Shortly after Dr. Nirav Shah started as the new director of the Maine Center for Disease Control and Prevention, Portland began seeing a sudden influx of asylum seekers.
Shah moved quickly, dispatching seven public health nurses to tend to the immediate health needs of about 200 asylum seekers being temporarily housed at the Portland Expo. The nurses gave vaccinations, conducted health screenings and referred those with minor illnesses to get care, including at the Greater Portland Health clinic down the street from the Expo.
It was the first major public action by Shah, who arrived in Maine this month with extensive credentials – as well as some political baggage. He holds degrees in medicine and law from the University of Chicago, and his resume includes work for the government of Cambodia.
In Shah’s previous job, as director of the Illinois Department of Public Health, he was at the center of a controversy over a Legionnaire’s disease outbreak that resulted in some calling for his ouster. The issue became part of the campaign against Shah’s former boss, Illinois Gov. Bruce Rauner, a Republican who lost a bid for re-election in November 2017.
The Mills administration has said it was aware of Shah’s background and has confidence in his abilities to lead the Maine CDC.
“Dr. Shah has the experience, knowledge, and enthusiasm to catalyze growth at the Maine Center for Disease Control and Prevention,” Health and Human Services Commissioner Jeanne Lambrew said in a statement. “He has successfully led efforts to respond to public health challenges, from the opioid crisis to childhood lead poisoning.”
Lambrew said Shah, who will earn $167,211 a year to head the CDC, has stellar credentials and the “ambition” to improve the agency.
Beyond the asylum seekers issue, Shah said “job No. 1” is to fully staff the CDC, which had more than 100 unfilled positions under the LePage administration and currently has 55 vacancies. Lambrew, who was appointed by Gov. Janet Mills shortly after she took office in January – has made staffing the CDC one of her top priorities.
For instance, the number of public health nurses has increased from 14 to 31 since Mills became governor, and the hiring is continuing, as a fully staffed public health nursing program would include 48 nurses.
Shah said once the CDC is fully staffed, he hopes to tackle Maine’s ongoing public health issues – such as school-required vaccinations, Lyme disease, opioids, lead poisoning and responding to infectious disease outbreaks.
“I am now in that sliver of people who got their dream job not once, but twice,” said Shah, who directed the Illinois Department of Public Health from 2015 until this February. He was also previously a health care consultant in Illinois and a chief economist for the ministry of health in Cambodia, where he worked to help prevent the spread of SARS, an acute viral respiratory disease, in 2003.
In Illinois, Shah became embroiled in a controversy over a Legionnaire’s disease outbreak at a veterans’ home in 2015 that sickened hundreds and resulted in 12 deaths that stemmed from a malfunctioning hot water system.
According to a performance audit released in March 2019 by the Illinois Auditor General’s Office, the state health department “officials often did not know the seriousness of the problem at the Quincy Veterans’ Home” because of a lack of communication from the VA.
Shah told the Press Herald that county health department officials were on the scene “within 12 hours” of being notified and that the state health department “followed a playbook” for a “robust” response to the public health crisis.
But the audit recommended developing improved communications between the Illinois Department of Veterans’ Affairs and state and county health departments during outbreaks, as well as a number of recommendations for the VA to avoid future outbreaks at its facilities.
Despite calls for Shah to resign by Democratic Sens. Tammy Duckworth and Dick Durbin of Illinois, Shah remained on the job through the change in administrations in 2019. Rauner lost in a landslide to Democrat J.B. Pritzker in the November general election, and the VA crisis was one of the campaign issues.
Also, while heading up Illinois’ top public health agency, Shah started a pilot program that steered those who were prescribed opioids for chronic pain into the state’s medical marijuana program and expanded testing of infants for lead poisoning.
Shah, who plans to live in the Brunswick area with his wife, Kara Palamountain, a research professor at Northwestern University, is now focused on Maine’s public health issues.
One major public health problem in Maine is pertussis, also known as whooping cough. Maine has the highest rate of pertussis in the nation, more than eight times the national average, with several outbreaks reported at schools every year.
Maine has experienced 208 pertussis cases through May, on track to eclipse 2018, when the state had 446 cases for the entire year.
Shah is stepping into the job shortly after Maine lawmakers approved a school vaccine law that will go into effect in 2021 that public health experts hope will reduce pertussis rates and make Maine less vulnerable to infectious diseases.
The law – signed by Mills – eliminates philosophic and religious exemptions to school-required vaccines. Maine will be the fourth state in the nation to ban non-medical exemptions for the school vaccines.
He said one of the top priorities in the time leading up to the law going into effect in 2021 is researching why some areas are seeing more parents forgo vaccines for their children than other parts of the state. Forty-three elementary schools in Maine had 15 percent or higher non-medical opt-outs for children entering kindergarten in the 2018-19 school year, putting those communities at increased risk for disease outbreaks.
Across the state, non-medical opt-outs were 5.6 percent in 2018-19, an increase from 5 percent in 2017-18. The Maine CDC reported in April that 172 of 341 kindergarten classes in Maine fell below the 95 percent immunization threshold needed for herd immunity. Herd immunity provides protection for people who can’t be vaccinated – such as babies too young to be immunized or children with diseases that suppress the immune system.
Shah said if part of the reason is lack of access, the CDC could consider mobile immunization units or other ways to bring vaccines closer to students.
“Vaccines should be widely available and easy to access,” Shah said. For areas where parents fear vaccine safety, Shah said he believes a public education campaign by the Maine CDC may help educate parents about why vaccines are safe and effective. When hundreds descended on the State House in March for a public hearing on the vaccine bill, many speakers repeated myths that question the safety of vaccines. Research published in 1998 that claimed a link between some vaccines and autism has since been proven wrong and retracted.
As for Lyme disease, another persistent public health problem in Maine, Shah believes a major push in public education on prevention strategies would be helpful.
Shah also wants to continue to improve Maine’s lead testing program – the state recently improved testing for lead in infants, and study how best to use the higher staffing levels for public health nurses.
“We’re on the right track, but there’s a lot more to do,” Shah said.
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