{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://globalhealthchronicles.aviaryplatform.com/iiif/rr1pg1kh2m/manifest","type":"Manifest","label":{"en":["Ward, John"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","metadata":[{"label":{"en":["Source Metadata URI"]},"value":{"en":["12746"]}},{"label":{"en":["Publisher"]},"value":{"en":["David J. Sencer CDC Museum"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum","Interviews may only be reproduced with permission from the David J. Sencer CDC Museum."]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. John Ward (Interviewee)","Dr. Mary Chamberland (Interviewer)"]}},{"label":{"en":["Date"]},"value":{"en":["2017-09-26 (Created)"]}},{"label":{"en":["Description"]},"value":{"en":["Dr. John Ward talks about his role in AIDS early history at the Centers for Disease Control and Prevention. \r\n\r\nPart of the David J. Sencer CDC Museum Collection at the Centers for Disease Control and Prevention. (Summary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Identifier"]},"value":{"en":["2016.500.33 (accession number)","OHCDCM500 (collection call number)"]}},{"label":{"en":["Relation"]},"value":{"en":["The Early Years of AIDS: CDC's Response to a Historic Epidemic (is part of)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}}],"summary":{"en":["Dr. John Ward talks about his role in AIDS early history at the Centers for Disease Control and Prevention. \r\n\r\nPart of the David J. Sencer CDC Museum Collection at the Centers for Disease Control and Prevention."]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum","Interviews may only be reproduced with permission from the David J. Sencer CDC Museum."]}},"provider":[{"id":"https://globalhealthchronicles.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["David J. Sencer CDC Museum"]},"homepage":[{"id":"https://globalhealthchronicles.aviaryplatform.com/","type":"Text","label":{"en":["David J. Sencer CDC Museum"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/248/993/small/data?1724265712","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993","type":"Canvas","label":{"en":["Media File 1 of 1 - 2016.500.33  John Ward"]},"duration":6199.682,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/248/993/small/data?1724265712","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/248/993/original/2016.500.33%20%20John%20Ward?1724313790","type":"Video","format":"video/mp4","duration":6199.682,"width":640,"height":360},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475","type":"AnnotationPage","label":{"en":["content172426571120240821-522984-73z92a.xml [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: This is Dr. Mary Chamberland, and I’m here with Dr. John Ward at\nthe Centers for Disease Control and Prevention in Atlanta, Georgia. Today is\nTuesday, September 26, 2017. I’m interviewing Dr. Ward as part of the Oral\nHistory Project, The Early Years of AIDS: CDC’s Response to a Historic Epidemic.\nJohn, welcome to the project.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=0.0,16.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Thank you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=16.0,17.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Do I have your permission to interview you and to record this interview?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=17.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yes, you do.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=21.0,22.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: John, you first arrived at CDC [Centers for Disease Control and\nPrevention] as an EIS or Epidemic Intelligence Service officer, assigned to the\nAIDS [acquired immunodeficiency syndrome] program in July of 1984. Much of your\nearly work in the AIDS program focused on the risk of HIV [human\nimmunodeficiency virus] transmission by blood transfusion. You subsequently\nassumed a series of increasing leadership positions within the AIDS program.\nLater, you became the editor of the MMWR [Morbidity and Mortality Weekly Report]\nin 1998, and since 2005, you have served as the director of the Division of\nViral Hepatitis. But before we discuss your work on AIDS at CDC, let’s talk a\nlittle bit about your background. Could you tell us where you grew up and about\nyour early family life? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=22.0,60.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Sure. I was born in Montgomery, Alabama, and spent most of my childhood\nthere. My father was a computer analyst for the U.S. Air Force at the Air Force\nbase there, and my mother was a clerical worker at a local department store. I\nhad one older sister, who went on to become a social worker and head of foster\ncare programs for the State of Alabama. And I think it sort of reflects the\nfamily I grew up in. I think it was a very religious-oriented family, one that\nwas very involved, in large degrees, with various social programs, and I think\nit sort of helped shape some of my attitudes in medicine later on. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=60.0,120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nI got interested in medicine because of a high school teacher in physiology who\nwas very captivating and suggested that I had the right aptitude, I guess, to go\ninto medicine, and so they got me thinking about that. And I went to the\nUniversity of Alabama in Tuscaloosa as an undergraduate in biology and with a\nminor in history. And then I applied and got accepted to the University of\nAlabama School of Medicine in Birmingham [UAB], which is where I did my medical\nundergraduate training.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=120.0,146.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: And then did you stay in Alabama for your clinical years?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=146.0,150.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I did. I did my internship and my residency at Alabama, and indeed, when I\ncame over to interview for the EIS program, the interviewers asked me if I had\never left the state. It looked like I had been fairly cloistered all my life. So\nI’ve always felt like I was on the remedial program here at CDC with that kind\nof introduction to the agency. But we had a very good infectious disease program\nthere. And actually, Jefferson County, which is where Birmingham is located, was\none of the four counties that had a viral hepatitis surveillance program\nsupported by CDC. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=150.0,181.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nAnd I got very interested in public health as a freshman in medical school\nbecause a Methodist minister who ran the Student Union at the University of\nAlabama had started a program called the Alabama Coalition for Community Health.\nAnd he would sponsor, or he would get the communities to sponsor, health fairs\naround the state. And then medical students would go and staff the health fairs\nand do screenings of various types, which was beneficial, obviously, for\nmarginalized populations in the state, but it also helped those communities\nunderstand how they could work together to solve common problems. And there’s\nexamples of communities continuing on to apply for federal grants for water\npurification plants, et cetera, et cetera. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=181.0,241.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nAnd so we went and actually lived with the Creek Indians for weeks at a time. We\nlived with the Choctaw Indians for a while, because they had to be responsible\nfor putting us up, finding a place for the health fair, finding a place for\neverybody to live, et cetera. And it really was very energizing to meet these\npopulations. Even though I had grown up in Alabama all my life, I really was not\naware of those populations until working in that program. So when I became a\nresident, I asked to be assigned to the health department. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=241.0,301.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: As one of your rotations?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=301.0,303.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: As one of my electives. And I was actually the first internal medicine\nresident to ever have an elective at the local health department. And so when I\nwent over there I worked in the TB [tuberculosis] clinic, but then I began just\nto look at the hepatitis surveillance data. And then I became interested in\nvaccination, because the hep B [hepatitis B] vaccine had just become licensed\nfor use, and I became very interested in how it was being used among the house\nstaff. So that was really sort of my first very—you know, very elementary\nintroduction to epidemiology and public health—was there.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=303.0,334.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: It struck me—and then you said this in your comments—that you were\nthe first student or resident to go over and do an elective in the public health\ndepartment, because these were the days when public health was not on any\nmedical student’s top-ten list of internship-residency programs. And it was kind\nof the bottom of the barrel in terms of—from the medical students’\nperspective—of people that ended up in public health. So you really were ahead\nof your time, so to speak.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=334.0,359.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, and even our epidemiology course ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=359.0,361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nin medical school was voted the worst course that we had, in fact.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=361.0,366.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=366.0,367.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: But despite that, I think in part because of that experience in those\nsummer programs, I became very interested in public health. Also, I began to\nrealize in internal medicine, in particular, how many diseases you’re being\nasked to be responsible for and take care of are preventable, and much better to\nbe prevented than to be treated. And I think that was the other impetus for me\nto get interested in public health. When I was working at the health department\nin Jefferson County, the local county epidemiologist, [Dr. James] Jim Alexander,\nbrought me over—this would be about 1982—brought me over to a meeting of a TB\nprogram coordinator meeting. So that was really my first meeting at CDC, with\n[Dr.] Dixie Snider, who was then head of the tuberculosis program, chairing the\nmeeting. So that was my first introduction to CDC. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=367.0,421.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nI then went back into my residency, and I had gotten interested in international\nhealth as well. I had done my last six months of my final year in medical\nschool. I had an elective in Melbourne, Australia, studying pediatric\nimmunology, so I got very interested in more global travel, more global\nexperiences. So I somehow arranged an elective at the London School of Tropical\nMedicine and Hygiene, and thanks to the good graces of UAB, they allowed me to\nserve that elective. And I really, really can’t remember how I put that together\nin the days before Google and, you know, email, et cetera. But, you know, I went\nover, spent two months doing clinical ward work and attending lectures, et\ncetera, which only increased my interest in global health. And, to some aspects,\npublic health, I guess. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=421.0,481.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo I got very interested in visiting the World Health Organization. So I had the\nhead of the program at the London School, the clinical program, write me a\nletter of introduction. I took—there was no Chunnel at that time, so I took the\nhovercraft over—got seasick on the way—hovercraft to Calais, rented a car, drove\nto Geneva, Switzerland, to interview. And so I got an interview set up with the\nWorld Health Organization, and Mr. Fontaine interviewed me, I can still remember\nhis name. And he started interviewing me in French. And, of course, I know a\nlittle French, but not enough to conduct an interview. So he completes the\ninterview and says, “You’re way too inexperienced to work for WHO [World Health\nOrganization],” and I said, “Well, where can I go get this experience?” And he\nsaid, “Go work at CDC.” ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=481.0,541.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Ah, so that’s how you—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=541.0,549.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: So that was really my first eureka moment, like, wait, maybe I should go\nwork at CDC.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=549.0,572.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Gosh, and it took traveling to London by air and then by boat and\nthen by car to finally hear about CDC. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=572.0,601.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Yeah, exactly. I had to go hundreds of miles. Yeah, exactly. It was really\nfunny. And then it’s like learning a new word, you know, so then I come back to\nmy residency, and lo and behold, the head of our residency program, Dr. [William\nE.] Bill Dismukes was a former EIS officer, infectious disease physician at UAB.\nAnd so I began to talk to him, and then I found that a resident a year ahead of\nme in the program was already applying—that would’ve been [Dr. Edwin M.] Ed\nKilbourne—and so I began to talk to him about CDC. And so he got accepted the\nyear ahead of me and went off and did, I think, environmental health or what his\narea of interest was. And then Dr. Dismukes helped me with my application—I\nthink was very supportive, you know—called CDC to reinforce his recommendation\nfor me, which I greatly appreciated him doing. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=601.0,661.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Now when you were—in between all of the travel, you obviously were\nseeing patients as part of your clinical rotations. Had you seen any AIDS\npatients, either in Alabama or even in London at that time, because it’s the\nearly ’80s, and they were starting to pop up?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=661.0,672.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Right. Did not see them in London, but when I came back to Birmingham, I\nwas very interested in infectious diseases already. And I was doing my\ninfectious disease rotations as part of my internal medicine residency program,\nand we would have, of course—we would have rounds most mornings with the\nattendings, where cases were presented. Now, at UAB, the Infectious Disease\nProgram was one of the most highly regarded departments at UAB. And the\nphysicians there who were the professors in that department were considered some\nof the best doctors there, so we felt like they were “masters of the universe,”\nas we used to say. And so they began to describe this man in his thirties or\nforties from Huntsville, Alabama, about a hundred miles away that had this\nrespiratory infection. He had hemophilia. The head of the department, Dr. Glenn\nCobbs, proceeded to go through the differential diagnosis. We anticipated his\nopinion, waiting for him to tell us what this person had, and he goes, “I don’t\nknow what he has.” And I can still remember the chill going up my spine that—the\nfact that this really young man—granted, with a chronic blood condition, but\npreviously in good health—would come down with this life-threatening pneumonia\nshocked me. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=672.0,721.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nLater, we found it was Pneumocystis carinii pneumonia. This would have been\nabout 1983, I think. That case was one included in one of the first case series\ncomplied by CDC that included persons with hemophilia. My first introduction to\nHIV/AIDS was the result of transmission by blood and blood products.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=721.0,738.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So was it at the end of your three years of internal medicine\nresidency that you had sent in your application to become an EIS officer at CDC?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=738.0,747.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: That’s right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=747.0,748.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Okay. And you and your EIS classmate—that, I believe, was [Dr.\nThomas] Tom Peterman—you were only the second set of EIS officers that had\nactually ever been accepted into the AIDS program at headquarters in Atlanta.\nWhen you came to interview for EIS during the conference and the matching\nprocess, had you set your sights on the AIDS program, or were you—With all of\nyour travels and experience, you certainly had had a lot of interests. What did\nyou come to Atlanta looking for and what did you—You obviously ended up with\nAIDS, and I’m just curious about how that worked? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=748.0,781.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Yes, it was interesting. I intended to work on hepatitis at CDC, as I had\nbecome interested in hepatitis, because, as I’ve mentioned, of my exposure to\nthe health department and their data regarding hepatitis and hepatitis B\nvaccination. However, when I arrived, I found that the hepatitis program was\nassigned an EIS officer every other year, and I was here in the off-year, so the\nprogram didn’t have an EIS position. Now at that time, the interviews were\nconducted on a Saturday and a Sunday for EIS. And as you know, Mary, it’s very\nmuch like fraternity or sorority rush, where you’re trying to find who you think\nwould be good, and they’re going to give you a ranking as to who they want. But\non the Friday night beforehand, the people who have positions in the EIS program\nin their departments, they were given three minutes to describe their positions,\nto attract you to apply for their positions— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=781.0,841.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Give their pitch.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=841.0,844.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: To give their pitch, exactly. And I can remember [Dr. James W.] Jim Curran\ngetting up, and I’m sure he said a number of things, but the one thing that\nreally stuck with me was how he, with alarming clarity, described how this whole\nepidemic was unfolding, there’s a lot of unanswered questions, and, “He who\nknows AIDS will know medicine.” And it was like I had, you know, just like— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=844.0,901.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: That was his hook.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=901.0,903.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: That was my hook. And it hooked me big-time. I mean, it was like the V8\nmoment, the lightbulb going off. I realized this is just the start of the\nepidemic. It’s just beginning. I really wanted to be a part of this. This was on\nFriday night. As you know, Mary, during the EIS week, programs are having\nbreakfasts and lunches and gatherings to attract interest. I had not gone to any\nof those for the AIDS program. I had a lot of catching up to do. On Saturday, I\ninterviewed with Jim and with [Dr.] Harold [W. Jaffe] and with [Dr. Kenneth G.]\nKen Castro, who was the EIS officer in the year before me, and then cycled back\naround on Sunday to let them really know my strong interest in this. I think it\nmight have helped that Jim Curran’s wife was from Alabama. I’m thinking that\nthere might be some—a little connection there, maybe. He gave me a nod. But I\nfelt very appreciative when I got the call that I had matched, so I was really,\nreally excited about that. The call came in April. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=903.0,961.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: April.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=961.0,962.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: April. So then you still have several months to go back and finish up your\nresidency program. So I go back to do that, and about a week or so after getting\nselected to be part of the AIDS program at CDC, [Dr. Robert C.] Bob Gallo and\n[Dr.] Luc Montagnier published their studies and their discoveries of the virus\nthat causes AIDS. At that time, the virus was identified as HTLV-III [human\nT-lymphotropic virus type III] by the Americans, and lymphadenopathy associated\nvirus, LAV, by the French. I can remember my colleagues in my residency program\ngoing like, “Well, that’s over, John. I don’t know why you joined that program.\nThey’re going to find a vaccine for that.” So it was a little bit of a mis-call\nthere, so that was my— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=962.0,1021.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yeah, we’re still looking for that vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1021.0,1024.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: We are still looking for that vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1024.0,1027.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So your arrival in Atlanta, which would have been in July of that\nyear, it’s really at a pivotal time. The cause of AIDS had been discovered, and\nthere are now serological tests to detect the virus that became commercially\navailable in March of ’85. And the availability of testing was obviously a\nwatershed moment, and in particular for blood banks, because at that point in\ntime, national surveillance was showing that about 1-2% of all AIDS cases\nreported to CDC were associated with receipt of transfusions. And although the\nPublic Health Service, really as early as March of ’83, had recommended that\npeople who were at increased risk for acquiring this new disease—this new\ninfection—should refrain from donating blood and plasma, we all know that that\nis far from a failsafe prevention measure. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1027.0,1081.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo, all of this is unfolding. You begin in the summer of 1984 in Atlanta, and\nI’m curious, because much of your EIS work and then after is associated with\nworking on blood transfusion issues, how did that come about? Did you volunteer\nfor this? Were you volunteered? Had you started on another AIDS-related project\nand then diverted over to this? I’m just kind of curious how they got you\nslotted in this particular area.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1081.0,1129.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: No, when I arrived they basically said, “John, your job is to protect the\nnation’s blood supply.” ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1129.0,1141.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Protecting the nation’s blood supply?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1141.0,1143.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Of course, I was going to have help, but that was pretty much what I was\nassigned to, right at the moment. And as you alluded to, this was a very\ncontentious aspect of the AIDS epidemic, because it was a risk that potentially\nanybody could have, receiving blood that was contaminated with HIV. There was\nthis sense of the “innocent bystander” of the AIDS epidemic, of people without\nanything that they could control becoming infected. As a result, it was a very\nhighly visible and politically charged part of the AIDS epidemic that attracted\na lot of interest from different sectors of society. And obviously, you know,\nit’s—a very major focus of public health continues to be protection of the blood\nsupply. I did a lot of work with the FDA [Food and Drug Administration] in that\nregard as things moved along. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1143.0,1201.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Now, I’m curious, because in your comments from the last few\nminutes when you walked us through your training and your various travels, I\ndidn’t hear any mention of blood banking.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1201.0,1208.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Right, exactly.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1208.0,1209.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So this was, I presume, a whole new arena for you, other than maybe\nordering blood transfusions as a resident.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1209.0,1214.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Exactly.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1214.0,1214.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: How did you get up to speed on just what the basics of blood\nbanking are and who the players are?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1214.0,1219.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I really think this is one of the real beauties of epidemiology and real\nbeauties of working at CDC. At CDC, epidemiology is perceived to be a mobile\nskill, and you’re to move around and apply it as needed. I think that’s what I\nhave seen time and time again here at CDC. And in my case, I was expected to\ncome up to speed on the—by—through reading about blood banking and begin to\ndevelop relationships in the field. I began to work on a regular basis with the\nAmerican Red Cross, American Association of Blood Banks, and the individual Red\nCrosses around the country at that time. I would go to their meetings, attend\ntheir conferences, and then progressively you become more and more knowledgeable\nabout the field. I think that’s actually one of the real attractions of\nepidemiology and working at CDC, is that you can move around while still having\nthe basic tenets of public health and epidemiology in mind. You can apply that\nto a variety of different health issues over the course of your career, which\nmakes it a much more rewarding career as a result. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1219.0,1261.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Mm-hm. You know, in preparing for this interview I went back to\nread some of the relevant publications and CDC’s MMWRs. It was interesting. In\nJanuary of ’85 there was—the Public Health Service came out with recommendations\nanticipating the availability of now commercially available HIV testing and\nserological tests. And these recommendations were introduced with some fairly\ncautionary language. They said while there is considerable experience with using\nthe ELISA [enzyme-linked immunosorbent assay] test, which was the serological\ntest in research laboratories, much additional information will need to be\ngathered following widespread application through blood and plasma donations. So\nalthough the test was obviously welcomed, it was clear that there was a lot to\nbe learned about unleashing it, if you will, on a population of blood donors who\nwould normally be expected not to be having a high prevalence of infection. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1261.0,1321.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCan you talk—I want to talk, obviously, a lot about studies that you and others\nwent about in evaluating this new test in the real-world setting of the blood\nbank. But maybe before we get to the mechanics of it, can you tell us a little\nbit about what were some of the concerns or pressing questions that, screening\nmillions of donors of blood and plasma, were being raised? What were some of the\nconcerns and questions that your studies really needed to address?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1321.0,1341.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Well, that’s right. I mean, just the—how well would the test work when\nscreening millions of people every year, rather than being out of the research\nenvironment? And what kind of quality control issues within individual\nlaboratories, the sort of variations just by the different staff working on the\ntests in laboratories? Who was being found positive? Were they really infected?\nBlood banks were always worried about throwing out blood unnecessarily. And so,\nare you over-calling an infection and therefore having a valuable product\ndiscarded unnecessarily? So those were those big issues too. And then, you know,\nthen actually how well does it really work in protecting the blood supply? So\nthere was sort of a mix of concern about quality, concern about documenting that\nthe test was indeed good, so you could protect the blood supply, but also\nreassure the public that the blood supply was being protected by the blood\nscreening. And then minimizing the discard of blood unnecessarily. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1341.0,1381.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Right. And that discard of blood, obviously, if a unit tested\npositive—no matter how good a test is, if you’re using it in a presumably\nlow-prevalence population, you’re going to pop up with some false positives.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1381.0,1392.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Oh, yeah.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1392.0,1393.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: And, obviously, even if subsequent testing went on to show that it\nwas likely that the donor was not infected, the blood bank would be nonetheless\nobliged to discard the unit. Were people concerned, again, about the impact this\nmight have on the donors themselves? Because I know the blood banks are\nvery—back then, and still today—are very protective of their donors in the sense\nthat they’re very appreciative, obviously, to these people who have given a lot\nof their time, and many of them do it repeatedly to donate a unit of blood or\nplasma. But were there also real concerns about the potential social or\npsychological impact that it might have on donors to sort of be calling them up\nand say, “Well, got the results of your test, and it’s positive”? I was curious\nif that was also part of the mix of discussions that you had before undertaking\nthe studies. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1393.0,1441.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Not before undertaking the studies. There was some concern about how you\nconvey the information to donors as they were found to be infected. I would have\nto say, the largest issue around donors was that by having the testing available\nin blood banks, the major concern was that you would be attracting people who\nwere at risk, had no other way of being tested, and then they would go and\ndonate blood just to see if they were infected. And even if the test was good,\nyou’re going to miss some people because no test is perfect, and you would\nactually be causing some harm unnecessarily. The other complementary activity\nunderway was to provide alternative test sites around the country so that those\npeople who did want to know their status would have an outlet, rather than only\na blood bank. It’s a secondary way of protecting the blood supply. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1441.0,1501.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yeah, that’s a really good point. And I’m assuming that you really\nweren’t particularly involved in the setting up of the, quote, “alternative test\nsites,” but that was fairly novel, I think, in and of itself—that this new test\nis available, there is a sense that people will want to know what their status\nis and there was really no place to go. I mean, you couldn’t go to your doctor’s\noffice, for the most part, and ask for a test. So people were going to show up\nat blood banks, which I could see would be worrisome.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1501.0,1551.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Right. And for some, they may even feel like it’s more confidential than\ngoing to a local clinic— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1551.0,1561.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Ah, yeah, good point.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1561.0,1562.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: —a small-town physician or something like that. A big concern how the\ndonor population might change because of the attraction of the test being available.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1562.0,1569.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Okay. So I imagine, these were all—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1569.0,1571.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: It was all swirling about.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1571.0,1573.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: It was swirling. Who were some of the players that were engaged in\nall of these discussions and—do you remember?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1573.0,1578.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Well, there was a lot of—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1578.0,1580.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Obviously, people within CDC—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1580.0,1581.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Obviously, well, within CDC, I would brief Jim Curran, obviously, Harold\nJaffe, [Dr. James R.] Jim Allen was my immediate supervisor and responsible for\nthese and other epidemiologic studies, [Dr. Walter R.] Walt Dowdle who was\ndeputy director of the CDC at that point in time, and [Dr. James O.] Jim Mason,\nthe CDC director. This was a high-visibility issue within CDC. We would meet\nwith people with FDA on a regular basis. The heads of blood banks, [Dr.] Roger\nDodd comes to mind at the American Red Cross. [Dr.] Paul Holland, who used to\nwork at NIH [National Institutes of Health] in the transfusion service, who ran\nthe blood bank in Sacramento, was still very influential. [Dr.] Harvey Alter at\nNIH was very involved in those early days. There was a number of others. I can’t\nreally recall all the various community advocates at that point that was having\na say around testing. But just access to testing— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1581.0,1621.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Was a big issue—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1621.0,1623.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: —because it was getting licensed now, how do you make this test available\nwas gathering steam as a major point of discussion between community advocates\nand the government, which, as you know, continues to this day.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1623.0,1639.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So let’s talk a little bit about your first big study to protect\nthe nation’s blood supply, as Jim Curran had charged you when you walked in the\ndoor as an EIS Officer. How was it decided that CDC would join forces with the\nAmerican Red Cross and their regional office here in Atlanta to do a\ncollaborative study on the test, how good it performed? How did that all come about?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1639.0,1671.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I wasn’t privy to all those conversations as an EIS—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1671.0,1676.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Oh, so some of them may have antedated your arrival? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1676.0,1681.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Well, I think the test came out, as I recall, in February, after I joined\nthe program as an EIS officer the previous July. It was licensed in February of\n’85. Right around that time, or maybe within one or two weeks, Jim Curran and\nHarold Jaffe come to me and said, We’re going to do an Epi-Aid to investigate\nhow well this test works. An Epi-Aid is the term for a CDC investigation of a\nnew outbreak or other health problem. I think it reflects the ongoing\ncollaboration CDC had with FDA already. You know, you’ve mentioned the 1983\nmeeting—CDC was already very involved in this whole area of HIV and the blood\nsupply. We can do this type of study much better than the FDA can, I believe. So\nwe took it on. They said, We’re going to do it here in Atlanta with the Atlanta\nRed Cross. We went over and met with [Dr. Alfred J.] Al Grindon, who was the\nchief medical officer of the Atlanta Red Cross. I’m not really sure how all the\nfunding worked at that time. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1681.0,1741.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: It’s probably better not to know.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1741.0,1744.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Exactly. But it was an emergency situation, and things get done. We\nfashioned the study: we developed a sample size calculation; we developed, from\nthe package insert, the estimated sensitivity and specificity of the test; we\nestimated prevalence, and then estimated how large the study needed to be to be\nmeaningful. As a young EIS officer, I think it really taught me how to evaluate\na test, predictive value positive, predictive value negative. And a lot of\npeople talk about sensitivity and specificity when they talk about tests, but\nwhat they’re really talking about is predictive value positive and predictive\nvalue negative. As this varies, your test interpretation varies, depending on\nthe prevalence of the infection in the population that you’re testing. In the\ncase of blood donors, you’re testing a fairly low-risk population. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1744.0,1801.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nMy job, after writing up, with help, the protocol—basically I went out and\ninterviewed people who were positive on the test. I did that at the Atlanta Red\nCross headquarters on Monroe Drive. I did it at CDC. CDC had a little clinic at\nthat time right between Building 1 and Building 6, which are no longer existing.\nPersons would come in. I would see them there and talk to them—I had a standard\ninterview, of course—draw blood on them myself, and then have that blood sample\ntested at CDC for confirmation of the antibody result and to do the Western blot\nto confirm the presence of HIV. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1801.0,1861.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Were people cooperative? Did you get—because obviously, the\ntest—the Red Cross would be running the serologic screening test and then\nidentifying who the people were that it deemed to be positive. I believe CDC’s\nlabs were doing confirmatory testing for that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1861.0,1873.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: That’s right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1873.0,1874.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: And then would offer, I guess, to these positive donors the\nopportunity to enroll in the study to be interviewed by you.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1874.0,1881.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: That’s right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1881.0,1882.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Were these positive donors cooperative?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1882.0,1884.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: They struck me as very cooperative.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1884.0,1886.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Yeah, because you were trying to find out if they had risk information.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1886.0,1890.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah. I had very few refusals. And again, we have to remind ourselves that\nthis study was being done in 1985 in Atlanta, Georgia. The AIDS epidemic is only\nabout four years old, and the test is new. Most people don’t know they’re\ninfected. And there were remarkable personal stories uncovered by the testing.\nNow, obviously, I met people who were false positive—you know, they were not\ninfected with HIV, and they had histories that were fully consistent with that\ntest result. But then you also were telling people for the very first time if\nthey were infected with the virus that causes AIDS. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1890.0,1921.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Oh, gosh.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1921.0,1922.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I really was the first one to tell a fair number of people that they had\nthe AIDS virus in 1985, at a time when it was a very, very scary disease. And\nAIDS still should be so considered currently. Fortunately we have interventions\nthat make it less scary than it was at that point in time. And the stories\nreally vary. A few come to mind. One, a minister in a small Southern town,\nmarried, with three to four children, would come up to Atlanta to see his\nparishioners in the hospital, and then stay over and have a separate lifestyle\nthan [what] he was associated with in his small town. I had to tell him he was\npositive. He had to share that information with his family. Difficult. However,\nhe became fully open about his sexuality and began to live his sexuality. He\nmoved to Atlanta, and fortunately, he was a long-term survivor. I saw him\nabout—at least twelve years after my study, and he was still doing fine and\nheavily involved in various AIDS causes. This is one example. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1922.0,1981.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nOn a more tragic note, I interviewed a woman who was found to be positive who\nhad only had—after years of celibacy, had just decided to become more sexually\nactive. She had had only two sex partners. Unfortunately, one of them was\nHIV-infected. She had become infected just recently. And another one: I\ninterviewed a man who was living in Atlanta from the New York City area, and he\nreported that he had fifty or more female partners a year and had no other risk\nfor HIV. As a result, I attributed his risk to heterosexual transmission. Years\nlater, when I was working at the VA [Veterans Affairs] Hospital here in Atlanta,\ndoing my clinical rotation in the HIV clinic as part of my commission core\nactivities, that individual came through the clinic and laughingly told me he\nhad been an injection drug user at that time. This was almost certainly the true\ncause of his HIV infection. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=1981.0,2041.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Oh, my goodness.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2041.0,2043.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yes, he admitted that he had made the whole thing up and that he was\nactually an injection drug user.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2043.0,2053.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So did you two immediately recognize each other?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2053.0,2057.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Oh, yeah—well, he recognized me and then introduced himself and then we\nbegan talking. So we had to correct that on the form, because heterosexual\ntransmission, you know, is a little bit less common, particularly\nfemale-to-male. So it was a little bit more consistent for him being a drug\nuser. And I met gay men who were already more open than the one I just\ndescribed. I had to return for some follow-up confirmatory testing, et cetera.\nWe developed doctor-patient relationships at a time when there were few\nphysicians who actually knew anything about HIV. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2057.0,2101.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yeah, and I’m really also struck how difficult this was, because at\nthis time, as you say, there’s not a lot of physicians that know much about\nAIDS, there wasn’t—we were still learning about the natural history of AIDS. You\ncouldn’t really give them a lot of detailed information about the likely course\nof their disease. There was no treatment that you could really offer them. There\nwere certain preventive messages that you could deliver, which, as you\nillustrated, in some instances would involve them in having to share their\nstatus with sexual partners or others. So I can see where this just must have\nbeen a really wrenching part of the study for you. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2101.0,2161.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: No, it really—it really made it real, very real, what was happening,\nhaving it done at the personal level. And so we did that study from late\nFebruary through, I guess, May. I presented it at the EIS conference.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2161.0,2169.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: And what did you find, in terms of the performance of the test? I’m\nsure everybody was interested in how that was turning out.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2169.0,2174.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: We were really trying to keep the study a bit under wraps, so, again, not\nto influence who was coming in to get tested, et cetera. In addition to testing\npeople here at CDC and at the headquarters of the American Red Cross in Atlanta,\nI would go out into rural areas and interview donors in small offices of the\nAmerican Red Cross. I remember going down to LaGrange, Georgia, which is about\nsixty miles south of Atlanta. I was supposed to meet a donor there who was\npositive. The Red Cross office was on the second floor of the courthouse. I sat\non the steps of the courthouse waiting for the donor to come by. Now, Coca-Cola\nhad just changed their formula from sugar to corn syrup. This media truck from\nthe local radio station pulls up. These people get out with all these\nmicrophones and everything. I’m going, “Oh no, someone’s found out about this\nstudy—I’m going to get interviewed. I’m going to get interviewed here.” And sure\nenough, they walk right up to me and they go like, “Can we talk to you?” And I\nsay “I guess.” And they bend over with a mic and ask, “What do you like better,\nnew Coke or old Coke?” I replied, “I think I like the old Coke better.” So the\nconcern over media leaks was a little over-call on my part. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2174.0,2221.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nI brought the data together. My first study at CDC, a very simple study, which\nwas perfect for me as an EIS officer—I began to analyze who was positive, and\nthen who was positive on the Western blot, to show they were truly infected with\nHIV, and their characteristics.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2221.0,2234.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: The confirmatory test is the—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2234.0,2236.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: And I found that the persons who had a small number, indicating less\nreactivity on the antibody test, were least likely to be positive on Western\nblot, and those that had a very high value were most likely. And so I came up\nwith, anything over 6.0, you had about an 88% chance of being positive, whereas\nif you were less than 2, it was 6% or 10% chance of being truly infected with\nHIV. And I have to say, you know, being my first introduction into doing\nstudies, I marveled at the fact that for that little space of time, I was the\nonly person in the universe that knew how well that test worked, you know, in\nthe blood bank setting. And so then I went in to show the results to Jim Curran,\nand I laid it all out for him. And of course I’m not fully certain how to\ninterpret these findings, and I said, “People that were positive with a value of\n6.0 or higher—” ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2236.0,2281.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: So, strongly reactive to the serological test.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2281.0,2285.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: “If they are strongly reactive on the antibody [test], they had an 88%\nlikelihood of being infected with HIV.” And I said, “It’s not 100%, but it’s\n88%,” and so Jim goes, “It’s okay, it makes it more believable if it’s not\n100%.” So that was a good joke. We had a good laugh about that. But then we\npresented it. We rushed it into publication. It was published in JAMA [Journal\nof the American Medical Association], and that 6.0 was really used as a real—you\nknow, those kinds of values, for a short time, as people began to get familiar\nwith the test—it was really used to help interpretation in laboratories around\nthe country. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2285.0,2341.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: So your findings did lead to—I don’t know if modifications is the\nright word, but it helped people interpreting, if you will, the EIAs [enzyme\nimmunoassays] and setting maybe some cut-off values and whatever?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2341.0,2352.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, absolutely. And then also just the likelihood—helping with the\ninterpretation with the EIA, and helping, as a result—like, you know, if you got\na negative Western blot but you had a high value on the antibody test, it was\nindicative that you probably should redo the Western blot, that maybe the\nWestern blot wasn’t done well. So it really helped in the laboratory to\ninterpret the test as people began to get more and more experience with it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2352.0,2377.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Okay. Okay. Yeah, so this real-world, real-time evaluation of a\ntest that is still with us today, obviously much-improved over time. Was the\nCDC/Atlanta region Red Cross study the only study that was happening to evaluate\nthe test? Were other entities involved? I was just curious if everybody was\nzeroing in on this very detailed study here in Atlanta, or were there others,\nand if you were communicating or collaborating or sharing results. Just curious. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2377.0,2401.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: No, it was really the only one.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2401.0,2404.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Really?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2404.0,2405.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Really, at that time. We were still a fairly small operation then. And\nAIDS had not really caught on as a large national health issue. Even though\nthere was a lot of concern about the blood supply and the case counts were up to\naround five thousand, we still did not have large budgets to study AIDS or to\nprevent AIDS. I think that really began to change when Rock Hudson was diagnosed\nwith AIDS, and people began to take it more seriously. You know, when I first\ngot there, to the AIDS program, the Georgia Public Health Association invited us\nto give a talk on Jekyll Island about AIDS. And I was asked to go and of course\nI said yes, but we did not have enough money in our travel budget to travel— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2405.0,2461.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: For you to drive down to Jekyll Island—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2461.0,2470.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: —from Atlanta, Georgia, to Jekyll Island on the Atlantic coast. It was\nreally amazing. And you know, over several weeks we were able to muster the\nmoney and I did end up going, but that just sort of shows you how thin the\nmargins were as far as budgets were concerned. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2470.0,2521.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: So this new test had been—it was being deployed in other, certainly\nblood centers around the country—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2521.0,2527.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Oh, absolutely.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2527.0,2528.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: But I’m really fascinated to learn there was just this one very\ndetailed look going on, at the Atlanta region’s collaboration between CDC and\nthe Atlanta region of the Red Cross. That’s fascinating.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2528.0,2539.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2539.0,2540.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: For a test that was going to have that much of an impact.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2540.0,2545.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, really, I have to say, I’ve often thought that CDC in the early days\nof the AIDS epidemic was very much like the Washington Post in the early days of\nWatergate. We were pretty much the only game in town for investigation. And then\nover time, more and more people got interested in it, got involved in—and\ninformation began coming from different sources. But at that time, CDC was in\nthe lead. And I think all the people you interview for this history will agree\nthat one of the accomplishments that CDC can be the most proud of is the steps\nwe took to protect the nation’s blood supply. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2545.0,2582.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Mm-hm. Do you remember, as the results of the study became public\n—you alluded to the MMWR, your JAMA publication—but I believe results probably\nbecame public earlier than the JAMA publication. Do you remember what the\nreaction was among public health officials, the blood banking community, the\ngeneral public? Because we talked earlier about the concern, the deep concerns\ngoing into the study about, how well would the test perform? Were we going to be\nin a position of having to discard a large number of units? Do you remember what\npeople’s reactions were, or how that played out? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2582.0,2642.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Well, it was very well received, because it was very good news that the\npeople that were positive, for the most part, were truly infected—that the\nnumber of persons found to be positive was relatively small, and so the test was\nfunctioning very, very well. So it was very welcome news. If anything, we had to\nsort of harness the enthusiasm of the blood banking community, because they\nwanted to really be very robust in their estimations of how many infections were\nbeing prevented here and the number of infections that were being missed. And we\ndidn’t feel like we had enough information yet to say that, so it was a little\nbit of a—I guess what we would call now irrational exuberance among the blood\nbanking, because the test was performing so well. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2642.0,2702.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Well, on that note, as the saying goes, no test is perfect. And\nsure enough, it wasn’t long before cases of AIDS started to be picked up in\npersons who had reportedly received blood that had been screened by this new\ntest and found negative for HIV antibodies—and you and others published a\ndetailed analysis of thirteen HIV-infected persons who had received blood from\nseven donors in February of 1988, in the New England Journal of Medicine. So\nlet’s talk a little bit about this. First of all, you start hearing about these\ncases—I’m curious how these cases started to come to light—and were you shocked?\nWas this unexpected? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2702.0,2762.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: It was surprising. You are really there dealing with the unknown, so you\nreally don’t know quite what to expect. Again, it’s a real testament to how\nclinicians have a vital role in public health surveillance, because they’re the\nones who begin to call attention to these cases of people having HIV antibody\ndetected that had no risk other than recently receiving blood transfusions that\nhad been screened by blood banks. And we had just shown that the testing was good.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2762.0,2782.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So what we did was we went in, I interviewed the clinicians, got the risk\ninformation of their patients, and then we got the information about the donors\nto those cases. And they were happening around the country. These weren’t—to\nyour point, they weren’t large numbers of cases at that time, but they could be\nindicative of a larger problem, because then everyone, obviously, is getting\ntested after they get a unit of blood. What we found was that the donors had\nevidence of recent exposures that could have infected them with HIV, and that\nthey were in what was called the “window period,” between the point of infection\nand the point of developing detectable antibody. And so that really helped to\nidentify an area for quality improvement of the test—how do you shorten the\nwindow period so that more and more of those infected donors can be picked up?\nIt also reinforced the value of screening out people who were at risk for HIV. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2782.0,2822.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yeah, most of these donors had risk factors?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2822.0,2826.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, almost all of the donors had risk factors, and so they could have\nbeen excluded, but they had donated, and they had donated during this window\nperiod, and therefore the blood was used for transfusion. It was interesting. I\ndid that study from my desk at the CDC. I did all of the interviews from my\ntelephone. I wrote it up with the help of [Dr.] Scott [D.] Holmberg and Jim\nAllen and Harold Jaffe and others at CDC. And because of the national interest\nin this issue, the New England Journal quickly accepted it for publication, and\nthe results really helped define what else needed to be done to protect the\nblood supply. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2826.0,2882.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nI have to say, the results spawned this “zero risk” guiding principle of the\nFDA—that our goal is to make the U.S. blood supply HIV-free. And over the next\ndecades, really, they have progressively sought to improve the antibody testing,\nsought to improve detection of the virus within that window period, first with\nan antigen test for HIV and then by PCR, polymerase chain reaction, which is\nused today. And so that window period has become very, very narrow. And so it is\nvery, very rare for HIV to be missed, certainly in blood banking.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2882.0,2929.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Yeah, because back then, I think the ELISA test took something\nlike, you know, maybe about eight weeks at least after infection—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2929.0,2940.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: That’s right. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2940.0,2941.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: —to develop a level of antibodies that was able to be detected by\nthe ELISA test. And as you say now, the tests are such that they can detect\nevidence of infection within days of someone having been exposed. Did your\ninterviews with these positive donors shed any light on why it was that\nhigh-risk donors continued to donate at blood drives? And did it help identify\nany additional measures that blood banks could take to try and dissuade donors\nfrom donating, or, if they felt pressured to donate, other ways that it would be\npossible for them to alert the blood center that you really shouldn’t use my\nblood here?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2941.0,2992.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah. I think it was a combination of donors not assessing their risk\nfully, so they sort of under— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=2992.0,3001.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Didn’t really think it could happen to me.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3001.0,3004.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, there may be a little bit of self-denial going on, that I could\nreally be at risk for HIV/AIDS, at that point in time. I think that was part of\nit. The other part of it was how blood drives are conducted, where people did\nnot feel like they could opt out without people feeling like, “Ah-ha, he must\nhave a—”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3004.0,3027.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Because these are done in the workplace or in a church setting?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3027.0,3032.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, in the workplace, and it’s a very promotional expectation that you\nshould be donating. And so people felt like, Well, if I say no to the blood\nbank, people will think I’m gay.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3032.0,3045.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: I have a risk factor.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3045.0,3047.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I have a risk factor. And so it helped people reevaluate how those blood\ndrives were conducted, so that people had a better opportunity to opt out in a\nway that would be less stigmatizing for them. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3047.0,3061.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: I remember in those days, while we were working at CDC, there used\nto be—and there probably still are, I guess—the Red Cross would do collection\ndrives here at CDC in one of the big auditoriums. And there would be emails that\nwould go around, and my recall is that there was particularly a lot of pressure\non people who had been previous donors to step up to the plate again. And so, as\nyou say, in these kinds of settings it would be potentially very uncomfortable\nfor someone to suddenly say, “Oh no, I’m not going to do it this time.”","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3061.0,3093.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"My recall is that I think some of the blood banks came up with novel ways to try\nand address this, to allow people to donate in a setting—but then there was, I\nthink, another step where they had this “confidential exclusion questionnaire”\nwhere everybody was asked to indicate, “Should my blood be used for transfusion?\nYes or no.” People could say “no,” and it allowed them to donate, but then given\nthis information that they provided in another question, if you will, to the\nblood collection agency. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3093.0,3121.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Mm-hm. The other thing that really changed because of the AIDS epidemic\nand the blood supply was how blood was used in clinical medicine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3121.0,3133.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Good point.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3133.0,3134.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Blood was heavily used in clinical medicine. You know, I can recall,\nduring residency, the notion was, “Let’s pink them up before they leave.” You\nknow, “Let’s top off the tank,” and people would be given a couple of units of\nblood just as a final measure. And all that got reevaluated because of the AIDS\nepidemic, and clinicians began to be more judicious in the use of blood, and\neven recapturing blood during surgery and having that used. So really, the AIDS\nepidemic totally transformed the blood banking industry in this country. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3134.0,3180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nThe other element of this is the plasma industry, and that’s where the clotting\nfactor products were developed from plasma donations, and I’m sure [Dr.] Bruce\nEvatt and others you’ve interviewed have talked at length about that. But that’s\nquite a different donor pool that you’re pulling from, much more frequent\ndonations, paid donations, et cetera. And the products from those are\nmanufactured from a large number of donations, and so your exposures through\nplasma products is much larger than through transfusion. And, regrettably, as\nyou go around the world, HIV was introduced in a number of countries by the\nplasma products that were manufactured here in the United States. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3180.0,3240.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Such as the clotting factor concentrates—the hemophiliac—your very\nfirst patient that you saw.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3240.0,3246.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Absolutely.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3246.0,3247.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: These clotting factor concentrates were comprised of hundreds, if\nnot thousands, of donors.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3247.0,3253.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Exactly.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3253.0,3254.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So a huge exposure over time, if you will. Your work in this\narea—you were able to spin off, if you will, some additional studies in this\narea –","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3254.0,3266.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of trying to get a better handle on the risk related to transfusion-associated\nAIDS, because now that you had a reliable test that could identify donors, you\ncould—with, obviously, external collaborators and blood collection agencies and\nhealth departments and the like—get a better handle on just what the risk of\ntransmission might be from an individual donor. And I’m thinking if—once a donor\nbecomes infected, was it pretty much a given that he or she would continue—if\nthey continue to donate—would be transmitting HIV? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3266.0,3301.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Yes, we did studies looking at the whole donor history for repeat donors,\nand after a certain point in time, because of the way HIV persists in the body,\nthat the donor remains infectious, certainly through blood transfusion—blood\ndonations leading to blood transfusions—as long as they donate. So you really\nneed to get them out of the donor circulation. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3301.0,3361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nYou mentioned the natural history and how little was known in 1985. People knew,\nobviously, that AIDS could kill people, but you didn’t really know, does it kill\neveryone? I mean, who survives this, who doesn’t, and why? And so the natural\nhistory questions were really, really big. So my second project as an EIS\nofficer was to develop the first natural history study of HIV at CDC, actually,\nand we did it by identifying these persons who had become infected through\nreceiving contaminated blood. Now, the beauty of that type of cohort study is\nthat you have a date of infection.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3361.0,3387.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: You knew exactly when they got infected.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3387.0,3389.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, you knew exactly when they got infected. The downside is that they\ntend to be older, they tend to have other diseases, they tend to die for the\nreason that they were given the transfusion to begin with. So you have some\nselection issues that you have to be mindful of. And so, someone getting\ninfected at age fifty may not be representative of someone who is getting\ninfected sexually much earlier. But at a time when almost nothing was known\nabout the longitudinal risk over time, it was a very important study. And we did\nthat in New York, Los Angeles and San Francisco. This is when you were given\norders without a lot of direction—that sometimes works out. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3389.0,3421.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo the San Francisco part of the study was not going well. So Harold Jaffe said\nto me, “John, I want you to go to San Francisco. Get the study straightened out.\nDon’t come back until it’s straightened out.” So I spent about two weeks in San\nFrancisco, which is not a bad place to spend two weeks, by the way. But also, it\nwas the heartland of the AIDS epidemic in America. It’s probably one of the\nhighest prevalences in the world. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3421.0,3481.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nI can remember Jim Curran going there and coming back and saying, “AIDS is\npalpable in the streets of San Francisco.” And at that time, it really was. I\nmean, you could really see people who were getting gradually decimated by their\nvirus. You became a lot more in tune with what was going on around the country.\nWe got the study going. San Francisco became a very productive part of the\nstudy. And those researchers, [Dr. Michael] Mike Busch and [Dr. Herbert] Herb\nPerkins and others, did a great job. Mike continues to be one of the world’s\nexperts on blood safety when it comes to HIV. We followed the HIV-infected\npersons over time, with periodic bleedings, periodic physical exams, history. We\nbrought the data together. We found that about 50% of persons would die of AIDS\nwithin eight years of their transfusion. So that was one of the first estimates\nof the natural history, what’s your risk of AIDS and death after infection. And\nso that was also published in the New England Journal, about 1989, I guess. It\nwas very important information, you know, at that time. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3481.0,3541.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Were there any differences among the recipients in terms of their\nprogression to AIDS? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3541.0,3601.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/152","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Yeah, that was really interesting. So I found that if the donor developed\nAIDS soon after giving that unit, that the recipient progressed more quickly\nthan recipients who got blood from donors who did not progress to AIDS as\nquickly themselves.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3601.0,3614.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/153","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: So from donors who were still early in their own disease, so to speak?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3614.0,3619.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/154","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Apparently earlier in their own disease. So that was also part of our\nfindings. Now, while we were doing those studies, and right around 1986-’87, as\nmore resources, money, became available, NIH became much more involved in\nHIV/AIDS. And so they funded a very large blood safety study—its TSS,\nTransfusion Safety Study—that was a few years behind us, but was larger. And so\nthat particular finding was not confirmed by their study. And so, for whatever\nreason—there may be other factors to explain that, sample size being one,\nperhaps—that study finding was not confirmed. We were reporting the data that we\nfound. Not everything in science gets confirmed. It doesn’t mean that you get\nbad science, necessarily, it just means you have differences in methodology or\nthe population and other factors. I believe that was apparently the case for\nthat particular finding. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3619.0,3662.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/155","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Because I know in your paper you hypothesized that one of the\npossible explanations for this might have been related to what we now call viral\nload. If the donors who were donating close—sort of at the end stage of their\ndisease, so they weren’t symptomatic, because they obviously would have been\nexcluded as a donor—but that you were hypothesizing that maybe they had a higher\nviral load as their disease churned on. And that maybe these recipients were\ngetting larger inoculums of virus. It sounded like a good hypothesis. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3662.0,3722.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/156","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Right. At that point in time, we were just putting out some ideas for\nfurther exploration. You have more pathogenic strains of HIV that were\ncirculating, and so we were just putting those out for areas for additional research.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3722.0,3749.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/157","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Now, you talked earlier about your opportunities to be interviewing\ndonors back with the study that you did with the Atlanta region of the Red\nCross. What about opportunities for contact with recipients? Were you\ninterviewing those, or did you have contacts with recipients or their families? ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3749.0,3782.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/158","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: I did on occasion. In particular, I did a study at Cedars-Sinai Medical\nCenter, which had given a lot of blood through their pediatric programs,\nparticularly their pediatric intensive care units. This study provided an\nopportunity, again, to look at the natural history of HIV among children, which\nwas even less studied at that point in time than adults. It was the first time I\nmet Dr. David [D] Ho, who was a young researcher at Cedars-Sinai at that time.\nHe later went on to become a science expert in HIV. We would follow these\nchildren. Of course, this was a very particularly tragic set of circumstances,\nwhen you have children who apparently have survived whatever disease resulted in\nthem going into the intensive care unit, now coming out and then several years\nlater becoming ill and succumbing to HIV/AIDS. I had a fair amount of contact\nwith some of those families through the Cedar-Sinai transfusion service. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3782.0,3842.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/159","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nAnd to show you how profound an impact this has, you know, even fourteen,\nfifteen years later, I would still get letters from the family members, the\nparents of those children, as they had taken on AIDS as a cause, I’m sure\nof—sort of in memory of their children that they had lost. You know, taking it\non as a cause, ensuring that no one had to go through this again. Ensuring that\nblood banking was very safe and looking for any kind of—any weaknesses in the\nsystem. And so they would write me when they would see something in the media or\nsomething that they were working on, knowing that I had worked on this at that\npoint in time. Even though I had moved on, they had not moved on. And so, you\nknow, all around you at that point in time, or at least all around for me, you\nhad those personal connections with the HIV/AIDS epidemic. And I’m sure that’s\nstill true for CDC, many of the large epidemics that we respond to. But I mean,\nyou’re involved at a government policy level, you’re involved at a science\nlevel, you’re involved in a clinical level, you’re involved with it at a\npersonal level. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3842.0,3902.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/160","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nAnd then, I think the other telling part of the AIDS epidemic in the ’80s was\nthe community response. Just being in the room with organizations that were\ndeveloped just really out of pure desperation—a mixture of desperation and love.\nI mean desperation because loved ones were being lost, and people who weren’t\nactivists by training, certainly, were becoming activists out of necessity. The\nLavender Hill Mob, you know, ACT UP—you know, we would have meetings like that\nat CDC with those organizations, being chaired by the deputy director of CDC.\nI’m sure it was a very new area for CDC to be involved in, and I think it was a\nreal testament to CDC that—to the flexibility of being responsive to a health\ncrisis, and then moving along in trying to engage the public in what you’re\ndoing so that you become—to develop a team that works together rather than works\nacross purposes. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3902.0,3962.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/161","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nAnd I really learned, whenever you can, seek to identify the community members\nwho are very interested in what you’re trying to prevent, and engage with them,\nbring them into what you’re doing. And maybe what you’re doing isn’t the best\nway. More often than not, working with those community-based organizations, I\nbelieve we learned something and benefited from it. Then in turn, they feel like\nthey’re listened to, they feel like their government is a participatory\ngovernment and not a top-down management government. And it really—it taught me\na form of public health that I tried to continue to follow, and to be respectful\nof the community-based organizations, be respectful of the public who’s\nconcerned about this, recognize that they are either living with it [or] have\nbeen impacted by it, and you can benefit from their point of view. And then, by\nengaging them, they have a better opinion of what you’re trying to do, and then,\nmore often than not, will join forces with you rather than not. And having that\nenergy is better than having people pulling in opposite directions. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=3962.0,4022.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/162","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yeah, that’s a really very good observation. And I was going to say\nthat AIDS, I think, on a national level, international level, AIDS was probably\nthe first disease that really brought about that kind of engagement. But I say\nthat—but I’m also, now, having listened to your stories of your early years in\nAlabama, that you actually—these electives that you did, that you went out into\nthe community and lived with these Native American tribes in Alabama, you were\nactually doing that—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4022.0,4050.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/163","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4050.0,4051.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/164","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: —way back when. Obviously on a smaller scale, but now, I mean it’s\nmore or less become—I hate to say commonplace—but this idea of activism on a\nnational level—breast cancer awareness, AIDS awareness—all of that, it really\ngot, I think, a big push from the AIDS epidemic. Not all of it was harmonious,\nbecause certainly in the early days—and we talked about—at the time when the\nserologic testing of the blood supply was about to begin, I’m not sure all of\nthe activist groups were particularly happy about that. I’m thinking of gay men\nin particular. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4051.0,4083.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/165","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4083.0,4085.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/166","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: That for them, it was very—there were real concerns about\nconfidentiality, concerns about the impact of a positive test on their\nlivelihood and things of that nature. So I don’t know whether you were directly\ninvolved or observing any of those discussions—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4085.0,4120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/167","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Oh, yeah.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4120.0,4122.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/168","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: There was not, at least in the beginning of testing of the blood\nsupply, complete agreement that this was going to be a good thing. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4122.0,4143.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/169","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: No, absolutely. I’m not saying it was all sweetness and light, but at the\nsame time, we didn’t shy away from the engagement. You know, you had to sort of\nstick with it, and I think even—as you stick with it, even if there are\ndifferences of opinion, you have a higher likelihood of resolving them over time\nbecause you’re working with them. And then as the AIDS community-based\norganizations became more established, some of their techniques were pretty\nastounding. So it wasn’t all sweetness and light. But I think to say, as a young\nepidemiologist at CDC, learning that that should be an expected part of public\nhealth—is to engage the community—was not lost on me. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4143.0,4203.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/170","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Well, I’m guessing that this was one of those lessons learned that\nyou’ve carried on to your job in the Division of Viral Hepatitis.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4203.0,4210.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/171","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Absolutely.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4210.0,4211.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/172","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Because your time in the division as its director has been\nabsolutely transformational in terms of some of the advances in therapy and\nvaccine and et cetera. And I assume that this is also a rubric that you’re\nfollowing in hepatitis, in terms of getting community involvement.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4211.0,4225.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/173","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Right, I think AIDS trained me well. I think my first supervisors, Jim\nCurran, Harold Jaffe, and Scott Holmberg and Jim Allen, were part of that\ntraining where you really were—where teamwork was valued, where people’s\nopinions were valued, where you were expected to do a good job and you were\ngiven assignments with that expectation. There was a real sense of expectation\nfor innovation and new ideas and not being stuck in the status quo, but that you\nwere part of large epidemic with a lot of unknowns, and you needed to try to\nstep up and fill out that void so that we would have a better sense of how to\nmove forward. And in the community work and engaging partners, I’ve already mentioned. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4225.0,4263.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/174","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo I think that really, that training has served me very well in my hepatitis\nwork, where we now have a curative treatment for hepatitis C— a lot of issues\nregarding access and cost of treatment, stigma of people, marginalized\npopulations having inequitable access to care. I have to say, what’s missing in\nthe hepatitis are those large vocal community-based organizations. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4263.0,4323.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/175","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Really?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4323.0,4324.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/176","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: So I really miss them. You know I—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4324.0,4327.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/177","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: How interesting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4327.0,4328.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/178","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Yeah, and just because of the nature of the differences in the disease and\nthe populations affected. But I really believe that my early years in AIDS has\nreally shaped my whole career in public health.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4328.0,4341.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/179","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: I wanted to ask you specifically about that in relationship to your\ntenure as the MMWR editor. Certainly, when you were a young recruit and a junior\nepidemiologist, you certainly had your chance, I’m sure, to write many an MMWR\narticle. And I was curious if your experiences working on AIDS influenced your\nthinking about the role of the MMWR during the public health emergency that\nunfolded during your time as editor. I’m thinking specifically of the SARS\n[severe acute respiratory syndrome]—the worldwide SARS outbreak, [and] monkey\npox, which is an outbreak we experienced here in the United States. And I’m just\ncurious, again, about how your early days on AIDS might have influenced your\neditorship at the MMWR. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4341.0,4383.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/180","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Well, I became interested in the MMWR because of my work in AIDS. We would\nput out reports quite frequently to update the country and public health\ndepartments, of course, all around the country, about what was changing in\nHIV/AIDS. So I became very accustomed to writing for the MMWR, and really began\nto value the role of policy development for CDC, how CDC can develop policies\nand put them out and really change the standards of health care—health care\ndelivery or public health delivery around the country. So I really began to be\nvery appreciative of the role of the MMWR for CDC. And, you know, there would be\nsome days, because of the high visibility of HIV and AIDS, where I would sit\nwith Walt Dowdle and Jim Curran sweating over one or two sentences in the\ndiscussion. And so, again, that was not lost on me, the power of precise\nmessaging. You know, making sure that what you want to say is being said and\nit’s not being misunderstood. And that’s very much what the MMWR really tries to do. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4383.0,4443.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/181","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo the editor did not turn over very quickly then. It turned over in 1998. And\nso I was ready for a change after fourteen years of HIV/AIDS, and so I took that\non. That sense of innovation, or the expectation for innovation, that I picked\nup during my years at AIDS was not lost on me at the MMWR, even though it was a\nfairly—it’s a publication that prided itself on not changing. But I felt like we\nchanged it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4443.0,4465.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/182","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I invented the Epidemic—I invented Epi-X, which is Epidemic Information\nExchange, a secure channel for people to share information about outbreaks. It’s\nstill going on. We made it move out of just a weekly publication to one that\ncould be published as needed, et cetera. Within a month after getting there, I\nwanted to start a continuing education program as part of the MMWR, thinking it\nwould help drive interest in readership. That part of CDC had no money for that,\nso I called the AIDS program. And it was the end of the year. They had some\nend-of-the-year money, and so I was able to buy the three computer servers to\nhelp me set up the—and it was the first online continuing education program at\nCDC—was in the MMWR, but, again, that was in part because of my relationships at AIDS. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4465.0,4503.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/183","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nThen we began to have some major public health emergencies. Over my tenure, we\nhad the anthrax cases right after 9/11 that we were heavily involved in. We\nwould stay up many a night, working all night to get the report out by 9:00 a.m.\nthe next day, as it was expected to be released at that point in time. I take it\nas a point in pride that at some point the FBI [Federal Bureau of Investigation]\ncalled the CDC saying that the MMWR was releasing too much information. I\nthought that was like—I thought I was doing my job, information sharing for the\npublic. So I don’t put that on my résumé, but I’m proud about that. And then we\nhad a large outbreak, and Mary, you were involved in SARS, coming out of China\nand Hong Kong. And, Mary, you did a great job of writing for the MMWR, as did a\nfew others, and we really chronicled that whole outbreak. If you go back and\nlook at the MMWR for SARS, every week you can see it unfolding, and then see it\nsort of— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4503.0,4563.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/184","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Yes. That’s a great word, chronicle, because for all the\ninnovations that you and others initiated. And the technological innovations\nthat allowed the MMWR to do things like turn things around on a dime, not be\nrestricted to a weekly format, be able to do it electronically instead of\nthrough the post, et cetera, I think it created a whole lot more pressure and\nthe expectations were a lot higher. Be that as it may, again, in preparing to\nchat with you today, I had a look back at the first five years of the AIDS\nepidemic. And in those days—I don’t know, I was told it was Jim Curran’s\nidea—but all of the AIDS-related MMWRs were bound together in a series of\nvolumes until, I think, the early to mid-’90s. And I was actually astounded that\nin the first five years, beginning with that first June 1981 report of\nPneumocystis carinii pneumonia and Kaposi’s sarcoma among homosexual men in New\nYork and California, CDC put out eighty-eight MMWRs, and it absolutely\nchronicled the unfolding of the epidemic in real time. And I think you’re right,\nit did the same for anthrax, for SARS, and for all the many public health\nemergencies that certainly came after that. So it really—it does serve as a\ntimeless resource. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4563.0,4623.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/185","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Absolutely. Absolutely. And so I really—and that’s why I wanted to be part\nof it, because I really saw it as a real gem, for MMWR and for CDC and, you\nknow, people really. In fact, just to that point, during [President] George\nBush’s administration, around 2003-2004, we had some type of entourage come from\nthe White House, maybe the Domestic Policy Council. So I was invited to the\nmeeting. This was when [Dr.] Julie [L.] Gerberding was the director. And after\nthe meeting, one of the people who was visiting pulled me aside and said, “The\nMMWR is the one publication that we all read every week in the White House.” ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4623.0,4683.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/186","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: How interesting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4683.0,4686.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/187","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: So that was—I know we’re a little off topic here, talking about the MMWR,\nbut just to your point—and I don’t know if the AIDS epidemic helped make the\nMMWR, the MMWR helped CDC, but I think the whole stature of the MMWR probably\nchanged a little bit, too, because of that frequency of publication regarding\nHIV/AIDS in the ’80s and then in the ’90s, I believe. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4686.0,4743.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/188","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Well, I think with the AIDS epidemic, and then, as you say, with\nanthrax and with SARS, people and even—and you’ve shed light on who some of the\nreadership was and is, the FBI and the White House—people come to rely on it as\na solid publication that, you know, it’s the facts. It’s the facts and some\ninterpretation and discussion, and it’s reliable.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4743.0,4757.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/189","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Maybe, if I have time—one other point quickly—and hopefully you’ll be\ninterviewing some of the people I worked with in surveillance, because obviously\njob one for public health and CDC is public health surveillance. And for AIDS,\nthat’s determined by what’s called the case definition, which were the criteria\nthat you can call someone to be AIDS. Now, originally, the first AIDS case\ndefinition was developed around 1982, early 1982. And it was a constellation of\ndiseases, because you didn’t know what was causing these diseases. And we had an\nAIDS-related complex of people that maybe was an earlier form of AIDS, but the\npoint is, these diseases which are rarely seen in people with normal immunity\nwould not develop, and it was a reflective of their immunosuppressed status.\nThen, when the HIV test became available, a few more diseases were added,\nbecause the HIV test helped to identify other diseases that were associated with\nthe infection. And so that was all very helpful. And then over time, in the\n’80s, as CDC got more resources, we were able to give money to states to\nactually case count. And so the surveillance improved, which greatly helped our\nmonitoring. So that was all good. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4757.0,4803.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/190","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nSo after my time in epidemiology and working on blood safety and a few other\nthings, I got interested in surveillance. And so I went over and joined the\nsurveillance program and eventually became the chief of the HIV/AIDS\nSurveillance Branch, and, as a result, wrote a lot for the MMWR and a lot of\nother publications, and developed surveillance systems to look at various\ndiseases associated with AIDS.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4803.0,4817.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/191","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"You know, rightly or wrongly, some federal agencies began to use the AIDS\nsurveillance case definition as qualifiers for various social services. So as a\nresult, community-based organizations began to be very interested in the AIDS\nsurveillance case definition, because it would have an impact on whether\nsomebody was getting housing or getting food or Meals on Wheels, et cetera. So\nthey began to lobby us to add certain diseases to the case definition. So we had\nto go through a very, you know, a very tough series of meetings to decide how we\nwere going to change the case definition around 1993. And so we decided to add\ntuberculosis to the case definition. And then there was a lot of interest in\nhaving cervical cancer, because of the immunosuppression increased the\nlikelihood of a woman having cervical cancer, even though that was a very small\nnumber of cases relative to other diseases caused by HIV infection. But, you\nknow, speaking of very contentious community meeting, we had a very contentious\none in 1993 that brought together a lot of groups in the CDC auditorium. But we\nwent through the process and got that case definition approved, and got it\nwritten up and published in 1993, and it’s still the surveillance case\ndefinition used today. So it’s served the test for time. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4817.0,4863.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/192","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nThe other issue for community-based organizations at that time was HIV reporting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4863.0,4869.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/193","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Ah, yes, yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4869.0,4871.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/194","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Community-based organizations were a little more accepting of AIDS\nreporting, because people often did not live long after that AIDS diagnosis.\nTheir point of view, though, was that if you required reporting of an HIV test\nresult, you may discourage people from getting tested, because they didn’t want\ntheir name reported to the government. And people were uncertain how the\ngovernment would use that information, and particularly now that that person may\nlive for a lot longer after that report. So it became a very contentious issue.\nAgain, it taught me a lot about engaging the community to get their point of\nview, to begin to develop working relationships with them. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4871.0,4924.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/195","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nIt also taught me a little bit about messaging what you’re trying to do. I\nremember being on the phone with [Dr. Jeffrey] Jeff Levi, who was a major AIDS\nadvocate at that time and helped develop the Ryan White legislation, and has\ngone on to a public health career of his own. But at that time, he was an AIDS\nactivist, and I was the surveillance program representative. I remember being on\nthe phone with him one day and him saying, you know, “Why does the government\nneed my name? Why does the government need my name?” And I said, Well— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4924.0,4984.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/196","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: And it’s not the federal government we’re talking about, because\nthe federal—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4984.0,4988.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/197","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: It’s the state government, right. CDC—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4988.0,4990.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/198","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: The state government. The federal government long ago had not been\ntaking names, so we are talking about state and local.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4990.0,4996.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/199","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Right. CDC does not get it, but they tend not to make that distinction.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=4996.0,5000.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/200","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: That’s true.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5000.0,5001.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/201","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: But “Why does the government need my name?” And then I started saying,\n“Well, it’s because we want to ensure the quality of the data,” and this kind of\nstuff. And he goes, “Stop right there. My soundbite is better than your\nsoundbite, so I win.” Now you can be cynical about that or you could take that\nas a lesson. And that lesson was, he was right. You know, it wasn’t a compelling\nmessaging. Like, if you can’t adequately explain your point of view succinctly\nand in plain English, then, yeah, you need to go back to work until you can. Or\nmaybe your position’s not that strong to begin with. I mean the point was, you\nknow, maybe they did have some legitimate discrimination issues, maybe they did\nhave some stigma issues, and maybe our pursuit of data quality doesn’t really\nmatch to that risk. So the risk-benefit calculation was not good. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5001.0,5044.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/202","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nNow, since that time, more and more states adopted HIV reporting. Of course, I\nthink all states now require reporting. But we have new treatments now. It’s a\nwhole different environment. Also, more of that information now is used to\nactually help people—“Data to Care”, it’s called. So rather than just using that\ninformation for pristine epi information, it’s actually being used to benefit\nindividuals. And so that changes that risk-benefit calculation. So, again, I\nthink that experience in surveillance was just very instructive on how to get\nthings done in public health. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5044.0,5104.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/203","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Well, I absolutely agree. We have, in this oral history, been\nfortunate enough to capture detailed interviews from people that have been very\ninvolved in surveillance, like [Dr.] Richard Selik and [Dr.] Martha Rogers, who\nwas involved early on in pediatric surveillance, and [Dr. Timothy] Tim Dondero.\nAnd absolutely, I agree with you, it’s the bedrock of everything that we do. I\nmean, going back to your early days in transfusion AIDS, there had to be a\nstarting point, and it had to be the ability to access information about cases.\nThere had to be a mechanism to get cases identified and then reported in a\nsystematic, cohesive way, to serve then as the basis for learning much more\nthrough detailed epidemiologic studies that you and others did. This has just\nbeen very interesting, talking about your work on AIDS from very early days, and\ncertainly the hepatitis epidemic, which is another whole interview— ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5104.0,5164.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/204","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nWARD: Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5164.0,5164.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/205","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: We’ll have to do an oral history on hepatitis.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5164.0,5166.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/206","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: I hope so.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5166.0,5167.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/207","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"CHAMBERLAND: Before we close, is there anything about your work related to AIDS\nthat we haven’t discussed that you’d like to specifically note or comment on?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5167.0,5173.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/208","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Well, I felt just very fortunate and privileged to be part of CDC at that\npoint in time. It was my introduction to public health. You know, at that point\nin time the attitude around being an EIS officer was that they wanted people\nthat didn’t know much about epidemiology or public health. They wanted a clean\nslate so that you could be taught the CDC way of public health. So I was a very\nnovice coming in. And people were very good mentors, but they gave you\nresponsibility at the same time. And as I mentioned before, they really\nappreciated CDC at that point in time in that program, really encouraging you to\nspeak up and really valuing opinions around the table. And I think if you really\ncreate that atmosphere you can, more often than not, get the best out of people,\nbecause people feel valued and respected. And I think that, together with a\nsense of innovation and seeking to do the right thing, keeping your eye on the\nhealth outcomes you’re trying to achieve and really developing warm collegial\nrelationships all along the way. I think it’s really been, you know, like I say,\na great privilege to be part of that. So I was glad I got a chance to talk about\nit today. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5173.0,5223.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/209","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\nCHAMBERLAND: Well, John, thank you so much for your time. And it seems like a\ngood place to close, on this note. And thank you again.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993#t=5223.0,5269.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2847/collection_resources/134197/file/248993/transcript/69475/annotation/210","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"WARD: Thank you very much. I appreciate it. 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