Leadership Trailblazer Spotlight: Jay Butler, CDC Deputy Director for Infectious Disease

Edited for clarity.

ASTHO is spotlighting trailblazers in public health. Among these influential leaders is Jay Butler. He sat down with ASTHO to answer questions about his professional journey.

What about your role continues to surprise or excite you?

JAY BUTLER:
I came to CDC really enjoying that excitement of never knowing when you might be on an airplane before the end of the day as part of an outbreak response. I think we could probably all use a little less excitement right now, but that is something that continues to really draw me and keep me in public health.

When we talk about excitement, I think it also highlights the opportunities we have looking forward. We have a great opportunity now as we look at the lessons learned from the COVID-19 pandemic to improve our generic response capability. We can move away from reinventing the wheel and instead have more pathogen-agnostic systems and methods to approach outbreaks of infectious diseases, as well as how we respond to non-infectious diseases and natural disasters. I think the pandemic has also highlighted the long-standing challenges we've had with inequity in health. We have an opportunity now to really focus on achieving health equity.

Is there a story in your career of a time when leadership meant listening to those around you?

BUTLER:
I think every day, leadership involves listening to those around us. In public health, I want to stress the “public” aspect. We are here to serve the public. We need to listen to the public. That was clearly written into my job description as a state health official. An example of this is the response to the opioid crisis a few years ago. We were just starting to get some of the overdose data and saw we had skyrocketing death rates. At the same time, I was getting pinged by some people in the community—oftentimes family members who had lost a loved one to overdose—who wanted to know what we were doing and how we were addressing this issue.

I talked with behavioral health colleagues, and I realized that this is actually a public health problem. And in behavioral health, the focus is generally on client services, not a population-based approach. So, it was great to get out into the community. I’ve sort of evolved from a boots-on-the-ground epidemiologist to a boots-on-the-ground health policy wonk. I listened to people and saw things in the community myself. I talked to people who were in recovery. I went into a variety of places, including homeless camps, to hear stories from people who were actively struggling with addiction and spoke with family members who had lost a loved one to an overdose or were struggling to find treatment.

Out of that, we were able to build a policy approach that I think was really public health-oriented. We started with the most acute problem: preventing overdoses and getting naloxone into the hands of persons who could be most likely to save a life by administering naloxone. Also, we tried to remove the barriers to treatment for addiction, particularly opioid addiction. And, finally, we went upstream, as we do in public health, and tried to address some of the drivers of addiction, such as adverse childhood experiences. These are all concepts that, while reading about them helps, ultimately cannot be learned from a textbook. They were learned by listening to people in the community and hearing their stories.

What steps can we take today that will have a major impact on public health in 10 or 20 years?

BUTLER:
I think the most important first step is science education. I bring that up with an eye towards the public health workforce of 2030 or 2040, as we make sure that we have a diverse cohort of professionals who are well-trained to step into those new technical roles in public health, as well as the emerging leader roles.

We look at public health as having more of a systems approach, so we can look at what has worked in the past and be willing to move past that if new tools are needed. An example I sometimes use is the concept of interrupting the chain of causation and infectious diseases throughout the 20th century. It was very effective for many infectious diseases, but as we look at the broader array of health challenges—chronic diseases, injury, some of the mental health issues, and some of the infectious disease challenges that continue to vex us—it's not as simple as just a circle that we can break through isolation and quarantine or vaccines or masks. It's a web of causation that's oftentimes driven by social factors and things that are a little bit outside of the traditional public health wheelhouse.

I think as we look at the opportunities over the next 10 to 20 years and where public health can improve, it is important to recognize that health is a universal factor that comes into the discussion of much of what we do, whether it's the economy or national security.

And finally, I think one of the things that we will embrace going forward is the concept of public health as a global issue. I think COVID-19, monkeypox (Mpox), and all these infectious diseases are certainly great examples of how we need to work together with a global approach to public health, not just what's within our own jurisdictions. You know, there's the old saying that microbes don't need passports to cross borders. People do, but some of the birds and insect vectors that carry those microbes certainly don't. So, we need to have a global approach to public health as we look at what's going to happen in the next couple of decades.