HEALTH

Surgeon General Jerome Adams uses Indiana HIV outbreak experience to fight coronavirus

Kaitlin Lange
Indianapolis Star

Before Surgeon General Jerome Adams was labeled a "star" by President Donald Trump for his handling of the coronavirus pandemic, he was the man behind Indiana's successful push to taper down its HIV epidemic.

Five years ago the now 45-year-old was the Indiana State Health Commissioner as the state faced an HIV outbreak linked to intravenous drug use in Scott County. 

He spent much of his time communicating the science behind syringe exchanges as an effective way to curb the spread of HIV, both to then Gov. Mike Pence and leaders in Scott County. The idea was unpopular among some conservatives, including Pence, who worried it would enable more drug use. 

As U.S. surgeon general, Adams now faces a similar but far more consequential challenge: persuading a restless nation to stay home, an unpopular recommendation for some as the economy craters but a recommendation based on science. Meanwhile, Adams, an African American, has tried to become a voice minorities can trust as he reminds them of the potential for coronavirus to disproportionately affect African Americans.    

Surgeon General Jerome Adams (right) listens to President Donald Trump speak to the press at the White House on March 19.

People close to Adams say his ability to communicate in a caring and relatable way is invaluable toward stemming the pandemic.

"He was made for that surgeon general position," said Julie Reed, executive vice president of the Indiana State Medical Association. She has known Adams for more than 15 years.

"He was kind of made for this moment."

Adams was 'instrumental' to needle exchange

Born in Maryland, Adams made Indiana his home after attending the Indiana University School of Medicine and the University of California, Berkeley. An anesthesiologist with a master's degree in public health, Adams was appointed to the position of state health commissioner in 2014 by Pence.

During his time in Indiana Adams addressed a lead pollution crisis in East Chicago and prepared for an Ebola crisis, which thankfully never spread to the state. 

But how he addressed the opioid crisis and HIV outbreak stands out among those who know him.

He didn't manage the crisis just by being able to parse through facts, those who know him say. He did it by listening and connecting to people.

Dr. Will Cooke, owner of the Foundations Family Medicine Clinic in Austin, Indiana, worked with Adams on his many trips to Southern Indiana to curb the HIV epidemic and share his views that a needle exchange was needed for the community. 

The trick, Cooke said, was convincing Pence. 

But not only Pence. Adams sat down with community stakeholders to share the science and ask about their concerns. Syringe exchanges, which provide drug users with clean needles, help reduce the number of infected needles in communities and therefore reduce the spread of HIV.

Among those Adams talked with was Scott County Sherriff Dan McClain, who initially had reservations about needle exchanges.

That conversation paid off. Just days before Pence started allowing clean syringes to be distributed in Scott County in March 2015, McClain told Pence he gave the plan his blessing. 

"Pence wouldn't have had the local sheriff's support if Jerome hadn’t taken the opportunity," Cooke said. "He just came down and said, 'Can I take you out for a drink and just have a conservation?'"

Jerome Adams chats with then-Surgeon General Vivek Murthy during his 2015 visit to Eskenazi Hospital in Indianapolis.

Adams did not respond to an IndyStar interview request. 

Joey Fox, who worked under Adams as the health department's legislative director, said Adams was "instrumental" in getting that needle exchange off the ground. 

He meets people where they are, Fox said. Part of that may be his life experiences. Adams' own brother struggled with substance use disorder, and his wife was diagnosed with cancer while Adams was surgeon general.

"Regularly he would tell us, 'We have books worth of information, but what actually helps people make better decisions?'" Fox said. 

President Trump gives praise

Often the country's surgeon general draws little notice from the public. As the nation's doctor, surgeons general are the leading voice on public health, but the title is perhaps most known for its use on warning labels on alcohol and cigarettes. 

After the Senate confirmed Adams in 2017 as surgeon general, he mostly stayed out of the headlines. In fact, he was left off the initial White house coronavirus response team until Pence, who chairs the task force, expanded it in late February. 

But since then he has been a regular on Fox News interviews, and on Friday Trump said Adams was doing a "fantastic job" and "hopes nobody steals him."

"Don't leave us," Trump said.

Jerome Adams fist-bumps one of his sons after being sworn in as surgeon general by Vice President Mike Pence in Washington on Sept. 5, 2017.

Earlier this month Adams garnered attention when he told Fox News host Chris Wallace that this was going to be "our Pearl Harbor moment" and "the hardest and the saddest week of most Americans’ lives" as a surge of coronavirus cases approaches.  

Adams also has tried to be a voice for minorities and those with preexisting conditions, groups that sometimes overlap. 

"I've been carrying around an inhaler in my pocket for 40 years out of fear of having a fatal asthma attack," Adams said during a White House press conference Friday as he pulled one out of his pocket while talking about the risk of coronavirus to those with preexisting conditions. "And I hope that showing you this inhaler shows little kids all across the country that they can grow up to be surgeon general one day."

Those in the medical community who have worked with Adams say his messaging is hitting the right notes.

"He's able to come across as somebody who has the right information to share," Cooke said, "but also somebody that seems to genuinely care."

Cooke noted a recent public service video involving Adams. Adams is making his own face mask, a popular DIY for Americans everywhere during the coronavirus crisis. He is using material from a T-shirt that both recalls an earlier crisis and reflects his good-natured approach to it. 

The T-shirt reads: "Got Naloxone?"   

Surgeon general draws criticism

Although Adams is widely praised in the Indiana medical community, some of his public appearances as surgeon general have raised eyebrows.

During Friday's press conference while drawing attention to the disparities minorities face, Adams cautioned African Americans to avoid alcohol, tobacco and drugs, among other things, in order to help stop the spread of coronavirus for their "abuela," "big momma" and "Pop Pop."

Later a PBS reporter asked Adams to comment on whether he thought his choice of words, and his demands, were offensive. 

"I used the language that is used in my family," Adams said. He added that his guidance to avoid alcohol and drugs was for everyone, not just communities of color. 

Surgeon General Jerome Adams at the White House on March 20, 2020.

Earlier in the pandemic, critics also accused Adams of not accurately relaying the full danger of the virus, criticisms his boss, President Trump, faced as well. In one press conference Adams told those listening in that young people are "more likely to die from the flu."

Despite such early comments, Adams' handling of the situation has drawn praise from a fellow former state health commissioner. Dr. Woody Myers, a Democrat who is running for governor, is critical of Trump for his messaging amid the pandemic and of Gov. Eric Holcomb for his response to the crisis. But not of Adams.

"Steph Curry misses a 3-pointer every now and again," Myers said. "I wouldn’t use that one comment to represent his entire history of communication on this virus."

Myers called Adams an effective communicator and said Adams knows the scientific jargon but doesn't overuse it. He praised Adams for his Pearl Harbor reference in order to drive home how serious the pandemic is.

"It's really remarkable the number of people that are actually complying with the orders to stay at home," Myers said. "There really isn't a kind of aggressive enforcement. Most people are complying appropriately because the way the messages were communicated."

Whether the general public will come to view Adams the same way is unclear. When Americans were asked in a Monmouth University Poll released last week which public official they trusted most to talk about COVID-19, 11% named Adams. That was more than the 10% who named Pence but less than the percent of people who named Dr. Anthony Fauci (35%), head of the National Institute of Allergy and Infectious Diseases, or Trump (20%). 

Regardless, Myers compared Adams to other influential surgeons general, such as Luther Terry, who first raised the alarm about the dangers of smoking, and Everett Koop, who served during the early years of the AIDS epidemic. 

Likewise, Reed of the Indiana State Medical Association said she is unable to name off many surgeons general. But the tenure of Adams is different, she said.

"I've spent 17 years at the ISMA and frankly haven't focused a whole lot on who the surgeon general was. It's not a person we would have necessarily interacted with," Reed said. "But I think we will remember him as surgeon general."

Call IndyStar reporter Kaitlin Lange at 317-432-9270. Follow her on Twitter: @kaitlin_lange.