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Last Updated

11 Jun 2003

Source: Atlanta Journal-Constitution, November 11, 2001.

As challenges to the CDC grow, director makes sure agency stands tall

By M.A.J. McKENNA, Atlanta Journal-Constitution Staff Writer

When the Centers for Disease Control and Prevention prepared to welcome President Bush, the agency selected the staff to hear his speech, asked for police patrols on nearby roads and pitched a tent to hide the president's entrance.

And Dr. Jeffrey Koplan stashed his crutch.

Koplan, the CDC's director, has used the crutch since foot surgery in mid-August; he was confined to bed for two weeks and still wears an orthopedic boot on his left foot. Yet on Thursday, he relinquished the crutch to a colleague before escorting the president past photographers and later while delivering remarks on live TV.

It was a small but meaningful gesture. Koplan is protective of his staff and acutely aware of the scrutiny the CDC is under these days. He would not allow the CDC to seem symbolically crippled, even at the price of a painful foot.

"I am very cognizant this is a big challenge," he said Friday. "We have got to meet it. This institution has terrific public trust and international stature. We can't afford to have a diminution of that, and it doesn't serve the public well if we do."

A harsh spotlight

It's often said within the CDC that the agency is better known on other continents than it is in its Druid Hills back yard. The anthrax attacks have changed that. The CDC now has a higher profile than at any time since the AIDS epidemic began 20 years ago.

The Sept. 11 attacks transformed it from an institution that researched obesity, diabetes and cancer to one overwhelmingly focused on bioterrorism. At the same time, the CDC moved from being an agency that was intermittently famous -- for combating exotic diseases, and for being the repository of dangerous organisms including smallpox -- to a potential target for terrorists.

The spotlight is shining with particular intensity and occasional harshness on Koplan, an internist and health care economist who became director three years ago.

Dr. James Curran, the former chief of CDC's AIDS division, says that Koplan and his agency face an extraordinarily difficult situation. "The CDC has vast resources, but they are finite, and he is having to mobilize them to investigate something that has never happened before," said Curran, who now leads Emory University's Rollins School of Public Health next door to CDC. "There are a lot of people second-guessing him, but he's a man of great perspective and resilience, and he doesn't lead with his ego."

Striking a new balance

Koplan spoke in his office five floors above Clifton Road, next to wide windows that overlook the new concrete security barriers protecting the CDC from the street. The agency observes casual Fridays, but he wore a dark dress shirt and a bow tie embroidered with tiny boats. "Forgoing a suit is as casual as I get," he said.

The tie's motif was echoed in a print hanging near his computer, of rowers straining at the oars of a scull. Koplan keeps a scull on the Chattahoochee; in an institution full of people focused on health, he was noted for working out two hours a day. That was before the attacks.

"I have always had a mind-set of trying to keep a balance in life: working very hard but having time to do other things," he said. "But this is taking place in a setting where you have very different proportions to your day and you don't know when it is going to end."

He sat across from a couch where he has caught naps since the anthrax investigation began. "I'm comfortable here when decisions are being made and new information is coming in," he said. "I am anxious and concerned enough when I'm at home that often I'm better off here."

Making a name with CDC

Koplan, 56, was born in Quincy, Mass., south of Boston, and went to boarding school in Milton, several towns away. He has degrees in English from Yale, in medicine from Mount Sinai School of Medicine in New York City and in public health from Harvard. He first came to the CDC in 1972 as a member of the Epidemic Intelligence Service, the elite disease-detective corps on the front line of the anthrax investigation.

A year later, the EIS sent him to Bangladesh to work on the eradication of smallpox, making him part of what was the CDC's most historic campaign.

Koplan had expected to stay with the agency for the two-year EIS assignment. Yet, he remained until 1994, when he left for the private sector -- running a health care research group -- before returning as director in 1998.

Koplan has been married for 32 years to Carol Koplan, a psychiatrist and professor at Emory University School of Medicine. They met at Tufts University north of Boston, where he spent the first two years of medical school and where Carol Koplan earned her medical degree. They have two children: Adam, 28, a graduate student in theatre in Seattle, and Kate, 24, a medical student at Emory.

The family settled in northeast Atlanta in 1978, but Koplan continued to travel: He worked in Finland and Hungary, led the CDC investigation of the Bhopal chemical disaster in India in 1984 and traveled regularly to China for more than 15 years.

Anthrax attacks

In his first speech to CDC employees as director, Koplan fondly remembered a longtime Chinese colleague in words that could apply to his own job today.

"He demonstrated the power of staying focused on your vision," Koplan said then. "Though regularly hassled and hindered by war, social upheaval, minimal resources . . . he never wavered from his priority of identifying health problems and solving them."

Staying focused has been a key challenge for Koplan and the CDC since the first anthrax case was identified in Florida on Oct. 4. The agency has faced sharp criticism before -- from members of Congress critical of its research into gun violence, from AIDS advocacy groups who oppose its intention to collect the names of those with the disease, and from patients with chronic fatigue syndrome who accused the agency of mishandling money appropriated for research into the problem.

Even so, the CDC has never faced a challenge of this magnitude, in which it has had to make predictions about a disease that seems to change in character almost daily. Agency scientists have been hauled before Congress to answer charges that the CDC had not distributed information fast enough, and then, after two Washington postal workers died of inhalation anthrax, to defend the failure to consider them potential victims.

"I am very concerned about what CDC is doing and how they are operating," Sen. Tom Harkin (D-Iowa) said on Oct. 23. "It just seems to me that something broke down here."

Koplan defended his agency. "These are tragedies for us as well and not something we take lightly," he said, "but you've got to know about cases to take action."

Trying to find a 'rhythm'

The CDC is neither a hospital nor primarily a laboratory: Its chief research material is data. The gnawing frustration of the anthrax investigation has been that even with almost 500 staff members working 20-hour days on the attacks, there is simply not enough data to know what might come next.

"In every other thing we have done, whether it has been a hurricane or an infectious disease outbreak or an environmental disaster, there has been a rhythm to it," Koplan said Friday. "Even if it's not entirely predictable, you can get some sense of where you are in it, enough to say, 'I think we are making progress,' or, 'We have learned enough to prevent this the next time.' While there is a criminal perpetrator putting this stuff out, we cannot say any of those things.

"People are still very much on edge, waiting for the next step," he added. "There won't be any closure for us until the perpetrators are apprehended, and we realize that could be a very long time."