March 22, 2018

Trump taps HIV/AIDS researcher to lead CDC

Daily Briefing

    HHS on Wednesday announced that President Trump will appoint Robert Redfield, a leading HIV/AIDS researcher and professor at the University of Maryland Medical Center, as CDC's new director.

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    Sources familiar with the decision said the Trump administration selected Redfield to lead CDC because of his groundbreaking research on HIV/AIDS. Redfield will replace former CDC Director Brenda Fitzgerald, who resigned from the position earlier this year amid reports that she traded stocks in a tobacco company while in office. Since Fitzgerald's resignation, Anne Schuchat has served as acting CDC director. The position does not require the Senate's confirmation.

    Redfield's background

    Redfield graduated from Georgetown University and Georgetown University School of Medicine and completed his residency in internal medicine at Walter Reed Army Medical Center. Previous Republican administrations have considered Redfield to lead CDC and NIH, though he never was appointed to the positions.

    Redfield is considered a pioneering researcher on HIV/AIDS. He co-founded the Institute of Human Virology, where he is the director of the division of clinical care and research. At the institute, Redfield focuses on clinical research and care for chronic human infections, with a particular focus on HIV/AIDS.

    Redfield has several years of experience treating individuals who use illicit drugs, such as heroin, with such patients accounting for about half of the HIV/AIDs patients treated at the institute. CDC has awarded the institute more than $138 million in grants to fight HIV/AIDS and other health issues in foreign countries such as Kenya, Nigeria, Tanzania, and Zambia.

    Redfield does not appear to have experience with leading a public government health agency. However, Redfield advised NIH and served on an advisory council on HIV/AIDS during former President George W. Bush's administration.

    Controversial ties

    Redfield has ties to some policies that are considered controversial, Politico reports. For instance, Redfield in the early 1980s supported mandatory HIV testing for patients and became closely tied to a congressional effort to pass legislation that would have required HIV testing for health care professionals who perform invasive procedures.

    Redfield also worked on an experimental vaccine for AIDS during the early 1990s while he was serving as a researcher in the Army, which has been the center of some controversy because of data inaccuracies, Politico reports. A whistleblower this week claimed Redfield either had mishandled or fabricated data when he had overseen the vaccine. The Army in 1994 cleared Redfield of any misconduct involving the research, but noted accuracy issues with data used to develop the vaccine.

    Further, according a 2002 article published in the Atlanta Journal-Constitution, Redfield disagreed with AIDS treatment advocates over whether the names of individuals who tested positive for HIV should remain anonymous. Bush was considering Redfield as a candidate to lead CDC at the time.

    Jeffrey Levi, a professor at George Washington University's Milken Institute School of Public Health who served as the deputy director of the Office of National AIDS Policy under former President Bill Clinton's administration, explained that those views were considered controversial because some believed they did "not embrac[e] sound public health approaches to the AIDS epidemic and were stigmatizing of those who were infected." Levi continued, "The context that people have to remember is that during this time, people could be fired for having HIV; they could lose their health insurance for having HIV. That's why there was so much furor."

    Redfield also has long advocated for the use of medication-assisted treatments (MATs) for substance use disorders. MATs involve a drug, such as buprenorphine or methadone, that helps to eliminate an individual's cravings for opioids and withdrawal symptoms without producing the kind of high associated with opioid drugs. Individuals receiving such treatments might have to take the opioid substitute for an extended period of time or for life. FDA has approved three MATs for use in the United States, but some substance use disorder experts have criticized the use of MATs, saying the only effective way to treat a substance use disorder is with complete abstinence.

    Redfield also is considered very religious, which one researcher has said "turns off some in the scientific and public health community." However, Redfield is well-respected in his field.

    Some raise concerns over Redfield's controversial ties

    Over the past few days, some observers have raised concerns about Redfield's controversial ties.

    For instance, Sen. Patty Murray (D-Wash.) in a letter sent Monday asked Trump to reconsider Redfield's potential appointment, citing concerns about "his lack of public health credentials and his history of controversial positions regarding the prevention and treatment of HIV/AIDS."

    According to Politico, sources have said Redfield in private conversations with public health and HIV/AIDS advocacy groups in recent days has attempted to address those concerns, assuring them that he is committed to taking science-based approaches in all of CDC's work.

    Some public health experts also have come to Redfield's defense, saying the controversial views Redfield held date back several decades, when the public and scientific community did not understand HIV/AIDS as well as it does today.

    Robert Gallo, who co-founded the Institute of Human Virology with Redfield, said, "That was a time of a lot of panic and a lot of pressure politically in a lot of directions. [Redfield], in his position in the Army, was concerned about soldiers and I'm sure he acted in the best interest of his patients."

    Jeffrey Crowley, former director of the Office of National AIDS Policy under former President Barack Obama's administration, said, "Questions raised by his past views are legitimate and I would love to know what he currently thinks, but what we need to recognize is the epidemic today looks very different than it did then and technology has changed our views dramatically. Redfield is a respected scientist and we could do far worse by some other appointment."

    Comments on Redfield's appointment

    HHS Secretary Alex Azar in a statement said, "Redfield has dedicated his entire life to promoting public health and providing compassionate care to his patients, and we are proud to welcome him as director of the world's premier epidemiological agency."

    Rep. Elijah Cummings (D-Md.) said, "Although I seldom agree with the Trump administration, I am in complete agreement that … Redfield is the best choice to lead the CDC." Cummings said Redfield "has devoted his life to improving the public health."

    Senate Health, Education, Labor, and Pensions Committee Chair Lamar Alexander (R-Tenn.) said, "Redfield has a strong background to lead [CDC]—he has spent his career researching public health threats such as HIV/AIDS and drug addiction. I am looking forward to discussing the work we have ahead of us to help states and communities fight the opioid crisis."

    Carlos del Rio—a professor of medicine at Emory University and chair of the U.S. President's Emergency Plan for AIDS Relief's Scientific Advisory Board, on which Redfield also serves—said, "[Redfield] has been a leader on the opioid epidemic. Right now, our biggest public health problem is the opioid crisis, and we need someone who actually understands and wants to do something about it."

    Other public health experts have said they respect Redfield's research, but are unsure whether he has the experience to lead CDC.

    Scott Becker, executive director of the Association of Public Health Laboratories, said, "He's a strong scientist and has really sound science credentials. The only red flag is that he hasn't led an institution like this." Becker continued, "The ability to really be a strong leader and spend time on Capitol Hill educating Congress about the importance of public health investments is really important" (Ehley, Politico, 3/21; Taylor, Kaiser Health News, 3/21; Frieden, MedPage Today, 3/21; Hellmann, The Hill, 3/21; Weixel, The Hill, 3/20; Murray letter, 3/19).

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