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THE POINT MAN IN GERM WARFARE
Many days, the man who stands between the American population and lethal epidemics of strange new ailments does so in Teva sandals and sweatsocks. Clarence J. "C.J." Peters, M.D., former Army colonel and chief of the Special Pathogens branch of the Centers for Disease Control & Prevention in Atlanta, earned his stripes investigating outbreaks in remote African and Latin American villages, and picking apart pathogens in government labs. Along the way, he picked up a pathogen of his own: The open footwear is meant to ease his recurring athlete's foot, a memento of some fieldwork in Central America.
LETHAL THREATS. Today, Peters, 55, coordinates the CDC's response at home and overseas to threats such as the lethal Ebola virus, which erupted earlier this year in Zaire and killed 80% of the 296 people it infected. Ebola is just one of a long list of killers Peters watches. Some, such as hantavirus, are already on U.S. soil. Others, with exotic names such as Machupo, Marburg, or Lassa, are just a plane-ride away. It's high-stakes, nerve-racking work, chronicled recently in the best-seller The Hot Zone and in the movie Outbreak, in which Peters' fictional counterpart was played by sultry actress Rene Russo. Virus hunting may be bookstore and box-office gold, but in the all-too-real world, Peters must plead for resources to fight strange foreign diseases that don't rank high on the list of U.S. priorities. Americans paid $13.4 million to watch Outbreak the weekend it opened--nearly double Peters' budget for a year (table).
Peters' most recent crisis began in May, when he sent a team to Kikwit, Zaire. They found a hospital deserted save for a few patients dying the ugly, bloody death of Ebola. Clean gloves and instruments were scarce. There was no running water, no telephones. But working with the World Health Organization and other scientists, the CDC team instituted careful infection-control procedures and stopped the spread of the disease. This outbreak is now believed to have "burned out," since the longest incubation period is 21 days, and the last known cases were in late June.
That was a triumph. But when Ebola gave up in Africa, it came to Atlanta in test tubes and specimen bags holding blood and tissue from patients. Now, in the CDC's sterile, air-sealed maximum containment lab designed to completely isolate lethal pathogens, no less critical work begins. Peters' team dons plastic suits to open the liquid nitrogen freezers in which over 14,000 Ebola-related specimens are stored, with more arriving each week. Besides patient samples, there are others from monkeys, birds, ticks, bats, and other animals and insects collected along a road that the first suspected Ebola victim walked each day, and where CDC field investigators believe he was somehow infected.
Peters' group may be on the verge of solving a mystery that began in 1976, with the first of four previous Ebola outbreaks. What insect or animal harbors the virus? How does it replicate? How might it be treated? For the first time, scientists were on the scene early enough to take adequate samples and question victims. And Peters' lab now has powerful new biotechnologies in hand. Answers could come in months.
Whether they do or not hinges on whether Peters can get the resources he needs, on whether Mother Nature holds off sending major new outbreaks to distract his troops, and on whether Peters can keep morale up in a group of virus hunters who are clearly exhausted. "We have a high-profile program without the ability to do the job in a meaningful way," fumes a grim-faced Thomas Ksiazek, CDC's chief of disease assessment.
The budget woes are particularly galling to Peters, who left the Army after 14 years and came to CDC in 1992 because military dollars were evaporating for research on these terrifying threats. Raised in Texas, he attended Rice University, got his M.D. from Johns Hopkins, and has published over 120 articles on virology. He worked for years in the Public Health Service before joining the Army's virology research unit. When he left for the CDC, he says, "I thought the civilian community would have a stable level of effort. I was wrong."
A staffer on the key House Appropriations subcommittee argues that CDC's budget has grown at an "unprecedented rate" over the past 15 years, and isn't being cut in the 1996 appropriations bill. "The CDC is a particular favorite of the Speaker's," he says. "That's why, in a year in which we had to cut 13% across the bill, CDC had no reduction."
Still, despite having to battle a growing number of outbreaks such as hantavirus and hemorrhagic fevers, Peters' 26-person unit is down four people from when he arrived. Meanwhile, with many pressing domestic health problems, such as the reemergence of tuberculosis, Peters and his staff must constantly explain why the U.S. should be fighting diseases like Ebola in far-off Africa. "Well, I'll tell you," says staffer Dr. Ali Khan. "If a Coca-Cola Co. executive comes home from a trip to Africa with a headache and fever and gives it to his family and people ask us what's he got, we'll all say, `We don't know. Why would we study some African disease?"'
Virologically speaking, it's a small world after all, thanks to improved transportation. Moreover, overpopulation, political unrest, deforestation, and development are helping to spread disease. "These viruses could be on our doorstep tomorrow," says Scripps Research Institute virologist Michael J. Buchmeier.
Make no mistake: Peters is keenly aware he's paid to protect U.S. taxpayers. When he learns of an outbreak, he asks a series of questions: Is the problem here? How easily can it get here? If it gets here, how easily can it spread? When hantavirus erupted in the American Southwest in 1993, Special Pathogens was lauded for identifying the virus in just months.
If Special Pathogens didn't handle these agents, nobody would. "The total capacity of the U.S. to deal with high-hazard agents resides with C.J.'s small unit," explains Dr. Philip K. Russell, president of the Albert Sabin Foundation, which helps promote vaccine development. The military's efforts have been ravaged by budget cuts, while drug companies work only on lucrative vaccines or drugs. And universities can't take on the liability or expense of setting up the labs needed to work on the most dangerous, "level-four" agents.
What Peters needs most desperately is staff, he says. He worries constantly about sending stressed-out scientists into the field or into the labs. Things got so bad last fall that he threatened to close the Special Pathogens lab. "People were tired and anxious to get out of the suits, working too fast, not being deliberate," Peters says. He got the O.K. to add seven people last October, which would have restored his staff to its 1992 level. But bureaucratic delays meant that hiring began only in June. Every time he approves one project these days, something else literally goes into the freezer. When Ebola erupted, for example, Special Pathogens had to put off analysis of Crimean Congo fever samples collected from the United Arab Emirates, and of hantaviruses from Brazil and Argentina.
Peters manages to inspire a team that routinely risks life and limb to do this work. Colleagues say he has a keen mind for lab and field work, but it's his outspokenness that wins their loyalty. "He tends to break a little crockery and make a little noise if he feels it's necessary," says Russell. His willingness to thumb his nose at the bureaucracy
doesn't hurt. Peters is a captain in the Public Health Service now, and officers traditionally wear uniforms at CDC on Wednesdays--which is when you're likely to find C.J. in a loud Hawaiian shirt.
CLEAN RECORD. Peters' own morale is clearly bolstered by his quick-witted, gregarious wife, Susan, who has a PhD in literature and is a librarian at Emory University. Does Susan worry about her husband? "He's not one to take unnecessary risks," she says. None of his staff has ever been infected by a virus they were hunting, Peters interjects.
People who operate in dangerous conditions often develop a taste for black humor, and Peters is no exception. In his office is an inflatable statue of the tortured figure from Edvard Munch's painting, The Scream. But Peters is deadly serious about the possible consequences of skimping on disease fighting. "Prioritization is a favorite management buzzword," he says. "What it really means is stuff that isn't going to get done." In this case, the stuff that may not get done is the effort to understand a world full of viruses that can kill people, that are killing people abroad now, and that could suddenly start killing people here someday.
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