HIV researcher is new head of US public-health agency

HIV researcher Robert Redfield will lead the Centers for Disease Control and Prevention (CDC), Secretary of Health and Human Services Alex Azar announced on 21 March.

Redfield "has dedicated his entire life to promoting public health and providing compassionate care to his patients," Azar said in a statement, calling the new CDC director's scientific credentials "peerless".

Redfield, co-director of the Institute of Human Virology at the University of Maryland in Baltimore, has studied HIV epidemiology, pathology and vaccines for over 30 years. He replaces former CDC chief Brenda Fitzgerald, who resigned on 31 January following news reports that she had traded stock in tobacco companies while leading the agency.

Redfield's appointment does not require confirmation by the US Senate — unlike many other top government posts.

“I hope [that as CDC director] he would be able to maintain the commitment to evidence that has been the hallmark of his career to date,” says Mitchell Warren, executive director of AVAC, an HIV-prevention advocacy organization in New York City.

Redfield began studying HIV in the early 1980s, as the US epidemic began. Back then when scientists were just starting to learn about the disease, Redfield questioned a leading theory that the disease spread through homosexual sex alone. In 1985, he and his colleagues published a study showing that the virus can be transmitted through heterosexual sex as well¹.

For the next decade, Redfield treated soldiers and searched for an HIV vaccine at the Walter Reed Army Institute of Research in Silver Spring, Maryland. His time at Walter Reed also sparked controversy. In 1993, the US Army investigated allegations that he had made the preliminary results of a clinical trial on a potential HIV vaccine sound more promising than they were. The Army found no evidence of scientific misconduct, but said that Redfield’s team had shared information with an advocacy group called Americans for Sound AIDS Policy “to a degree that is inappropriate”. A few years later, Redfield pushed for mandatory HIV testing of military personnel. At the time, some public-health researchers and patient advocates argued that the practice could lead to discrimination.

Mixed reception

The episodes have attracted criticism from a prominent member of Congress. In a 19 March letter to US President Donald Trump, Senator Patty Murray of Washington — the highest-ranking Democrat on the Senate committee that oversees the CDC — cited a “pattern of ethically and morally questionable behavior” in questioning Redfield’s suitability for the CDC job. Murray also said that Redfield may not have the public-health experience necessary to lead the agency.

Mark Harrington, director of Treatment Action Group, an HIV activist organization in New York City, is also concerned about Redfield's appointment. He notes that Redfield remains on the board of the AIDS organization cited in the 1993 Army investigation, and that the group — now called the Children’s AIDS Fund — has promoted an abstinence-only approach to HIV prevention in Africa. In the early 1990s, Redfield said publicly that condoms are not adequate protection against HIV. Studies have shown that abstinence-only programmes do not reduce the risk of HIV transmission².

Redfield did not respond to Nature’s request for comment. But William Pierce, a director at communications-consulting firm APCO Worldwide in Washington DC who is advising Redfield, says that Redfield supports comprehensive HIV-prevention strategies, including the use of condoms.

And some scientists and HIV-policy experts say that Redfield's call for mandatory HIV testing in the 1990s might have reflected the times. “I am not justifying that position, but we need to recognize that several decades ago we didn’t know much about the virus, and that led us to make several poor decisions,” says Warren. “The important point is to see if he still feels that way — positions do evolve.”

Looking ahead

Redfield left Walter Reed in 1995. The following year, he co-founded the Institute of Human Virology, a facility operated by the state of Maryland that combines research on viral and immune disorders with clinical care. That care began with Baltimore residents and has since spread to seven countries in Africa and the Caribbean.

Many of Redfield’s patients also struggle with heroin addiction, an institute spokeswoman says. She adds that the facility’s treatment approach is holistic, addressing addiction and mental-health issues alongside HIV.

Redfield’s clinical experience in treating heroin addiction makes him an attractive fit for the Trump administration, which has said that it wants to fight the growing US opioid crisis. Trump proposed US$10 billion in new funds to combat opioid abuse in his 2019 budget request — including $126 million for programmes at the CDC. But the president’s plan would reduce the agency’s overall budget to $5.6 billion, 12% below the 2017 level.

Redfield, whose career has included public-health work overseas, may also have to contend with a reduced budget for stemming diseases abroad. CDC staff members do not expect that a $600-million fund to support countries in preventing Ebola and other outbreaks will be renewed before it runs out in September 2019.

Robert Gallo, a virologist who directs the Maryland centre with Redfield, says that Redfield’s wide-ranging experience qualifies him for the position. “Not only has he overseen the biggest health crisis in modern history, but he’s an excellent infectious-disease doctor, he works like a dog, and he’s smart as a whip.”