reprinted from Issue 23, Fall 2016 of Frontiers of Medicine (PDF)
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Julie Gerberding, MD, MPH, began her medicine internship at UCSF in 1981, just as the HIV epidemic emerged. "My cohort was the HIV cohort," she said. "We learned not just the comprehensive medical care of people with complicated immunosuppression, but also about the social, cultural, and behavioral context of illness."
Her patients were her best teachers. "They knew as much or more about their disease as we did, and often told me what therapy they needed and how they wanted to die," said Gerberding. "I learned to respect the co-creation of medical solutions, which is something that has stayed with me my whole life."
At that time, little was known about how HIV spread. "As interns, it was exciting to be blood-covered in the emergency room – it meant we were ‘real’ doctors doing important procedures," said Gerberding, who contracted hepatitis B after caring for a dialysis patient during her training. Around that time, the Centers for Disease Control and Prevention (CDC) – the agency she would eventually lead – issued a memo stating that HIV was probably transmitted like hepatitis B. "That sent a little shock through my system," she said. "I became very curious about the risk, and how the virus was transmitted in health care settings."
After completing her residency, chief residency at Zuckerberg San Francisco General (ZSFG), and a fellowship in clinical pharmacology and infectious diseases at UCSF, she joined the UCSF faculty. To investigate the question of HIV transmission in hospitals more deeply, she earned an MPH degree from UC Berkeley, then took a leading role at ZSFG writing safety guidelines, guidelines that ultimately would be used around the world.
"We gave our best expert guess, based on the limited information we had," said Gerberding. "In San Francisco, it wasn’t possible to know which patients had HIV the first time we met them, so we assumed that any blood or body fluid could be a hazard." The approach she and her colleagues recommended became the basis for a new approach by the CDC, dubbed "universal precautions" – for example, using gloves, masks, and gowns to limit contact with all potentially infectious materials.
Leading the CDC
In 1998, she took a leave of absence from UCSF to go to Atlanta to direct the CDC’s division of Healthcare Quality Promotion, working to prevent hospital infections and antimicrobial resistance. "I had every intention of coming back to UCSF," she said. Instead, she was promoted at the CDC, eventually becoming the director of the entire agency, with its expansive mission and multi-billion dollar budget, from 2002 to 2009. She led responses to many crises, including anthrax, West Nile virus, SARS, and Hurricane Katrina.
As a trainee, Gerberding had moonlighted at various emergency rooms to earn money. "Because of my ER experience, when these national crises emerged, I was comfortable making hard decisions where there was inadequate data to be 100 percent sure we were doing the right thing," she said. "ER doctors are very good at adaptive reasoning, and we tried to apply that model at CDC. We’d say, ‘Today, this is our interim advice, but we’ll know more tomorrow. If we need to do something different, we’ll update you.’"
Her clinical experience also helped her communicate with the public. "I’m an introvert, and the only way I could get through a press conference was to pretend I was talking to a patient," said Gerberding. "That made it a lot easier to translate the science into something people could understand, and to express the empathy that was in my heart but was sometimes hard to read off a piece of paper."
Since 2010, Gerberding has worked for pharmaceutical giant Merck, where she is the executive vice president and chief patient officer, focusing on strategic communications, global public policy, and population health. She is particularly proud of working to reduce the manufacturing costs of vaccines for diseases like human papillomavirus (HPV) and rotavirus, thus making these more widely available in developing countries.
Outside of medicine, Gerberding enjoys gardening, Pilates, and hiking with her husband, David Rose.
Gerberding appreciates her training at UCSF, which prepared her well for her non-linear career. "UCSF is just a star," she said. "People leave extremely well-equipped to take whatever next step they want."