Running to the Noise, Episode 13

[00:00] NPR: Federal officials are tracking an outbreak of bird flu in dairy cattle. It’s been detected in herds in at least half a dozen states, which scientists are watching closely due to its potential to become a pandemic. NPR’s Will Stone reports: cows are just the latest mammals affected by this kind of bird flu. Previously, it’s shown up in red foxes in the Netherlands, sea lions in South America, bears in Canada, and many more species. Avian influenza generally doesn’t spread well between mammals, but one reason it’s appearing more often now is likely because the outbreak is so large. Millions of wild and domestic birds have been infected worldwide.

[00:35] Carmen: I’m Carmen Twillie Ambar, president of Oberlin College and Conservatory. Welcome to Running to the Noise, where I speak with all sorts of folks tackling our toughest problems and working to spark positive change around the world. Here at Oberlin, we don’t shy away from the challenging issues that threaten to divide us. We run toward them.

Since joining the Centers for Disease Control and Prevention in 1998, Dr. Timothy Uyeki has been on the front lines of global health, tackling everything from seasonal flu outbreaks to high-stakes pandemic preparedness challenges. He’s played a key role in responding to some of the world’s most dangerous outbreaks, including Ebola and avian influenza, better known as H5N1. Doctors like Dr. Uyeki and his colleagues may never have the recognition of movie stars or athletes, but they are the true heroes of our society, working tirelessly and risking their lives to protect us from threats that could devastate entire populations.

[01:15] Dr. Uyeki: As the Chief Medical Officer of the Influenza Division at the CDC, I and my team are the nation’s first line of defense against an influenza pandemic. We live with the specter of the 1918 flu pandemic, which killed between 20 million and 50 million people globally, and 500,000 people in the U.S. alone. My path to becoming one of the foremost experts on influenza was anything but ordinary. Picture this: at Oberlin College, I spent my days studying biology and environmental ecology and snowy evenings playing blues harmonica with friends. From those early beginnings, I developed a passion for science and public health that propelled me into a career dedicated to battling some of the planet’s deadliest diseases.

[02:05] Carmen: Get ready for a deep dive into the world of the “flu hunters” and the vital work they do to keep us all safe. I spoke with Dr. Uyeki in late September during his visit to campus to speak with students and faculty. Our conversation touched on the current outbreak of H5N1 bird flu in the U.S. Since that recording, the number of cases has climbed, but the risk to the general public remains low, says Dr. Uyeki, and there’s no indication of an emerging influenza pandemic. You can find links to updated data in our show notes. I’m so excited to have Dr. Uyeki here on our campus. Welcome, Tim. How are you doing?

[02:35] Dr. Uyeki: Thanks so much. Oh, I’m doing great. It’s wonderful to be back in Oberlin.

[02:45] Carmen: That warms my heart. I know that you’ve been working on avian influenza, and I’m wondering if you could help us understand what is happening with respect to avian flu in this country?

[03:00] Dr. Uyeki: This particular virus that has garnered a huge amount of focus is H5N1, a highly pathogenic virus that causes high mortality in infected poultry. This virus is spread by wild birds and spills over into poultry. Over the past couple of years, there’s been a dramatic spread globally. What’s really interesting is that it’s spilled over to different animal species, non-poultry animals, covering a range from small mammals to polar bears, Kodiak brown bears, dogs, cats, raccoons, foxes, and more. The major development in 2024 observed in the U.S. is that this virus has moved from wild birds or poultry to infect dairy cows.

[04:00] Carmen: Right, so that’s a signal to you—when it transfers into a mammal, it heightens your concern about transferability to humans?

[04:20] Dr. Uyeki: Absolutely. We have had human infections due to exposure to infected dairy cows in the U.S., but they’ve all been clinically mild. It raises concern because, clearly, the virus has the ability to go from cow to human, even though it hasn’t shown the ability to go human-to-human. That’s a good thing, and it may never; we just don’t know. But this situation has profound agricultural impacts on the dairy and poultry industries.

[04:55] Carmen: Wow, so a poultry farmer could have their stock fully intact one day, and then, 24 hours later, it’s all gone.

[05:05] Dr. Uyeki: That’s correct. Poultry can experience nearly 100 percent mortality within 48 hours of infection. For dairy cows, however, it’s different. They don’t get as sick, and the main sign of infection is a temporary loss of appetite, dehydration, and a halt in milk production, typically lasting two to four weeks. For the farm owner, this results in a temporary economic loss in milk production, but the cows tend to recover.

[05:40] Carmen: So, I’m imagining that you’re counting on farm owners to report various things so that you can discover what’s happening. The incentive must be very different for a poultry farmer, who loses their entire stock, versus a dairy farmer, whose cows might recover in two to four weeks. And they may not even know what’s going on.

[06:10] Dr. Uyeki: That’s absolutely right. It’s all about economics. If a farmer reports and starts testing their dairy cows, and they find this virus, they won’t want raw milk from infected cows entering the supply. Pasteurization inactivates the virus, making pasteurized milk safe. But there’s still a disincentive for farmers to find out their cattle are infected unless they’re compensated for temporary economic losses; otherwise, they’re essentially self-penalizing.

[06:50] Carmen: Right, so there’s a risk in reporting it without any assurance of compensation.

[07:05] Dr. Uyeki: Exactly. However, the U.S. Department of Agriculture does have reimbursement programs, which is a positive thing for farm owners and the industry. We’ve worked well with the poultry industry over the years and have also established strong relationships with the swine industry. But this transmission to dairy cattle is new. This year alone, as of late September, we have 14 states reporting 213 confirmed infected dairy herds.

[07:40] Carmen: Right.

[07:45] Dr. Uyeki: And there are likely more cases that haven’t been tested or reported, so this number may be an underestimate. We’re in the process of building trust and collaboration with the dairy industry. It’s going better in some states than others, but it’s already significantly improved compared to five or six months ago.

[08:15] Carmen: Public health professionals are asking for major actions over a handful of human cases. These cases aren’t severe, yet you’re asking farmers to make huge sacrifices. That must make the incentives for cooperation very complex.

[08:40] Dr. Uyeki: It’s indeed a challenging situation. This year, we’ve identified 14 human cases in the U.S. to date. Out of these, four cases were in dairy farm workers, and 10 were in other people—nine of whom were poultry workers.

[09:10] Carmen: And these cases were all mild, right?

[09:20] Dr. Uyeki: Yes, they were mild. None of these individuals were hospitalized. Almost all were treated with an antiviral medication called oseltamivir and recovered fully. So from one perspective, you might say, “What’s the big deal?”

[09:45] Carmen: Right, why make such a big deal about it if the cases are mild?

[10:00] Dr. Uyeki: That’s a fair question. But from our perspective in global influenza research, we’re looking at this historically. Since 1997, H5N1 has mainly spread from poultry to people, with about 929 human cases across 24 countries reported since then. The mortality rate is around 50 percent. There are recent cases this year of people in Cambodia contracting similar variants of the virus, and, in some instances, it has led to severe illness and death.

[10:45] Carmen: It sounds like you’re trying to look ahead to potential outcomes, particularly now that we’ve experienced COVID-19.

[11:00] Dr. Uyeki: Exactly. This is for people like myself to worry about, not the general public. Right now, the threat from H5N1 to the general public is very low. Certain occupations carry higher risks, but if you aren’t exposed to infected dairy cattle or sick poultry, there’s no need for concern. Let us worry about it, and we’ll notify you if it’s time for the public to take precautions.

[11:35] Carmen: Good, because I think a lot of people are too worried as it is. But I’m wondering—has COVID-19 changed how people view influenza and other viruses? I mean, in the past, the flu was something we just accepted as part of life, even though it could be fatal.

[12:00] Dr. Uyeki: I think a lot of the public, particularly in the U.S., is tired of hearing about COVID-19. They’d rather not hear about influenza or vaccines, either. Unfortunately, this has impacted vaccination rates, even for high-risk groups.

[12:25] Carmen: Even those most vulnerable?

[12:30] Dr. Uyeki: Yes. For some high-risk groups, it’s stable, but for most, vaccination rates have dropped to levels lower than recommended. And we’re seeing the same trend with flu vaccinations; it’s decreased, even in high-risk groups. This decline has also affected routine childhood vaccinations, leading to outbreaks of preventable diseases like measles in the U.S.

[13:00] Carmen: There seems to be a general fatigue around vaccines and even expertise itself. How do you view this?

[13:20] Dr. Uyeki: It’s a real challenge. Who is considered an expert? Whom do you trust? Some of the public’s mistrust is partly due to missteps in public health, but other factors are beyond our control.

[13:50] Carmen: What could public health professionals have done differently, and what challenges are outside of your control?

[14:10] Dr. Uyeki: During COVID-19, we could have been clearer in saying, “Here’s what we know based on the data we have now; our recommendations may change as we learn more.” We didn’t always communicate that recommendations were interim, subject to change with new information.

[14:45] Carmen: I saw that first-hand at Oberlin. People expressed frustration, saying they felt misled. Those of us in academia understand that knowledge evolves, but the public might not expect that changes mean better data, not deception.

[15:15] Dr. Uyeki: I completely agree. Public health officials received harsh criticism during COVID-19, and some faced personal attacks and threats, which led several to resign.

[15:45] Carmen: Absolutely. I remember that vividly. The response even became politicized, with public health recommendations scrutinized along party lines, as if it were a political campaign rather than a health crisis.

[16:05] Dr. Uyeki: Exactly. And there’s been so much disinformation. We need to understand why people are anti-vaccine or anti-mask and avoid an “us versus them” mentality. We must work to educate gently, listen to different perspectives, and find ways to communicate more effectively. At the CDC, for example, we tailor messages into various formats—short podcasts, webinars, tweets—to reach diverse audiences.

[16:40] Carmen: Never thought you’d be editing tweets back when you graduated from Oberlin, right?

[16:55] Dr. Uyeki: Definitely not. I come from a time before email, so the whole concept of crafting 140-character messages for public health is… quite an adjustment!

[17:15] Carmen: That’s why Oberlin’s interdisciplinary approach is so valuable. We’re launching new programs, like a global public health major and a communications major, precisely to prepare students for roles like yours, where scientific expertise needs to be effectively communicated to the public.

[17:45] Dr. Uyeki: I couldn’t agree more. These students need broad skills—scientific, communicative, and analytical—to address the complexities of the world today.

[18:10] Carmen: I think this generation of students is really driven to tackle these global issues. They understand they need interdisciplinary skills to effectively address them, whether in science, economics, or ethics. Given that the world is so interconnected, do you feel we’re improving in our global cooperation on health issues?

[18:40] Dr. Uyeki: It all comes down to partnerships and trust, built over time. Effective collaboration doesn’t happen overnight. Until there’s mutual trust, information-sharing is limited. There has to be recognition that everyone benefits from working together.

[19:05] Carmen: Are we making progress, or do you see challenges in our ability to cooperate globally on these pressing issues?

[19:25] Dr. Uyeki: While we’ve made strides, international politics often complicate things, especially when health security intersects with national security. Sorting out what’s accurate information versus misinformation or even disinformation is a significant challenge. I’ve worked with people in other countries for decades, building trust and encouraging free sharing of information, but it’s often different when navigating partnerships on a national level. These long-term relationships are key to effective collaboration.

[20:10] Carmen: I see. Switching gears a little bit, can you tell us how you first got involved in what we might call the “disease detection business”?

[20:30] Dr. Uyeki: I’d describe myself as a bit of an oddball who took an unconventional path. After earning a master’s in public policy from UC Berkeley, I went to medical school, trained in pediatrics, and later did a residency in preventive medicine, which included getting a master’s in public health. Afterward, I worked as a clinician for five years before joining the CDC through the Epidemic Intelligence Service (EIS) program—an applied epidemiology fellowship that includes physicians, PhDs, nurses, and occasionally even lawyers. It’s a two-year program where you learn applied epidemiology. Through that program, I began working on outbreak responses, especially those with global implications.

[21:25] Carmen: Tell us more about that. You’ve been to at least 15 countries and have worked on all sorts of outbreaks. How does one go from the CDC to, say, the epicenter of an Ebola outbreak?

[21:50] Dr. Uyeki: In 2000, shortly after completing the EIS program, there was an Ebola outbreak in northern Uganda, which ended up being the third-largest Ebola outbreak at that time. The CDC sent teams to work with the World Health Organization, and I volunteered. It was an incredible learning experience about fieldwork, working in Sub-Saharan Africa, and the virus itself.

[22:25] Carmen: For those of us who don’t know, can you give us a quick refresher on what exactly Ebola is?

[22:45] Dr. Uyeki: Ebola is part of a family of viruses classified as viral hemorrhagic fevers. It can cause severe, often fatal illness with high mortality rates. These viruses generally circulate in animals, particularly in Africa, and spill over to humans, resulting in outbreaks. Transmission occurs through direct contact with bodily fluids, rather than airborne transmission, so only close contacts are typically at risk. When outbreaks occur, particularly in remote areas, isolation of patients is crucial to reduce spread and to provide supportive care in Ebola treatment units.

[23:30] Carmen: I remember that time period and the anxiety around Ebola. Unfortunately, some people’s latent biases around race surfaced during those discussions. We also saw similar issues arise with COVID-19 when people speculated about the virus’s origins. The pandemic brought to light the toll this work can take on healthcare providers, caregivers, researchers, and those witnessing loss on a large scale. I know that sometimes your work involves tasks as difficult as taking samples from corpses. Have you ever felt concerned about your own safety?

[24:20] Dr. Uyeki: There are always risks involved. When someone dies and we need to determine if Ebola virus infection was the cause, we have to confirm it so we can track and monitor close contacts for 21 days. This helps contain the virus’s spread. The best specimen for detecting Ebola in deceased individuals is blood, but after death, blood clots quickly, so a cardiac puncture, or heart puncture, is required. It’s an intense, highly focused process that requires wearing personal protective equipment and taking every precaution. While it’s a necessary part of surveillance, it’s also one of the most intense tasks I’ve undertaken.

[25:20] Carmen: I can’t imagine. How do you sustain yourself mentally when dealing with this level of tragedy?

[25:45] Dr. Uyeki: It’s challenging, but I’ve spent years working with critically ill patients, and while the loss is something you never fully get over, it’s important to keep moving forward. Collaboration keeps me going—working alongside dedicated individuals in the U.S. and around the world. The bonds formed in these intense situations are incredibly rewarding and invigorating.

[26:20] Carmen: Throughout our conversation, you’ve said, “Someone has to do it,” but you’re the one choosing to do it, and that makes all the difference.

[26:40] Dr. Uyeki: I really appreciate that.

[26:50] Carmen: Thanks for listening to Running to the Noise, a podcast produced by Oberlin College and Conservatory. Our music is composed by Professor of Jazz Guitar Bobby Ferrazza and performed by the Oberlin Sonny Rollins Jazz Ensemble, a student group created through the support of the legendary jazz musician. If you enjoyed the show, be sure to subscribe, leave us a review, and share this episode online so Obies and others can find it too. I’m Carmen Twillie Ambar, and I’ll be back soon with more great conversations from thought leaders on and off our campus.