Trump's Second Leader of CDC Brings Baggage and Opportunity

James Gathany, Centers for Disease Control and Prevention (Public Domain)

At first glance, it would seem as if HIV advocates should be thrilled by reports that Robert Redfield, M.D., is the Trump administration's pick for the now vacant directorship of the Centers for Disease Control and Prevention (CDC). A physician and accomplished clinical researcher with more than three decades of experience working in HIV, Redfield seems tailor-made to provide the sort of knowledgeable and engaged leadership that has been so sorely lacking from presidential appointees over the past 14 months. With a resume that includes more than a decade's worth of infectious disease research at Walter Reed Army Medical Center, the co-founding of the Institute of Human Virology, and a stint on the Presidential Advisory Council on HIV/AIDS, on paper Redfield looks like an ideal candidate to helm the CDC.

Unfortunately, there are substantial discrepancies between how Redfield appears on paper and his career in practice, with a series of controversies marring what might otherwise be a stellar record. For example, during his time as a researcher at Walter Reed, Redfield was accused by colleagues of "potential scientific misconduct" for what they alleged was a distortion of study results on the efficacy of an experimental AIDS vaccine. Redfield was ultimately exonerated of any wrongdoing in the matter, but questions concerning the study remain.

In a letter sent to President Trump on Monday, Senator Patty Murray (D-WA) cited Redfield's conduct in the aforementioned vaccine study, along with his support in the 1980s for mandatory patient testing for HIV and the segregation of soldiers diagnosed with HIV, as indicative of a "pattern of ethically and morally questionable behavior" that has raised concerns for her about his suitability to lead the CDC.

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While these issues are certainly serious, they are more than two decades old. Of more immediate relevance to Redfield's fitness for the office of CDC director are the two things that likely led to President Trump's selection of him -- and secured him prominent roles in the George W. Bush administration's HIV response efforts: his conservatism and his strong Christian beliefs. It is no secret that Redfield is a both a devout Catholic and a long-time supporter of the Republican Party, a combination that has sometimes puts him at odds with his peers in the scientific community and has led him to associate with some organizations of dubious repute, such as the Americans for Sound AIDS Policy (ASAP), which was founded by the virulently anti-LGBT and anti-abortion activists Shepherd and Anita Smith.

In its report ultimately exonerating Redfield of scientific misconduct during the AIDS vaccine trial, the U.S. Army criticized him for having a "close relationship" with ASAP and sharing scientific information with the organization "to a degree that is inappropriate." His continued service to this day on the board of directors for Children's AIDS Fund International, the organization that sprang from ASAP, is of significant concern.

Redfield has been outspoken about the role his faith plays in his work and his desire to see the church play a more active role in addressing the HIV epidemic. At evangelist Rick Warren's Disturbing Voices HIV/AIDS conference in 2005, Redfield gave a presentation entitled "The Local Church Engaged in Prevention/Treatment/Care/Support," in which he advocated for churches to take over some of the clinical burden of hospitals and treatment centers for HIV service provision.

"I want people to be comfortable in being part of the daily treatment where five churches, for instance, can take care of patients under a simple system under the supervision of a hospital," Redfield told the audience. He also said that it was up to churches to make up for their past failures in addressing the HIV epidemic in a compassionate and informed way, and encouraged them to learn from experts how they could provide treatment and medication adherence support for their communities. Of the church's potential response to the HIV pandemic across the globe, Redfield said, "This may be the ultimate Christian opportunity."

While Redford's track record has some in the HIV and public health advocacy communities worried about the prospect of him helming the CDC, others paint a different picture. Multiple sources contacted by TheBody who have worked with Redfield over the past decade describe him as an extraordinarily knowledgeable man and a consummate professional whose devout adherence to the Catholic faith and conservative political leanings have not been a hindrance in his work as a researcher and administrator.

It is clear at this point that Robert Redfield is not the best possible candidate for the office of CDC director. However, the case can be made that he is the best possible candidate that we can hope for at this particular political moment. Anyone who would pique the interest of the Trump administration for a major public health position is guaranteed to have beliefs and qualities that many HIV advocates would find troubling, but few would have the breadth of knowledge and experience around HIV that Redfield has.

Some might be put off by his overt religiosity, while others might be concerned about how his history of reactionary responses to early HIV crises might be reflected in his handling of current contentious HIV-related policy issues, such as syringe access programs and pre-exposure prophylaxis (PrEP) access. But, regardless of one's rationale for skepticism, it is nearly impossible to think of anyone who might be on President Trump's shortlist for CDC director who would be as attentive, informed, and passionate about HIV-related issues as Redfield.

Now that he has been selected to lead the CDC, the HIV community will have Robert Redfield's ear. It is up to us to make sure that he listens.