Dr. James Zingeser

Dr. James A. Zingeser

Q: This is Sam Robson here with Dr. Jim Zingeser. Today's date is August 30th, 2017, and we're in the audio recording studio at CDC's [Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. I am interviewing Dr. Zingeser as part of the CDC Ebola Response Oral History Project for the David J. Sencer CDC Museum. Can I call you Jim?

ZINGESER: Yes, please.

Q: Great, thanks. Thank you for being here with me, Jim. Would you mind pronouncing your full legal name and telling me what your current position is with the Carter Center?

ZINGESER: My full name is James Alan Zingeser, and right now I am the senior project advisor for Guinea worm eradication at the Carter Center.

[interruption]

ZINGESER: I'm working in the [global] Guinea worm eradication program as an epidemiologist.

Q: How long have you been doing that?

ZINGESER: I moved in March of 2016 to the Carter Center, so that's when I left CDC. But I had already spent ten years at the Carter Center earlier in my 00:01:00career. I left CDC, went to Carter Center, and back to CDC, then back to the Carter Center. [laughter]

Q: If you were to tell someone, give an elevator speech or just a capsule description of what your role was in CDC's Ebola response, what would you tell them?

ZINGESER: I was basically an epidemiologist going out into the field, but I was the response team lead in the very beginning and at the very end in Guinea. So I was responsible for the epidemiologists under me who were working. All of us were working to try to support WHO [World Health Organization] and the Ministry of Health [and Public Hygiene]. But in the middle, as part of my role of being the CDC liaison to the Food and Agriculture Organization of the UN [United Nations]--I was at FAO in Rome. I got FAO to send me to Sierra Leone twice for 00:02:00one month each to work on how FAO could support the response. The two things that I did there was we brought to light the importance of food security during the epidemic, and what I was really interested in doing was using agricultural extension officers to do health education to try to stop the epidemic. This was all in Sierra Leone. The reason for that is because [agricultural] extension officers have access to rural populations that the Ministry of Health [and Sanitation] does not even have contact with.

Q: I want to return to that because that's fascinating. Would you mind telling me when and where you were born?

ZINGESER: I was born in Detroit, Michigan, in 1954.

Q: Did you grow up in Detroit?

ZINGESER: I grew up in the suburbs and I lived in Detroit after graduating from 00:03:00college. I lived in the city.

Q: Can you just tell me about growing up in Michigan a little bit?

ZINGESER: Yeah, it was suburban youth in the 1960s. Growing up in a big city. All the things you've seen about the Detroit riots, that was where I was. I was thirteen when the riots happened. It was a really good time in America. The middle class was strong. My father's a veterinarian--was a veterinarian, and he was doing well. We lived a good, middle-class life in the suburbs. All of that was good. It's a very good education. I went to the sort of high school where everyone was talking about going to college, and I pretty much had it in my mind that I was to be a veterinarian like my dad. It was only after that when I was working as a veterinarian in small animal practice that I got the bug to do 00:04:00other things.

Q: Where did you go to college?

ZINGESER: Michigan State University. I'm an MSU--did my undergrad--before I finished undergrad, I got accepted in the vet [veterinary] school. I had taken a year off to go to France to study French, and just did that on my own. Then I went to veterinary school, got my doctorate, and went into small animal practice in the suburbs of Detroit.

Q: Why did you decide to learn French?

ZINGESER: That's interesting, I think. I learned French because of French poetry and French movies. I was very, very interested in the Dadaists and the Surrealists starting from the visual arts and film and then into the poetry. So I really wanted to learn French. I was watching all the French New Wave films, so [Jean-Luc] Godard and [Francois] Truffaut and all of that. I liked that. I loved the films so much that I had a real passion for learning French, and in my first year at Michigan State, where I was in this great residential college 00:05:00where you could do things like this, I took intensive French--because I had to have a language. I thought well, let me do it right. I did so well in French that for the second year, I applied to the Alliance Francaise in Paris. In those days, it was cheaper to live in Paris than it was in New York. Now to really go [far] afield, I went there to work--I was there on a student visa, but that was just my way of getting a visa to live in France. I was really working for an art festival. I worked, I volunteered. I said, all I want are tickets, so when all of these American artists would come to France and they needed somebody to take them around to do laundry or to do grocery shopping, whatever, I was one of the people who did that. I was working with John Cage, Merce Cunningham Dance Company. Philip Glass was just starting to get some fame, but the French liked 00:06:00him very much. He already spoke French and he had already studied in France, but other musicians from his group I was hustling around Paris. As well as a guy named Robert Wilson--theater person, wonderful stuff. Did a lot of stuff in Iowa, I think, too. He's from Texas, but Robert Wilson's wonderful, too. It was a great experience. Then I thought well, I don't really want to be in the art business because by that time I started to see what the business was like, and I came back and went to veterinary school.

Q: Also Michigan?

ZINGESER: Also Michigan, yeah. The vet school is at Michigan State. In those days, it was a great vet school. I think it still is. When I got out, I was really aiming toward small animal practice, and then I would satisfy my interest 00:07:00in other cultures, in other places, by being a tourist, right? To do that. I soon learned that that was really not the direction I wanted to go in. I really wanted to travel and work with other people, and so seeing my life ahead of me in the suburbs wasn't quite what I was aiming for. I went into the Peace Corps, and in the Peace Corps--that was 1985 to '87--in Peace Corps, I ended up picking up a veterinary epidemiology project that I volunteered to do for a veterinary epidemiologist who's quite famous. He's at Louisiana State University and now retired. But he took me under his wing and I did veterinary epidemiology. He wanted me to be his graduate student, and when I explained to him what I wanted to do, he said oh, you want to go to EIS [Epidemic Intelligence Service]. I had not heard of EIS, and he said this is EIS, and I'll put you in touch with 00:08:00somebody who can help you out. He put me in touch with Louise Martin, who is very well known at CDC. At that time, she was brand-new at CDC. She had just finished EIS and she helped me out, told me how to apply and all of that. So I went back to school to get a Master of Public Health [degree] at the University of Michigan. Once I finished that, I went directly into EIS.

Q: [pause] Sorry, just scribbling down a little bit here. [laughter]

ZINGESER: There are lots of twists and turns.

Q: Yeah, a lot of twists and turns. I think there are a few oral histories buried in there. For some reason, I have a predilection for asking about mentors and people you really learned a lot from. Was this person from LSU--what would you say you learned from him looking back that was really important?

ZINGESER: His name is Martin Hugh-Jones. Hugh-Jones is a Welshman with the sort of sardonic sense of humor you would expect from a Welshman in Louisiana, and he is one of the world's experts on anthrax. But what I was doing with him was working on bovine mastitis and tick-borne diseases in ruminants in Jamaica, and that was really interesting work. It got me hooked on epidemiology. But Hugh-Jones also had a very wide vision because he worked on a lot of zoonoses, and he really was a mentor. He was somebody who said, you don't have to be my graduate student. You don't have to work on cows and goats. I think what you really want to do is go into public health, and I think CDC is the place for you. And he was right.

Q: Wow. Can you tell me what country you were in, in Peace Corps?

ZINGESER: Jamaica.

Q: Oh, it was Jamaica.

ZINGESER: It was Jamaica. That's another crazy story, I learned it's very typical of Peace Corps. I was a graduate veterinarian who spoke French, and I could speak very well. I always think of being native as being fluent, but I speak French well enough to do all my daily work. I applied for that. They were going to send me to what was then Zaire, which is now the DRC [Democratic Republic of Congo]. There was a whole veterinary project going on there. I quit my job, I sublet my apartment. I was all ready to go, and the Peace Corps got in touch with me and they said, you cannot go to Zaire because of your asthma. I said, but I don't have asthma. [laughter] I got my allergist--because on some form I had ticked off "do you have allergies" and I said yes, and it said "what are you allergic to" and I said molds and dust or something like that. It says respiratory allergy, and they translated that into asthma. Now I know that if I 00:11:00had made a big enough stink I could have gone to Zaire, but I found out afterward that that project was a bust. That it really didn't go very well. I by chance ended up meeting Martin Hugh-Jones, who led me to CDC and literally changed my life. So it was pretty cool.

Q: Yeah, that is pretty cool. Okay, so you're in EIS. What years were you in EIS?

ZINGESER: I was there in 1989 to 1991.

Q: Where did you get matched up?

ZINGESER: I went to Vermont. I worked for Rick [Richard] Vogt, who is a state epidemiologist, and Rick was another mentor. Rick was great.

Q: Tell me more about Rick.

ZINGESER: Rick is like the consummate state epidemiologist. Not only did he do good epidemiology and he writes well, but you could see that he was protecting 00:12:00his people. In Vermont, the state public health office is also the county public health office and the city public health--there's only one office for the whole state. There's only half a million people in the whole state. I think I was there the year that the human population became greater than the cow population in Vermont. You know about these things, being from Iowa.

Q: I do.

ZINGESER: What I really appreciated and what I learned about was the politics of public health, and Rick was protecting us all the time from the political forces above us in the state health department and in the state government. We got to see everything because we were the city of Burlington, we were the county, and we were the state health department. I wanted to get the broadest education I could, and I got it there. It was great.

Q: Can you tell me a little more specifically what he was protecting you from?

ZINGESER: Oh, that sort of thing is just when the political machinations of something when they want to cut budget--if somebody wants to move people to a different office or wants to move our office to poorer facilities--they want to take away our budget for whatever. My office was right next to Rick's office, and so I got to see how--basically, I never had to worry about any of that stuff. Rick just made sure we could do our work. EIS officers are pretty much babied. They're taken under the wing of somebody and it's important they're free to the state but the state also wants to make sure that they get a lot out of us. So it was good. The people I worked for on this end were great too, in Atlanta. EIS was a really good experience for me.

Q: So EIS until '91, and then what did you do?

ZINGESER: During EIS, I made sure that I kept in touch with what was then called the International Health Program Office, IHPO, and it was a wonderful office. It 00:14:00was great. It was a lot of former smallpox people who had really eradicated smallpox, and it was well-connected with Bill [William H.] Foege, who was then professor emeritus at Emory [University], the past director of CDC. I was aiming for a position there. Right after my last leg of EIS, I came down and interviewed for a job, actually almost right where we're sitting right now in those days. It was what they used to call "the motel." I got a job to go to Cameroon. We were just my wife and myself in Vermont, and we took off for Cameroon as part of IHPO.

Q: Where did you meet your wife?

ZINGESER: She's from Michigan. Here's another story. I was friends with a pretty 00:15:00tight group in college and a lot of people who went into various creative fields. People went into theater and people went into music, and one of my friends was a poet. We had a deal that Michael was never going to make any money because he wanted to be a poet. I learned a lot about poetry from Michael, which I already liked poetry, but I learned a lot about writing poetry. I told Michael, "I'm going to be a veterinarian, so you'll always have a place to sleep in my house. I'll always have a room for you." Well, Michael got into advertising as a writer, and he was great at advertising. Michael did very, very well. He's a great writer with a wonderful sense of humor and within a few years, he was writing advertisements that were on the Super Bowl, during the Super Bowl breaks. That, for advertising, is great. Michael had invited me to a party with a bunch of his advertising friends, and Michael and I went to this party, and we both met the woman who I ended up marrying at that party. It was a 00:16:00croquet party in Gross Pointe, Michigan. Everyone was required to wear white, and Nancy, who's now my wife, didn't wear white. But she stood out in other ways, too. That's where I met Nancy.

Q: What was she doing at the time?

ZINGESER: At that time, she was finishing--she had gone back to college. She had stopped going to college when her mother became ill. She took care of her mother until her mother died, and then she went back and she was studying architecture, interior architecture, so it's structural interiors. She was studying interior architecture and aiming toward working for an architecture firm. When we got married, she got distracted, then we ended up going to Cameroon, and then we had children. We found out when I was in Atlanta trying to do all of the work to get 00:17:00us off to Cameroon--all the paperwork and taking trips out to Cameroon to work with the people who I would be working with in the future--Nancy went in for her physical and found out that she was pregnant. In those days with malaria in there, being early in a pregnancy is not a good time to be moving. So it was tough. And being pregnant with all the smells and all the food differences, pregnancy accentuates all of that. She really was more than a trouper. She did a lot.

Q: Can you tell me what you were doing in Cameroon?

ZINGESER: It was part of a maternal and child health project. So in those days we talked about international health, not global health yet, and a lot of what we did was coming from USAID [United States Agency for International Development] funded projects for maternal and child health. My specific task 00:18:00under this project was to help Cameroon to set up a health management information system, what we called the HMIS. I worked with the Ministry of Health through the USAID office in Cameroon. I was in Yaounde, but I worked a lot all over the country and I ended up doing a lot of epidemiology for meningitis, yellow fever, and cholera, but mainly meningitis because the north of Cameroon is in the meningitis belt. That's why I was working on that.

Q: How long were you in Cameroon?

ZINGESER: Two years. We would normally have stayed, but they shut down the USAID office in Cameroon after [President] Paul Biya had elections that were not deemed to be free and fair. The Clinton Administration decided to crack the whip and that was it.

Q: But that was the first extended time that you'd spend in Africa, right?

ZINGESER: It was. I'd just gone on short trips before that.

Q: What was it like living in Africa?

ZINGESER: It was good. When you start off in the government, you get the lowest level of houses. We were literally on the low part of the hill just over the shantytown, more or less, that was down the hill from us. But it was a typical embassy sort of house. It was nice. In Africa, when you have little kids--we had our first son born in the [United] States, but when he was six weeks old, Nancy brought him back to Cameroon. You always have a housekeeper, and it's very comfortable except for in those days especially there was no Skype. Telephone calls were very difficult. Email was always on a dial-up modem, so it was iffy at best. It was not easy, but it was good work for me, and Nancy always finds 00:20:00interesting things to do in the communities that we're living in and when you have small children, you get very, very busy.

Q: What kinds of things did she find to do?

ZINGESER: In Cameroon, I have to think about what she was working with, but I think she was working with the--she's not an embassy person, she doesn't work on embassy projects. The most interesting thing she did in Cameroon was that there was a photographer. He was a husband of somebody at the embassy, and he had gotten money from the big museum in Chicago. The [Field] Museum of Natural History in Chicago.

Q: Oh, sure.

ZINGESER: He had gotten money from them to photograph the royal archives and museum, essentially, of the Bamoun people. In the city of Foumban is an 00:21:00independent ethnic group within Cameroon, and they have a sultan, and the sultan of the Bamoun people is a very important--politically is very important culturally there. In this case, the old sultan had disappeared. They would never say that the sultan "has died" or "has passed." The official word went out that the sultan has disappeared, and the elders got together and chose a new son, and the new son was this person who had been very, very well educated abroad and had been the ambassador, I think, to Germany and the ambassador to Saudi Arabia, so he was well-traveled, he was very high diplomatically within the government. He came back to assume his father's throne. During this time, they had decided that they wanted to have the museum cleaned up and photographed so that they had an 00:22:00archive of all the things there. Nancy went out with my son, who is a year old or less, in a car chair that turned into a stroller, and she took him and her work during the day was to dust--she's extremely good at this sort of thing--dusting and prepping and cleaning up all of the artifacts in this museum. They just did this job, and she designed a lighting box so that they could photograph this. This is very structural. Very much the way she's good at. She made this black box with probably a felt interior and lights set up inside. This was 1992 or 1993, so the technology was pretty simple. She had to be very clever about doing this. They photographed all of the things, and it was a big exhibit 00:23:00at the Field Museum in Chicago. That was just very cool. That was the coolest thing she did. She's always doing cool stuff.

Q: That is particularly awesome.

ZINGESER: That is awesome, yeah.

Q: Yeah, wow. Okay, so until maybe '94 or '95 you're in Cameroon?

ZINGESER: Yeah, we were there from '92 to '94. It was 1994 that I came back. Early in '94, so it was really just two years. They shut down USAID, so I had no supporting country. In those days, we didn't have CDC country offices. I came back and my office wanted to keep me, but there was a big cutback in the government. The terminology was "downsizing and rightsizing," so we were being rightsized out of existence--our office was.

I [was in the office], a French speaker, when somewhere between half a million 00:24:00and seven hundred fifty thousand refugees were crossing the border from Rwanda into Zaire. I got to go to Zaire because UNHCR [The Office of the United Nations High Commissioner for Refugees] had requested a CDC epidemiologist to be the deputy health director for the refugee camps. I was there, and I went off and left Nancy here, and I went to Zaire for I think six weeks. We worked in the refugee camps, and it was a very interesting experience, and I did a lot at the border. There were very good French speakers in my office in IHPO, so several of them who were senior to me were out there and they were great to work with. For a lot of the other stuff, I was helping to translate. But it was mainly because my direct supervisor was the medical director for all the refugee camps. I was her translator to make sure that she was working well with CDC and others--so 00:25:00many of the people who came out were English speakers. But it was also to try to put the epidemiology into how we made decisions for the refugee camps. It is not always easy.

Q: I'll bet. Can you give me an example of a decision for example that you'd have to--

ZINGESER: Part of what was going on was, we knew that there were going to be three big diseases that were going to come. We just didn't know which would come first. Lake Kivu, where the refugee camps were situated, has cholera. It's endemic for cholera. But there was also measles because of so many unvaccinated children, and we were bringing people from the hills of Rwanda down to a lower area and so we expected that there could be a lot of malaria. Before I even arrived in country, the cholera epidemic had started, and by the time I got there, there were stacks of bodies--literally stacks of bodies. Much more 00:26:00dramatic, much more woeful than the Ebola epidemic really because with the cholera epidemic, it's so explosive. We couldn't bury people because we were literally on volcanic rock. They put the refugee camps on the side of the volcano where no one was doing farming, where no one wanted that land because Zaire was not going to give them good land, fertile land, land where it's easy to put in a fence post or put up a tent post. They were not going to volunteer that for the refugees. We were literally on rock, and the sort of rock that when you hit it with a hammer it just splinters. We had people who were defecating with cholera into this sort of an environment, so we knew that we were either going to get cholera or we were going to get a dysentery outbreak. It was going to be one of the two.

Cholera hit, and it was devastating. The epidemiologic decisions in a situation like that--you know what to do to try to get people clean water, you know what 00:27:00to do to try to keep people from drinking out of the lakes, but you also need to know where to target resources for the people who are ill because you just need massive amounts of treatment, which is mostly replacement fluids for the people. For that, we needed to really work on getting all of the various groups that were volunteering. There was MSF [Medecins Sans Frontieres] and there was IOM [International Organization for Migration] and there were all of these small NGOs [nongovernmental organizations] that were coming out. We had to collect data from all of them and put it together so we had a picture of where we were having outbreaks, how bad they were, where we had to move resources. But at the same time, refugee camps are dangerous places and these were a lot of soldiers who were being chased out of Rwanda by Paul Kagame and his troops that were coming in. Supposedly, everyone was disarmed before they came into Zaire, and we 00:28:00very quickly found out that there were plenty of weapons in the camps. It was a tricky situation. There was a lot to learn. And at the same time there was a volcano.

Q: Yeah, right. Is this an active volcano?

ZINGESER: Yes, and at night the volcano glowed, and then one day they called a meeting and they brought us all together. At that meeting, the volcanologist came in and everyone was doing their "live long and prosper" for the volcanologist. The volcanologist said to us the reassuring words that it is a very low-silicate lava and the side of the mountain is weaker than the top of the mountain. If the mountain explodes, it will be like Mount St. Helens and 00:29:00blow out sideways, probably in the direction of Lake Kivu, where we were. And that this low-silicate lava would flow at about sixty miles an hour. We couldn't outrun it. If we climbed a tree, it would take so long to cool off that we would starve to death, and if we went into the lake, the gasses that would rise above the lake would suffocate us. So this is what we were hearing in the middle of a cholera epidemic in Zaire.

Q: In the wake of a genocide.

ZINGESER: In the wake of a genocide. It was what we would call a complex emergency.

Q: I'm floored. Wow, that's crazy.

ZINGESER: I was there, once again, with these wonderful people who did really good work. There's a report, the Goma refugee group report that CDC put out is 00:30:00very good. Some outstanding people came out of that. We had great CDC people leading us, and good friends of mine were there at the same time, so it was interesting times again.

Q: No doubt. I think my downfall as an interviewer is that I'm interested in all the interesting times and I get wrapped up. Was it maybe two o'clock when you said you had to go or two thirty?

ZINGESER: Let's make it two o'clock.

Q: Okay. Well, we might need to fast forward here a little then.

ZINGESER: Yeah, let's jump forward.

Q: Looking briefly from that time that you were in then-Zaire to your involvement in the Ebola epidemic, roughly twenty to twenty-five years, were there other experiences that you can pick out and say, here was a turning point, or here was something that I used and carried with me and was an important 00:31:00experience going into Ebola?

ZINGESER: What happened was that IHPO, where I worked, was shutting down. It was being shut down by the government, which was cutting off funds for international health to CDC. The person who ran IHPO had gone to the Carter Center, and I had already done a Guinea worm mission for him, and so I was asked to go to the Carter Center before they shut down IHPO. I left CDC and went to the Carter Center, and there I worked on the Guinea worm. They posted me in Niger. We spent three years in Niger working on Guinea worm. I'd taken from being a fluent French speaker in French-French, Parisian French, to going to work in West Africa full-time. More even than in Cameroon because I was running this office. 00:32:00I wasn't just running a project like I was in Cameroon. I wasn't just a technical assistant, but I was, in fact, the resident technical advisor for Guinea worm eradication in the Ministry of Health. I had a team of people who worked under me. We had vehicles. We had a project that we were doing, and I worked hand in hand every single day with my Nigerien counterparts. I spent three years, and it was just a great education, a great experience at running a health project in West Africa. At the same time, because of my connections to CDC and because I don't really see boundaries--I would never say I can't work on this or that because I'm busy doing Guinea worm--we were available. I made myself available for polio eradication projects, for meningitis work, and for other work that was being done in West Africa. Because of that, I worked with 00:33:00outstanding people in both polio and in meningitis. The best experience I had was that Anne Schuchat came out--who is a friend from EIS. She was in the class ahead of me. She came out and spent time in Niger on her project, and of course, I was more than happy to help her out as much as possible. That friendship has gone on for all of these years. But what I really learned was how to juggle these things. At this point I was the boss in my office with resources at my disposal to make things happen, which is quite different from being an epidemiologist in the Ministry where you are buffeted by all sorts of forces and you can't make things happen. You have to try to convince other people to do that. This was that turning point experience that taught me how to run a project. But then I came back after three years. I was asked to come back to 00:34:00Atlanta to the Carter Center to be the senior epidemiologist there. But that experience in Niger really was total immersion in French culture, as well as total immersion in really making a global health project work.

Q: What years were you in Niger again?

ZINGESER: We were in Niger from the very, very beginning of 1995 until the last day of 1997. We had gone out in early January, and we spent Christmas in Niger and New Year's Eve in Atlanta, between 1997 and 1998, and then the very first of January--the first working day of January I was working in Atlanta.

Q: So you stay in Atlanta as the lead epidemiologist for the Carter Center for--

ZINGESER: Right. My position was senior epidemiologist, but there were great 00:35:00people running all of the programs. I was working outside of that. I ended up starting the Trachoma Control Program, which is another direction, and that was to build on the Guinea worm experience. Because we were sure we were going to eradicate Guinea worm soon, so we needed a follow-on project, and we thought trachoma would be a good idea. That's where I did that.

Q: Okay. What's the next swerve in your journey?

ZINGESER: The next swerve is when Guinea worm was--well, what happened was, I was turning fifty. It was 2004, and I was offered a position in the [Polio Eradication Program [Global Immunization Division, National Immunization Program] from friends here at CDC to be seconded to WHO in Copenhagen. It was the right time. I was sure that Guinea worm was finished and that I would be 00:36:00looking for another position because of the end of Guinea worm, that the Carter Center would be changing dramatically in their health programs. This came up, and it was the right time for the kids--I have three children--and it would be perfect for them to go and live in Europe. I would be working mainly in Central Asia, an area where I've never worked before, and the timing seemed right. Little did I know that twelve years later I would come back to the Carter Center to work on Guinea worm eradication. I never dreamed that that would happen. But I came back to CDC. I was in polio eradication from 2004 until 2007, I guess it was.

Q: Seconded to WHO in Copenhagen?

ZINGESER: Right. Then I came back and I thought I was going to go to India. I 00:37:00was preparing to go to India because polio was a real problem in India at that time, and one day I was offered a position in a very new office. An office that had just been created called the One Health Office. They were looking for someone who would go to Rome, Italy, to be the first CDC liaison person at FAO. The FAO office really strongly stressed that they wanted a fluent French speaker to be there, even though it's in Italy. Italian is not an official language of the United Nations. French takes you a lot further in the countries we were working in--the countries I was working in. I went off and stayed for six years doing that, but it was during that time that I went off to do Ebola. That was 00:38:00partly because one of the diseases that I was working on--so the One Health Office looks at the human-animal interface. It's not only zoonoses, but it's zoonoses plus other ways that people and animal health and in agriculture can work together to advance the mission of the CDC, let's say. Along those lines. I worked very, very closely with WHO, with the OIE, which is the [World Organisation for Animal Health] in Paris, and with my office at FAO.

One of the diseases that we worked on is called Rift Valley fever. Rift Valley fever is another hemorrhagic fever caused by a virus, and I was given the task of organizing several meetings on Rift Valley fever. It was because of that that I had the pleasure of working with Stuart [T.] Nichol and with Pierre Rollin and people in their team, people like Brian [H.] Bird and others. It was a great 00:39:00experience and I really enjoyed everything that I learned and just the experience of working on Rift outbreaks. I had never seen a case of Rift because I was always working in the office in Rome. But I took on this role of learning and working in the support role to make sure that these meetings went well. But it was because of that, that I got to know the people in [CDC's] Viral Special Pathogens [Branch], so that when the Ebola epidemic happened, first of all, I knew who to call from Rome to talk to.

The whole time I was in Rome--just to jump forward on that--the whole time I was in Rome, I took my role as liaison between FAO and CDC very seriously. It was a lot of building relationships with people in the FAO, in the agriculture 00:40:00community, but also remember that the World Food Programme is housed in Rome. The medical director of FAO, whom I got to be close with, was also the head medical director for all of the UN agencies in Rome, and that's all the UN food agencies. Through him, I was in touch with--and I was seen as the gateway not only into CDC, but into HHS, for the embassy and for the US military because there were a lot of military in Italy, and for the UN agencies. I had built these relationships and I nurtured those relationships. At least once every two weeks probably, by email contact or by telephone, I was communicating with people back here in Atlanta either about a specific health issue for which I 00:41:00would talk to the epidemiologist in charge of that or I would be touch with Ray [R.] Arthur or Kira Christian or Myron Schultz or someone like that, to talk to them about a rumor or report that I had received. To make sure that the Global Disease Detection people were up to date. And also, the door swings both ways. I was telling my people at FAO, be careful because there's an outbreak of a zoonotic disease. We know that there are human cases in Egypt--let's see if there are any animal cases. So we would mine those contacts on that side and I would find out. So heads up, something's going on. Typically, with something like Rift Valley fever, we don't find out about the animal disease until there are human cases or it can work out that the avian influenza--there can be cases 00:42:00where you find a human with avian influenza, then you go back and find out that a lot of birds died in the marketplace. We can use animals as a sentinel for human diseases. We would prefer that humans do not become the sentinels for animal diseases.

That brings us, I think, to Ebola, where I had a colleague of mine who called me up and said, "Jim, my wife is a nurse at the World Food Programme and there's something strange going on in the Forest Region of Guinea. I'm well-versed with that region because I used to live there." My good friend Philip [Ankers] said this, and he said, "Can you find out from CDC if they know what's happening?" Because World Food Programme is concerned about their staff. And it was that report--so I requested the official report. I got the official report from World Food Programme, and that same evening--so within twelve hours from the first 00:43:00report being sent from the Forest Region of Guinea through their channels to the World Food Programme office in Rome, I was in contact with CDC about the first report of Ebola. It turns out that CDC didn't know about it because WHO had not been notified yet. The CDC report was three days before the official WHO report came out, and for the rest of that, I know my side, we have to leave that up to Ray to tell the other part of the story because I'm not sure what happened after that. But on our side, we kept track. I have another interesting email that I found when we were first talking about this that I had sent back. I had to have been in touch with either Stuart Nichol or Pierre Rollin because I wrote an email back to the World Food Programme to say, please tell your people that 00:44:00Lassa fever is common in that area, but in any case, they should collect a sample of this and send blood to the Lassa fever lab, which is in Kenema, Sierra Leone. I have that message, "Send blood to the Kenema laboratory for confirmation," at which point they would have found out that it was Ebola. And I said, "Please use full precautions in the hospitals and at funerals." This was early. This was in March of 2014.

Q: Yeah. Oh, my goodness.

ZINGESER: It's interesting, and it's all because CDC had the foresight to put an epidemiologist as a liaison officer in an agricultural organization in Rome. That was fortunate. It was all because of building relationships and nurturing 00:45:00those relationships to where people trust you enough to say, I know that you'll give me a straight answer. You'll get it fast. And we did. I give full credit to my colleagues here in Atlanta. Ray Arthur and his team, Kira Christian and those people. They are so responsive. I would always get a reply from them immediately. They reached out and got in touch with the Viral Special Pathogens people right away. That's great.

Q: I like the way that you phrased that because I can imagine that there's some level of distrust or enmity that just might naturally develop between organizations working in the field who don't have regular communication. Having 00:46:00that already in place so that you were there at that crosscurrent where you could hear that rumor from your friend about his wife being the nurse and relay it to CDC--it makes sense that you were the person to relay that message.

ZINGESER: If you work within United Nations organizations, you learn very quickly that a lot of the people in a UN organization would say, we cannot release this information to CDC because CDC would embarrass us by knowing about it before WHO. But the relationship was a trusting relationship to the extent that they said, if we get in touch with Jim, Jim will get in touch with Atlanta and we'll have an answer right away. And we don't care about being embarrassed because especially the Global Disease Detection people are so discreet. We had 00:47:00been dealing with things with governments and with other organizations for years by that point, where people just said, we want you to know about this. It might be nothing, but if it is something, please do not spread--don't tell anybody else because we haven't told the minister about it yet. We want to know if there's something going on because we're getting hospital reports or we're getting reports about chickens dying or about cattle dying, farmers who are sick, whatever, and they would say, please keep this confidential, and it always was. In my whole time, there was never a leak of something that was requested to be confidential. If I sent information to Atlanta, we never found out about it from another source. Like, " Oh, Atlanta told us this," or the other way around. If Atlanta told us something and said, "Please keep this confidential because 00:48:00we're giving you ministry of health information," or "We're giving you WHO information, and we want to see what's going on, on the FAO side. Do you know about ____? You've got people in ____." FAO is structured like WHO, so there are regional offices, sub-regional offices and country offices. There's always somebody whom I could reach out to and say, "Do you know anything about a disease that looks like this?" "Do you have farmers who are ill, or do you have cattle that are ill, or do you have chickens that are ill?" We would always be passing this back and forth. I can honestly say that in the six years that I was at FAO, we never had something embarrassing leak out. If anyone talked to anybody else about this, they always did it in complete confidence. That's pretty good. A matter of three days or a week in an Ebola epidemic means something. It's important. We need to do that. We need to maintain those relationships.

Q: At that point, did you have any contact with MSF or any knowledge about what their understanding of the situation was?

ZINGESER: I think it was MSF that takes credit for being the first ones to get the virus out and the first ones to have identified the virus, and that's great. I think the world of MSF. They do a great job. They are a culture unto themselves. They're very, very specific about what they do. They're very regimented. They have been embarrassed many, many times in the press and embarrassed in front of governments, and so they are very cautious about communications, but I've always gotten along really well with MSF and partially because I have to respect that culture. I'm working across the cultures in that.

We did not get a report from MSF. When MSF gets something like that--and I know the organization well enough to know that if they were sending blood samples out, they probably did not request permission to do that, [laughs] and they 00:50:00would not want anyone to know what they were doing until they had a positive diagnosis. Whereas Special Pathogens here said, tell the Ministry [of Health] to get blood to--now if we had a CDC office in country, we would have acted completely differently, but we didn't. Not at that time. The message that I got was, please have them get blood to Kenema in Sierra Leone and have it tested. Please advise the Ministry. All of the advice that I sent back was the right thing, but MSF is very much: We're going to take charge. Let's get a sample, let's get someone on a plane with that blood and go to Paris or go to--I think they went to Geneva for that one, and that's it, and then we will announce--

Q: I remember there was an Institut Pasteur confirmation and--

ZINGESER: There was an Institut Pasteur----

Q: The 20th or 21st of March.

ZINGESER: Yeah, we got the whole history. We can check that because that was--and there was a scramble at that point early in the epidemic to get virus. Everyone wanted virus. At the same time, CDC sent out Pierre and Ute [Stroeher], who was out there to grab some virus. Everyone wanted to see what this--you know, it had never showed up. Was it the Taï Forest [ebolavirus], or was it--we did not know what the virus was. Then the Chinese and the Russians and the Canadians and the Brits and the Germans and everyone wanted to be in there, and I'm sure everyone was making sure that they had a little vial of blood with them when they went home. It's a good thing. I always supported my CDC virologists who wanted to get this, so I can't fault people from other institutions wanting to do the same thing. But it was an interesting [unclear]. 00:52:00A lot of laboratory people came down right away.

Q: To your knowledge, did a sample get sent to Kenema to the Lassa fever ward there?

ZINGESER: I don't know. I know that when Sierra Leone had the outbreak they did, but that was a disaster, what happened. There were a lot of political problems in that laboratory that I don't really know all the details about. At the time that I was in Gueckedou, we had Pierre Rollin and Dan [Daniel G.] Bausch out there. Dan is no longer at CDC, but he had been and his training--I think he really got his training under Pierre and the others who were here and Tom [Thomas G.] Ksiazek and people like that who were here in Atlanta. He knew as much as you could know about hemorrhagic fevers. He would have known to get a sample out to them [the Kenema laboratory] if something had to go out to them. By that time, we already knew what it was. By the time I got to Gueckedou, we knew that it was Ebola Zaire. But Pierre Rollin also knows all the people in 00:53:00Kenema. It was either Stuart or Pierre, I'm sure, who advised me to tell them to get a sample off. Which really was the right way to do it. If you have a laboratory in the region and you can just get in a vehicle and drive across--Gueckedou is right on the border with Sierra Leone. That's the right way to do that. As far as I know, that didn't happen. The confirmation was made in Europe.

Q: Right. That's my knowledge on that.

ZINGESER: And it came from MSF, and it's probably Institut Pasteur.

Q: Right. Okay, so you're making these calls, warning people. What happens now? Is this something that you are involved in tracking? Is this taking up a lot of time for you? What's the progression here?

ZINGESER: At that point in time, I had done my part and I was a distant spectator. After my discussions with Pierre and Stuart, it was very, very clear 00:54:00to me that my role at that time was to take the pressure off of the animal health side. Because the veterinary epidemiologists, the veterinary virologists and the animal health people were literally chomping at the bit to go rushing off to the forest around Gueckedou and try to find the animal reservoir that had spilled over into the human population, and I'm pretty certain it was Stuart who said to me, "We know that once you have human-to-human transmission, forget about the animal reservoir. There's not going to be another spillover event of any consequence. This is human-to-human, we know what to do, and if you have a 00:55:00bunch of veterinary virologists going out into the forest, it will only complicate things in an already complicated situation." So my role at that time as the expert now on Ebola in the FAO office was to convince them to hold back.

Q: These are FAO animal health people?

ZINGESER: These are FAO animal health people, and I have to say that my boss at FAO, a guy named Juan Lubroth, he actually is an American raised in Spain, but he went to school at the University of Georgia. A veterinarian with a PhD from Yale, so he went to a human--same as I did--he went to a human medical school for his public health epidemiology training, but is a veterinarian. And he's awesome. He is great personally, but also understands public health, and he 00:56:00understood right away when I said, "The monkey is dead. Whatever it was--bat, monkey, duiker, whatever it was. It's dead now, forget about it. It's human-to-human transmission we have to worry about. How can we help?" The first thing we could do is to make sure that everybody who was responding to the Ebola epidemic was somebody who could really move the response forward. It was a public health response now. We really worked at trying to keep the ministries of agriculture focused on working with the ministries of health. Not to get them to break off and start doing their own animal investigations. One of the things that can be a big distraction--everyone gets excited about the monkey or the bat. If you see the posters that say "do not do these things," right? Do not 00:57:00defecate in public. If you have a fever, go see a doctor--it goes down the line. And then there's a picture of someone with a bat or a monkey. Everyone focuses only on that picture of the bat or the monkey and they get all excited about that. It's distracting, and it takes away from the basic sort of fundamentals. If this was a basketball game, we would say dribble, pass, shoot, dribble, pass, shoot. Don't try to do layups and don't try to do anything fancy right now. We've got to play the basic ground game. Because of that, my job at that time was actually to put on the brakes.

While I was out in Guinea, on my first deployment--I went out in April of [2014], and I went out to be the epidemiologist in Gueckedou, not to be the 00:58:00country lead. It was really a problem in the Forest Region. There were some cases in Conakry, but it was really a disease of the Forest Region. I was there to support WHO. They had the office there. The hospital was run by MSF, and the laboratory was run by the European emergency virology team. I have to look up their name [note: the European Mobile Laboratory], but they were awesome also. Laboratory people in these epidemics are just perfect. They're really so good. When I was out there, I got asked to go back to Conakry and replace Pierre Rollin. No one can replace Pierre Rollin, but I was asked to be the response lead. In that position, I orchestrated a meeting at FAO's office in Conakry with 00:59:00the Ministry of Agriculture and the Ministry of [Livestock] together with Dr. Sakoba [Keita] from the Ministry of Health. We sat down and went over what are the things that we can do. We went over the reason why they don't need to be going out and doing animal studies. Our focus at that time--and they followed through on this--was, let's train ag [agricultural] extension workers to be communications officers. We asked Dr. Sakoba if he would have his education people do training of the ag extension officers. At that time, we thought the epidemic was waning. All signs were good. All signs were going very, very well until the last week that I was in Conakry, at which point the epidemic started to come up because we had outbreaks in several areas close to the capital, far from the Forest Region. Then we had more outbreaks in the Forest Region, but I was gone by then. I had already left the country. But I did the same thing when 01:00:00I went out in Sierra Leone. I went out to work with the Ministry of Agriculture to get ag extension officers to support health education activities, and also to do surveillance because they would know the signs and symptoms of Ebola, and to get them to report those. By that time in Sierra Leone, there was a whole structure for surveillance. Health education was just a mess in those early days. They just hadn't gotten the hang of it, and it's such a difficult disease to do health education for. I think a problem was also that there were just too many voices at one time. We had WHO people, we had UNICEF people, we had the government people, we had CDC. We had all these different groups that do health education, and you would think communications people would communicate well with each other, but it's difficult. No, they do not. [laughter] The thing about 01:01:00agriculture extension officers--

Q: Can you define that to me? Because I'm not sure that I know what that means.

ZINGESER: They have that in Iowa. Basically, what will usually happen is that alongside of the ag school at the university, there will be a USDA [United States Department of Agriculture] office--an APHIS [Animal and Plant Health Inspection Service] office or somebody from the government or somebody from the university who's paid by the government or the state to go out to farms and talk to farmers about diseases that are happening. Or to talk to them about better ways to plant crops. Or global warming has affected this, and we're going to change these practices. To try to get best practices to the people, to try to train farmers who had less education to improve their farming practices, whether it's rotating crops or whether it's different types of fertilizers. The same 01:02:00thing exists in Africa. A lot of that is actually supported by the Food and Agriculture Organization of the UN. FAO supports a lot of these government extension officers. Here's the difference between those agricultural officers and the health officers: the only health program that usually would go out to these remote villages in rural areas is the polio program. Polio gets out in these areas because polio has to vaccinate every child. So maybe twice a year they would see people from the Ministry of Health. But to have a bunch of Ministry of Health people or a bunch of MSF people or Red Cross people showing up in their village is very frightening because they've never seen this before. To have an ag extension officer show up was normal.

Q: Right. Because they're used to this program.

ZINGESER: They see the Ministry of [Agriculture] vehicle coming down the road 01:03:00and they say okay, he's bringing us fertilizer or bringing us seeds or bringing us vaccine for the animals--something. Something's up. They know people by name in the villages and the people know the name of the ag extension officers. They know the rotation cycle for when fertilizer comes out or when it's time to get new seedlings or whatever. That's what the Ministry of Agriculture does. The people are not afraid of ag extension officers. If the agricultural extension officer goes out and says, "Listen, there's a disease in another province and that disease is really a dangerous disease. It looks like this. If anything should happen, here's the hotline number for the Ministry of Health." Or to talk to people and say, "I understand that there are people who are sick in your village. Why aren't you talking to the Ministry of Health?" That may very well have helped out the situation. They are a tremendous resource.

I didn't have the resources to do a lot of documentation of what we were doing. It was a bad epidemic and it was raging by the time I went to Sierra Leone. We just went out and did it. It was all hands on deck. We were going to train everyone, and so we had hundreds of agricultural extension officers who were trained by UNICEF and the Ministry of Health in how to deliver health education messages. They did the same thing in my absence in Guinea. It's one of those things that doesn't get recorded very much. I don't know what the impact was because if you look at the epidemic curve of the epidemic, it seems that it really ran its course to a large extent. It's not as if I can say, two weeks after we started this intervention, cases stopped.

I also tried to deal with the secret societies, especially when I was in Guinea. I talked to the local veterinary officer. He told me, "I'm not a member of the 01:05:00secret society, but very good friends of mine are members of the secret society." And I said, "Can we get them?" Because burials are very important in those societies. I said, "Can we talk to them about what this epidemic means?" This is in Guinea. And he said, "Yeah, they would be open to that." We arranged all of that, for someone who was from the community to go and talk to the people in the secret society. But all of my dealings with the secret society were just wonderful because no one ever said to me, "I'm a member of a secret society." It's just like Fight Club. [laughter] Every time you hear somebody say, "I'm not in the secret society, but I know someone who is." Now I've seen from anthropologists, especially an anthropologist by the name of Paul Richards whom I worked with in Sierra Leone and whom I like very, very much. He's lived in 01:06:00Sierra Leone for a long time. It's Paul, just like it sounds. He's another Brit. He wrote a book that is well worth reading, and the book is how people became--I'd have to send you the name of the book, but it's Paul Richards. It's a very small book with big print. It's great. He says wonderful things in there about how people took charge of the epidemic. It's basically how epidemiologists had to learn how to be anthropologists and how people in villages had to learn how to be epidemiologists. People who were not being reached by the national program in Sierra Leone were finding their own solutions. Their solutions were oftentimes informed by the Ministry of Health or by other epidemiologists, but people found ways to help and protect their own communities. It's an interesting 01:07:00book. It's well worth reading.

Q: That sounds fantastic and that's kind of--I'm sorry, usually I try not to talk. But we have our exhibit and it's a point that I try and emphasize to people when we have tour groups coming in, that it's not all outsiders who come in with knowledge that that pour into locals or take control. So much of what stopped the epidemic was local people.

ZINGESER: [retrieves papers from work bag] That was one of the things that I gave to the students at Emory in this lecture that I just gave. I gave them as a reading assignment.

Q: I've read this before. Yeah.

ZINGESER: It's wonderful, isn't it? And Paul Richards is one of the people who wrote that piece.

Q: Article, Ebola: Limitations of Correcting Misinformation.

ZINGESER: For the record.

Q: For the record, yep.

ZINGESER: The same Paul Richards wrote this other book. He worked with us--he's 01:08:00really an agricultural anthropologist, so it was working with Paul in Sierra Leone on rabies before the Ebola epidemic that I got working together with him about how agricultural extension officers can help us out with rabies, which as a zoonotic disease, crosses the borders and people. He's a wonderful guy and an interesting person to work with.

Q: Do you mind if I back us up real quick?

ZINGESER: Sure.

Q: Okay, thank you. So how much time did you spend in Gueckedou when you got there?

ZINGESER: One month.

Q: You spent a month in Gueckedou?

ZINGESER: Oh, in Gueckedou? Sorry. I'm sorry. I spent two weeks in Gueckedou and two weeks in Conakry.

Q: Still, two weeks is a--

ZINGESER: I think it was two weeks and two weeks. That was because Pierre was really ready to go back. I would have stayed in Gueckedou. I wanted to be on the front lines, but the important thing was that they were shutting down the CDC laboratory at that point. As I said, the epidemic seemed to be waning. I took 01:09:00charge of that, but I also had to be in touch with our people in Gueckedou to make sure that they were doing to their jobs and not putting themselves in harm's way, which at that time was a serious concern. Listen, there were people who said to us, "We never see Ministry of Health vehicles out here. We've never seen an MSF vehicle out here or Red Cross, and two weeks ago, you came out and started talking to us. You drove out here in those vehicles. We had four vehicles come out here and then two weeks later we have people dying. What did you do? What did you bring to us?" That is perfectly rational, what they were saying. Our enthusiastic, hardworking epidemiologists were being targeted just for that enthusiasm, for going back out to villages and checking on people and 01:10:00going back out again. Because it just didn't add up to the people in the village.

Q: Do you remember any specific instances where it seemed someone was in danger, an epidemiologist?

ZINGESER: Sure. Two of my epidemiologists, KP [Kpandja Djawe]--you've already interviewed him?

Q: I haven't, but I've heard about him.

ZINGESER: KP is great, and Mateusz Plucinski. Plucinski, right?

Q: I don't know how to pronounce his name.

ZINGESER: But Mateusz and KP [note: Mateusz was actually not present for this specific incident] went out to a village with Madam Sia, who is one of our health educators who was at the very beginning working with us, "us" being the Ministry of Health in Gueckedou. I had her younger sister working under me in 01:11:00the very end of the epidemic, and she told me that her sister was still working in Gueckedou. She speaks Kissi language, and she was really doing the communications with people, with the Kissi community, which is the major ethnic group where we were in Gueckedou. She was out, and several vehicles went out to this village that was recalcitrant. This was a village that was very resistant to having healthcare workers go out, and they were sure that there were sick people in this village. We had some people go out, and the people in the village said, there's no one sick here. Go home. We don't want to talk to you. And they went out again, this time with the mayor and with some other authorities from the region, probably the medical officer. And they were told, "There's nobody sick here. You cannot look at the house. We will not line up the kids for you to look at them. Go home." So they decided to have a third trip, and KP and Mateusz 01:12:00were on that trip and they went out. Madam Sia was with them. It's KP who has to tell you the full story on this one, but the way I understand it was that Madam Sia said to the drivers, "I want you to turn the vehicles around. I want you to go down the road just around the bend. Don't stay here in the village. Go around the bend and keep the motors running."

Madam Sia's very sharp. They were having discussions with the people in the village, and they were getting heated, and at a certain point, Madam Sia just turned to my epidemiologists and she said, "Get back into the vehicles right now." She said, "Run and get in the vehicles." Suddenly, young men came out of the bush and they had--I think they had pangas [machetes], and they had rocks 01:13:00and sticks, and they chased them. But the vehicles were already running and they were around the bend prepositioned to head out. Madam Sia saved our people. Now, they got into that village and they got the sick people out, but it took a lot of negotiations.

I received a telephone call in March while I was in Rome, and it was Stuart Nichol, and Stuart said, "Jim, it is Ebola." At that point, we didn't talk about epidemics. It was an outbreak. We've never seen an outbreak in West Africa, but it's definitely "Ebola Zaire," (which later turned into just "Ebola virus"). But, "It's Ebola. We're going to do everything that we can." This was probably the point where we talked about, "Forget about the monkey, we're going to focus on human-to-human transmission." But he said, "I was looking through out CDC 01:14:00database for French-speaking epidemiologists with experience in West Africa and your name was at the top of the list. Will you go out to work in Guinea?" I said yes. I think the first thing he said was, "Would you be the team lead in Guinea?" And I said, "Stuart, you know that I've never seen an Ebola case. I am not an expert on hemorrhagic fevers, and as much as I like working on these things, to take a lead position is maybe asking a little bit too much. I don't know if I could do what you want me to do." Stuart said, "Don't worry about it. You can do everything we need you to do." He said, "You know the science, and this is more a job for mediation and organization." And he said, "You're a fluent French speaker with experience in West Africa, you're the person we need. 01:15:00I'm sure that you can do this."

I negotiated to spend my first time in Gueckedou so I can actually see Ebola cases so I could work with the laboratory people. I could get my firsthand experience. I would hate to go in as a bureaucrat in the capital, never having seen an Ebola hospital and Ebola cases. I was able to go out. In fact, at that point in the epidemic, I was close enough with the docs [doctors] who were out there that one of the--he was a US Navy doctor who was in Conakry, and he had me gown up and go in. I put on the full PPE [personal protective equipment] and I went into the isolation ward and got to see exactly how they do Ebola treatment and how they care for the patients. It was a great experience to be able to do all this. But I also got my fieldwork as an epidemiologist in Gueckedou. I was asked to go out, and I personally asked if I could go to Gueckedou first, but 01:16:00the deal was that I was going to go and replace Pierre and do the [unclear]. But even what Madam Sia did with that vehicle and with the people in the village, trying to finally get them to bring out the sick so that they could be tested and treated, that's really about building trust and mediation with other people and it goes way beyond the regular training that we get in public health. That's absolutely essential.

Paul Richards is the one who said that Ebola is a complex disease because first you have Ebola virus disease, then you have Ebola panic disease. It's true. These diseases will engender a really great deal of fear and panic on the part of the communities. I think because it hits us in our most vulnerable place. 01:17:00It's killing our close and beloved family members and we are being punished for caring for the sick or burying the dead. It just scares people, I think, beyond other diseases that are terrible diseases that people say well, it happens. Rabies is the most awful way to die that I can think of if I were to catalogue these things or to have a child who gets bitten by a rabid dog and see them descend into rabies. It would be horrible. Yet as fearsome as rabies is, it doesn't create the sort of panic that you get with Ebola. It's a very special sort of an epidemic, as we learned.

Q: I need to take a moment here. So you're good until two? That's okay?

ZINGESER: Yeah, and I can come back some other time.

Q: Okay, that might be good, too. That might be really good. You mentioned that when you went out to Gueckedou, you went out because you wanted to see things firsthand. Didn't want to be the bureaucrat, understand where the rubber meets the road.

ZINGESER: Right. It's also really difficult to make decisions about things if I don't know what they're doing in the field. Now, Pierre or Stuart or any of those guys would know right away exactly what they're doing in the field because they've done it a dozen times. But I needed that firsthand experience.

Q: Tell me about gaining some of that. Tell me about something that you saw that stayed with you, that shaped--

ZINGESER: The first one was to see the clinical situation and to understand what 01:19:00MSF was doing now. Remember, MSF's culture is very much--even though I was CDC, I was there under WHO, and they always wanted to maintain a difference. We had to build the relationship with their epidemiologists to get information on what was happening in the hospital. Luckily, I was very close with the virologists who were out there. In particular, Ed [Edmund N.C.] Newman who was terrific. He was the head virologist at that time and Ed was very transparent about the data. They belong to the Ministry of Health. He made sure that what was happening in the clinic--how many people were confirmed as being sick, and how many people were ill that we were waiting for confirmation or whatever--how many deaths there were. We got all of that right away. Ed was one of the people who put together the line that traced back to the child in Meliandou. He was one of 01:20:00those people, along with Sylvain Baize and the others. I learned a lot about how their laboratory worked. That really stuck with me, was how they put together a really fine high-tech laboratory under those conditions. But it was also really important for me.

I was given the responsibility by WHO to go along a certain line that went up through villages to the next city from Gueckedou in that region. I would go from Gueckedou to Kissidougou and would check all the health facilities along the line and, as was normal for the way that I work, we organized to have community meetings with various communities in health centers--to see if the health 01:21:00centers were responding well, and to see if the people knew about what this was, and to sort of get feedback from people. You know, "Do you understand?" "You tell me what's going on." "Tell me what this is." Because, we can talk all we want in our language--with our [own] concepts of what is happening, but they are [our] constructs. We have to understand the world, and that other people have other constructs. We have to find a place where those [worlds] meet together. I had wonderful meetings with people trying to understand what they thought was happening, and would they--or would they not--be reporting these things, or sending people to the hospital if someone was sick. One of our biggest problems was that there just wasn't decent ambulance service. If people did call in to say that they were ill (this was before there was a hotline or anything like 01:22:00that)--if people telephoned the hospital in Gueckedou, they couldn't rely on someone coming out. And the waiting is horrible. The waiting is a terrible thing.

I was really impressed that the Forest Region of Guinea looked to me like Cameroon twenty years before--the roads were all broken up. In Africa, there has been a lot of progress made. A lot of progress made in communications (cell phones revolutionized a lot of things). A lot of progress made in commerce. And [yet], a lot of that depends on having decent roads. And the roads in the Forest Region around Gueckedou (Macenta was another story), but [around] Gueckedou--they were a mess.

You could see how difficult people's lives were--there was a real lack of clean water, or sufficient water, to keep things hygienic and clean. We were out giving people chlorine to put into their jerry cans so they could do that. I 01:23:00still have clothes that have splotches of bleach on them because there were some clinics that we went into and I would say to somebody, "What are you doing with the chlorine to try to keep people from--?" "We use chlorine on every person that comes in." In one place, they came with a bottle and they poured it on my hands--it was straight bleach and it splashed all over my clothes. (I kept the shirt that has all the big chlorine splotches on it.) We had to say "No! no!" What we knew at that point was we had to get a hygienist or an environmental engineer to go out and start training people how to dilute, how much to use for dilution, how to know that it's working, how to smell it and make sure that you don't have just pure water in there or whatever. It was a real lesson. One of the doctors who I worked with who came from Gabon, and he came from the 01:24:00laboratory in Gabon--they have an excellent laboratory there, and he was out helping us. I traveled with him to go to some of these clinics. The first trip that we made, we made together. Then he went to Macenta and I went to Kissidougou. We took two different tracks. I talked to him about epidemiology and he talked to me about virology. We were in Macenta and we had been at the hospital in Macenta and he asked, "Are there any Ebola survivors around here?" Somebody said, "Yeah, there's an old man who lives right around the corner." So he said, "Take us to him." We went there, and he did something just absolutely wonderful. Without making a big to-do about it, he had us take photographs with he and I with our arms around this old man who was an Ebola survivor. He said, "Look, I've been through a bunch of these epidemics, and you people are going to see us doing this, and it's going to do a lot to help to remove the stigma from 01:25:00this old man who has already suffered enough." Everyone else in his family had died. He was the only one left. Those experiences were really good experiences to learn in the middle of a terrible epidemic.

Q: Thank you. That gives me a sense of what you saw and experienced there that would have been invaluable to have once you went back into Conakry.

ZINGESER: Yep. In Conakry, you have to understand that the way that they set it up was a little bit strange. They brought in a bunch of people. It became more dramatic later on, but they put us--the embassies insisted we go to these four-star hotels. They put people up in these luxurious hotels. It's very difficult to understand what's going on in a place like Gueckedou where the power was going off all the time. There was not a hundred feet of solid concrete 01:26:00road anywhere that you could go. Then you go back to Conakry where there are restaurants and things are bustling and moving and you're staying in a very nice hotel with wireless, and telephones work, and all that. It was important to be out in Gueckedou.

Q: One of the first articles that I read when I took this position as the Ebola oral historian back in 2015 was, there was an article in The New York Times that came out in December 2014 called "How Ebola Roared Back," and it talked about that interim period in April, May, when it appeared like Ebola, all signs indicated that it was on the downswing.

ZINGESER: Right.

Q: That this is going to be not too different from the Ebola epidemics of the past. In my interviews with Pierre, he's talked about how when he left Guinea, 01:27:00it wasn't over, but it really certainly seemed like it was going to be over soon. When you have since looked back at that time and knowing that things did erupt later and became the worst epidemic of Ebola in history--

ZINGESER: It is the one epidemic.

Q: The one--you're right. We've had outbreaks.

ZINGESER: We've had outbreaks, but this one--I remember at a point, Tom [Thomas R.] Frieden was talking about the Ebola outbreak, the Ebola outbreak, and I was looking at the numbers. I wasn't here, I was in Rome, but I was talking to my group in Rome and I said, "No, this is an epidemic." I said at some point when you see that number of cumulative cases, when it goes up like that, this is not an outbreak. Let's not try to--

Q: Downplay it, yeah.

ZINGESER: Yeah, let's not be polite about it. This is a real epidemic. But if I can, let me correct Pierre using Pierre's own words. When Pierre handed things over to me, he said very, very wise things, as he always does. The first thing 01:28:00he said was, "I told the president that if this thing comes back--" so he was already thinking, if this thing comes back-- "you need to get the military out and we need to have ambulances going up and down all of those roads in the Forest Region all the time. The way to do it is the military." I thought, "Wow! You're jumping--the cases are coming down and you're saying now that you told Alpha [Conde], the president, that if this thing comes back, we have to scale up and we have to scale up big."

The other thing he said to me was [when] we were looking at the map, and Lofa County in Liberia had already said "no more cases." We were going to shut down 01:29:00the shop there. Things were trailing off in Gueckedou, and we were sending the laboratory people home from the laboratory in Conakry. I was overlapping with Pierre. I said, "Pierre, it just doesn't make any sense to me. We've got all these cases that were here in Liberia and all these cases that were here in Guinea and they wrap right around the Kailahun region of Sierra Leone. And Sierra Leone is still saying zero cases." Pierre looked at me and he said, "Jim, if you don't look for them, you're not going to find them." He was thinking, as I was, that something's going on, and there were certainly cases that were going unreported in Sierra Leone, to say the least. At least we were looking for them in Liberia and in Gueckedou and in Guinea. But those borders are porous and a 01:30:00lot of truck traffic goes across those borders. If somebody dies in one country, their burial may be in the other country. None of these things were surprising, and it came roaring back.

The thing that was surprising about it coming roaring back was that it was a taxi-driven outbreak. It was not just outbreaks that were in contiguous areas where people could travel to go to a funeral or where people would go to a hospital and then that community around the hospital. It was someone who felt sick and they said, "The only place I can get proper care is in Conakry." And they'd get in--or in one case, a family that was on their way to Bamako, Mali. That's how we got these cases going into Senegal. (Senegal was a student, I think.) But we had people in taxis going long distances, and that is the new thing. Communications and roads really changed this--people could get in a taxi 01:31:00to go see their doctor halfway across the country or all the way across the country. That was something new. It was a very interesting outbreak.

Q: What was your communication like with--did you have any communication with the Sierra Leonean government trying to inquire, are you guys checking out what's going on in Kailahun?

ZINGESER: That would have been--I did not and I didn't try. I was focused on my people because I had a group of young epidemiologists who were out in Gueckedou and I felt my responsibility was to make sure that everything was safe and that they were doing their jobs. Nothing was getting in their way. Remember, I told you about working under Rick Vogt. I learned a lot from Rick Vogt. One of the things I learned from Rick was take the barriers away from your young people so that they can do their jobs, and that's where I saw my role, as taking away the barriers for them to do their job. So it was negotiating with WHO. Going to a 01:32:00lot of WHO meetings. Negotiating with the Ministry of Health and making sure that laboratory support was there (it wasn't the CDC lab out there). That's what it was--and making sure that they stayed alive. [I will be] thanking Madam Sia forever. That's what I saw. I would imagine--knowing how things work--that if CDC got in touch with the Ministry--they would probably get in touch with the Ministry of Health in Sierra Leone through WHO. And there, for me, the thread ends. I would not know what the discussion was between WHO and the Ministry of Health in Sierra Leone. But it may very well have been, "We've checked with all of our health centers and there is no Ebola." It didn't make sense to Pierre at that time, and it didn't make sense to me at that time.

Q: Interesting. If we had a lot more time I'd want to ask you to describe your 01:33:00young epidemiologists a little bit. But we're verging on two o'clock, and I know you've got to run. Would it be possible to get you back in here?

ZINGESER: I'm gone all next week, but then when I come back--I'm going to be busy, but I enjoy this. I think it's important to have these interviews.

Q: It's really important, and you're a good storyteller, and so we've got to milk this. [laughs] Thank you so much, Dr. Jim Zingeser, for coming in and being part of this CDC Ebola Response Oral History Project. It's a pleasure to have you here.

ZINGESER: Likewise. I enjoyed it.

Q: Great.

END