It’s been 9 years since D.A. Henderson — who I call the commander-in-chief of infectious disease — died. As I do each year to mark his passing, I have assembled some questions I would love to ask him. I used to have the privilege of walking down to his office and posing these questions to him regularly and then rushing back to my office to look up things he said, historical examples he drew on, and make new integrations his thoughts prompted. In the last few weeks, amongst the mountain of infectious disease books I am always trying to get through — I am always reading an infectious disease book — I came across this quote from Jonathan Quick’s The End of Epidemics.
“Sherman tank of a human being—he simply rolled over bureaucrats who got in his way.”
What a simple and accurate way to concretize how D.A. Approached the field and the confidence in his own expertise. How needed this attitude is today. Imagine D.A. in the COVID-19 response — that would make for awesome fan fiction (to see how bureaucracy and politicians destroyed the chance for an appropriate response see Deborah Birx’s Silent Invasion). Another fun aspect of the quote was that upon reading it, I sent it to two friends/colleagues who also got to work with D.A. I asked them who it was describing and within seconds the correct reply came, illustrating just how unmistakeable D.A.’s modus operandi was.
On to the questions I — and the world — desperately needs D.A.’s answers to:
1. How would you handle the H5N1 outbreak in dairy cattle? What would you do to get more cattle testing performed on farms and of farm workers? How would you deal with the conflicts between USDA, FDA, CDC, state health departments, and state agriculture departments? (I think it would involve the Sherman tank mode) What would your threshold be for deploying vaccine to farm workers? Do you think clade 2.3.4.4B is constrained in some way from causing severe disease?
2. Is the solution to Mpox — including clade Ib — aggressive vaccine in endemic countries? Or is there more to it? Would you use the ring vaccination of contacts of cases plus high-risk individuals or universal immunization? I know you would be happy to see LC16m8 (you used to just call it “LC” like it was your friend’s initials) — the next generation Japanese smallpox vaccine you advocated for and told stories about — finding a use.
3. What do you think the outcome of the polio eradication effort will be? I ask this every year. I recently had to discuss this topic and I said “everything D.A. predicted would occur, has occurred.” Not only has the virus — wild or vaccine-derived — defied efforts, but a new vaccine also (nOPV2) deployed has caused the same problem of vaccine-derived cases (albeit at a lower rate). I still think what you said is the most reasonable approach — focus on wild poliovirus only if eradication is the goal.
4. How would you optimize wastewater monitoring in the US? Currently it is being used, variably, for SARS-CoV-2, mpox, antibiotic resistance genes, influenza, and polio? What else would be good? How about the airport wastewater monitoring? Should airports be just sequenced for everything in the hope of early detection of something novel or worrisome? How do you use that information for public health intervention ?
5. What do you think of the CDC director becoming a senate-confirmed position? Will it cement the idea of Republican CDC directors and Democrat CDC directors? Will presidents and HHS secretaries look for CDC directors that are able to be confirmed and politically savvy vs. competence in epidemiology and infectious disease?
Those are my top questions right now but there are so many controversies and conundrums that’s D.A.’s mind, expertise and wisdom would cut through like a razor — a razor that is so desperately needed in this field.
