Dr. Inger Damon ’84 led the CDC’s Ebola response and determined its smallpox strategy. Now she’s preparing for the next public health crisis, whatever it might be.
Inger Damon’s CV reads like a litany of potential pandemics and apocalyptic scenarios: She has taken on rabies in the Americas, a multistate outbreak of monkeypox, smallpox as a possible bioterrorism agent and the largest Ebola outbreak in history.
Because she’s the director in charge of “high-consequence” pathogens and pathology at the Centers for Disease Control and Prevention, you might expect Damon to be constantly anxious. She is, instead, a model of calm, unflappable, reassuring efficiency. She comes across as exactly the person you would want deciding what to do with the nation’s smallpox stocks, preventing the inadvertent release of anthrax and overseeing the CDC’s response to the Zaire ebolavirus outbreak in West Africa. All of these are, in fact, tasks with which Damon has been charged during her 15-year tenure with the agency.
Walking across the grounds of the CDC headquarters in Atlanta, Damon points out the various locations in which she has worked: here’s the site of the original smallpox lab, a rabbit warren of cinderblock no longer standing; there are the new glass buildings that today house the rabies group, the personnel for chronic viral diseases and genomic sequencing, and the global communications center. An artificial creek bed meanders along, sans water, and a volleyball net sits on a manicured swath of green, looking more decorative than functional. Guards check badges at every building. The atmosphere is more staid than playful, more high-security complex than Googleplex.
Damon’s division, part of the National Center for Emerging and Zoonotic Infectious Diseases, has five branches that are responsible for studying and managing dozens of alarming-sounding diseases, pathogens and syndromes, from chronic wasting disease, to rat-bite fever, to tick-borne encephalitis. In her office, high above the lawn, orchids and African violets sit alongside a copy of the Manual of Clinical Microbiology. A caricature of Damon as “Pox Avenger” hangs on the wall. And a photo album labeled “Ebola Response 2014” rests on her desk—a souvenir of Damon’s eight months as head of the CDC’s efforts to contain the deadly virus.
The first Ebola outbreak to reach epidemic proportions began in Guinea in December 2013 and quickly spread to Liberia and Sierra Leone. It has now killed more than 11,000 people and infected more than 27,000. When Damon took over the CDC’s response in July 2014, she says, “it had become painfully clear that the outbreak was not in control.” She was charged with creating and carrying out the agency’s strategy, and overseeing the day-to-day operations of the CDC’s largest international emergency response to date.
Ebola is a brutal hemorrhagic fever that overwhelms the body’s defenses, disarms the immune system and has a 50 to 90 percent mortality rate. While past outbreaks had been brought under control within a few weeks, the one in West Africa proved resilient. Fueled by improved transportation and increased connectivity, the virus jumped across borders and spread rapidly through densely populated urban areas, overwhelming health care systems that were already under-resourced and short-staffed. Multiple factors compounded the rapid spread, including extreme poverty, traditional hands-on burial practices and a widespread distrust of government officials.
Hospitals and clinics struggled to stay open. Even as their doctors and nurses began to die from the virus, these centers had too few gowns and gloves—basic equipment for personal protection. “These were countries already ravaged by years of civil war,” says Damon. In Liberia and Sierra Leone, for example, insurgencies and coups had led to the looting and damage of medical clinics. Hospitals lacked electricity and running water. Health care workers were scarce. It was not the ideal scenario for a potential pandemic. Rather, it was ideal for the pandemic; not so much for the humans.
The outbreak was out of control when Damon took charge. Doctors were dying.
Clinics were closing.
IN A SENSE, Damon had spent her entire career preparing to lead the fight against Ebola. The daughter of two academic scientists—her father was a physicist, her mother a chemist—Damon decided to take a different path. “My parents were aghast when I told them I was thinking about medical school,” she says, only half-jokingly.
Her father, Dwight Hills Damon ’53, grew up in Amherst and attended the College on a scholarship for town residents. When Inger first arrived at Amherst, she joined her sister Candace ’81. Inger majored in chemistry, joined the coed fraternity Alpha Delta Phi and worked in the lab of chemist Dave Dooley, now president of the University of Rhode Island. At Amherst, she says, she developed “a level of curiosity and critical thinking” that continues to influence her work.
After earning an M.D./Ph.D. from the University of Connecticut Health Center, she did her residency in internal medicine at the University of Pennsylvania. After that, she completed a fortuitous infectious-disease fellowship and molecular virology postdoctoral fellowship at the National Institute for Allergy and Infectious Diseases. There, she worked in Bernie Moss’s lab on poxviruses, studying how viruses invade cells, how poxviruses replicate and how vaccines work.
She married a fellow scientist, Greg Armstrong, and they settled on Capitol Hill, commuting by Metro to the NIH in Maryland. When Armstrong got a job with the CDC’s hepatitis group, Damon began looking for a position in Atlanta. She joined the CDC’s poxvirus group in 1999 as a medical officer in the U.S. Public Health Service, with the rank of lieutenant commander.
“Atlanta, the CDC and Emory were perfect for my interests—the triple threat of clinical, research and teaching,” she says. In addition to her work with the poxvirus group, Damon lectured at Emory’s School of Medicine and treated patients in the HIV clinic at the Atlanta VA Medical Center.
She became one of the world’s foremost experts on orthopoxviruses—a group of viruses that includes monkeypox, cowpox, camelpox and, most famously, smallpox. Like ebolaviruses, orthopoxes are zoonotic; that is, they are able to jump from animals to humans. Damon has studied their genetic diversity, resolved outbreaks around the globe and learned how these viruses “outthink” their host organisms, becoming efficient and adaptive. Among many other projects, she compiled the first significant database of whole-genome sequences of variola, the virus that causes smallpox. This intimate familiarity would go on to serve her well.
Damon was a lead investigator of the first (and so far only) outbreak of monkeypox in the United States. Monkeypox is rare in humans, and until the 2003 U.S. outbreak, it had been limited to Africa. It causes fever, swollen lymph nodes and a rash, and is usually relatively mild. In deciding how to respond to the U.S. outbreak—which was traced to imported exotic rodents—Damon and the CDC looked to the worldwide eradication of smallpox as a model.
Smallpox killed millions each year until it was wiped out in 1979 through vaccination efforts and other tried-and-true public health practices: educating and engaging the community, quickly identifying new and potential cases, isolating patients and tracking their movements to find people with whom they had contact.
To contain the monkeypox outbreak, Damon and the CDC employed the same strategies, including smallpox vaccination, which is effective against monkeypox. Seventy-one people came down with monkeypox in the Midwest. All recovered. Although no vaccine exists for Ebola, the basic “shoe leather” methods—case identification and isolation, contact tracing, community education—are the same tools the CDC would rely on in 2014.
“Ebola was a huge wake-up call in terms of how globally prepared we are to handle an epidemic.”
A MASTER SWIMMER and one-time marathoner, Damon was training for a new challenge—the 17.1-mile Imogene Pass high-altitude run—when the CDC tagged her to lead its Ebola response. In July 2014 she gave up her training and prepared for a different endurance challenge, setting up shop in the agency’s Emergency Operations Center.
Activated during hurricanes, terrorist attacks and disease outbreaks, the Emergency Operations Center is staffed with CDC experts dedicated to the task at hand. An open space, it is filled with video screens, banks of computers and clocks set to the local times in cities around the world. Once activated, the center is busy 24/7.
By this point, the World Health Organization was calling the escalation of the Ebola outbreak “precarious.” From July 28 to 30 alone, 117 new cases and 97 deaths had been reported in West Africa. Then, in August, the crisis came home: two American medical missionaries who acquired Ebola in Liberia while tending to patients—Dr. Kent Brantly and Nancy Writebol—were flown to a special isolation unit at Emory University Hospital in Atlanta, built in collaboration with the CDC to safely treat patients with highly infectious diseases. (One of the pilots was Randy Davis ’76, of Phoenix Air Group. He told ABC News that it was an honor to do the job.) Public anxiety in this country began mounting.
“Ebola was a huge wake-up call in terms of how globally prepared we are to handle an epidemic, and how interconnected our world is,” says Damon. “I mean, you can’t close the borders.” Under Damon’s leadership, the CDC tracked reports of all passengers who developed fevers and other symptoms while flying internationally and sent in medical teams whenever anyone—such as the Liberian-American lawyer who fell ill before landing in Nigeria on July 20—tested positive for Ebola.
The CDC initially aimed to send 50 staffers at a time to work on the ground in West Africa. As the death toll rose, however, the agency increased that number to 250. Damon visited one of the Ebola treatment units being built in Liberia. “My job was to gather information, identify gaps and needs, and provide continuity and leadership,” she says. She talked daily with CDC Director Tom Frieden, and when President Obama visited the CDC in the fall, she briefed him on the epidemic.
Damon, a U.S. Public Health Service captain, is one of the world’s top experts on poxviruses.
Damon coordinated work among agencies within the U.S. government, state and local health departments, and international agencies and organizations. A major obstacle was in training enough workers to staff the treatment units in West Africa—and in replacing the staff who were dying. “Ebola took out a third of the physicians and healthcare workers in some places,” Damon says. Media reports told of families driving from one clinic to the next in search of help, and of victims dying in the streets.
Damon and Stuart Nichol, the chief scientific officer for the response, came up with the idea of a CDC training course to augment the efforts of the nonprofit Doctors Without Borders. The course, held in Anniston, Ala., ultimately graduated 600 volunteers, largely American doctors and nurses, many of whom immediately went to work in West Africa.
This effort was not entirely altruistic. As Frieden said often during the outbreak, “We are all connected by the air we breathe, the water we drink, the food we eat, and by airplanes that can bring disease from anywhere to anywhere in a day.” With the death from Ebola of Thomas Eric Duncan—the first person to be diagnosed in the United States—in October in Texas, and the subsequent infection of two health care workers who treated him, our own vulnerability was clear.
“To protect our interests, you have to develop capacity in these countries,” says Damon. “They are clamoring for it, but they need resources and technical assistance.” The CDC provided both, as well as guidance on infection control and clinical care.
Frieden remembers Damon as focused and calm, even when the death toll was at its highest. “She is the epitome of a CDC scientist,” he says: “dedicated to service, committed to evidence-based medicine and passionate about public health.”
Damon looks back on those eight months as exhausting—she took a total of four days off—but exhilarating. They were also highly successful. Today, the epidemic has scaled down to a scattering of cases in Guinea and Sierra Leone. Liberia, the country hit hardest, is officially Ebola-free.
IN DAMON’S LINE OF WORK, there’s always another threat looming just beyond the horizon, like a gathering storm. “There are constantly new emerging infectious and zoonotic diseases,” she says. “And there are even more now, with climate change and our global interconnectedness.”
Recently her expertise on poxviruses thrust her into the international spotlight. When the WHO declared smallpox eradicated, the remaining stocks of variola were voluntarily consolidated in two WHO Collaborating Centre labs. One of these labs is at the CDC in Atlanta, the other at the State Research Center of Virology and Biotechnology in Russia. This spring, scientists and policymakers asked: What should happen to these stocks? To understand the emotional desire to eliminate every last remaining trace of smallpox from the world, all one needs to do is view a photo of an infected child. But while the scientific community is somewhat divided on the question, many top researchers argue that destroying the known stores does not guarantee elimination of the scourge.
The World Health Assembly (the WHO’s decision-making committee) convened on May 19 to vote on whether to recommend keeping or destroying these stocks. Damon, in her role as director of the WHO Collaborating Centre for Smallpox and Other Poxvirus Infections, falls strongly on the “keep” side of the argument: “There’s always the possibility that smallpox could re-emerge, through undisclosed stocks or biosynthesis of the virus. We must conduct more research [on the live virus] to be prepared.”
Damon meets with colleagues in the midst of the Ebola crisis in August 2014.
In an opinion piece for the journal PLOS Pathogens, Damon and her coauthors wrote: “Despite significant advances, there is more work to be done before the international community can be confident that it possesses sufficient protection against any future smallpox threats.” Keeping the existing stores, they maintained, would allow scientists to conduct research that might eventually lead to newer and safer vaccines, antiviral drugs and better ways to diagnose the disease.
Today, Damon continues to study the genetic sequencing of existing poxviruses, to identify new ones and to work on the development of vaccines. Her emphasis is on what’s safe, cheap and effective—vaccines or treatments that can be stockpiled or produced quickly and at large volumes, and that are hardy enough to be transported and used in developing countries and rural areas.
“It’s tremendously rewarding to continue to learn and be curious at the intersection of communities, the environment and basic science,” she says, as she hurries off to a meeting across the CDC campus, this one on redefining chronic fatigue syndrome.
Through all of this—brainstorming with colleagues, creating protocols, weighing in on international policies, researching, writing and educating—Damon is protecting hundreds of thousands of people who most likely will never know her name, or the fate that would have befallen them, or the catastrophe that was, quietly and calmly and systematically, prevented from ever even happening.
Mary Loftus is editor of Emory Medicine magazine and recently reported on the treatment and recovery of four Ebola patients at Emory Hospital’s Serious Communicable Disease Unit.
Photographs by Christopher T. Martin and ©Branden Camp/EPA/Corbis