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Brenda Fitzgerald at a TEDx event in Atlanta in 2014.

TEDx Atlanta/Flickr (CC BY 2.0)

Trump taps Georgia health director to lead CDC

President Donald Trump has tapped two state health commissioners to fill key posts in his administration. 

Today, Health and Human Services Secretary Tom Price announced the selection of Brenda Fitzgerald, an obstetrician-gynecologist who is commissioner of the Georgia Department of Public Health , to direct the $12.1 billion Centers for Disease Control and Prevention (CDC) in Atlanta.

“Having known Dr. Fitzgerald for many years, I know that she has a deep appreciation and understanding of medicine, public health, policy and leadership—all qualities that will prove vital as she leads the CDC in its work to protect America’s health 24/7,” Price said in a statement.

Fitzgerald—a one-time adviser to then-Representative Newt Gingrich, herself a two-time Republican candidate for Congress, and formerly a major in the U.S. Air Force—has been in her current position since 2011. She will succeed Tom Frieden, who stepped down this past January after leading CDC for 8 years.

Fitzgerald is the second key public health appointment made by Trump in recent days. On 29 June, Trump nominated Jerome M. Adams, an anesthesiologist who is Indiana’s health commissioner, to be the U.S. surgeon general.

"Very proactive"

Fitzgerald gets good reviews from the health and research community. “I’ve been impressed with her energy. She’s been very proactive on access to family planning in Georgia and promoting early childhood development,” Frieden says.

“I’m optimistic that she will be an effective CDC director,” said James Curran, who once led CDC’s HIV/AIDS efforts and is now the dean of the Rollins School of Public Health at Emory University in Atlanta. Curran has worked with Fitzgerald for several years in his role as a member of the board of the Georgia Department of Public Health. “She has great respect for science,” he added.

As state public health commissioner, Fitzgerald made access to long-acting contraceptives easier for women on Medicaid, by obtaining a waiver that improved incentives for physicians to provide such contraceptives immediately after delivery of a baby. Fitzgerald was also a key architect of a model Ebola screening program at the Atlanta airport, which laid the groundwork for later Zika screening in the state. Concerned by a high rate of early elective deliveries in Georgia, Fitzgerald had state data analyzed; they showed a significant difference in third-grade school test performance between children who had been delivered at 37 weeks of pregnancy compared with those delivered at 39 weeks. When hospitals and obstetricians got the information, Georgia’s rate of elective deliveries before 39 weeks plummeted from 65% to 3% over about 2 years.

Fitzgerald is a “solid choice” to head CDC, Donna J. Petersen, chair of the Association of Schools and Programs of Public Health in Washington, D.C., and dean of the College of Public Health at the University of South Florida in Tampa, said in a statement.  Tony Mazzaschi, ‎senior director for policy and research at the group, says that Fitzgerald’s commitment seemed total when she attended a recent Atlanta roundtable on population health organized by his group. “She not only came, she was 100% there,” he says.

Importantly for her upcoming role, Fitzgerald is president-elect of the Association of State and Territorial Health Officials, a position reflecting a vote of confidence from a key CDC constituency—state public health workers.

Fitzgerald has gotten embroiled in the politics of abortion. At the direction of Georgia Governor Nathan Deal (R), Fitzgerald’s department ran an investigation of Planned Parenthood Southeast and four other Georgia abortion providers, after abortion opponents released covertly filmed videos in the summer of 2015 that showed senior Planned Parenthood officials frankly discussing their provision of fetal remains for medical research, a practice legal under U.S. law.  Fitzgerald found no evidence of wrongdoing. However, the Atlanta Journal Constitution reported that the Department of Public Health wrote to Planned Parenthood Southeast the day after Deal called for the inquiry, “saying the state was canceling a program that provided Planned Parenthood with free test kits for sexually transmitted diseases.” Planned Parenthood and the department soon reached a compromise under which the state continued to provide the test kits but Planned Parenthood paid for them.

Fitzgerald is a cook, a gardener, and a runner who begins her days with “sun salutation” yoga and green tea and loves to vacation in the south of France. “I practice what we preach in public health—I eat healthy foods and I make sure to include physical activity in my schedule every day,” she said in a recent interview that is packed with personal detail.

Frieden, however, emphasized his concern for the agency no matter how competent or devoted the new director. In late May, The Washington Post reported that the agency has nearly 700 staff vacancies. Trump’s 2018 budget proposal would cut the agency by $1.2 billion, or 17%.

“She can succeed by listening to and supporting the staff at CDC,” Frieden says. “Supporting means making sure that CDC has the budget it needs to protect Americans.”

Surgeon general pick

If confirmed by the U.S. Senate, Adams, the surgeon general nominee, will replace Vivek Murthy, whom Trump ousted in April. Adams has been Indiana State Health Commissioner since October 2014. He was hired by then-Governor Mike Pence, now the vice president. 

Early in 2015, Adams confronted an HIV epidemic in rural Scott County in southeastern Indiana, fomented by needle-sharing among prescription opioid users; 158 cases of the disease were diagnosed by May 2015 when Adams urged citizens to practice safe sex and, “If you’re injecting drugs, don’t share needles.”

It was, however, Pence’s reluctant decision, 2 months after the outbreak began, to implement a needle-exchange program that put the brakes on the epidemic.  In this New York Times depiction of Pence’s conversion to the idea, Adams is quoted defending Pence’s weeks of inaction. “The governor wanted to make sure if we went this route it was absolutely necessary,” Adams said. “I believe he was praying on it up until the final decision.”

Late last month, Adams touted the now-2-year-old needle exchange program in a Department of Health press release. “Syringe exchanges aren’t pretty,” he wrote, “but the opioid epidemic is far uglier.”

As an undergraduate in the summer of 1996, Adams was a Howard Hughes research scholar at the University of Colorado in Boulder lab of Thomas Cech. There, Adams studied the structure of the Tetrahymena group I intron that had won Cech the Nobel Prize in Chemistry in 1989 for his discovery of its catalytic properties. “I’m thrilled that Jerome’s research experience … in my lab helped propel his career,” said Cech, now a distinguished professor in the department of chemistry and biochemistry at the university.

Adams later earned a master’s degree in public health from the University of California, Berkeley, and an M.D. from Indiana University. He completed a residency in anesthesia in 2006 and has been a practicing anesthesiologist since then.