A Conversation with Mark Pendergrast, author of INSIDE THE OUTBREAKS: The Elite Medical Detectives of the Epidemic Intelligence Service
What is the EIS and why have we never heard of it?
The Epidemic Intelligence Service is a two-year service and training program of the Centers for Disease Control & Prevention, the CDC. It began in 1951, during the height of Cold War paranoia over possible biological warfare during the Korean War — hence the name, which implied a sort of medical equivalent to the Central Intelligence Agency. It is indeed the most important (and effective) government agency of which you have never heard. EIS officers have investigated many famous epidemics, but they generally maintain a low profile.
What is the significance of the EIS logo, with the damaged shoe?
The logo features the world globe with a shoe superimposed on it, a hole prominent in the shoe’s sole. EIS officers call themselves “shoeleather epidemiologists” because during investigations they get out into the field, right into the middle of an outbreak. Hence the worn-out shoe, though they have also traveled by dogsled, elephant, camel, dugout canoe, and helicopter, to mention a few modes of transportation.
How big is the Epidemic Intelligence Service? Can you tell us a little about how it operates?
In recent years about 80 new EIS officers enter the program for July training in Atlanta. There are now over 3,000 EIS veterans, most of whom have gone on to careers in public health, either at the CDC, state health departments, the World Health Organization, the Gates Foundation, or schools of public health. How do they operate? An EIS officer is usually pretty young (average age around 34, and more than half are women, though at the onset most were men). About 20% are minorities, with a substantial international component. They are on call 24 hours a day. Many stay at the CDC and specialize in a particular area, such as foodborne/diarrheal diseases or influenza. Others are stationed within state health departments and serve as “general practitioners” of public health, chasing any kind of outbreak. All are subject to being sent at a moment’s notice to an emergency anywhere in the world.
Is the EIS program unique to the United States?
No. The EIS program has spawned clones and imitators around the world. There are now 36 such programs serving 82 countries, with plans to develop eight new programs to serve 11 additional countries. EIS alums have helped to start all of them.
It sounds like you really admire the EIS, but did you uncover any dirt? Surely every organization has skeletons in the closet.
Yes, in general I really came to admire EIS officers – their curiosity, courage, integrity, intelligence, and perseverance. But I did uncover some skeletons, if you want to call them that. Alexander Langmuir, the visionary founder, could be a harsh taskmaster, so he is not the untarnished public health saint that some would prefer. He also suppressed two papers on polio investigations that he apparently felt might jeopardize the new polio vaccination program. Also, in the early years a few EIS officers (like many others in medicine) used prisoners and mentally ill patients as volunteers in medical experiments.
Your stories of EIS exploits are really amazing, particularly how they helped to identify new diseases and their causes. Can you name some of them?
There are so many! Let’s see. EIS officers started the first poison control program in the United States, saved the polio vaccine program by identifying which vaccines contained live instead of killed virus, pioneered the identification and control of hospital infections, learned that people could contract rabies from bats without being bitten, helped to eradicate smallpox, realized that even unbroken eggs could carry Salmonella, first identified E. coli O157:H7 as a lethal pathogen, were pivotal in testing oral rehydration therapy for cholera, started the first surveillance system of birth defects and helped to identify folic acid as a prevention for Spina bifida, proved that aspirin caused Reye syndrome, that toxic shock syndrome was caused by super-absorbent tampons, and that Lyme disease came from ticks. They pioneered effective disaster relief, blew the whistle on lead poisoning from smelters, and identified vinyl chloride in PVC factories as the cause of a rare, lethal liver cancer. They first identified Lassa fever, Ebola, Legionnaires’ disease, and Hantavirus Pulmonary Syndrome. They investigated mass hysteria in schools, sick building syndrome, the Dalkon Shield, forced sterilizations, homicidal nurses, and terrorist anthrax letters. Do you want me to go on? I haven’t mentioned solving listeriosis, identifying AIDS, finding Cryptosporidium in drinking water, battling rotavirus, multiple-drug-resistant tuberculosis, botulism, yellow fever, parasites, pesticides –
All right, stop! I guess we’ll just have to read the book. But tell me, do EIS officers combat only infectious diseases?
No, they try to study and prevent virtually every threat to public health. I already talked about lead poisoning and other environmental problems, as well as psychological problems and criminal activity. EIS officers have also studied tobacco, cancer clusters, obesity, heat waves, binge drinking, violence, suicides, and injuries (they don’t like the word “accident”). Unfortunately, problems stemming primarily from human behavior are harder to combat and solve than threats from microbes – even though microbes are also devious and opportunistic.
Given the incredible reach and achievement of the EIS program, it must be well-appreciated and well-funded. Yes?
No. The EIS program is perennially underfunded. It was severely hampered during the Reagan administration, which ignored AIDS for years and then didn’t want to talk about condoms. But it wasn’t just conservative Republicans. The EIS program was nearly killed during the Clinton administration’s “re-inventing government” reforms. Unfortunately, chronic under-funding is typical for public health. We prefer to throw money at individual clinical care rather than funding prevention, surveillance, and disease detection.