A career fighting infectious disease

James L. Hadler, M.D., FW ’80, M.P.H. ’82, said that his relatives, many of whom are physicians, sometimes tease him for not working at the bedside. “They ask me, ‘When are you going to be a real doctor?’ ” But, he said laughingly, “The public is my patient.”

Hadler, who retired in June after almost 25 years as Connecticut’s state epidemiologist and chief of the state health department’s Section of Infectious Diseases, has steered the state through a plethora of public health crises, from AIDS to Lyme disease to anthrax. Although he started his career as a physician while working on the Navajo reservation for the Indian Health Service and the Centers for Disease Control (CDC), Hadler found he liked looking at health from the perspective of populations. The experience, he said, “sold me on a career in public health.”

He came to the state health department in 1984, just as the AIDS epidemic was picking up speed. For the first four or five years, “HIV became my life.” High-profile debates kept him in the public eye. For example, Connecticut had one of the first cases of a school-aged child with AIDS, and under national media attention, Hadler developed safety guidelines to allow the child to return to school.

The mid-1990s saw a dramatic shift in emphasis after the Institute of Medicine published a paper stating that the country was unprepared to combat emerging infectious diseases. In 1995, the Emerging Infections Program, affiliated with the CDC, was established in partnership with the state health department and the Yale School of Public Health. It was soon busy with outbreaks of Eastern equine encephalitis and West Nile virus and the re-emergence of the then rare tick-borne diseases babesiosis and ehrlichiosis.

After September 11, 2001, bioterrorism preparedness became a priority. Hadler was on the front lines during that year’s anthrax attacks (he still attends an annual symposium in honor of victim Ottilie Lundgren, a Connecticut resident and one of five people who died from exposure to anthrax), and later faced a crisis of conscience when he was instructed to prepare mass smallpox vaccinations prior to the invasion of Iraq, which he strongly opposed. Reasoning that to do so might embolden the Bush administration’s threat to invade, he considered resigning. In the end, he decided that to quit or go on strike would not stop the war, and chose to stay, “although uneasily.”

While in office, Hadler also oversaw an increase in childhood vaccinations against preventable diseases, the elimination of race-based disparities in childhood vaccination rates and the reduction of the rates of tuberculosis and several sexually transmitted diseases.

Hadler said that what has motivated him, in large part, is the combination of Connecticut’s small size and its great population diversity. Its problems come in manageable “little packets.” “New Haven has its down-and-out side, Hartford does, but … they’re all small compared to New York or Chicago,” he said. “To me, [Connecticut] is a perfect laboratory to try to take on the challenges of diversity and health disparities.”

adler grew up in Bethesda, Md., where his father worked as a naval architect and international consultant. The family hosted exchange students and had friends from other countries, and Hadler says those experiences—and his stint in Pakistan as an exchange student—gave him and his three siblings a global perspective.

He attended McGill University in Montreal, then went to Columbia University’s College of Physicians and Surgeons. After an internship at Roosevelt Hospital in Manhattan, Hadler joined the Indian Health Service in a position supported by the CDC as a tuberculosis control officer. He completed his residency at Waterbury Hospital in Connecticut, did an infectious diseases fellowship at Yale-New Haven Hospital and then earned an M.P.H. Finally, he and his wife and two children spent a year in China as part of a School of Medicine exchange with Hunan Medical College. He began as Connecticut’s state epidemiologist the following year.

The job, he said, has allowed him to combine diverse interests and to work with people from all walks of life. “Public health is dynamic,” he said. “I love that aspect of the job.”

Hadler lives in New Haven with his wife, Alice, who speaks several languages and whose experiences with adult education on the Navajo reservation with her husband grew into a teaching career; she is now an associate dean at Wesleyan. They have three grown children.

Hadler plans to work as a public health consultant to the state and to New York City. He will also write scientific papers, deliver talks and continue to teach at the School of Public Health.