Remarks by James W. Curran Upon Receipt of the ASPPH Welch-Rose Award for Distinction in Public Health

Thanks to Dean Ayman El-Mohandes of the City University of New York Graduate School of Public Health and Health Policy, the Association of Schools and Programs of Public Health (ASPPH) board of directors, ASPPH President Laura Magaña, and the selection committee for the ASPPH Welch-Rose Award. I am especially grateful to all of the ASPPH staff for your consistent productivity and support for all of us through the years. And thanks to my fellow deans and program directors, present and past, including our dean and past president of ASPPH, the late Harrison Spencer. Your collegiality and shared experiences have so enriched public health and my own career.

In spring 2023, I participated in my 27th and last commencement ceremony as dean of public health at Emory University. I stepped down as dean in July 2023 and rejoined the Rollins School of Public Health faculty in epidemiology and global health. My son, David, skeptical that I will fully retire, calls me Tom Brady. This past July, the Rollins School of Public Health was fortunate that Dr Daniele Fallin accepted the position as dean and professor of epidemiology.

The annual ASPPH meeting allows me to look back over my 5 decades in public health. I was very fortunate to meet and marry my wife, Juanita, at the beginning of my career. We just celebrated our 50th anniversary.

I did not realize that, after medical and public health training, I would begin a 25-year career at the Centers for Disease Control and Prevention (CDC). My first CDC assignments were in local public health in Memphis, Tennessee, and Columbus, Ohio. These assignments involved several years of conducting research on sexually transmitted diseases and running a local vaccine campaign against swine flu.

In 1978, I moved to Atlanta, Georgia, to become chief of the Venereal Disease Research Branch at CDC. In 1981, I was assigned to lead the investigation of 5 cases of a rare pneumocystis pneumonia reported among gay men in Los Angeles, California.^1,2 Of course, these were the first 5 reported cases in the world of what is now known as AIDS. Within 2 years, the causal agent, now known as HIV, was discovered, making accurate clinical and laboratory diagnosis feasible. During these early years, HIV/AIDS was a lifelong, inevitably fatal infection. Efforts at control were hampered by homophobia, racism, and government neglect. For more than 14 years, no long-term lifesaving therapies existed. No cure or effective vaccine exists to this day, but lifelong therapy is now very effective.

Of course, the AIDS epidemic changed my life and marked my career and the careers of countless others. More important was the impact on the tens of millions of people worldwide who died and those who continue to die from AIDS. My colleagues and I recently published a book summary of CDC’s work on AIDS. ²

In 1995, I was fortunate to join Emory University as dean of the Rollins School of Public Health and also continue my more than 40-year involvement in AIDS as codirector of Emory’s Center for AIDS Research.

Three years ago, we were all confronted with the COVID-19 pandemic—the public health crisis of the 21st century. During the past 3 years, COVID-19 has seemed to define public health for many, and it greatly affected our schools and programs of public health and the educational experiences of our students. We will remember the impact of COVID-19 for the rest of our lives. Even though the story of the COVID-19 pandemic is incomplete, many observations can be made.

First, SARS-CoV-2 is a new RNA virus that likely emerged from an animal (hence, a zoonosis like HIV). ³ It rapidly spread to billions of people worldwide. In the United States, life expectancy declined dramatically during the pandemic. ⁴ More than 1 million COVID-19–related deaths occurred from March 2020 through February 2022, ⁵ causing overall mortality to increase 25% in the first year of the pandemic alone. ⁴ COVID-19 has also greatly increased mortality from chronic diseases and other causes.^4,6

Homicides in the United States rose greatly during the pandemic, along with suicides and deaths from drug overdoses, rightly termed diseases of despair. ⁷ Not surprisingly, as with other epidemics, certain groups, including Black, Hispanic, and American Indian/Alaska Native people, as well as elderly people have been disproportionately affected.^8,9 Separate but related, we have witnessed increases in mass shootings, murders, and even police violence during this period. Acts of racism and discrimination against Black, Hispanic, Asian, and Jewish people and immigrants have increased. ¹⁰

The public health report card in the United States in response to COVID-19 is mixed. ¹¹ First, the science thus far has been amazing. What took many years for the discovery of HIV as the cause of AIDS was accomplished in weeks for SARS-CoV-2. Until recently, it would have been unthinkable to witness the development and deployment of effective vaccines, rapid genetic identification of variants, discovery of several effective therapies, and early attempts to share resources worldwide in such a short time frame.

But not everything has been positive. The COVID-19 pandemic has highlighted the urgent need to strengthen our health and public health systems. COVID-19 has had major adverse effects on our education system at all levels and disrupted employment, global commerce, and social services. CDC and state and local public health agencies have been under great duress and received strong criticism from politicians and the public. The COVID-19 pandemic has brought long-awaited recognition of the need to strengthen the public health workforce, data systems, and communication capacity throughout. Unfortunately, at the federal level, political dialogue has thus far focused on criticism more than commitment to reform and financial support.

Public health is always political because so many diverse populations and groups are affected, but the politics should never be partisan during a pandemic. Unfortunately, COVID-19 emerged during a presidential election year in the United States, and government communication was hampered initially by underestimation and understatement of the problem and disagreements about the correct approaches to take. Very damaging has been the frequent disrespect of science and scientists and public health officials, including those from CDC, the US Food and Drug Administration, and the National Institutes of Health. Of course, scientific information was constantly evolving and communication was often inconsistent, which contributed to public confusion. But the incessant political criticism further eroded trust in public health officials at the time we needed it most. Public health workers worked tirelessly throughout the pandemic, often at low pay, only to be disrespected and even threatened. Many left their jobs. ¹²

Despite these difficulties, I am optimistic about the future of public health. COVID-19 will likely stay with us for the long term, and many new public health challenges will emerge. For COVID-19, vaccines, therapies, and other measures will continue to have a positive effect on transmission, hospitalizations, and deaths.

During the next decade, we must take every opportunity to strengthen a coordinated global capacity to face future threats to the public’s health. Combating racism and discrimination will remain crucial. In his book about AIDS, Gardening in Clay, Dr. Ronald O. Valdiserri, a professor at the Rollins School of Public Health, compares combating discrimination with weeding a garden. Combating discrimination must be continuous and collaborative. We cannot take a break and let up or the weeds of discrimination will flourish. ¹³

Public health challenges will arise throughout our careers. While it is not possible to predict the future, we can prepare for it. It is important to know yourself and your own strengths. Be confident in your abilities, and remain open to new opportunities and challenges. Work closely with others with whom you share goals and passion and have complementary skills. Science will progress and greatly assist our efforts. We need to exploit the strengths of science but also recognize its limits. Science by itself will be insufficient. Improving public health and engendering trust require leadership, advocacy, excellent communication, and hard work. Do not be satisfied with the status quo. Improving public health will require constantly redefining what is unacceptable and taking action.

Academic deans, directors, and faculty have great opportunities and responsibilities for leadership in public health, both at our own institutions and more broadly. This leadership involves working with colleagues locally and globally to define and address public health challenges with science and social justice.

A close friend and colleague of mine was the late Dr Jonathan Mann, who died with his wife, Dr Mary Lou Clements-Mann, in 1998 in a Swiss Air crash en route to Geneva. At the time, he was serving as the founding dean of the Drexel Dornsife School of Public Health in Philadelphia. In the 1980s, he was the founding director of the World Health Organization Programme on AIDS, where he linked the global fight against HIV to the pursuit of human rights.

Shortly before Dr Mann and his wife died, he addressed the XII International Conference on AIDS in Geneva, stating, “Our responsibility is historic. For when the history of AIDS and the global response is written, our most precious contribution may well be that at a time of plague, we did not flee, we did not hide, we did not separate ourselves.” ¹⁴

As with AIDS and COVID-19, we must continue to face future public health challenges by working together. You and your colleagues are up to the challenge, and you will have great success, satisfaction, and enjoyment in your public health careers. Thanks to all of you for this recognition and especially for what you do in public health.