was there until I graduated in 2007. And then in 2007, after I graduated, I took an ASM [American Society for Microbiology] post-doctoral fellowship in the Salmonella reference lab at CDC.

Q: I think we're going to go just a little bit slower, if that's okay?

MCCOLLUM: Sure, no problem. I can slow down. [laughter] Whatever you want to know about.

Q: Just tell me about you growing up in Greenville. Were you interested in genetics even then? How did your interest develop through high school?

MCCOLLUM: I was interested in sort of science. I've always loved animals, that's probably how it started when I was really little. I always loved animals and natural sciences and being outside. We just had a dog growing up. I always loved biology and I entered college thinking I wanted to be a veterinarian. I realized pretty quickly that that probably wasn't good for me and I also didn't have the grades to go to vet [veterinary] school, quite frankly. I had good grades, but you need even better grades to go to vet school. I thought about med [medical] school for a while and then I started working in the lab and I realized I really enjoyed science. So that's kind of how I took the path down--specifically 00:03:00genetics I really enjoyed. That's how I landed there. It was all somewhat targeted, yet random.

Q: Why specifically genetics?

MCCOLLUM: It was a major at UGA that's not a common major at most universities, or at least it wasn't back in the late nineties. They had a major in that. I enjoyed the classes--the lab that I was fortunate enough to work in was a genetics lab and so all the pieces kind of fell together in that manner.

Q: Was there something specifically within genetics that caught your interest?

MCCOLLUM: No. I mean, I really enjoyed population genetics, which is actually a study in the field of evolutionary biology and trying to understand relationships, either among individuals or among large [groups] of organisms. Also trying to understand relationships within populations at the gene level, 00:04:00but really it has large-scale influences in terms of--I mean, you can even think as large as the study of species and speciation or as small as the development and splinter off of population groups. Anything within that whole realm is covered by the term "population genetics" or "population biology," and I really enjoyed it. I was fortunate enough to have some really good mentors and people that took me under their wing. I really learned how to do good, basic science, which I think a lot of people don't have the opportunity to learn, at least that young. Not that I do the best science now, but I learned really good science.

Q: Can you tell me about some of the mentors?

MCCOLLUM: Yes. The lab that I worked with was Professor Wyatt [W.] Anderson. He was a well-known geneticist and a member of the National Academy of Sciences. He 00:05:00was a well-known member of the department, active teacher, and also dean of the College of Arts and Sciences at UGA, which was a huge college within the university. I worked in his lab, and then day-to-day I worked with a research scientist in his lab, Yong-Kyu Kim. Yong-Kyu brought us in as undergrads to do basic work and quote-unquote "grunt work," but we really learned what it takes to do science and how to follow through with method and collection of data and entering data and being good stewards of that entire process, and of course working with others in that type of environment. That was a Drosophila lab, so those are fruit flies. We did all kinds of work with Drosophila from rearing them to actually doing behavioral experiments, all the way to helping make the food for the flies to raise them. There are still certain smells--when I smell 00:06:00rotten bananas, I think of that lab. [laughter]

Q: Did the mentors kind of influence the direction of your studies, like what you ended up doing your dissertation on?

MCCOLLUM: A little bit. That was my undergrad and I didn't have to do a research project, and then I moved on to my master's with another lab in the department. John McDonald's lab, working on transposable elements, which were these little bits of genes or remnants of old viruses that actually move around in your genome. So right now you have genes, but then they're hopping around to different cells. You shouldn't worry. It's fine. It's a normal process, but they have a lot of implications with development or alteration of genes and you can even again, it extends to things like speciation and things like that. So I worked on that in John's lab with fruit flies and with C. [Caenorhabditis] 00:07:00elegans, which is a type of nematode that you can grow in the lab on plates, which was pretty cool. I learned a lot during that process. I also for the first time was a teacher's assistant in courses, which I really enjoyed, evolutionary biology courses. That was something I really, really enjoyed doing. I entered the master's program saying nope, this is it, just a master's. I don't want a PhD. I don't want an additional level of responsibility. I don't want to go to grad school that long. And sure enough, about a year and a half into it I thought, well, I actually kind of enjoy this. This is kind of fun, so I think I'll continue. But I made the decision to leave UGA because I felt like I'd been there long enough. I knew the people really well. I actually had a professor say to me, "Why are you leaving? You are in the best spot right now because people will let you do whatever you want. We're really supportive of you and what you want to do." I realized later what that actually meant. It meant you had the 00:08:00opportunity to really freely explore topics, which is not all that common in grad school.

But I decided I needed to leave and I needed to work in a different atmosphere and gain new experiences and things like that. I applied to a couple schools, interviewed at a few and chose Emory [University], primarily because of the association with CDC or that a lot of professors there seemed to be doing what I perceived to be much more applied research than where I came from. I came from UGA and I was working on very specific research topics that I didn't see to be enormously applied, which were really interesting. They are extremely important, and it's still some of my favorite things to read are the basic research. But to me it was more important to learn and be in an environment where there may be different applications to that, so that's why I chose Emory.

Q: Tell me broadly about arriving at Emory, about the new environment that you found there because you wanted to leave UGA. How that meshed with your expectations.

MCCOLLUM: I think it did. It met with what I was expecting and it was nice to work with a different group of people. And then I had the opportunity to do some sort of what they call "rotations." You do three or four in your first year of grad school with different labs to figure out where you might want to work. It's kind of a trial run for both the lab group and the professor and then the student. I did two at Emory and then one at CDC. None of those were a good fit and I reached out to my last lab option, which was a lab at CDC. We did a short trial run for three to four weeks and it was a great fit, so I stayed there. That was in Dr. Kumar's [Venkatachalam Udhayakumar] lab working with Kumar and 00:10:00Ananias Escalante who was a researcher there at the time. I loved it. It was a great group of people. It still to me, it's hard to top that lab in terms of the people and their support for you as a student and support for each other and the work they do. While I was there, Kumar and Ananias were pretty much my primary supervisors. Ananias left for a faculty position at Arizona State [University], but I stayed in Atlanta, at Emory, to do my work there, and then I would go out to Phoenix once every year or so.

Q: How were they especially supportive?

MCCOLLUM: They were just great with students. They were really good, patient, allowing you to learn, to ask questions. I think it's true of any environment where you have trainees and at some point you're always training, right? You're always learning and growing, so, it's important to have an environment of people who are willing to recognize your limitations--recognize what you're good at, 00:11:00recognize your limitations and where you want to be and try to help you meet that as long as it helps them, that group, meet their own goals as well. In the end, I think if you have a happy worker, you're going to get more out of them. To me it's a no-brainer. I try to carry that with me to this day, because now I'm supervising trainees, but I still feel like I'm still learning a ton. I try to keep that environment as best as I can and model it after some of my experiences that I've been through in those groups.

I worked on anti-malarial drug resistance. I had the opportunity towards the end of my PhD to actually visit Peru for a month to work at the Naval Medical Research Unit down there with some sort of what we call "tech transfer"--transfer of laboratory methods, and also helping crunch through a bunch of data down there, working with them trying to understand, again, this 00:12:00whole notion of population genetics and methods we can use to better understand. This was populations of parasites that cause malaria, for example. There, I had the opportunity to go out into the field as well just for like four days for a site visit along with the principal investigator. We went out into the Peruvian Amazon and actually visited clinics. It was the first time I really saw, okay, when someone comes in and they give blood and they're diagnosed and they're treated and then that blood is sent to Lima for further work, and kind of the work we were doing as well. It connected all those pieces, and you actually also get to see just the state or the conditions of the labs in the field, both the good and the bad and the state and conditions of the people who live out there and what their needs are. That whole period during my PhD when I was at the 00:13:00malaria lab, I was part of the branch and that branch was really great--malaria branch, having weekly meetings. I was working closely from time to time with epidemiologists on some of the projects where we had the samples and we were working in the lab. Even though kind of lab and epi [epidemiology] sometimes were very separate there, they really made great strides to come together at times. I learned a lot about CDC and sort of federal work and federal service within CDC and I also learned a lot about epidemiology. I was increasingly interested in it. Epi is just population biology and for me, that's what I was doing. I was just looking at it at the DNA [deoxyribonucleic acid] level and now I look at it at a different level, but to me, it's all very similar. All the 00:14:00concepts are very similar.

I also got to hear about this program called EIS [Epidemic Intelligence Service] training program and I became more and more interested. I didn't apply for EIS straight out of grad school. I decided to pursue what I call the traditional path for most lab scientists, which was to do a postdoc working on Salmonella in the Salmonella reference lab for about a year.

Q; And that was here at CDC?

MCCOLLUM: That was here at CDC as well. I continued to work there and I learned a lot there. I think about how the reference laboratories here at CDC worked with state laboratories, so that was really the first time I really saw a lot of interaction between the federal level and the state level. It was probably a year into that, that I decided I was going to go ahead and apply to EIS. By this 00:15:00time, I had a couple friends who had gone through EIS. I had someone who was just like me--he was a laboratory-based scientist. He actually was doing his postdoc in the same lab where I did my PhD, and then he went into EIS and so he was able to give me a lot of advice and suggestions. I applied to EIS and I was actually put on the waitlist the first year and I found out I was accepted into EIS one week before the EIS Conference. Which is the one week of the year that all the officers come together to present their work and all the new folks find their positions for the next year. Most people know about three or four months in advance. I knew one week, but that was okay. I was ready. I went for it. It was there that I--what they call "matched." I matched up with a position in poxviruses, which is part of the Poxvirus and Rabies Branch at CDC.

Q: How did you feel about that?

MCCOLLUM: Oh, I was excited. I was thrilled, it was my number one choice. I was excited about it. My second choice was the other group that was near and dear to my heart during that period of time and still is, Viral Special Pathogens. The group that works on Ebola and all other sorts of nasty viruses.

Q: So tell me about working with the poxviruses.

MCCOLLUM: It was great. Actually, we came out of training and my first project I was assigned to start helping think about surveillance for monkeypox, specifically in the Democratic Republic of the Congo. So I had that, I was working on it, and then I received an e-mail from the head of the rabies group, which was also within our branch. He said, "Our folks are really busy. We need 00:17:00another set of hands to help us out in Flagstaff, Arizona, for two weeks. Are you interested?" I said, "Yes, I love Flagstaff." He said, "Great, we'll meet later this week and we'll talk about what you're going to do." I said "Perfect." So we sit down in the meeting and I said, "What am I going to do at Flagstaff, Arizona?" And he's like, "You're going to trap, vaccinate and release skunks for two weeks." I was a little blindsided and I looked at him and I said, "Okay. Is someone going to teach me how to handle said skunks?" and he said, "Yes." They were having a problem with a rabies outbreak in skunks actually in the area and this was a unique outbreak because rabies is a series of viruses. Rabies is a disease caused by a series of viruses and one of those viruses was a bat-specific rabies virus. It had actually jumped out of bats into skunks, and they were seeing transmission within the skunks. It's not uncommon for bats to 00:18:00say, for example, bite a dog or bite a human and then that individual would contract the rabies disease. It's very uncommon for that to then be sustained within that sort of second species. That's what was occurring in Flagstaff. They were trying to understand biologically why the skunks were able to harbor and continue to transmit this virus, but what was more concerning is that these skunks were right in town interacting with humans. There's skunks all over Flagstaff, and I never had any clue before. One guy described a skunk following him. He had gone on a hike at a local mountain and the skunk followed him a mile down to his car. Not in sort of a rage pattern, but just walking in circles all the way down the mountain.

[interruption]

Q: So we were talking about investigating skunks with rabies in Flagstaff and a 00:19:00skunk had followed a man down a mile?

MCCOLLUM: A mile down the mountain, just kind of dumbfounded. Literally the skunk acting like--anyway, that was really a lot of fun. I learned a lot. That was my first foray technically in the field of epidemiology. My next project was to go with my supervisor to Congo and start talking about issues regarding surveillance for monkeypox, which is caused by a poxvirus called the monkeypox virus, which is closely related to smallpox, and to this day it has developed to the project that I'm still working on to this day. I was an EIS officer for two years with pox and then I stayed on as a staff epi [epidemiologist] after that. This summer will be seven years total in pox for myself.

Q: So that means that you got out of EIS five years ago, in 2011?

MCCOLLUM: Yeah. EIS was 2009-2011. I ended EIS in July of 2011.

Q: Can you tell me just briefly about some people you worked with during EIS and in the years leading up to Ebola, the few years?

MCCOLLUM: Yeah. My work really was just with poxvirus during that period of time, so of course it was staff in poxvirus most closely, probably with here at CDC with Mary Reynolds and Inger [K.] Damon on a variety of projects regarding poxviruses, including response to individual cases in the United States that pop up. We also deal with a lot of vaccine-adverse events related to smallpox vaccination. It still occurs in selected populations--mainly military members, but also laboratorians who work with poxviruses are offered vaccination.

I also was assigned to the H1N1 influenza outbreak. I had the joy of hanging out in the CDC for a month and trying to collect surveillance data from a region--a region comprised of four or five US states. And also being there to be on call, so if that region had questions for headquarters or for me, I could fish down the answer and then provide that back to them. We served as a resource, kind of a two-way resource that they could contact me and then I could contact them. Certainly, some things became more apparent during that time. For instance, there was an increasing concern about severe infections in pregnant women during that month that I was there. I was able to contact the states and say, look, these are discussions. Nothing's firm, nothing's formal, but if you do have 00:22:00cases in pregnant women, please follow them closely and if you see more severe events, please contact us. We'd like to have you investigate that more seriously with formal investigation, so that we can collect the data we need to try to understand if something is really happening with regards to pregnant women or not.

It was probably my first time to really see an EOC [Emergency Operations Center] response and sort of a response on that level--particularly a response where they're pulling in people from across the agency, so it doesn't matter if you're a flu expert or not. The point is you have the background or some skill set that they can build off of to have you do some of the work, so that was interesting. That was in the old EOC that was in Building 1 that doesn't exist anymore. It was in a basement with no windows. [laughs] You can tell I'm a fan of that. It was a nice space, it was just a little depressing, with no windows down in a basement.

Q: Given your subsequent work or your continuing work in DR [Democratic Republic 00:23:00of] Congo, I'm wondering how you found it when you were going the first few times.

MCCOLLUM: It was fun. I've always wanted to work in Africa, always. I don't know what it is. I'd see wildlife videos as a kid and I just wanted to be in Africa. I've always found that the populations and the cultures there are very interesting. I'd never been to Africa before until I went to Congo for that work in poxvirus. It still is really fascinating to me, but of course the first couple trips, everything was new and exciting and interesting. After that, it doesn't seem as new or fresh anymore. But it's still interesting. It's still exciting.

Q: Any vivid memories that stick out from the first few times?

MCCOLLUM: Yeah. The first visit, and of course it was my first visit in Africa, so we get there and I was just wound up and excited. I didn't actually go to sleep until like 2:00 am and we had an early morning meeting the next morning. I 00:24:00set my alarm for six thirty and my hotel room faced a street, it was sort of a main street where there's a lot of foot traffic. About 6:00 am you hear this clack, clack, clack, clack, clack, clack, clack and I thought oh, horses. They have horses here. I looked out my window and there were no horses and it was later in the afternoon we were outside and I heard that clack, clack again and there are these young men who walk around with two pieces of wood clacking them together to alert you that they shine shoes. Have I seen a horse--yes, I've seen a horse in Congo, but I've never seen a horse in the capital. Those were really guys, shoe shiners. I'm not the only one who has had that initial response to that. Other people have said to me, oh, there's horses here. I'm like no, shoe shiners. [laughs]

Q: Were you mostly in the capital?

MCCOLLUM: Mostly in the capital initially, and then a year after that we had another subsequent trip where we went what we call out in the field to Boende, which is an equatorial province. My joke about Boende is I'll meet Congolese here in the US or even in Kinshasa, the capital, and I'll say, I work in Boende, and their immediate response is, Boende? Why are you going there? [laughs] It's just kind of middle of nowhere. It is a proper city, but it is very rural, impoverished. There's not a lot of people from the outside going in there. It's not an area with a lot of wealth or a lot of external interest. It's a town with no running water and no electricity and no paved roads. I call it basic and rustic if you must, but it is a town. There are cars, not many. There's probably 00:26:00five or six cars and a handful of motos [motorcycles], but it's a town where we've set up a lot of our work and I've been back a lot. I've been to Congo now eighteen times as of last week and I've probably been to Boende at least ten times. I've lost track about Boende--I keep track with the country. All those visits have been for monkeypox, except for two were for Ebola outbreaks. So most of my work's been on monkeypox in Congo.

Q: Were you working largely with staff who had flown from Atlanta or at all with local staff?

MCCOLLUM: Both. We certainly have our cohort of people here. We're never traveling alone. I'm always with another staff member from here in Atlanta when 00:27:00we go in. But we have collaborators in Kinshasa and then locally, primarily from the Kinshasa School of Public Health. The CDC office, we have a locally employed staff there, from the Ministry of [Public] Health, from the national laboratory, from the Ministry of Agriculture and from the University of Kinshasa. We are one team and everybody is involved in every step and we work closely together in the capital and of course out in the field as well. At some level, we are all considered strangers when we go into Boende. Some of us are a little more obvious than others, like myself with white skin, but we all work together when we're out there, which is great. We have a really great partnership and I'm really proud of the partnership we've built and we've had a couple people, external people happen to sit in on meetings every now and then and one of the 00:28:00best things I've heard is, you guys have a really, really great team. You guys really work well together. I'm proud of that. I think it's a good thing.

Q: How did you get involved in the Ebola response?

MCCOLLUM: Do you want me to start before West Africa or do you want me to start with West Africa?

Q: What's before West Africa? Oh yeah, no, Ebola in general. Let's do Ebola in general.

MCCOLLUM: The division I'm in is the Division of High-Consequence Pathogens and Pathology. Within that division there is the branch I've been residing in, Poxvirus and Rabies Branch. Another branch is Viral Special Pathogens Branch, and I've known the people in the branch really well. One of my fellow EIS officers, Barbara Knust, is one of their head epidemiologists there as well. She did EIS with them and then continued as staff epi afterwards, just like I did 00:29:00with pox. We've just always known each other. Of course, I've been working in DR Congo. So 2012, I believe it was August, 2012, I received word from Viral Special Pathogens Branch that there was an outbreak of suspected Ebola virus in--I guess we would call it northern DRC [Democratic Republic of Congo] in Isiro. A town called Isiro. Sorry, northeastern DRC, not northwestern. In Isiro, in an area that I had not been to before. It was Ebola virus, it was Bundibugyo, which had only been seen once before in Uganda. Isiro wasn't too far from Uganda, but it's not a stone's throw from Uganda--it's quite a distance.

We got the call that that was occurring and that they could--at the time, the 00:30:00branch had already dealt with an Ebola outbreak in Uganda. The same time they were dealing with a hantavirus outbreak in the US and then an outbreak of another virus called Lymphocytic choriomeningitis virus, LCMV, in captive-bred mice that were unintentionally having interactions with wild mice that were entering the facility. So there was a lot going on at the branch level. The branch was still asked by DRC, the Ministry of Health in DRC to help them with the response and to set up a laboratory--a testing laboratory, and to help with the epi response. The branch knew that I knew Congo well and I knew the people probably leading the response there as well. Like, I knew the partners from the 00:31:00Ministry of Health. I knew Congo. I knew some French. I was not conversational at that point at all. I still am not fluent, but I manage to get by for work. So they said, we'd like to send a team with two or three lab, maybe two epis. They had an EIS officer who spoke some French, so the branch chief, Stuart [T.] Nichol, called me up. He said, "We'd like you to be in charge of the epi component. We have a lab component and then I will be there as well to help supervise the team. Are you interested in going for a month?" I said, "Sure." So we cleared it with the branches and I went out with them out there.

We went to Uganda first, to one of their associated field labs out in Uganda, and then we went from there into Isiro. We were greeted on the runway by the Ministry of Health. Again, it was people I knew, so that made the situation very 00:32:00easy, at least for me. I felt very comfortable with the people that I was working with on this. Different disease, but a lot of the principles are still the same that we dealt with, with monkeypox. Certainly the Ebola experts that I was with, they answered all my questions and then some to help bring me up to speed and make sure I felt comfortable. That was Isiro. We were there for about a month. There were two CDC teams that were in there, but we were part of the first team and then another team came in to replace us.

I learned a ton on that. That was actually my first, even though I had been in EIS and I'd helped out with H1N1, I really had not participated in a large-scale outbreak on the ground until that point. So that was a huge learning experience for me. It's something I enjoyed. It was really interesting. I felt like we had 00:33:00impact. It was the first time I had worked in a situation with multiple international organizations, so Red Cross was a part of this. MSF [Medecins Sans Frontieres] was certainly a huge part of this. They ran the isolation and treatment ward and were on-site in the field working with households in communities. We had our office literally next door to that ward, so we were constantly interacting with them, and of course the lab was in another building just next to the ward. We were well positioned to be able to communicate well with them as well as the Ministry, who was in another building very close by.

Actually we arrived and we were trying to establish what we were going to do and Dr. [Robert] Shongo, who I worked closely with, with monkeypox, he was there. He's actually in charge for surveillance for hemorrhagic fevers and monkeypox in the country. He said, "Andrea, this is what I need your help with." I said, "Okay, Shongo, what is it?" He said, "We need to build the chain of 00:34:00transmission." The tree of all the relationships of all these people, who got sick when. He said, "We need to go backwards in time. We're learning a lot now and people are on that, but I want to build it backwards down to that first person who became sick. I need to connect all the branches. That's what I need help with." I said, "Alright. I'm you're lady, let's go. I'll do whatever, you tell me what we can do." He took me with him and others to visit households to talk to people, even though that's in a local language. He would translate back to me in very simple French, which I understood and I'd be able to--together, you can ask a lot more questions and fill in the gaps than just one person. We also visited clinics, talking to nurses, asking them to think about events that had happened two and three months in the past. We reviewed charts.

There was another woman for the national lab, Elisabeth Pukuta, she went with me to several clinics. We probably reviewed over a thousand medical charts during that period of time too, again, trying to find charts for people who we knew had Ebola and had been to other clinics in town to, again, gather a history of what their symptoms were, where they were, who they had contact with, so we could then tell that doctor or nurse, that was an Ebola patient so we need to put you under surveillance. Things like that, trying to gather additional history, and we really pulled together a pretty good chain. It wasn't complete, but we were able to pull together a lot of information fairly quickly and I think met his goal of trying to reconstruct what had happened back in time. This was an outbreak that was very similar to many outbreaks with Ebola where the first cluster--the first big alert that goes off is you have a cluster of healthcare 00:36:00workers who are ill rapidly. Sudden illness and death, and that's exactly what happened in this case.

Q: After 2012, I don't know of any other outbreaks between '12 and 2014 in West Africa.

MCCOLLUM: Yeah, so 2012 went by and I worked on that for a month and that wrapped up, that finished. And I still stayed--when I was in Congo working with monkeypox, I stayed in close contact with the Ministry and learned a lot actually about what they do after an outbreak is over. Congo has experienced now I believe seven Ebola outbreaks, so Isiro was number six, so by that time they had a lot of experience in the country. They really knew a lot of the needs of the local populations and healthcare workers. They were doing a lot for the next 00:37:00year or two, some of the people including this Dr. Shongo who I mentioned who were going back to Isiro multiple times for continued training and support for local healthcare workers and the system there.

Two years went by and in 2014, this time Viral Special Pathogens wasn't embroiled in all these other outbreaks, but my friend Barb Knust, who's one of their head epis at the time, was I believe six or seven months pregnant and there were reports of hemorrhagic fever in Guinea. It's funny, I just saw her in passing and she's like, "By the way, Andrea, this is happening, and you speak some French, and you know my branch loves to work with you. I certainly can't go." I was like whatever Barb, this is going to go away. About two days later I 00:38:00got the call, "This is confirmed. Can you go out on the first team?"

[interruption]

Q: I think I tried to stop you right when you said "I got the call."

MCCOLLUM: I got the call, "Are you interested in going to Guinea? We're looking at leaving in two days," and I said, "Sure." That was from Pierre Rollin. So Pierre, myself, Craig Manning, who's their communication specialist, Ilana [J.] Schaffer, she was still their EIS officer, and Erik Knudsen. He was with Epi Info. That was the team that went out. We spent all weekend at CDC completing necessary medical clearances and X, Y, Z for WHO [World Health Organization], because we were actually being technically invited and brought in under WHO. We were CDC under WHO. We completed that all over the weekend and took the flight 00:39:00out to Paris--from Paris to Conakry. I remember in the airport or the day before, we had heard of suspected cases in Conakry, so when we were called in, in late March, we were aware of really this huge epicenter, two-hundred-plus cases that they had identified at that point in time in Gueckedou, which was in eastern Guinea, right on the border with Sierra Leone. We really thought we're going to be out in the field, that's where we're going to be. That's where we'll be going. We'll spend a couple days in Conakry, get our gear set, figure out what's what and we'll get out to Gueckedou. It was just before our departure we heard of suspected cases in Conakry, and I remember talking to Pierre about it and he's like, "No, no, no, this is not going to go anywhere." Way back when there was even a contact in Congo who traveled to Kinshasa, which is a huge capital city, but they clamped down on it really fast. This guy ended up having 00:40:00Ebola, but the Congolese authorities really clamped down on it and they provided care and things for that in a very isolated, quarantined area. He was not allowed to have contact with anyone else. He's like, "This won't be a problem. If it moves there the support is going to be so fast." And we said, "Okay, okay." He's like, "I bet it's not even there."

In Paris, Pierre got the e-mail, when we're in our layover in Paris, that it was confirmed in Conakry. We thought okay, well this changes it a little. We'll stay in Conakry a few more days, but we've got to get out to Gueckedou. That's where they need us.

We arrived in Conakry, and by that time, MSF was really officially setting up the ward and we noticed they were even clearing land to pour cement. We thought, isn't this presumptuous? Do we really need to be pouring cement? In terms 00:41:00of--cement meant more of a permanence there. They kept saying no, no, we just think this is a lot worse than we know about. This has been going on for months and we just fear that this has ballooned. We don't even have a feel for what we're really dealing with. I thought well okay, okay. I remember my first day or two I was actually at one of the isolation wards interviewing someone who had just been discharged and trying to get a better sense of that little transmission chain just in Conakry--try to clamp down on it really fast and figure out really what we were dealing with, with the outbreak, what the response should be dealing with.

We actually ended up being in Conakry about a week, week and a half. The entire team, I mentioned there were five of us. Four people stayed in Conakry the entire time. I was there for about a week and a half or so--week and a half, two 00:42:00weeks. We were really trying to carve a path for CDC and figuring out how we could fit into the response. How we could fulfill needs. What did we need to do to help the response? One large component of that was this Epi Info application of our hemorrhagic fever application. So that's why I mentioned Erik Knudsen and Ilana Schaffer were there working on that, trying to get one solid database to manage all this information from across the country. Particularly Conakry, we were trying--there were a lot of communication needs, so Craig took on a lot of that, and then there were needs for training of contact tracers in Conakry, who had not been trained at all, and identifying resources and support for that work moving forward. Of course, Pierre was involved in all of this. I tried to help out with the database as much as I could, which usually meant entering data into it until 4:00 am in the morning if I could stay up that late [laughs]. And then 00:43:00I tried to really become involved with training of the contact tracers and getting that system set up, along with WHO. We worked really closely with them and all the partners, but I would say WHO were the ones we really were side by side with on a lot of that, as well as MSF.

I knew there was a WHO, there was another WHO epidemiologist, Dan [Daniel G.] Bausch, who was going out to Gueckedou, and Pierre and I had decided we needed to get someone out there to figure out really what was happening. We really weren't getting clear details on the situation out there and we knew that there had been a lot of cases and that the isolation or treatment ward out there was really quite full. We were hearing fifteen, twenty patients at any given time, which was a lot. I arranged for a ride with this WHO truck to go across the 00:44:00country, so we left at 4:30 or 5:00 am one morning with a WHO chauffeur and logistician. We drove thirteen hours across the country to Gueckedou, where we arrived. I literally had my backpack on my shoulders and was walking through to the hotel, the same hotel where Red Cross was staying, WHO was staying. The members of the European lab that was there running diagnostic tests, they literally just stopped us and said, "Contact tracing. You've got to work on contact tracing." And I said, "Well, let us talk to you, figure out--" "No, no, no, contact tracing. This is a disaster. We need contact tracing."

We got settled and then the next day we met up with MSF and the first thing they said was contact tracing. What it came down to, it looked like they had 00:45:00something around a hundred and fifty or two hundred contacts listed--so people that needed to be seen every day. There was not really a dedicated quote-unquote "team" to follow that up with. MSF had one group of people in a car and they were trying to cover one region. They knew they couldn't do it all, but they knew they could cover one area really, really well. So they visited those people every day, so that was twenty or thirty or forty people. The guy for WHO who was also managing the database knew he couldn't do a lot, but he went out and saw ten people a day. Meanwhile, you have a hundred fifty plus people who had never been seen. Or never been followed daily. That's what we needed to address. Really, my only experience with contact tracing structure and organization had been just a couple weeks prior in Conakry. We sat down with them and I said, 00:46:00"Okay, this is what's working in Conakry. I don't know if it would work here, but let me show you what we've set up, what we've trained and what at least to this moment is working and the structure and how it works." The local Ministry folks just ran with it with their existing structure of personnel and how things are arranged within public health there. They said no, we can do this. We'll use these people and this is how it'll work, and then they'll call me, and they figured it out. I merely put an idea out there and they ran with it, which was nice to see.

I spent the rest of the time sort of doing supervisions and trying to help out where I could on that end with Gueckedou, and really trying to again, carve out a path for CDC and figure out if we had more staff here, what could they do and what are the needs and who should they be interacting with? Really trying to set the stage for that. Meanwhile, more cases kept occurring in Conakry, as well as 00:47:00some other districts by that point. It was not what it [would] become, but it was still a large outbreak. At that point it was the largest Ebola outbreak that had been documented. CDC also at that same time had teams in Liberia. And Sierra Leone and Liberia had a few cases. The cases associated with the Firestone plantations. Cases had not been really detected in Sierra Leone at that point, but there were teams there trying to help establish surveillance. Given the porous nature of the borders and the notion that it's just a border, the borders don't separate families, they don't separate cultures, they don't separate tribes. People freely move without much respect to the borders. Knowing that, and given how Guinea just started to get bigger and bigger, we had an indication 00:48:00that things may be missed in the other countries and trying to get a better handle on that and what was really happening.

I ended my time in Gueckedou, I flew back. MSF offered me a spot on their plane--

Q: When was this?

MCCOLLUM: --to fly back. That would have been at the end of April. I was back in Conakry for two or three days before I departed. So I was in Guinea a total of a month, the first month of CDC deployments there.

Q: I have a couple of follow-up questions on that if that's okay. There was a lot of talk in the media, [and] within CDC I've heard some, about initial problems between partners. CDC, WHO, MSF, yada yada, Ministries of Health, and 00:49:00the message that I've gotten is that really the problem was with regional WHO offices who wanted to see credentials for instance of people who were in CDC and who had to go, and had put a lot of bureaucratic hoops in the way of you guys getting there, getting on the ground. Do you have any insight into any of that?

MCCOLLUM: I did not see that. I did see problems at the country office at the time, that was evident. There was really a lack of appreciation from the top for the gravity and the seriousness of this outbreak and the resources that would be needed to bring it under control. I tried to address that directly with a budget for example for contact tracing at that time in Conakry, assuming that this outbreak was going to be under control and peter out. I went forward with a very 00:50:00small budget for what would be needed for contact tracing and was told well, that's a lot of money. It was something like thirty thousand dollars, which is pennies, and it was pennies at that point. Now in hindsight it really was nothing, but even at that point it was a drop in the bucket for what was being spent. I think, my understanding is, I mean I wasn't back in-country, my understanding is that was addressed shortly after. I didn't see all the bureaucratic stuff, but lack of real understanding and comprehension for really how serious this was when you had people from WHO headquarters, CDC, MSF, Red Cross, who had been through this in other countries and were really sounding the 00:51:00alarm that this is getting worse and this is bad and it's not getting better. You really need to pay close attention. You need to learn from the mistakes of the past or else and don't create new problems because this is just going to get worse. That was evident.

Q: Another question I had, was Conakry really your first foray into contact tracing?

MCCOLLUM: Yes. I had some experience monitoring it from afar during Isiro, but I wasn't actively engaged with setting up a system, thinking about who would be involved, training them, really going out with them to families. Seeing how they interacted with them, making sure that they kept an appropriate distance--not appropriate, they kept appropriate distance in terms of culture, but a safe 00:52:00distance. Things like that I had not done before and I certainly had not attempted to manage the data, which was another component of what we were trying to do was manage that, so that it was actually an efficient management and it was easy to manage--most importantly, for the people actually doing the work. Not for the people crunching the numbers and putting in a report. Our main concern was, is this useful for the people actually doing it?

Q: Out in the field.

MCCOLLUM: The people talking to people. That was most important because if what they are delivering to you is not correct, then it's useless and it's not going to help them in the end.

Q: We've talked a little bit before this about the Epi Info, VHF [viral hemorrhagic fever] module. Can you tell me about your experience with that?

MCCOLLUM: Yeah. When we went out--this was a project that originated after Isiro 00:53:00actually. Ilana Schaffer was in Isiro with us as part of the response and her main position in Isiro--she did a lot of things, but her main objective was to help maintain one single database. The problem is when you have data by multiple people and it constantly gets changed, it's a mess. To put it simply, it's a mess. She was trying to maintain one database and work closely with the Ministry and really train the Ministry. She was doing this with someone from the Ministry with her actually doing it daily, so that they could be more efficient, produce reports efficiently, be accurate, things like that. She started talking to the Epi Info team. When she returned she said, "Actually, I used Epi Info in the field. We use it to create simple reports and compute simple stats--it's great. It would be awesome if you had something that could help collate all this data and keep it." They actually started over the next two years to work on that and 00:54:00it became this major project, which was this viral hemorrhagic fever module within Epi Info. They had done some test runs just here amongst groups of people at CDC and they had run a pilot of it in Uganda, just a round table focus group pilot, and work with the Ministry of Health in Uganda. How do you like it? Could you use this in the field? I think it's important to keep in mind this was designed for what I call traditional, small outbreaks of eighty to ninety cases--maybe you're managing data from three hundred people. This was not designed for an outbreak of over twenty thousand people. We took it to Conakry. I joke because Eric and Ilana wanted to call it the beta test. I called it the delta test. I thought it was wonderful. We had Eric with us because we knew little bugs and problems would come up and so he could fix it onsite. It was 00:55:00nice for him to be onsite to see how this actual outbreak happened in the field and all the components and the people and the emphasis on these databases and the reports that go out daily and things like that. Actually, we were able to enter in all the data from the past. We were able to get all the contact tracing data from Conakry up to date in there and the system worked in Conakry. It worked really well. At some point, it fell apart. I wasn't present during that, so I don't know when it was, but at least that month that we were there--and when you have a dedicated team of individuals working on particularly the contact tracing part, it worked. But it requires someone being present when the data comes in at 6:00 pm to enter it in in the evening, and then be present at 8:00 am to print off basically the sheets to tell people what to do the next day. That is a requirement, which initially that took a good deal of work at 00:56:00night, but after it was up and smooth, one or two of us could spend two hours and be done. So that worked beautifully in Conakry. I don't know when it fell apart.

When I was in Gueckedou, I did not take it with me to Gueckedou. I had it with me, but they had their own system that seemed to be working and I was involved in some other things and I thought you know, I'm not going to rock the boat. I'm not going to push this when they have something that actually seems to work and works pretty well. It's not efficient, but it works.

Q: What were they doing?

MCCOLLUM: Excel. They were using [Microsoft] Excel. It seemed to be working pretty well. It wasn't perfect, but it worked.

Q: Who was entering the data into the VHF module back in Conakry?

MCCOLLUM: Ilana was really seeing that through, along with a database manager 00:57:00from WHO and a Ministry of Health database manager. That was the agreement from day one--so we presented what we had. We presented what we wanted, to see if it could work and actually be helpful, but it absolutely was not going to be done without someone from the Ministry and WHO alongside. It was a team of people doing it. Contact tracing initially really fell on us at night to put in the backlog to get it up to speed, and then when it was up to speed it was transferred over to that team of people. But often, since it had to be done late at night, it often fell back on the CDC team back at the hotel sitting in a room just entering it in. Someone would call it out, the other enter it in, vice-versa.

Q: I had remembered you saying something about Pierre being up super late at night entering stuff onto it.

MCCOLLUM: He can function without sleep. I can't do it. I got to where I could 00:58:00stay up until about 2:00 am routinely. Anything beyond that was really going to be disastrous for the next day. [laughs] He could just keep going. I don't know how he does it, but I guess it's the adrenaline push, that my adrenaline runs out by 2:00 am. Here in Atlanta, my adrenaline is done by 9:00 or 10:00 pm, so I consider 2:00 am a success. [laughter]

Q: At the time you're leaving Guinea after the month, what are you thinking about in regards to the outbreak? How it's going, what's going to come next?

MCCOLLUM: I've left three Ebola outbreaks and each one the initial emotion you have is guilt. You really feel like you're leaving a team of people. You feel like you've done something good. I can't tell you exactly what it was, but you've done some good and you've worked really hard and you're so engaged. It 00:59:00takes over all your thoughts day and night and then you're just all of a sudden leaving and it's this huge sense of guilt and it's really hard to separate yourself from it. You get back to the US and you feel disconnected and you really want to be a part of it again. That's tough and that's something I think a lot of responders have felt. Someone else in our group came to me with these problems. He said, "I don't know how to leave this behind." I said, "You will, but it will take a week or two before that sense of having to be there and having to help will dissipate."

In terms of what was happening in Guinea and what we thought, I knew it was still going to go on, so I knew this was not going to be a situation where we had two CDC teams and it was over. I knew that this might go on for several months. Did I think it would be what it became? I couldn't have imagined that in my wildest dreams. Did I feel like a lot of training had been done? I did feel 01:00:00like a lot of training had been done. I felt like people knew the basic processes, for example for contact tracing. More resources were still needed to be dedicated to that. I felt as though the Ministry was really probably getting their feet under them and more confidence that they had the knowledge now to proceed. You have to remember, this was a country that had never experienced anything like this. The Congolese had, and three hundred cases would have still been a ton for Congo to deal with, but they had the experience. They had the knowledge. If you go into Congo, they know what to do. They may need help doing it, but they know what to do and they know how to do it well. There were a lot of training needs in Guinea to bring them up to speed on what to do and how to handle it and how to work with populations. I knew it would continue, I just had 01:01:00no clue it was going to turn into what it turned into. Absolutely not, not at all.

Q: So tell me about what happens next.

MCCOLLUM: For? In the history? In my history of Ebola?

Q: Yeah, looking at your chronological history--

MCCOLLUM: I came back here, so that was at the end of April and all summer we kept hearing more reports and it was clear this was getting worse. I kept telling my supervisor, I think we're going to have to go back in. She said, well, let's see how this goes, not right away. Which I understood. I had other work to do. During this whole time as employees, we're still expected to continue all the work we have on our plate to do. That makes it hard. By September, I guess end of August, early September--in August I heard again from 01:02:00my friend Barb Knust and some other people who were officially in the EOC full time by now. They had been activated. She said, "I could really, really use your help to parse out this, to help me with this. Someone I trust, I know, I know you'll do a good job." So I said okay. I planned to be in the EOC for a month. I said, "I have this trip to DRC in September for about a week. It's a short trip, and then when I arrive I can come back in the EOC." "Perfect." So I was actually in DRC with my supervisor and someone else and we were alerted then that in the area where we do monkeypox work in Boende there were reports of suspected Ebola, just south of the town, about one or two hours' drive south. I was immediately concerned for our personnel and all the healthcare workers we had worked with in the area as well as the population.

I remember the national lab, the director of the national lab, Professor [J.] 01:03:00Muyembe, who has been present for every Ebola outbreak since Yambuku--since the first Ebola outbreak. He said, "Andrea, don't worry about this. This is going to be okay. There were some reports earlier. It looks like Shigella. I don't think it's Ebola. Don't worry about this. It's going to be okay and we'll be in touch, I'll let you know what the results are." He actually that day took a flight out to Liberia. He was going to head up the response in Liberia. So he was leaving to help out in West Africa, and Liberia was certainly at a point that was quite severe by that point. We knew the samples were coming in to the national lab for testing there. By this time, by 2014, they had diagnostics to do that. We left for a flight in Atlanta. I come back, I get in the EOC and about a day later we received confirmation. They decided to then send those specimens on to Gabon, to 01:04:00an Institut Pasteur lab in Gabon, for independent confirmation and also sequencing because they knew it was likely Ebola Zaire and they wanted to confirm that it was a different virus than the one circulating in West Africa. They wanted to answer the question, is this an importation from West Africa, or is this a naturally circulating endemic virus in DRC?

It was about a week delay there and of course, we were extremely concerned, so I was trying to help out in the EOC, doing what I could for the response from headquarters and then contacting our collaborators and partners and the couple nurses we employ in Boende. I said, you've got to make contact with them to make sure they know how to protect themselves, what's going on, signs and symptoms. I wanted to know more. Had they had contact with these cases? I was extremely 01:05:00concerned for our nurses. Thankfully, they didn't. They were an active part of the response. They did a wonderful job. They knew what they were doing. So about a week and a half, two weeks into that, we received the official request from the Ministry of Health in DRC. CDC was completely immersed in the West African response. I had a talk with the incident manager, Inger Damon, who was my old branch chief, and then Stuart Nichol, who was branch chief of Viral Special Pathogens, and they said, "Look, if you want to go in, we want to offer a response. Can you take a team in there?" I said, "Absolutely, try to keep me off the plane." [laughs] So we went in with an initial group that deployed, was myself, our EIS officer, and then we picked up four FELTPs [Field Epidemiology and Laboratory Training Program residents], based out of Kinshasa, so these were 01:06:00Congolese FELTPs that we helped support and take out in the field, to again, do whatever was needed.

That outbreak was a little interesting because there were two epicenters. There was the town of Boende, they had had a few cases there, so MSF set up a treatment ward. They took over a ward of the hospital--an existing ward of the hospital and set that up as an isolation ward much like they had in Isiro. Then you took a drive two hours south to Lokolia, the more rural location, which was really the focus and where all this started and MSF set up a temporary structure there. Basically, we lived in a tent campground area. MSF offered us space and they said if you can bring your own tents, you can stay right here with us. Eat food with us. We'll do your laundry. All that sort of stuff. We graciously accepted. It was a safe place to stay. The Ministry [of Public Health] was there 01:07:00as well. I always joke that I always bring my tent with me, and I actually needed it that time. We had a four-man tent. The EIS officer had his own tent. We had a four-man tent where the FELTPs stayed, and then I had a little one-person, tiny, skinny, one-person tent--actually, I have a picture of my tent and then one I call the gentlemen's tent, the four-person tent next to it.

Q: We should get that for the record. [laughs]

MCCOLLUM: Yes. I would cram into my little one-person tent and my backpack and all my stuff at night. It was cozy, but it actually worked. It was actually a really nice place to stay. We had some folks in Lokolia, and one or two people in Boende, doing work. I felt as though my job during that was to help guide and supervise and really do what I needed to do, so they could do their work. And so 01:08:00they could be part of the response and then help out as needed, wherever it was needed. I went back and forth between Boende and Lokolia a couple times helping with that over the course of about three and a half weeks. I had to leave at three and a half weeks because I had met my maximum period of time according to the State Department for travel in-country--these rules and regulations. So I actually had to leave when I left because I was prepared when I went in, I was actually prepared to extend to stay up to six or seven weeks and really see this out, but I had to leave.

Q: Can you tell me more about what the work entailed when you were supervising people?

MCCOLLUM: Most of our crew and the FELTPs were involved in contact tracing or investigation of alert cases, so they went out with teams to investigate alert 01:09:00cases and try to talk with the locals and work with them carefully. I'm really proud of the--particularly the FELTPs. There was one FELTP who went literally into the jungle--where no one else wants to go, where you have to hike for five hours and get on boats and you have no connection to anything else in this world for three or four days and trying to assess the situation out there--[who made] recommendations, helped people while he was there and then got back, so he could report. We had another FELTP, they could only go so far on motos and they had a case--it was a confirmed case who refused to come into the ward, just absolute refusal. They tried to set up isolation in the home and so it was really important to visit that home every day and they lived in a village in the forest. It sounded like a hunting encampment almost. That was an area where the roads had been washed out, so they could take a moto so far and then they had to 01:10:00get their boots on and go hiking for three hours to get to this house every day and visit this family every day, along with MSF. They did patient observation and care when they were there and then a large part of what he did was just working with the family to make sure they understood how to care for themselves. How to provide care for the patient, but then how to protect themselves, and it actually sounds like it worked pretty well, believe it or not. There was no additional transmission from that, which was really quite amazing.

Those are the stories that I'm just amazed by because I would fall apart probably with something like that. Those are dedicated public health officials right there.

Q: Do you feel like naming any of them just for the record?

MCCOLLUM: Oh yeah. The FELTPs, let me just sing their praises. That was Jacques Katumba, Jacques Likofata. I like to refer to them as Jacques Un and Jacques Deux. And then we had Marcel Sefu and Jean-Paul Moke Six, that's how he goes by. They were great and then Chris [Christopher H.] Hsu was the EIS officer who was with us. We came out and then the second team transitioned in, which was EIS officer Raina Phillips, Ben [Benjamin P.] Monroe from our group, Mary Reynolds from our group and Melissa [E.] Kadzik from CGH [Center for Global Health].

Q: And that continued for how long?

MCCOLLUM: They continued for another three to four weeks and then they all came out. This was an outbreak that was fairly well controlled. I still question some of the areas. Not now, but question if they were really well controlled during that time. It was an outbreak that was well controlled, small, limited movement. 01:12:00Being in that area of Congo and even in Isiro, and then going to Guinea, the first time I was on the roads in Gueckedou, it was so obvious to me. Huge structural, infrastructural differences. For example, Guinea, everyone has cell phones. Congo, that's not the case in rural Congo. The area where we work in Boende, it's 1.6 million people. There are three cell towers. Most people don't have cell phones. Most people have never used a cell phone. They just don't have the access. In Guinea, you saw motos everywhere in Gueckedou. First of all, you saw really good roads. A lot of them paved or really well-maintained dirt roads. You saw bridges made of steel and a ton of just moto taxis. There was just a ton of movement. In Boende, that's not the case. You have dirt roads, some steel 01:13:00bridges, not many. Most bridges are made out of a series of logs that you kind of say a prayer as you're going over on your truck that you don't slide off of it, and far less moto taxis. Far less movement and people in general. I don't know the quantitative numbers to back this up, it's just in Guinea, just looking at how people are dressed. I never walked in a household, but you could peer in and you can see they have items. They have possessions. They have things. One man and his associated wives may have several buildings, structures that they live in. In Congo, that's not the case. You'll see twenty people under a roof, in clothing in tatters. They have hardly any possessions. They just have more means, or they did from what I saw in and around the Gueckedou area, than they do in certain areas of the Congo. I'm not going to call the people rich there, 01:14:00but I think the level of poverty that we've seen in Congo is far worse and there's just not as many means to do things in terms of money or availability of motos or other resources. Movement's a lot harder.

Q: Tell me about that. Tell me how that relative deprivation affects your work.

MCCOLLUM: Infrastructure's huge. When I was in Guinea, it was during a relatively dry season. The Boende outbreak in 2014 was an outbreak that crossed over into the rainy season. The first week we were there and we took a truck from Boende to Lokolia, we got there in about an hour or hour and a half on dirt roads, on roads that are imperfect, it was pretty good. Now, you bring in rain every day, plus trucks going back and forth every day, which effectively ruined the roads. My last trip from Lokolia back to Boende took three and a half hours 01:15:00and we dug the truck out two or three times. So there's things like that. Just the lack of cell service was huge. In Gueckedou, people were able to--I talked about this contact tracing structure and it was a large area, right? You needed a contact tracing team in every--I think for the US we think about counties. In one county you would have your public health official and your people going out. They check on people, then they come back to that team lead. They tell him who they saw, who they did not see. And then in Guinea, that person could call into a central level and tell them that. They didn't have to see them every day. You can do a lot by phone calls. Or if by chance you have internet, you can send the info [information] by internet. That does not exist in the area of DRC where we 01:16:00were working. Or in Isiro, for that matter. That did not exist. Boende didn't even really have a stable internet source when that outbreak started. The way people communicate between different counties there is by radio, if they're lucky to have a radio that works at their local health center. Logistics are compounded enormously. The need for communications even by radio are huge and really are not met. The response never really met those needs. So it means if you want the information, you have to send somebody out there to get it, which is a larger personnel cost and need for trucks or motos. Motos are much easier to get around on than the trucks, especially when the roads are taking a beating because of water and use.

Q: I might have missed it. Were there results that came back from Gabon?

MCCOLLUM: Yes. They came back and the virus was determined not to be from West Africa, so the most reasonable hypothesis is that it originated locally within DRC. This was not an importation from West Africa, which that made the response a bit easier too. Because if it had been an importation, there would have been an immediate need to figure out how did that happen. The first thought would be that it was somebody that came with the virus unintentionally, but someone that traveled who was sick. That did not occur, so that was good news.

Q: Good.

MCCOLLUM: Yeah, it is good. [laughter]

Q: Anything more about your three and a half weeks in DRC on that deployment, on 01:18:00that specific one-eighteenth of your time?

MCCOLLUM: Nothing specific that comes to mind unless you have a specific question.

Q: Any other vivid memories that you have of something you saw, what you ate, people you met?

MCCOLLUM: What I ate was rice and beans for three and a half weeks--no, sometimes fish.

Q: Is that par for the course?

MCCOLLUM: That's par for the course. Well no, I usually eat fish and rice most nights. That time it was mostly rice and beans with a little fish. I was happy I brought my oatmeal. I could have some oatmeal some mornings, change it up a bit. There were some guys from MSF buying turtles locally to have turtle stew every morning, which of course I say well that's fine if you have that, but I don't 01:19:00want to see the turtles alive because I'll just think they're your pets. They just thought that was hysterical. [laughs] I did a lot of reading at night in my tent while those guys actually were just sitting right outside watching--a couple of guys--it was like MSF film night most evenings. Somebody would put in a film and everybody would congregate around the laptop and watch it.

Q: I like weird details. Do you remember what you were reading or anything they watched?

MCCOLLUM: Yes. I was reading World War Z, which was really quite dare I say appropriate [laughs] for an outbreak. I just happened to have it. It was on my reading list and I started reading it out there and I remember sending e-mails to people saying, this is probably the most appropriate thing to read in this circumstance right now. What were they watching? I seem to remember--I think 01:20:00Rambo was one. They always watch Jack Bauer. They love 24 and Jack Bauer. All you have to do is say "Jack Bauer" to any man between twenty and forty in that country and they know Jack Bauer. They love it, love it, love it, can't get enough of it. There were a couple different zombie films they were watching. They love any of the action, zombie-type movies, and then I was reading a zombie book. That worked, but they were a nice crew. I tell people after Isiro, when I really saw what MSF did, it made me want to go back and go to med school and be an MSF doc [doctor]. They're an amazing group of people. Really passionate. They work really hard in what they believe in. They've personally been very good to me. In Gueckedou, they reached out to me to work on trying to figure out what 01:21:00had happened there previously, sort of in the past. Making sure that data was collected and sent to the Ministry appropriately. Made sure I had a flight back out of the town. They made sure before we went to Boende, they talked to us. Some of those same people that I'd seen before, so we had a good rapport. Actually, my flight out of Boende, I was scheduled to be on a UN flight on one day and it had been cancelled. One of the CDC office contacts who we work with, she used to work for MSF, she made a phone call. They said if that flight doesn't arrive tomorrow for her, she's got a spot on the MSF flight. They've been really generous to me, nice, and that's not just me, they've really been generous and nice to CDC on the whole, but I have a special place in my heart for MSF, certainly. Some of the WHO staff have been great as well. I had a good 01:22:00time working with them. One of the men, actually it was Congolese in Gueckedou, Vital Mondonge, he works with WHO out of Kinshasa, and he used to work with the Ministry in DRC, he's Congolese. When I came to Gueckedou, he was there and I remember I met him and I said, "Where are you from?" There's just something about the name and some of the behavioral aspects that I can't quite pin, but I could pick out a Congolese when they're not in Congo. He said, "I'm from Congo," and so we kind of developed a friendship there and then I saw him again in Lokolia, so that was nice.

Q: So you come back from that specific deployment to Congo. Do you have any additional work on the 2014 Ebola response?

MCCOLLUM: I don't. I was planning to go back out. I came back and sort of had family issues to deal with. My dad was very sick, so I was not actually able to 01:23:00go back out. I was scheduled to go back out. I was hoping to go back out in December and then again March, but both of them just ended up falling through for personal reasons at that time. So no, I didn't have any further engagement with that.

Q: Briefly, just bring me up to today and what you're doing now.

MCCOLLUM: Today I'm back, and I have been full-time with poxvirus. Still working in Congo. Last week I was in Kinshasa. Still working on monkeypox. We do a lot of work with surveillance and research studies and I'm really happy to say that we're going to try to go out there and roll out a study looking at use of a third-generation smallpox vaccine that's safer than the original one to actually protect healthcare workers against monkeypox infection. It's an exciting time. I think a lot of people are really excited to see people go in there, do good work 01:24:00and then try to do something that's impactful for them and so that's nice to see. It's nice to be a part of and it's nice to see. I still see the same guys that we've worked with for years and the same guys that were on the Ebola outbreak. They're still there. It's nice to see them and we joke, oh, it's good to be here when there's no Ebola, and things like that.

Q: Well, looking back over your response, over--we've reviewed kind of your career. Anything that you want to make sure that we have for the record?

MCCOLLUM: No. I mean I think we've covered a lot. I think these responses are something that CDC really excels in. I've seen that as part of it and I try to step back and look at it as well and it's really a pleasure to be a part of the response. The partners, yes, nothing's perfect. Yes, there have been problems, 01:25:00but there are really some really phenomenal people and organizations out there and it's been a pleasure to work with them and to interface with them. I hope we've learned a lot from this. I hope the world's learned a lot from it and we're better prepared for the next threat, be it Zika or whatever it may be. Until then, people can read World War Z and hope for better. [laughter]

Q: Right on. Well, with that, it has been a pleasure listening to your experiences. So thank you for being here.

MCCOLLUM: Thanks.

END