key: cord-0008209-khyidi9s authors: Jafari, Hamid S. title: Stephen L. Cochi, MD, MPH: An outstanding leader in global eradication, elimination, and control of vaccine-preventable diseases date: 2004-11-24 journal: Semin Pediatr Infect Dis DOI: 10.1053/j.spid.2004.08.003 sha: 00b050ecae47c925db0eb4db5769ff1f907644b7 doc_id: 8209 cord_uid: khyidi9s nan F rom 1993 to 2003, Dr. Stephen Cochi led the global immunization activities of the Centers for Disease Control and Prevention (CDC) and directed a $150 million-per-year program with more than 90 CDC staff providing technical and programmatic support. He also was responsible for directing vaccine grants as a major partner in the global polio eradication initiative, global measles control and mortality reduction initiative, and other priority global immunization activities. In early 2004, Cochi was appointed as Acting Director of the National Immunization Program at CDC. During his outstanding career of more than 22 years working in the field of immunization at CDC, Cochi has had a major impact on the prevention of virtually every one of the vaccine-preventable diseases, particularly diphtheria, Haemophilus influenzae type B (Hib) disease, measles, mumps, pertussis, polio, rubella, varicella, and tetanus. Vaccines remain the most cost-effective preventive intervention, and their potential for providing further control of communicable diseases and significant reduction of childhood deaths also remains enormous. Thus, presentation of Cochi's biography in this issue of Seminars in Pediatric Infectious Diseases is particularly relevant. This article seeks to honor his contributions to the field of infectious diseases by looking at his background, family, and career, all of which demonstrate his devotion to humanity and his commitment to attaining high standards that ensure a better world for tomorrow. Stephen, or Steve as he is known to family and friends, was born on August 19, 1951, in Potsdam, New York, the second child of Winifred (Whitelaw) and Oscar Cochi. A month later, the family moved to Webster, New York, a suburb outside Rochester. At the time of Steve's birth, his father was a recent graduate of St. Lawrence University, and he had accepted a teaching and coaching position in the Webster school district that later would lead to the position of principal of the high school. Eventually, the family settled into the family home in Penfield, where they have lived now for more than 50 years. Winifred had more than a full-time job as homemaker, lovingly rearing their five children ( Figure 1 ) and supporting their various endeavors. Steve came from a close-knit family and, as a young boy, he spent his summers visiting his extended family. He particularly enjoyed visiting his paternal grandparents, Leonina and Carlo Cochi, immigrants from Maenza, Italy, who had come through Ellis Island and settled in upstate New York and Long Island, where they established their own business, a single-pump gas station and small neighborhood store. After Carlo's death, Leonina continued to run the business until she was in her late 70s and a hip fractured forced her to retire. Today, Steve fondly remembers the summers spent helping her pump gas and selling ice cream and candy to the local children, as well as playing with his cousins and attending the annual St. Johnsville Fireman's Fair (personal correspondence, Jane Skvarich). Visits to his maternal grandparents' home were equally memorable. The family trips to Wiliston Park, Long Island, where his mother's parents, Anna and Charles Whitelaw lived, were particularly exciting. Anna had served as a Yeoman First Class in the Navy during World War I, and she is one of many women honored at the Woman's War Memorial in Washington, DC. One of Steve's most cherished memories of these visits is the year his father and grandfather took him and his brother Robbie to see his childhood idols, Willie Mays of the New York Giants, compete against Hank Aaron of the Boston Braves. Steve's wife relates that she doesn't know if any connection exists between that memorable event and one of Steve's favorite movies, The Pride of the Yankees, the Lou Gehrig story, but the latter still manages to "choke him up" (personal correspondence). Summers also involved hard work in addition to the family visits. Steve worked on local farms picking fruit or pumping gas at the local filling station. Although the work was hard, he preferred the farm work because he was allowed to eat all the fruit he could consume! As a child and adolescent, Steve demonstrated exceptional academic and athletic capabilities that foretold his later accomplishments. His academic success began when he was in the fourth grade and won the spelling championship in the Webster school district. He still has the trophy that his mother saved all these years. In high school, he continued to shine academically, graduating as salutatorian of his class. He also was an excellent musician and played the trumpet until time constraints precluded his continued participation in the band. Despite his 5=7Љ, 140-pound frame, Steve also excelled in his athletic endeavors in high school, where he played football, basketball, and lacrosse. He played defensive safety on the All County Football Team and, in lacrosse, he was the high scorer, helping take his team to the New York State Title his senior year. His father says that it was his "tremendous speed and determination that made him so successful in sports" (personal correspondence). After graduating from R. L. Thomas High School, Steve matriculated Massachusetts Institute of Technology (MIT), intending to study aeronautical engineering. However, the decreasing demand for aeronautical engineers led him to consider majoring in biology and pursuing a medical career. His years at MIT were especially significant to Steve, both academically and socially. He joined Sigma Alpha Epsilon fraternity and lived with fraternity brothers in Back Bay, where for fun they would go out after dark and chase rats from the trash bins with their hockey sticks! On a more standard field, Steve continued to play lacrosse, and in 3 years of play, he broke the MIT all-time scoring mark. He held this record until just a few years ago, when a young player broke Steve's record-but took 4 years to do so. So, in the eyes of his family, Steve still holds the record! After graduating a semester early from MIT, Steve went to work at Massachusetts General Hospital as a phlebotomist to earn money for medical school. He was accepted to Duke Medical School, where he worked hard and had the privilege of meeting Dr. Samuel L. Katz, for whom he has great respect (for biography of Dr. Katz, see July 2002 issue of Seminars in Pediatric Infectious Diseases 1 ). He considers Dr. Katz his role model and mentor throughout his career. Between work at Duke and the hospital, Steve also sang in the choir. From Duke, Cochi headed back to Boston and Massachusetts General Hospital, where he completed a 3-year residency. While he was doing a pediatric residency program, Cochi met a lovely young nurse in the pediatric intensive care unit, Jane Skvarich. He also enjoyed spending time with friends, hiking, and going to movies, in addition to keeping a busy schedule at the hospital. When, after completing his residency, Cochi left for the Midwest, Jane accompanied him. Their destination was Gallup, New Mexico, where Cochi went to fulfill his medical school grant commitment by working in the Indian Health Service, for which he served as a primary care physician at Gallup Indian Medical Center. He and Jane both enjoyed the beauty of the Southwest (Figure 2 ). Whenever he could, Cochi traveled throughout the Southwest, hiking and camping ( Figure 3 ). These days were especially happy ones, for in addition to enjoying the beauty of the Southwest and its fascinating history and interesting people, Cochi had for the first time HBO and all the movies he wanted-and at home! For a movie buff who had worked and struggled through college and medical school, this was an indescribable luxury. Gallup served another purpose in Cochi's life: an earlier interest in infectious diseases reached a peak in this area, where physicians placed an intense importance on managing infectious diseases that were highly prevalent in their patient population. After considering fellowships in infectious diseases, Cochi eventually decided to apply for the Epidemic Intelligence Service (EIS) program at CDC. Several fellow residents had gone through the program and spoke very highly of it. Taking this step seemed the right thing to do, and Cochi was very pleased when he was accepted into the EIS program. When he left New Mexico for Atlanta, he went by way of New York, taking Jane with him. They were married on Long Island on June 27, 1982. After making a short trip to Nantucket, they headed for Atlanta, where they have remained for 22 years. For both of them, being away from New York was a "first" for their families, each being the only member of the family to move away. Jane had gone to a hospital-based nursing school, Pilgrim State Hospital, before meeting Cochi. On their arrival in Atlanta, she en- Cochi has had an extraordinary career at CDC, and his contributions to national and international public health can be described in broad categories that include global eradication of poliomyelitis, regional elimination of measles, reduction of measles mortality rates, and control of vaccine-preventable diseases, mainly in the United States. According to Cochi, his goal is "to lead CDC efforts in reducing the global burden of vaccine-preventable diseases, both to protect against the greatest infectious disease killers in developing countries and to protect American people against importation of these diseases." As Director of the Global Immunization Division and Associate Director for Global Immunization, National Immunization Program, Cochi was in the forefront of shaping national and international public health policy for vaccinepreventable disease activities. For more than 10 years, he has directed CDC's expanding global immunization activities and has tirelessly spent 40 to 50 percent of his time traveling around the world on behalf of these programs to protect the world's children from the devastation of vaccine preventable diseases. Global polio eradication is his highest priority (Figure 4) . Cochi's leadership of this program, in coordination with the World Health Organization (WHO), Rotary International, UNICEF, and other partners has led to the following extraordinary achievements: • Only six countries in the world remain polio-endemic, the lowest number of endemic countries in history. Since the initiative began in 1988, the number of polio cases has been reduced from more than 350,000 annually to 784 cases in 2003, a decline of more than 99 percent. • Since 1988, an estimated 250,000 lives have been saved and nearly five million cases of childhood paralysis have been prevented through the initiative. In addition, more than one million lives have been saved since 1998 by administering vitamin A during polio-immunization campaigns. • In June 2002, the European Region of WHO became the third region, along with the Americas and the Western Pacific, to be certified polio-free. Now more than 3 billion people in 134 countries, territories, and areas are living in certified polio-free zones. Cochi also led CDC efforts to support the elimination of Before becoming fully involved in global immunization issues, in the early 1990s, Cochi supervised the creation of the national Vaccine Adverse Events Reporting System (VAERS) and the Vaccine Safety Datalink, the two major systems in the United States for reporting and monitoring adverse events following immunization. Like all exceptional leaders, Cochi is a visionary. His particular vision is guided by foresight and an ability to perceive how global health programs and the public health challenges will evolve in the future; it has focused on several principles that have been forged throughout his career: Threats to the health of American citizens have changed in numerous ways during the last 22 years. Together with the increasing global role of the United States as the only remaining superpower, none of these changes has been more pronounced than the impact of global travel and telecommunications in making the world smaller. The impact of imported diseases such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), measles, West Nile virus, and severe acute respiratory syndrome (SARS) combined with the threat of bioterrorism has rendered it imperative that the US public health institutions think globally as they consider ways to protect the health of Americans. To be effective in acting globally requires partnerships with other agencies, organizations, and governments. The U.S. public health leaders and scientists will need to be even more effective by the force of ideas, skills, and idealism joined in partnerships to protect and enhance health. The products of biotechnology will advance and change nearly as fast as naturally occurring pathologic organisms in the setting of a rapidly changing global political and social environment. The result will be a continuing plethora of new challenges. The U.S. Government must be ready to lead in responding effectively to these changes. At the heart of this response must be a programmatic commitment to "do what it takes to get the job done." Cochi's vision of service includes bringing public health benefits to the poorest and most underserved communities of the United States and the world. A reduction of disparities in health will help bridge the "equality gap" that exists between developed and developing countries and may help reduce global political tensions and improve global security. Regardless, it is the right thing to do. For the past decade, Cochi has led efforts by CDC that have vaulted the United States into the position of being one of the leading global immunization partners, with a current budget of $150 million and close linkages to other key partner organizations including WHO and UNICEF. These activities have had substantial measurable impact on vaccine-preventable diseases and highlighted the positive contributions of the US Government. He led the creation of a strategic plan that provides a blueprint for further expansion of support for global eradication of poliomyelitis, accelerated control of measles, and reduced the mortality rates, improving global childhood immunization by strengthening of immunization systems, expanding use of under-utilized vaccines, and developing and introducing new vaccines. These goals provide an avenue for the United States to increase its role in defining the global health agenda. Cochi possesses an optimum combination of qualities that make great leaders in public health. These qualities have been central to Dr. Cochi's success in translating his vision to measurable achievements: Dr. Cochi has earned respect widely by the quality, quantity, and integrity of his work and by the respect he shows to superiors, peers, and subordinate staff. The respect of those with whom he has worked is evidenced by the collaborative successes that have been achieved in domestic and global immunization activities. The combination of his scientific credibility, operational success, and willingness to share credit has contributed to his effectiveness as a leader. Leaders must be able to see beyond one project or program and anticipate how collaborative efforts by all relevant partners can be used to achieve a global good. Cochi has demonstrated the ability to "think big" by successfully collaborating on global poliomyelitis, measles, rubella, diphtheria, and other infectious disease surveillance initiatives. He has helped to bring CDC's influence to a new level on a global scale through the assignment of officers who have helped shape the policies and funding of traditional and new partners, including the American Red Cross, WHO, UNICEF, and the UN Foundation. Leaders can lead effectively only if they have buy-in from staff, partners, and customers. Cochi has forged consensus on projects within CDC and with numerous national and international partners involved in global immunization activities. The results have been documented and can be measured in the number of cases, disabilities, and deaths prevented. Rotary International, which has contributed more than $500 million and made numerous other significant contributions to eradication of poliomyelitis, represents one of the best examples of Cochi's ability to forge consensus in an effort to multiply resources to attack a public health problem. Motivation occurs when individuals and teams place a high value on a work objective and their roles in achieving an objective, especially when they know they are supported by managers and supervisors. Cochi consistently has been successful in framing objectives so that individuals could readily perceive the value of the objective and their contributions. He has a strong history of supporting and recognizing staff. The successful manager must be able to make decisions and take action even in the absence of all necessary data and information. When lives are at stake, one does not always have the luxury of waiting until all desired information has been obtained. Cochi has an impeccable record of making critical decisions on time, taking risks when necessary, and demonstrating outstanding judgment in complex situations. In addition to being engaged in the activities noted above, Cochi has authored or coauthored more than 100 scientific journal articles, letters, and book chapters on vaccines and vaccine-preventable diseases and more than 150 CDC publications, including articles published in MMWR. He has served frequently as an expert consultant and lecturer on international immunization issues for WHO and other international organizations. He is a Fellow of the American Academy of Pediatrics and the Infectious Disease Society of America and a member of the American Public Health Association, Pediatric Infectious Diseases Society, and American Epidemiological Society. Cochi has been recognized by the U.S. Public Health Service and has received the Distinguished Service Medal and the Meritorious Service Medal, two high-level awards given by the Service. He also has received the prestigious Phil Horne Award from CDC in recognition of his leadership abilities both nationally and internationally. Cochi has also received the Shepard Award, CDC's highest scientific honor. Although he is grateful for and proud of the recognition that has been bestowed on him by the scientific community, Cochi's greatest treasure is his family, which has had to share him with the CDC and the world. As often happens when individuals are called to positions of great magnitude, challenges, and responsibilities, Cochi's commitments often took a toll on his time with the family, which now includes two children ( Figure 5) . Bradley was born on June 5, 1986, and like his father is very athletic. This summer (2004), he will be playing Ultimate Frisbee on the United States Junior's Team at the Ultimate Frisbee World Championship in Turku, Finland. Their daughter, Shea, was born on July 11, 1989. She takes after her father in her musical acumen, having played the piano since she was in kindergarten. Despite the demands on his time, Cochi is a devoted husband and father, as well as son, and he makes time to be with his family. In 1995, he returned to New York for a family reunion ( Figure 6) . Also, he spends as much time as possible with his wife and children, and they travel together whenever possible. One especially memorable trip was made to Venice, Italy, in 1998 (Figure 7) . It was followed by another trip to Italy in 2002, this time to Maenza, Italy, where Jane and Steve attended a wedding (Figure 8) . When the children were younger, they often had difficulty understanding why their father had to be away from home so often. They both missed him and expressed desires to travel with him. Cochi promised them that when they were 13 years old, he would take them on a trip of their choice. That day finally came! Brad chose to go to China, and he and his father traveled together for 3 weeks in 1999 throughout China. When Shea's turn came in 2003, she and Cochi traveled to Switzerland, Northern Italy, and Austria. On weekends, Cochi enjoys playing tennis with friends, and during the week, he satisfies his voracious hunger for news by daily reading the newspaper from cover to cover. His fascination with current events may be due in part to his involvement in CDC and the world at large, but it also likely comes from the interest his father instilled in him when he was a boy. The newest addition to the family's interest is a house on Lake Hartwell, South Carolina, that includes a boat, and the entire family is enjoying learning about boating and lake life. And, of course, Cochi still loves movies of any kind. Pioneer in development of and international advocate for vaccines The author is especially grateful to Dr. Cochi's wife, Jane Skvarich, for her contributions, including providing personal information and photographs, and for her role in keeping this biography a secret until its publication. The author also thanks Dr. B. Lee Ligon for editing the different components and combining them into a cohesive whole.