Walter Dowdle



CRAWFORD: Today is Friday, November 3, 2017, this is Hana Crawford. I am interviewing Dr. Walter R. Dowdle for the Global Polio Eradication Initiative [GPEI] History Project in the Broadcast Department of the Centers for Disease Control and Prevention [CDC] in Atlanta, Georgia. Mr. Todd [F.] Jordan is our studio engineer and videographer.

Dr. Dowdle served as director for the Virology Division at CDC from 1973 to 1979, assistant director for science at CDC from 1979 to 1983. He served as director for Infectious Diseases from 1980 to 1986, and he was acting director at CDC from 1989 to 1990. Thank you for being here. In 1994, Dr. Dowdle retired from CDC and moved over to work at the Task Force for Global Health, where he served as director of the U.S. Polio Virus Laboratory Containment Preparedness and as director of the Polio Virus Antiviral Drugs Initiative. You've had a very long career, and thank you for being here today.

DOWDLE: Thank you.

CRAWFORD: We'll be discussing your involvement in polio eradication, expanding the program even before [the CDC] Polio Eradication Activity [PEA] had a name, here. To begin, I'd like to record your verbal consent. Do we have your permission to interview you and record it today?

DOWDLE: Yes, you have my permission.

CRAWFORD: All right. If you would, introduce yourself by name, say where and when you were born and briefly, a bit about your early life and education leading you into microbiology.

DOWDLE: My name is Walter Reid Dowdle. I was born on December the eleventh, 1930 in a small town in South Alabama, and from there I went into the military, after one year of college, and [served] during the Berlin Airlift and the Korean War. Then after that [experience], I pretty much had formed what I had planned on doing. [Because] I was in the [U.S. Air Force] Medical Corps during the Korean War, I thought I was more interested in patients, but [later] realized I was more interested in the scientific side. [When] I was discharged from the military [after four years], I went into school with the objective of microbiology and of course, eventually, virology. I pretty much followed through on my basic interests, and everything just worked out fine.

CRAWFORD: What interested you about microbiology and virology?

DOWDLE: Well, at the time, [there] was really quite a lot to do. I mean it was clearly a field where it was wide open. [There] was a whole lot being done and being learned, but it was also a field--[that] was obviously something that was exciting [with] much more to [come] in the future. I like to tell the story that when I got here, to CDC in 1960, that Alexander [D.] Langmuir [MD, MPH], who was an epidemiologist, used to say that the only reason for the lab [laboratory] is for the epidemiologist to be able to confirm that they were right. We used to make a [joke] of that, but in many respects, he was correct.

I mean, there was just so much the laboratory couldn't do, because at that time when I first came in, we didn't know what caused the common cold. I mean just stop to think about that. Now we know, you know, [and] have for years., [We] had never seen the measles virus. All these things were completely new. We knew a lot about polio and knew a lot about influenza, but there were many--[unknown agents]; hepatitis viruses [now five] had not been isolated. None of the other [respiratory viruses]--the coronaviruses, the many viruses that we [now recognize], none of those had been isolated. You see, it was a totally open field.

My career here at CDC, well, even beginning before that, because [of] the work I did at the University of Maryland and the work that I did at the University of Alabama was [during] an era where everything was just so exciting; everything was happening. Tissue culture, which is the whole basis for the polio vaccine, was actually developed while I was still in graduate school. Just think how all this was happening, all this expanding at the same time, extraordinary exciting times.

CRAWFORD: I remember you saying over the phone [in the pre-interview] that one of the strains of virus in the vaccine was developed in Montgomery [Alabama]. Is that correct?

DOWDLE: Well, that's correct. In fact, Montgomery was the site of the virology laboratory at the time CDC was formed in the 1950s. The virology laboratory was [located] in a [group] of unused Quonset hut at Maxwell Air Force Base in Montgomery. At that time, there were a number of people back in the early '50s, who were working on a live polio vaccine, not just [Albert B.] Sabin [MD]. In fact, Sabin was one of many. Probably the most advanced work was done by Hilary Koprowski [MD], who was also interested in live polio vaccines and developing strains that [would] actually [immunize], but not cause disease. The same was true in Montgomery. The CDC laboratory there was working on strains, in fact, the strain that was used in the trivalent [oral polio vaccine, tOPV]--that means, [of] three vaccine strains in the Sabin oral polio vaccine--one was the strain that was developed by the CDC laboratory in Montgomery.

Because there were so many people trying to develop [vaccine] strains and so many people competing, there was a meeting to decide which strains would be the best to go forward with and somehow, Sabin strains actually were seen as probably the most reliable and the least dangerous strains to use. One, of course, was the strain from the CDC lab, which Sabin had gotten and made one or two more transformations before presenting it as a strain, which would be part of the vaccine. To make a long story short, once these strains were selected, then the message went out, no more polio research by the other organizations, because you had to go forward and use your resources for developing one vaccine and that was the Sabin vaccine. Actually, Sabin strains came from several different places, one being from CDC.

Of course, this was in [1959.]--At that time, the CDC lab in Montgomery was, as you could say, a little devastated by having this program taken away from them. The laboratory director at the time was Morris Schaeffer [MD, PhD]. Morris Schaeffer left CDC to become the health commissioner of the City of New York. The other person who was involved was C.P. Li [sic] from Taiwan, and he went, I think, eventually back to Taiwan. The laboratory in 1960 moved here [Atlanta]. It was a very early involvement in polio [control].

CRAWFORD: In 1960, you came to CDC. Did you come directly from University of Maryland?

DOWDLE: Yes, I did.

CRAWFORD: OK, and you walked into this milieu of opportunity in your field of study.

DOWDLE: Right.

CRAWFORD: Could you talk about when you first came here?

DOWDLE: Well, when we first came here, the building, which of course no longer exists, but the building was so-called state of the art at this time. The building, interestingly enough, had restrooms for white and colored. That is hard to believe, but it did. Now the plans for these buildings were actually designed or were drawn up in the probably mid-'50s, '55 or something like that, and that was standard. When we first entered the building, I mean everybody, you know, said--well, even the--well, everybody at CDC said, "We can't do this. We can't do this at all." The decision was made that all the extra restrooms that were considered to be colored restrooms were given to the women. This is probably one of the fairest decisions that have ever been made.

The women ended up with at least, probably a three-to-two ratio over bathrooms in the building, and I thought that was remarkable. I thought this is a great place to work if you can make those types of decisions. Then we had things like rugs on the floor that were supposed to be filled with formaldehyde or some disinfectant to walk on. I mean, it was incredible.

All of those have gone by the wayside and went by the wayside pretty quickly. But it still was an inadequate building for infectious diseases, and so we had problems in the building, of course, for transmission, at least. We had a couple of deaths back in 1977 of Rocky Mountain Spotted Fever, and that's what finally sort of stimulated a little movement towards developing the laboratories and buildings that were more safety focused than we'd had before.

CRAWFORD: One follow up question to segregated bathrooms at CDC in the '50s and '60s: were people segregated from each other?

DOWDLE: No.

CRAWFORD: Did it impact the working culture?

DOWDLE: No. In fact, not at all. I mean, the five years there between '50s, you know the early '50s and by the time the building was actually built, I mean and from a social standpoint, the changes were enormous and so this was not a problem. In fact, from the beginning here, there was a real concerted effort to make sure that we were totally integrated and a real effort to try to make sure that there was no distinction. One of the reasons--well, the big problem was that we had, for example, visitors early on from African countries and this type of thing, and then finding places for them to stay right near--we finally made arrangements for certain places that we could have the visitors stay.

CRAWFORD: Where were some of those places?

DOWDLE: Well, part of it led to the development of the International--I'm trying to think of the name of it, it's right over here, it's the international house that actually serves to house visitors for both Emory [University] and CDC.

CRAWFORD: Is it Scarborough?

DOWDLE: No, it's right here on Clifton Road. I'm sorry, I can't remember the name of the place now [Villa International]. But it's still in operation, and it was actually--that's part of the reason for it to be set up, so it would be a place where you could actually house people of all races, and it would make it convenient to be near the CDC.

CRAWFORD: At that time, was CDC seen by other agencies as being progressive?

DOWDLE: Well, but see, most of the agencies of this size were located in Washington [DC]. We're one of the few agencies that are outside of Washington, so they assumed that you had to at least abide by the mores of the location, and so that's where the assumptions came from, I guess. But that was not true. CDC was quite a leader and in fact, breaking down the barriers to full integration.

CRAWFORD: And that happened at an institutional level, right? With changes in the bathrooms, reassigning bathrooms to women?

DOWDLE: Yep.

CRAWFORD: But what about on the interpersonal [level]?

DOWDLE: Oh yeah, it was all through it. It was no problem. Believe me, it was a wonderful place; there's never been problems like that. I mean, starting from the top, you know, the top was very progressive, and I think most people who work in public health are--you know, that's not an issue. I mean, in fact, it's an issue, but the other direction, you know. So once again, it made me really proud to be hired by an organization with this type of spirit and this type of sensitivity.

CRAWFORD: To return to the labs, there are two different directions I have in mind right now. One is to ask you to describe the new facilities as CDC lab facilities became more safety-minded. But also, I wanted to ask you about--you said over the phone in our pre-interview that you knew [Jonas E ] Salk [MD] and Sabin personally, so I wanted to find an opportunity to talk about that, as well.

DOWDLE: Well, interestingly, my direct involvement with both Salk and Sabin came not through polio, but from influenza, and for about ten years there, I guess, I was the director of the [World Health Organization International Influenza for the Americas, Atlanta, Georgia, USA] for the Americas. [There] were two [global] centers. One was in Atlanta, which we operated here, and the other one was in London, England. And between the two of us--and it's still true, but some variation--but from the two of us, we pretty well had networks out in both hemispheres and so therefore, we had all the Americas. The European facility in London had all of the other laboratories in the world. That's how I first got involved in networking and setting up labs in all these different places.

To make a long story short, when the 1976 Swine Flu Vaccine Program [National Influenza Immunization Program, NIIP] was finally enacted, then Sabin was one of the [signatories] of this action and encouraged [the administration] to ask Congress to fund such a program. Sabin then later changed his mind, [deciding] that there was no evidence of [swine] virus [circulation] and, therefore, couldn't support [the program] anymore. That led him into other interests in influenza, and then he became convinced that influenza vaccine wasn't very effective against elderly Americans, I mean, against flu for elderly Americans. He was absolutely right, and I didn't have a lot of complaints, but I seemed to have been a target of Sabin, Sabin's target. I'll always remember that Sabin would call up--he had a lot of interest in this, and he was going to push this--if he wanted something, it was always, "Walt." If he called me up and [said], "Dr. Dowdle," I knew I was in trouble. It was an amazing relationship, but actually, I really enjoyed it.

We had an occasion one time where we were to debate the immunization program for elderly adults and the effectiveness and practicality and all this sort of thing. We were scheduled for this television debate out on Long Island, in New York, one of the studios in Long Island, and so the morning we were to be picked up by this limousine. We were staying in different hotels. I'm sure mine was a little--a few dollars down from his, but when we were picked up, we were picked up by the same limousine, so we sat in the back, and there was a snow storm. It took hours and hours to get out to the Long Island studios, and during this time, we had the whole debate in the back of the limousine. By the time we got to the studios, we had pretty much agreed on what we were going to agree on, and it was--I don't know that that program ever aired. I don't think I ever saw it. There may have been parts of it, but I think it was pretty much a disaster. So that's one of the things I remember about Sabin, and there were other issues.

Also, I think that in regard to Sabin and regard to polio, one of the most, I think, interesting aspects of Sabin's interest in Brazil and really pushing these eradication programs, always omit the fact that his second wife was Brazilian. She played a remarkable role, a very, very important role in his life. I mean to see the two of them, I mean, her Albert--"my Albert," she referred to him--her Albert was, I mean, on a pedestal with her, just constantly. She happened to be the daughter of the owner of what at that time was the equivalent of Time Magazine in Brazil--very powerful, very wealthy, very politically-connected family--and so his sort of, you know, [interest] in Brazil--really a lot of it was due to her. I often thought how little credit she's gotten for it; I'm sure he wouldn't agree to that, but how little credit that she got.

Then we discovered-- Olen [M. Kew, PhD] and his group--[a polio outbreak caused by a] circulating vaccine-derived polioviruses, where the virus clearly had to [have] come from continued circulation of a vaccine virus. I remember specifically talking to her about it. She said that she thought it was wrong [and] that we [had] actually created a problem [with] Sabin's vaccine and his image. She was very upset to the point that she was crying.

CRAWFORD: Where did this happen? Where did you--?

DOWDLE: He was dead. He had already died when this came--and when I was talking to her.

CRAWFORD: But where did you see her?

DOWDLE: I don't remember where the occasion was, but I had known her. I mean we had crossed [at] different [professional] events and this type of thing, not in a social setting, unless you call those social settings. But, she's a very remarkable person and so intense in her support of Albert and the polio program and everything else. She's quite a remarkable woman. The fact that she was so tied-in to the Brazilian political situation made it also possible for Sabin to have in-roads into the polio program there. Of course, we all have to say: Brazil was the beginning of the polio eradication program.

CRAWFORD: Do you have a sense of any of the details of how that evolved?

DOWDLE: Of the details in Brazil?

CRAWFORD: Yes.

DOWDLE: Well, it was very stormy. I mean, it really was. They had various different starts, by the way. It had nothing to do at that time with eradication; it really had to do with just control of polio in Brazil. They tried a number of different ways, for twenty years, to eliminate polio in Brazil, and they just couldn't. To make a long story short, Sabin was pushing mass immunization. They went to mass immunization, but it wasn't successful, because they really didn't have the control or the organization that was needed. Finally, instead of state control, they went to federal control, and that pretty much worked. That pretty well set the standard for the type of approach that would be used in other countries for polio eradication. It was federal control, immunizing all the children in the country up to, at that time, three to five years [of age] with two drops of polio vaccine, two months apart. [This strategy set] the way and the format for the [polio eradication] program [of] the future.

CRAWFORD: That happened after Cuba?

DOWDLE: About the same time. The first attempts in Brazil were actually mass immunizations, but they weren't done very well, and that was the same time as in Cuba. Of course, [the Cuban strategy] worked, but the reason why nobody picked up on the Cuban program is because they said number one, Cuba was communist and therefore, they could [force] everybody to do this. [Number two,] Cuba was an island, and therefore, you didn't have importations and [continued] circulations, like you did in other countries. Basically, everybody dismissed Cuba, because they said, you know, it was just not a good model for the rest of the world. Well, it turned out it was more of a model than people thought it was, and getting around to that was what took a little time.

But at the time--we were talking about Sabin's involvement--this was in the '80s, and pretty much--yeah, I'd say pretty much from '85-'86 and that period of time.

CRAWFORD: Did you know Ciro [C.A.] de Quadros [MD, MPH]?

DOWDLE: Oh yes, very [well]. I think that when we go back to the beginnings of the program, the person [who] doesn't get a lot of credit, [and who] I think deserves a huge amount of credit, was Dr. [Joao Baptista-] Risi who actually was Ciro de Quadros' boss back during the smallpox eradication days. All these people were in [the] smallpox eradication [program], and that was--again, it was these people who had this eradication mindset in Brazil that made the whole thing happen.

CRAWFORD: Could you describe the eradication mindset?

DOWDLE: The eradication?

CRAWFORD: Mindset.

DOWDLE: Oh, the mindset, the eradication mindset. Oh. Well, I mean, the eradication mindset is fairly straightforward. It's, "Hey, what's the ultimate goal of public health? Doing away with a disease, right? So that should be the goal of every public health program."

CRAWFORD: But not everybody answers that question in the same way? What is the goal of public health? Primary health care.

DOWDLE: Oh, yeah, yeah, but I mean, we think of it from the standpoint of infectious diseases. Yeah, it's not--you don't want to waste your time sort of administering to the effects of the disease; you just want to get rid of it. I mean why have it around? If you see that you can eliminate a disease within countries, why can't you apply that widely? I mean, why just keep spending money and spending money without doing the job?

CRAWFORD: So [Batista-Risi] was an eradicator.

DOWDLE: Yeah, pretty much. Well, he was actually, I [would] think, a superb organizer and good motivator. He was head of the federal program at the time. Sabin would run hot and cold, you know, at times praise them and [other] times just create huge problems, because he was so critical of the program.

What I will say [is] that the other thing they introduced was a laboratory component to the program because up until then, it was mostly lameness surveys or [clinical] evidence of poliomyelitis. In fact, the laboratory then was brought in to confirm that it was polio. As time went on, the laboratory program, instead of being hindsight became the engine that moved the program, because not only could it confirm that it was polio, but also distinguish whether it was vaccine or wild virus. But also, it got to the point [where the laboratory] could determine by sequencing whether or not it was [vaccine or wild], how long it had been in circulation, [and] where it came from. I mean, it's just an incredible program, which is another [story]--but back to Sabin and Salk.

That was the story on Sabin pretty much, but Salk also [worked with] influenza. In fact, [Salk's work] with influenza vaccines to improve them, to further purify them, make them so that they were less reactogenic, increase dosage, and so and so [was cutting edge]. Probably some of the best work that Salk ever did was prior to [his] polio work [was when] he was working with influenza vaccine. That's probably the reason why he was selected to work with [the killed] polio vaccine. These were both inactivated vaccines, so it [meant] that the techniques were very similar [in theory]. [All] he really needed to do was [apply] his expertise in influenza [vaccines] to [develop a] polio vaccine. That was the concept [at] the time, and it pretty much worked that way, except by that time, it was [already] possible to use tissue culture to grow the virus. [His group introduced] tissue culture [for polio vaccine production], which was something new.

CRAWFORD: Did that enable the vaccine to be mass-produced? Is that part of that story?

DOWDLE: Yes. Yes, it's the actual formulation of the media that would grow the tissue culture [cell culture]. It was called "tissue culture" [then], and "cell culture" now. But yes, that allowed the whole thing to [succeed]. [Growth of the virus and] the ability to concentrate the viruses; all came together about the same point. [Both] happened to be [technologies] that [were] developing at the time.

Then my memory of the two of them--later, I also had more [interaction] with Salk on HIV [human immunodeficiency virus] vaccines, [when] he decided he was going to get back into the vaccine business. Well, it didn't work. I mean it was pretty dismal [attempt], but he was at the age--he didn't quite understand how dismal it was, but anyway, it didn't work.

I'll always remember [one incident] at a meeting on influenza and the efficacy of the vaccine. Salk [was] sitting on one side of the table and Sabin on the other side of the table. [They] were discussing a paper that I had written a few years before. They both got into this discussion, and one or the other, I forget which, says, "That isn't what he said. What he said was so and so." Here I was, sitting there. I finally asked him, "Can I say a word?" I'll always remember that as probably the--

CRAWFORD: Do you remember what you said?

DOWDLE: Well, I said, "You're both wrong," is what I started out saying, and I forget all the content. That was some years ago. That's a little [humorous] incident I'll always remember.

CRAWFORD: That's great. I wanted to ask you, too, for your memories of first meeting each of them.

DOWDLE: Well, [not unlike] so many other [instances], you know, the way you meet these people who are, at that time, very famous and this type of thing. You [first] see them at large conferences. [You] see them, but you don't really know them, but at least you know who they are, and you feel like they are people [like everyone else]. They are not entirely foreign to you. It's not so much worshipping somebody from afar; you gradually see that they are human like other people. So, then, as circumstances arise, you may get to know them, actually, personally.

CRAWFORD: Do you remember the first time you spoke with Albert Sabin?

DOWDLE: No, I don't know that I could identify [a first time]. He was incredibly--I mean he could be extremely cruel to people, or to put it another way, he didn't suffer fools gladly, and unfortunately, many people he met were fools [in his eyes]. Having said that, on the other side, he could be extraordinarily gracious and very kind. I always had a good relationship with Albert, and it wasn't always in agreement, but I never had a real problem.

CRAWFORD: I'm wondering about the story of how that relationship kind of cemented itself, how it developed--like how did you get to a point in your relationship with Albert Sabin at which he would pick up the phone and say, "Dr. Dowdle?"

DOWDLE: Oh, I'm sure it was totally initiated by him. But again, we'd met at meetings and smaller and smaller meetings, and you know, these smaller meetings--in fact, I spent I want to say, must have been 1975, I spent a week with Sabin at a [small group] retreat in Switzerland. I mean, just to give you an idea, and that's where I also got to know his wife very well.

CRAWFORD: What was the occasion for that? What was that retreat?

DOWDLE: We did a retreat to try to make a decision on, "OK, where do we go next on influenza vaccines?" you know, "What road should we take?" because we weren't all that happy with the efficacy of the vaccine. What might be next on the horizon? There was this small meeting, primarily organized by the World Health Organization with the two influenza centers that I referred to earlier and then a number of other experts that were involved. It was in Rougemont [Switzerland], which is just north of Geneva [Switzerland]--I'm sorry, east of Geneva.

CRAWFORD: How about Salk? Do you remember the first time you met and spoke with Salk?

DOWDLE: No, again, it's, you know, the large meetings and then you know [the pattern], but he was not as much involved. I think my better working relationship with Sabin, actually, occurred after our debate that fizzled out in New York, because we had a lot of time to actually work it all out.

CRAWFORD: That's great. You were working in flu, how did you come into polio?

DOWDLE: Well, actually, being a virologist, I'd worked with polio in graduate school along with other viruses. At the time--this was at the time before a live vaccine had been licensed when I was in graduate school, so we were still all caught up in the development of the live vaccine. By that time, of course, the killed vaccine, Salk vaccine, had already been introduced, but so yeah, we worked with the polio strains, and it was one of the things we were all sort of excited [about]. I mean after all, it was a major, major accomplishment of the time, so polio was a big thing. So, my interest in polio really came from then, at that time.

Then when I came to Atlanta and was working with influenza and other respiratory diseases, the polio lab was right around the corner, and so we had a lot in common, in terms of techniques used and so on and so forth. It was sort of a natural flow; the interest was always there. Frequently, we would get viruses that belonged over there and vice versa, so we got to know each other quite well and worked very well together so that was not a problem.

I guess my real interest in polio, again, sort of started out from the possibility of the elimination of polio in different countries. This was before the eradication program actually was set up, but my actual real involvement in polio came from the time that I was appointed the director of the Virology Division--

CRAWFORD: Nineteen seventy-three? I'm sorry to interrupt you.

DOWDLE: The time?

CRAWFORD: Yes.

DOWDLE: The time actually was in '72, the latter part of '72. But the case was the very famous case of Reyes versus Wyeth vaccine [Reyes v. Wyeth Laboratories, 1974]. What was happening is that there was a Sabin vaccine, vaccination day, and the young girl who had had the vaccine came down with polio a few weeks later. The parents and the lawyers had blamed this on the vaccine, but in fact, we [CDC] knew that polio was occurring in the location at the time. Secondly, we [CDC] were able to show that epidemiologically it was most likely wild, and CDC provided that information. Third is that the strain, having been analyzed at the laboratory here in CDC, was most likely a live virus and not a vaccine virus. There was no evidence that it was a vaccine virus that caused the paralytic result, but at the same time, there was no way that you could say that it is absolutely sure that this was a wild virus versus a vaccine strain, because we had no techniques that would say that for sure, beyond some biological variable characteristics. We couldn't say for certainty, although we could say ninety percent or eighty percent, or what have you. It became very clear that we had to have some other test, because it was extremely embarrassing that the jury just totally ignored everything we presented because you couldn't prove it with true physical proof. At that time, I said, "We can't continue like this. We've got to come up with some way to distinguish reliably between wild and vaccine strains."

Then that's where we started getting a molecular group in to start doing this, and so we've hired our first molecular virologist [John F. "Jack" Obijeski, PhD], who in turn hired Olen Kew to work specifically on polioviruses. Then Olen hired Mark [A.] Pallansch [PhD] a little later on, and the rest is history. But it's just incredible, the difference the whole thing made from the, once again, the laboratory that was hindsight or to confirm something, versus the laboratory, which was leading in terms of epidemiology, because the way in which the virus became characterized. That was how my interest really got [started].

CRAWFORD: The lab was really key, became key, in surveillance. Would you say that it was key to surveillance from the beginning?

DOWDLE: No, in the beginning there [were] some surveillance approaches used other than just lameness or [the] paralytic disease itself, but it was very difficult, because it was often almost impossible [for the laboratory] to [reliably] distinguish between live vaccine strains and wild virus, almost impossible to the point that it just took too much time, and so you had to rely on other ways. But there was also surveillance, which was done with looking at, say, subsamples of the population [for evidence of past infection] and even environmental surveillance for [current] virus [circulation]. But all these were sort of hindsight or special studies. They weren't a component at the time or even in the definition of polio. Later, it became that this was true, so it's always had a role, but often, because of the time it took, it was an after--the data came later, even though it was compiled, and it was extremely important, but you had to have something faster than that.

CRAWFORD: For the record, could you explain what happened when a case of acute flaccid paralysis was identified in the field, in the early days? What happened?

DOWDLE: Well, I think Olen could probably fill you in on this, so I won't say much about this. But basically, it was the clinical definition which sort of held sway. But it became clear, the reason why the lab follow-up became important: it's because it became clear in the early programs in Brazil that often you would come across a paralysis that was not polio, and clinically, most of them were pretty evident that it wasn't polio, but not always. Therefore, if you could isolate a virus in the laboratory at the same time you saw the patient, then you were certain that that was a polio-associated paralysis. It was paralytic poliomyelitis, which you could now say that's for sure, because we've got both the virus and the clinical definition. As a follow-up, that was always important, but that follow-up often took a little time, because you had to grow the virus. Then as always, [you had to do] a sixty-day follow-up, whether or not the child was still paralyzed.

CRAWFORD: Before Kew came in 1979, could you describe the technique used to determine that ninety percent likelihood that "x" virus came from--you know, to trace the virus?

DOWDLE: Oh, you mean whether it was wild or vaccine-associated?

CRAWFORD: [Yes.]

DOWDLE: Yeah, largely it had to do with temperature, the growth at which the virus would replicate, and the other thing was the appearance of the strain, the plaque size, and so on at these different temperatures. There were a number of these biological [properties] that you would look at, and of these, then temperature was probably the most important, plaque size [and] temperature. But all these were variables. All of these would change, because they [could] change--in other words, the longer the virus circulated, [the more likely] it would become more wild-like, if it was successful in its transmission. You couldn't say for certain, because it was always, you know, sort of a continuum. There was a line there that sort of separated the attenuated strains from the fully virulent strains, and it wasn't straight. I mean it was always a continuum, the line was, because it was biological, whereas if you looked at the nucleic acid, looked at the genetic material, then you could see exactly what changes were being made and what the origin of what the virus was.

CRAWFORD: Which was what Olen Kew brought to--

DOWDLE: Exactly.

CRAWFORD: --[the] lab.

DOWDLE: Yeah, and perfected it as time went on.

CRAWFORD: Could you talk about where you were in your career at this time, though. You were--1973, director of the Virology Division--

DOWDLE: [Yes.]

CRAWFORD: But then [in] 1979, you moved into a different role, so I'm wondering about the timing when you recruited Kew and how that happened.

DOWDLE: Well, this [role] was the assistant director for Science [assistant director, CDC, Science], I believe, at the time. It was an internal move within CDC into reorganized--sort of getting [prepared] for a different organization, quite frankly. There was a--

CRAWFORD: What do you mean by that?

DOWDLE: No, what I mean by that is that they [the CDC director and staff] really were thinking in terms of combining the Laboratory branch and the Epidemiology branch into a new center [Center for Infectious Diseases], and that took about two years in the making. All of this happened to occur about the time of the incoming--it was the Reagan Administration, I think this was. Yeah, and there were serious, at that time, proposals of cutting CDC by twenty-five percent and reducing staff. We actually had lists drawn up of who would cut--reduction and force, and all this sort of thing. It was really quite scary. All this, the reorganization, got caught up, and so they were able to move at least on a few things. One of the things was just to have an assistant director for Science, and that's sort of how that happened. But the rest of the reorganization got caught up, and all that occurred a few years later. It was when I was appointed the director of Center for Infectious Diseases. That was the result of the reorganization that affected us directly.

CRAWFORD: That would have been James [O.] Mason [MD, MPH, PhD]. He had arrived at CDC by that time?

DOWDLE: Not yet, it was still [William H.] Bill Foege [MD] . It's that time under Bill Foege's direction that we established the different centers, and Center for Infectious Diseases combined Bureau of Laboratories and Bureau of Epidemiology--

CRAWFORD: That was in response to this?

DOWDLE: --and lived happily ever after. It really was. I mean, it was a fun time. Not on the political side, but I mean, at least from the organization side. But as I point out, by being a part of the virology division early on--and from the beginning, we've had very close working relationships with the epidemiologists. I mean, really, it didn't so much matter, the organization lines weren't that important. They really weren't. If you needed to work on a particular outbreak or a particular disease, hey, it just sort of flowed naturally that you would work together. It really worked out quite well.

CRAWFORD: After the reorganization, you were the director for the Center for Infectious Disease, and that was 1980 to 1986, right?

DOWDLE: Yeah.

CRAWFORD: What were you hearing about polio at CDC and more broadly than that at that point in time?

DOWDLE: Well, being in the Center for Infectious Diseases, of course, polio was still very much a part of that and the interest. Yeah, I was aware and getting reports from the different staff members on this, and so I was fully aware of what was going on. I wouldn't say inserted myself, but at least I tried to keep up with what was going on. But, it's mostly what was occurring within the organization. I mean I wasn't personally directing this.

CRAWFORD: I wondered if you heard responses. There was a meeting in Talloires, France in 1983, I believe, NIH [National Institutes of Health] Fogarty Center sponsored a symposium with PAHO [Pan American Health Organization], and I was wondering if you heard reactions of your colleagues to that meeting?

DOWDLE: Oh, yeah, yeah, that was--most of the reaction to that meeting [Talloires] was total disbelief after it happened. Here again, this was a meeting was sponsored by the Task Force for Global Health. Bill Foege, essentially, was chairing it, headed it. I'm not sure he was chair of that meeting, but basically, with previous meetings, he was. This [the Talloires meeting] involved WHO, director of WHO [Mahler], director [James P. Grant, JD] of UNICEF [formerly, the United Nations Children's Emergency Fund], and Rockefeller Foundation, World Bank, and the usual group that formed the Task Force [for Child Survival] at that time. They were charting where to go next and how to improve immunization by continuing to work together, which was the whole concept of the Task Force. [That is], to try to get above the sort of institutional blinds and to try to put your forces together to really do some good, instead of [worrying] about turf.

Then sort of just a natural outcome of that meeting then--and I say "natural outcome"-- Ciro de Quadros pushed very hard, and [Carlyle Guerra de] Macedo [MD, MPH, MPHA] from PAHO also was very strong on polio eradication, because they had done very well in Latin America by that time.

The major outcome of that meeting was the fact that they had convinced Mahler, who was the WHO director, [to support] another what was referred to as a "vertical program." Where WHO had just--what, about three years earlier in the Alma-Ata conference [International Conference on Primary Healthcare, Alma-Ata, Kazakh Soviet Socialist Republic, September 6-12, 1978]--had made the decision to never have another vertical program. All these programs were to be integrated into a "single control," or what was called a "horizontal program," where you put everything together. Mahler then went back [to WHO and] in about three months [later] talked the World Health Assembly [WHA] into having a polio eradication program. It was an extraordinary outcome, which flip-flopped. I mean he was [initially] totally against it, because [WHO] said that when smallpox finished in 1980, when it was declared eradicated in 1980, that [WHO] said there'd never be another vertical program. All this was just, at that time [and] from that conference, it turned around.

CRAWFORD: Did you hear any mention of incoming Director-General [Hiroshi] Nakajima [MD, PhD]?

DOWDLE: Well, I think we have to say that the staff at WHO had bought into the "horizontal program, no more vertical programs," and pretty much that was the mantra within the organization. When this decision was made to go on an eradication program for polio, the thought was among the staff that, "Hey, we've got no resources. We've got--how are we supposed to do this? Is this just one more thing that's going to be a pie-in-the-sky type of goal, and will eventually go away?" or, "How many years we've got?" and so on and so forth. They were very reluctant to move forward, and I will say, [Ralph H.] Rafe Henderson [MD, MPH, MPP] was one of the proponents of polio eradication, who was also at the conference. Rafe Henderson, of course, was a CDC person assigned to WHO at the time. He was in favor, but not in favor of going right now, but a little bit later.

It took a lot to get it started. It took a lot. It was very slow getting things going and getting people to think about it [polio eradication] in different ways, because it was huge. I mean just think of what few resources are available to WHO and the staff members. The staff is so small. So how do you do it? That's when CDC--and I give a lot of credit to [Robert A.] Bob Keegan and [Stephen L.] Steve Cochi [MD, MPH] and others who said--now we're getting into the '90s, though, and then they were saying, "OK, OK, why don't we hold these meetings," trying to get all the groups together and trying to move forward.

CRAWFORD: Before we go there, could you talk about where you were in your career in, I guess, mid- to late-'80s? Something like that, around the time that the WHA, so around 1988.

DOWDLE: Nineteen eighty-eight?

CRAWFORD: Yes.

DOWDLE: I was at the Task Force. No, I'm sorry, I was not at the Task Force. Oh, I was--

CRAWFORD: Were you working on AIDS [acquired immunodeficiency syndrome]?

DOWDLE: No, I was working on AIDS, yeah. Sorry.

CRAWFORD: That's OK. I'm interested in the story of your mentorship [of] Steve Cochi, Bob Keegan, Olen Kew. Actually, maybe that's a good entry point. Could you tell the story of recruiting Olen Kew to CDC in 1979?

DOWDLE: Well, the actual recruitment was done by Jack Obijeski, who was actually the first molecular virologist that we had on the staff. He was the first one, but as you can imagine, he was overwhelmed. What we needed was a person assigned just to do polio, to work on polio. Jack was the one who actually interviewed Olen, but Jack was the person who actually hired Olen, because he was familiar with the molecular virology field, and at that time I was the director of the Virology Division.

CRAWFORD: Did you give Jack the OK to hire this new person?

DOWDLE: Yeah, yeah, yeah.

CRAWFORD: Bob Keegan wrote [an informal] paper1. It's a history of CDC's role in polio.

DOWDLE: Right.

CRAWFORD: Mainly from his tenure and before that too; he really did a wonderful job, and I'm so grateful to have been able to read it and work with that. It laid a foundation for me in what I'm doing now.

DOWDLE: But, once again, though, let me pick up on what I was saying about we weren't moving forward that much with WHO, and we'd assign people over to WHO and not much was happening. It was just hard to push; hard to push because Nakajima at that time wasn't that supportive, and so on. So that's when Bob and Steve and also [Peter A.] Patriarca [MD]--

CRAWFORD: Peter.

DOWDLE: Peter Patriarca was involved, as well. He was very much a supporter, and they started having meetings here at CDC, getting WHO people to come over here. I don't know how many meetings there were, but it must have been three or four meetings over here, at least. It got to the point, it kept growing and growing, and more and more excitement and interest and support was developing here. WHO decided, "Hey, we've got to bring this back," so they brought the whole program back, and from then on, it went fine--I mean as fine as you can, you know, imagine here, but at least that [CDC] was the--that really is what I thought made the program go forward.

Now, Steve may not tell you that, but that's what I thought was the big push to get the program part, and that was sending WHO the message, "OK, if you're not going to do it, we [CDC] will do it."

CRAWFORD: When did those meetings begin? When did they start hosting WHO staff here?

DOWDLE: Right around '90. It must have been, probably in '92 or something like that--'91 or '92, something about that time.

CRAWFORD: Was that before or after the funding request?

DOWDLE: Oh, that was before, actually.

CRAWFORD: Before, OK.

DOWDLE: Yeah, that was before.

CRAWFORD: I want to go ahead and think about 1989, April 1989.

DOWDLE: Yeah.

CRAWFORD: If my dates are correct, you received a proposal, I believe, that you later passed on to James Mason, director of CDC.

DOWDLE: Yeah.

CRAWFORD: Eventually, I believe, that that resulted in the $3.1 million dollar allocation that continued to allow the polio program at CDC to expand. Could you tell the story of the development of that proposal, whether or not you were involved? At what point you became involved in it?

DOWDLE: Yeah. Well, let me back up a little bit. CDC was, from its beginning, has always been seen as a domestic organization, and its mission was domestic for disease control here [in the United States]. And then, there was thought that all the international work that was done in medicine or in health, public health, was to be done by the Agency for International Development, [US] AID, which was out of the [United States] State Department. For a long time, there was this very, very strict line between no authorization for CDC to do any global work, but all the authorization would go through Agency for International Development, who would in turn, quote-unquote, "hire" CDC to do this work.

Now, they [CDC] did a lot of work overseas. But even the smallpox eradication work, that CDC did was primarily provide technical assistance and people in the field, and this type [expertise] of thing. Whereas the money for anything else--which was very, very little--but would come out of AID. It was about this time that, in the early '90s, that there was a lot of, I think, more and more support [to free] CDC [from] being shackled with this arrangement and that there should be direct funding for any of the--particularly health programs. I mean later with Ebola, for example, everybody understands that it's something that CDC needs to get involved in.

That was pretty much a breakthrough. There may have been other sort of direct funding to CDC, but not many. This sort of broke the sort of, tradition, if you will. It was a big thing, and then in order to get more funding, of course, then this relationship was set up with the Task Force and Rotary [International] for fundraising--lobbying, if you will. But then that got to be a problem. I got it worked out pretty quickly, and I don't want to go into this, but the way it was worked out is that Rotary, then, accepted the responsibility for lobbying for CDC.

CRAWFORD: That's actually a really important story, and I know you said that maybe you would not necessarily want to talk about it just now, but would you tell the story of how all of that worked out? How Rotary came to lobby, because there is a bit of history of Rotary International feeling under-credited by CDC--

DOWDLE: Right.

CRAWFORD: --and I was wondering if you could talk about it a little bit and how it was resolved and how the two have worked together.

DOWDLE: Rotary, of course, was involved very early in polio elimination in the Americas, and that was through Pan American Health Organization, through PAHO. It was intended to be a very limited program and targeted only to Latin America--the Americas--at the time. The assumption was that this would be for a short period of time and they'd move on and do other things. The involvement of Rotary with the program, again, goes back to Albert Sabin. Albert Sabin was the one who talked them into doing this, helping out Brazil.

That's how it all got started. This was a departure for them, because usually they're on short-term programs, and this type of thing. They'd never taken on anything like this. They didn't know how big it was going to get at the time, but it really got big. It was a learning process for them. It was a learning process for everybody.

When it came to getting funding for themselves, of course, they depended entirely on the membership, but then it also became clear that they could play an enormous role with their good relationship with Congress to lobby for polio eradication for getting funds for CDC. But that didn't immediately become clear to them; it became clear to them when the Task Force for Global Health actually hired somebody to start doing lobbying for polio for CDC.

When Rotary got wind of it, well, I mean they were informed, but when they got wind of it, they decided that wasn't a good idea, because they thought it would work better under them.

CRAWFORD: Because of their ability to advocate and influence?

DOWDLE: Well, they were planning on doing something similar, but you know, I mean hey, Rotary doesn't actually have to introduce themselves in various places. Many members of Congress are Rotarians, and so it's a very easy thing to do to get this type of support. You know, it's humanitarian. It's a thing the Rotary organization does, and so it was a natural fit. I think the Task Force made a nice gesture, but it was the right thing to do, to go with.

Actually, Rotary didn't have anybody in mind, but had John [L.] Sever [MD], and John Sever was a virologist, someone I've known for many, many years. At the time, John had, through his hospital, had had various people who were lobbying, and one was this newly-formed Capital Associates, and that's how that came about. John was a member and still is an advisor.

CRAWFORD: We actually spoke, I interviewed him.

DOWDLE: Oh, did you? Oh, OK.

CRAWFORD: In Evanston, Illinois. He's wonderful, and he actually lives in Potomac, Maryland, which is the county I went to high school in.

DOWDLE: There was a lot of movement, then, that Bob Keegan was involved in. Bob worked very closely with Rotary, but he also did a lot of work in the legislative area, as well, and primarily through the Bumpers, [U.S.] Senator [Dale L.] Bumpers and his wife [Betty L.F. Bumpers]. These people were prime movers on immunization. It's that connection that--

CRAWFORD: I was hoping--could we back up a little bit?

DOWDLE: Yeah.

CRAWFORD: Because I did want to bring in this bit of information. Rotary withdrew, if I understand it correctly. Did they withhold funding or decided at one point that relationships were not great, [that] they were going to withdraw or decrease the amount of funding that they were giving to CDC? Then later, that changed and the partnership continued, but I wonder if you could--

DOWDLE: You know, I've often thought about that, but I'm not certain that this was a Rotary concern, so much as it was an internal organization issue, which they abandoned. And that's what made the relationship work once they sort of abandoned their internal organization that had to do with polio, because they had experts in polio, who were actually on the staff.

CRAWFORD: Dr. Sever or--

DOWDLE: No, no, he was always an advisor at the higher level. He was never a technical advisor. I mean I'm sure he was, but he was on the governing body, and so when they actually decided, themselves, that they would continue to be fundraising and to continue to do lobbying and this type of thing and let WHO and CDC and UNICEF do the technical stuff, then everything worked fine. We didn't hear any more about lack of identification or lack of credit and this type of thing. I will say in their defense that they probably were not getting credit as much as they should have, but it was not a conscious thing. It was just something that somebody had to be aware of. I always felt that the withholding of money is trying to decide what they're going to do, rather than any problem related to that. I always thought that was a little thing, I thought it got built up beyond what it really was.

CRAWFORD: Because I think Rotary, at that time, experienced a shift in their leadership, also.

DOWDLE: Yes, of course, it was all at the same time.

CRAWFORD: OK.

DOWDLE: Yeah, that's my point. It's the internal organization that they had to decide on, and they made the right decision, and that's where [William T.] Bill Sergeant came in.

CRAWFORD: Can you talk about Bill Sergeant?

DOWDLE: Oh, just a remarkable guy. I mean remarkable--gruff, very gruff. He would--I mean it's amazing how gruff he could be and how critical he could be, yet he's one of the most sensitive people I think I've ever known. I mean he really, sincerely believed in this program and believed in what Rotary was doing. He was quite a guy. And we've run across quite a few of these guys--women, as well, I can assure you.

I don't know how much time we're going yet to have, but this is a point I'd like to make. We're maybe getting away for a little bit from the subject. The people who worked on this program and in many of the health programs, particularly international health programs, are just extraordinary people. And they all are. In the polio program, there's been many situations where security problems--there's, you know, internal strife. There're all sorts of opportunities to be threatened in the process, and as we know, there have been a number of people who were polio vaccinators who've been killed. And particularly in the Middle East, we've had people here. To me, some of the most dangerous positions have been filled by women, CDC women, and I'm always just amazed at what they've done and the extraordinary work that they've done under extremely difficult and threatening conditions.

CRAWFORD: Could you tell some stories about them? Who were these people that you're thinking of?

DOWDLE: Well, one person comes to mind. There are many others. One person comes to mind is Anne-Reneé Heningburg [MPA]. I don't know if you've run across her.

CRAWFORD: I have not met her in person yet, but I am looking forward to it.

DOWDLE: Yeah. Well, Anne-Reneé has been involved in some of the most difficult parts of the program: Somalia, Sudan, almost all in a civil war times, all these issues. Almost every time there was a big problem, Anne-Reneé got sent to it. Anne-Reneé, just to give you--and there are other examples, but I can just say something about her and that gives you an idea of what others have done. She was in, I think it was in Somalia, in Mogadishu, running back and forth, trying to get refugees immunized and working within the country and this type of thing. She was stationed in Nairobi [Kenya] at the time, but that was her base of operations. She was not at Nairobi at the time but still the base of operation. She was there when [Mary] Louise Martin [DVM, MS] was killed in the [U.S.] Embassy bombing, and Louise Martin was there as a previous CDC employee, but her husband, [Douglas N.] Doug Klaucke [MD] was there on the polio program.

CRAWFORD: Were their three children there, too?

DOWDLE: Yeah, there were three children. And so in addition to all of her other problems, Anne-Reneé did her best to try to hold family together, and so it was really quite a tragedy. That was another thing in which she had done a remarkable job. To put in a plug here, we started the Task Force, and CDC colleagues and friends of Louise took up collection to form a memorial to her. This memorial was an endowment fund for scholarships for girls' education in Kenya, and that has continued to grow, and the program now supports the endowment fund, which is operated out of CDC Foundation. Anne-Reneé and myself continue to work on this program, and we now support--the endowment now supports--six girls a year. We'll hopefully get more than that, but through secondary school in this very successful girls' center and school in Nairobi. It just keeps going on, and contributions will be accepted.

CRAWFORD: Thank you, Dr. Dowdle.

DOWDLE: But it's something that CDC employees recognize, that you've got all these things. Then you've got Bob Keegan's program that he started, his endowment program for people who were injured, or for the families who were killed working on polio eradication and these wonderful programs.

CRAWFORD: Could you talk about Bob Keegan? Maybe we can keep going with talking about individual people. I would love to hear more about some of the women that you were referring to before, but Bob Keegan and then the group of people that you mentored closely, as well.

DOWDLE: Yeah, well, I mentioned Anne-Reneé, because I know more of what she did, but there are really, literally, many other women who have done a tremendous job. I'd hate to go much further than that, because I'd be leaving out somebody. They'd all recognize that it's OK to mention Anne-Reneé. Many of these are supporting roles. They were also women who were involved in the big strategies of the programs and that type of thing. But you know, they weren't all in the trenches like they were. But also, men too, have had and still do, have some very challenging jobs.

CRAWFORD: There are many, yes. I did a pre-interview yesterday with Dr. [Elias] Durry [MD, MPH].

DOWDLE: I mean, he's another one of these people that if you have something that's an impossible situation, you send him there.

CRAWFORD: Sounds like it, yes. In the early '90s, I was hoping to talk with you about navigating bureaucracy in the early '90s. This team, Bob Keegan, Steve Cochi, Olen Kew, Mark Pallansch, Peter Patriarca--

DOWDLE: Yeah. Well, Peter Patriarca left in the early '90s. I mean, when was this? Yeah, it must have been mid-'90s, yeah.

CRAWFORD: I wanted to ask you about them on an individual level and then also ask you--I guess ask you about your role as a mentor. Several of these folks have described you as the "godfather" of polio eradication, the Polio Eradication Activity [at CDC], and just as a very influential person to them in learning to make things happen. I was hoping you could speak about them and speak to working with them.

DOWDLE: Right, yeah. Well, first, during this time I was deputy director. During that time, I was also acting director of CDC on two occasions, and one was for a year or more. That's where, you know, there was a lot more interaction with the program and support of the program, and the support was more obvious, I guess, during that time.

As far as mentoring, I would have to say I was mentored by them, the other way around--that they had these extraordinary ideas. They had this commitment and just very dedicated to the whole concept and getting the job done. I mean how can you not get excited and enthused over the program? You might say, "I did what I could to try to help things along," and this type of thing, but they're my heroes. It's not the other way around. I mean these guys just did extraordinary work.

CRAWFORD: What were some of the first things that happened to get things moving?

DOWDLE: What happened to get things moving, really, was the meetings over here at CDC back in the early '90,s instead of WHO. It's that CDC took the initiative and said, "OK, we're going to get the job done."

CRAWFORD: Who was it?

DOWDLE: Well, who actually started? My memory of it was with Bob and Steve, but Peter may have been involved in the first one. That's what I can't be sure of. But that's my memory of those meetings was with Bob and Steve.

CRAWFORD: Do you remember when you first heard about the idea of these meetings? Did they come to your office and say--

DOWDLE: Yeah, yeah, definitely, we talked about having them here, which I thought was a great idea.

CRAWFORD: But they approached you. When would you see them? On a day-to-day, what were your interactions with Steve Cochi and Bob Keegan--like, would you see them in meetings?

DOWDLE: No, we had frequent meetings and generally in the office, and I would attend what meetings I could with them, but I had many other things I had to deal with, as well--other programs that were going on. But again, I would downplay my job, I mean, my role as a mentor. I still think they're the ones that were stimulating me, instead of the other way around, but I'm glad they think that way.

CRAWFORD: I mean I've heard the comment that you really encouraged them to kind of expand their vision.

DOWDLE: Yeah, but that--

CRAWFORD: And dream really big?

DOWDLE: Yeah, yeah, yeah, but that's easy to do, right? It's the people who are down at the bottom that are thinking of all of the barriers and all of the needs and the money and this type of thing, who tend to think a little smaller. When you're up thirty thousand feet, it's easy to think about expanding it and keeping it moving.

CRAWFORD: But how did you kind of guide that shift?

DOWDLE: Oh, well, let me--I can tell you, give you one example here, that Bob Keegan used to always say that one reason why the polio program took off is because the formation of the National Immunization Program [NIP], and--

CRAWFORD: [U. S. President William J.] Clinton?

DOWDLE: Sorry?

CRAWFORD: Clinton--was that under Clinton?

DOWDLE: Ah, yes, it was. But anyway, the National Immunization Program, which is a CDC program, that was actually under the Bureau of State Services. The Bureau of State Services is what it is. It handled block grants. At that time, all immunization had to do with states, so it was working with states to get their immunization programs up to par and all this sort of thing. So in many ways it was a natural fit in the Bureau of State Services, but it was pretty much down the organizational lines, so to speak. By pulling the National Immunization--creating the National Immunization Program--and bringing it up to director level, so that it reported directly to the director, well, then, this changed the whole sort of environment and also the image--you know, the way in which the program was viewed.

But it didn't happen exactly the way they thought it did. The way it happened is that at the time that--I'm just trying to think exactly--it was Clinton, I guess. When actually the new administration came in, [Donald Ainslie] D.A. Henderson [MD, MPH] was brought in at the [deputy] assistant secretary level at the HHS, Health and Human Services. D.A. Henderson felt like that the immunization program was very bad. He was extremely critical, and so he said that he felt like the program should be brought up to his office in the assistant secretary for health [deputy assistant secretary for Health and senior science advisor in the Department of Health and Human Services].

At that time, I was acting director here at CDC so we said, "This can't happen," you know, "We can't do that." He went through a whole series of things. This went on for weeks. Finally, I proposed to him, I said, "OK, if we pull the program out of Bureau of State Services and bring it up to the director level, that's the most we can do. We cannot agree for this program to go up to your office, no way." Anyway, he accepted the compromise, because then he thought he had a way to get to it this way. So that's how it happened. It wasn't consciously done, in the sense that there wasn't a real, you know, motive to do so, but that's the way things often get done. Unfortunately, D.A. was a real critic of the polio program.

CRAWFORD: Could you talk about that?

DOWDLE: Well, I mean, D.A. headed up the smallpox eradication program in WHO, and before that I had worked with D.A. fairly closely. I've known D.A. since I guess he arrived. Well, he arrived about the same time I did, here at CDC, but in a different position. But, you know, he did a good job in smallpox, and [in] smallpox [it] was primarily the U.S. and Russia who actually supported the program and got it done. D.A. headed up what small monies there were, compared to polio eradication and did that type of work at WHO. He had done a good job, but he also felt like he could advise other programs, as well, including the polio eradication program. They [polio eradication strategies] never quite suited him. He never thought it [eradication] was going to work, and he was just constantly critical to the point that it just wasn't helpful.

You know, it's one thing to be critical and be helpful, and this was part of that time where he was just extremely critical of the whole program, which was too bad. I mean I personally had good relations with D.A., but it didn't extend all the way to the working relationships. But he, you know, had a lot of credit, and he deserved that credit.

CRAWFORD: When Clinton came into office, that provided an opportunity, I think, for the Bumpers to be more involved in expanding immunization. Could you talk about their role?

DOWDLE: Well, this is where Steve comes in. Yeah, he can give you a real good breakdown. He and Bob were very much involved, and Bob really more so.

CRAWFORD: I'm very disappointed that I will not have the chance to meet Bob Keegan.

DOWDLE: Well, aren't we all. Yeah.

CRAWFORD: I am, truly. Could you talk about him a bit in terms of personality and work style? It seems like he had a very strong value for collaboration, but yeah, you know, I see that play out in the writing that I've seen of his and just the things that I hear other people say about him.

DOWDLE: I would put this just a little differently in that I think Bob had this very deep commitment to accomplish something in this world. Not himself, I mean, but to change, you know, to get things like eradicate polio or things that were big and things that could be accomplished. In that desire, in that commitment, he recognized the only way you do that is through collaboration.

CRAWFORD: It was a strategy.

DOWDLE: Yeah, that was the strategy. He recognized that you just had to make collaboration work, because if you didn't, you're not going to accomplish what you-- accomplish the goal and the mission. In that respect, he was very, very, I think, influential and helpful in almost anything that was done.

Bob was the type of person, for example, that if you could have a meeting for thirty minutes or an hour to actually come to some agreement on some particular course of action to take, Bob would say--often he would, if he wasn't chairing the meeting, he still had the same role--but anyway, he would say at the end, he says, "OK, what's the action here? All right, who's going to do it?" We never left a meeting there by leaving it open. It never happened. Bob just moved everything along: "OK," you know, "what's going to be accomplished? Who's going to do it? When are you going to do it? How are you going to pay for it?" All this sort of thing had to be thought--I mean he really committed, and nothing was left open. It was always a decision had to be made.

But I mean he had many--I used to always say that when you're meeting with Bob, you always had to hold on to your wallet, because he was determined. I used to accuse him of dueling with windmills, because he just had so many different things he wanted to do. He wanted to get involved with gun control, form a gun control group here in Atlanta. Well, that never got off the ground, despite all the ways of trying. He was really quite a motivator, really quite a motivator.

CRAWFORD: We are at about an hour and a half at this point, so we can start the winding down process.

DOWDLE: OK.

CRAWFORD: I wanted to ask you about the Task Force and your work there. You retired from CDC in 1994. Did you move over to the Task Force for Global Health immediately?

DOWDLE: When I retired, because of my WHO Network Lab development for influenza, I really enjoyed that area. The thing that I found most stimulating is building these laboratories in developing countries, because I mean, they were absolutely abysmal. They were just--not only for the laboratories, but competence and so on and so forth, they really were. The general feeling was you can't build functional, really high-quality laboratories in these areas. They don't have the equipment; they don't have the money; they don't have the personnel, and so on and so forth. But yet in flu, it worked pretty well, but it was not the same level that was needed for polio. That was a real interest of mine.

When I retired, with that interest, I went then to Mark and Olen and said, "Hey, here's your new volunteer hand," and so I went back to the lab. Then I gradually sort of got involved into the program, but the lab base, working out of their labs. I've gone back to the labs. I went back and did all of the procedures that I hadn't done in my earlier lab days and so--

CRAWFORD: What were some of those?

DOWDLE: Well, I mean like the new molecular virology, it was sequencing and all of these, the nucleic acid isolation and all that sort of stuff. It wasn't even invented at that time, so I went back and did a lot of that. I never became as proficient as they were, obviously, but that was enough then, so I felt confident to go back and start helping develop the network. I will say that we all were a little reluctant to give too much responsibility to these labs, because of what they could really accomplish, but in the end they were really very good.

CRAWFORD: What were some of your concerns, the specific concerns, about giving too much control over to the labs?

DOWDLE: Well, the main thing we had to be concerned about is quality control and the whole concept of quality control and how do you do this. That's what we set about doing first, is getting these labs--starting off with the most basic things, and then that is just isolating the virus, isolating the virus, and being able to identify the virus. Then you sent it to a next-level laboratory of more capabilities, larger facilities, and this type of thing. [The next-level laboratory] would actually distinguish whether it was wild or vaccine-type. Then as time went on, then you went to the even larger laboratories, which is like CDC, and to do the sequencing, genetic work, at this time. But then, as time went on, you started bringing these things down to the developing laboratory level, so that you started then letting them doing the separation of wild and vaccine type strains, and you can see how this--and then some genetic work, which would allow them to start doing some of the sequencing, and so on and so forth. That kept going further and further down. The labs, by and large with, I would say, a very few exceptions--but there were a few exceptions--but the rest of the labs, I mean they all did a superb job and still do.

CRAWFORD: Within your own story, when did you go back into working with lab?

DOWDLE: When did--?

CRAWFORD: When did you return to lab work?

DOWDLE: Oh, immediately. We took two weeks off, I think, and I went back.

CRAWFORD: In 1994?

DOWDLE: Nineteen ninety-four.

CRAWFORD: Incredible. You were working on a programmatic level?

DOWDLE: Yeah, oh, yeah, I was in the lab working on some of the polio research issues.

CRAWFORD: What kinds of meetings were you a part of?

DOWDLE: Oh, at that time, all of them. I mean anything that involved the lab here at CDC, I was involved in. But then I started gradually involving myself with the WHO at the Geneva level.

CRAWFORD: Could you talk about that experience?

DOWDLE: Well, again, by my first involvement with WHO in Geneva, at that level and the regional level, was back to influenza, because I operated a similar-type program for influenza. That goes back to '64 or '65, so quite a while ago. I think at that time I recognized what WHO's strengths were and what their weaknesses were, and at the same time, I also gained enormous admiration for the people who worked at WHO at the technical level, who weren't concerned with the bureaucracy so much, but rather at the technical level. All through, from the '60s on, it's been my experience that the people that you've worked with on these specific programs are just--they're all so extraordinary, very dedicated people. It's always been a very pleasant experience. Again, differences of opinion, this type of thing, but everybody's working for the same goal. There are certainly bureaucratic problems, but your role is to try and work around them. Bob understood that very well.

CRAWFORD: Can you give a few examples of when you have been involved in working around bureaucratic problems?

DOWDLE: Most of the bureaucratic problems related to money and money issues, and so I didn't get that much involved in that. But the people who did were Bob, and the other person who was an expert at taking shortcuts was Anne-Reneé and working around it.

Now, actually, in the smallpox eradication program, they actually handed out cash to get around the--but there are ways of doing it, and you can get around it.

It's not that it's so much that the hierarchy is trying to enforce the bureaucracy, but you've also got to think in an international organization, you can't have the organization have the face that everybody looks alike. I mean you've got to have different countries represented. You can't have too many from one country, for example. If you want a good technical operation at WHO, then you want to get the best technical people you could get. Well, in the early days they all came from where? They either came from the U.S. or they came from Britain, some from Germany, so it was almost a U.S.-British type of operation. That has changed a lot, so that now they have to have quotas, which is bureaucratic. Even then they had these types of problems, but they in some ways ignored them, but they've had to enforce them as time has gone on. You have people who are not so competent, who haven't had the experience, and then people who do. But you try to get at least the head of the program--somebody who's very competent--and usually that person would be from the U.S. or the UK. I mean, that's the way it was, but not anymore. But that was part of the bureaucratic problems that we had. Once again, to see what's changed, but in a very limited time, but some of these developing countries have very strong technical people now in almost any aspect.

CRAWFORD: Who would you name among countries with strong technical programs?

DOWDLE: Well, for example, when we first started out with China on the polio program, China had nobody, I mean virtually nobody. Then we trained the person over here who headed up the program, and then we also, here at CDC, trained other people from the China program, but virtually nobody.

CRAWFORD: What was the name of the person who headed the program in China here? The CDCer?

DOWDLE: You mean who was here?

CRAWFORD: [Yes], who was working at CDC on China? Who was the head of the program?

DOWDLE: I'm trying to think of the--at the lab level?

CRAWFORD: [Yes.] Yeah, the lab person that would share the information with China.

DOWDLE: Oh, hm. Oh, now I know who you're talking about. I'm sorry. There were two people from Taiwan, and they're no longer here. You're right. Both have retired now.

CRAWFORD: OK.

DOWDLE: Sorry, I was trying to think who was it that was trained here.

CRAWFORD: Oh, no, no.

DOWDLE: No, you're right, yeah.

CRAWFORD: Still learning. I wonder if it makes sense to continue--did you ever go out on lab visits?

DOWDLE: Oh, yeah.

CRAWFORD: OK.

DOWDLE: Oh, that was all part of the--

CRAWFORD: Yeah, could you talk about some of your experiences, memorable visits?

DOWDLE: Well, in the early days, we'd go to these different labs and trying to focus on the labs that needed the most help at the time, and primarily setting up the quality control programs and making sure they understood what they were, the techniques involved, and so on and so forth. I went through all that with them, and so I used to say that the most frequent phrase I ever used was, "You're doing what?" and that used to be what I would get every time I'd--"You're doing what?" So then you would correct that.

CRAWFORD: Which labs in your memory needed some more support than others? Where did you spend the most time? Where did you need to spend the most time?

DOWDLE: Well, as we got--we had different tiers, as I mentioned earlier. You had the labs that did the work in the countries, and then you had lab at the regional level, which actually then was a bigger institution, better trained personnel, in fact, often career personnel in the job and so on and so forth. They took a lot of the responsibility at the regional level for going out, as they became stronger, and to going out and making sure the labs were all helping them to get up to speed and so on and so forth. I guess some of the biggest problems earlier on had to do with the regional labs in China, because they were all so far behind everywhere--so going out to all the provincial labs in China and also, working with the Chinese lab that was responsible for all these. That was probably a challenge. But again, they ended up doing quite well.

CRAWFORD: Dr. Pallansch mentioned in his pre-interview, observing very, very high rates of unexplained wastage in China. Were you aware of that?

DOWDLE: Wastage of?

CRAWFORD: Of vaccine.

DOWDLE: Oh, vaccine, yeah.

CRAWFORD: And he attributed that to the one-child policy--

DOWDLE: Yeah, that's right.

CRAWFORD: --and people having more than one child.

DOWDLE: Yes, that's correct.

CRAWFORD: I was wondering if you had heard about that in your work?

DOWDLE: Yeah, that's a problem with the program, all the hidden children who are not registered, yeah, at all. Yeah.

CRAWFORD: Yeah, I thought that was very interesting.

DOWDLE: It really makes you realize that when you give people opportunities and give them the ability to work with something and give them the tools to do something that almost anywhere in the world you can get these--you can bring people up to standards. We don't have a monopoly and fortunately, less and less. There's nothing about the UK and the U.S. that's so bright that the others can't do it. It all has to do with opportunity, and that's what sort of building the lab work always just proved to me all the time. It's just amazing what people can do if you give them the right training, the right opportunities and right equipment to do it.

CRAWFORD: Did you ever advocate on a policy level for the lab network?

DOWDLE: Oh, yes, of course, but I mean, at the level I worked at at WHO in Geneva, that was a responsibility, yeah.

CRAWFORD: Could you share some of your thought processes or strategies that you remember from that time in learning to communicate that message, that given the tools and the opportunity, people can be competent?

DOWDLE: Yeah, well, it was just a developmental process. In other words, a lot of this was actually consciously done by the laboratory network [Global Polio Laboratory Network, GPLN] with Olen and Mark actually, because they visited a lot of labs, as well. But given their sense of readiness, you know, "We think this lab now is ready to actually start doing sequencing," for example, and if so, "How do we get the equipment to do it?" The other labs, for example, the Indian labs, the Indian labs just have done--did--a fantastic job, but it was largely funds that were provided by WHO through Rotary or through our funding, or what have you.

CRAWFORD: What were some of the indicators of readiness when you would look at a lab?

DOWDLE: Well, I guess a lot was subjective, in some ways. But at the same time, you could see how these labs would perform and the more--the basic tests and the more difficult tests, as you went up--I mean it was pretty obvious who--

CRAWFORD: In terms of skills?

DOWDLE: Yeah, in terms of skills, it was pretty obvious. But it was more than the skills. It was also reporting, I would say, not just accuracy, but also timeliness was important and the ability to get things out fast and the dedication to move things along. That was also part of the evaluation.

CRAWFORD: Anything else you'd like to say about lab, the lab network?

DOWDLE: No, I mean just to say that I guess my career has been more learning than anything else. One thing I think I've learned from the very beginning, I just keep getting it reinforced and reinforced, is again, the concept of what people can do if given the right opportunity all over the world.

That's, of course, one thing we feel so strongly about the girls' school that we're promoting is to give girls a chance to get ahead in life and to realize their potential. That's something that can be repeated all over the world. There's no exception. I remember in the HIV program that we were in Kinshasa and actually were meeting with this guy who I refer to as a bush doctor. He had no equipment; he was a doctor out in the bush, no equipment, nothing but his knowledge and his hands. We were trying to really get a fix on [whether] there [was] HIV occurring in Africa, as some had reported.

Well, it was showing up in the hospital in Kinshasa, and this guy, in very broken English, I mean he just--and his own observations, he had HIV down to a T. It was just incredible how he could actually identify the cases, how he could describe the cases and kept up with this in his own little surveillance, if you will. If you ever saw a person, I mean dressed very poorly, but if you ever saw a person that you would expect to do a job like that, it wouldn't have been him.

CRAWFORD: What did he look like?

DOWDLE: Little small guy, not well dressed, clearly about on a level of poverty of many others, but he was serving out in the villages and doing the best job he could. But he understood, recognized HIV well before it had been recognized globally.

CRAWFORD: That's wild. I feel like I've heard similar stories of country doctors.

DOWDLE: Which is what he was, yeah. Just a lot of bright people out there.

CRAWFORD: Yeah.

DOWDLE: A lot of bright people.

CRAWFORD: Absolutely. There's a really great [Stephen Jay] Gould quote that I tend to mess up a lot, but the gist of it is that he says he mourns for all of the people who could have been great scientists or whatever but labored away in fields and expired in exploitation, which is interesting.

DOWDLE: Right.

CRAWFORD: Kind of a loaded idea to leave this interview, so I'm sorry to do that. I didn't mean to do that. Yeah, somehow that seems relevant. You said earlier that you would be open to a second interview.

DOWDLE: I don't know what else there is to say.

CRAWFORD: OK, well, that's a great indicator. Maybe we got most of it. Do you have any other kinds of closing thoughts? Anything that's hanging on? Did we miss anything?

DOWDLE: No, but I think, I mean when you think back to what my career was, I was involved in so many other things at the same time. For example, at the time of Louise Martin's death at the embassy, I was actually heading up a malaria program. She was working for me on the malaria program. She had never actually worked at the Task Force, but because we were working out of Nairobi, well, Kenya and Uganda, and she was there with all these talents, we just hired her for the program. She was never actually at the Task Force, but she was a Task Force employee there in Kenya. I was doing that, plus I was doing polio, plus, you know. I never stopped doing polio, but I was also doing that, as well.

The point is, when you get to Mark and Olen and Steve, they have all the details, because they were fully involved, all the time, twenty-four hours a day. And Mark, I'm sure has a lot of stories.

CRAWFORD: Yes, we will be doing his interview tomorrow.

DOWDLE: Oh, OK, well, tell him I'm sorry I missed him, but he knows what I've been doing.

CRAWFORD: All right, well, should we close it for today?

DOWDLE: Yeah, I think so.

CRAWFORD: All right, thank you so much, Dr. Dowdle.

DOWDLE: Yeah. Don't know that I've helped, anyway.

CRAWFORD: Oh, you certainly have, absolutely. Thank you.

DOWDLE: Thank you very much.