Willard (Ward) Cates: Champion Extraordinaire for STD Prevention

Ward, born as Willard Cates, Jr. in 1942 and died at the age of 73 in 2016, was a tireless public health advocate and pioneering epidemiologist in HIV, sexually transmitted diseases (STDs), and women's reproductive health. He is widely known for his global work leading multidisciplinary teams conducting complex clinical trials and programs that investigated the effectiveness of contraceptive technologies and HIV prevention and treatment methods, predominantly in women who he believed should be empowered to control their own destiny and risks. Yet, his impact on STD prevention in the United States, often not mentioned, has been immense, and this journey was initially not by choice. For political reasons, in 1982, Dr. William Foege, the Director of Centers for Disease Control and Prevention (CDC) at the time, asked Ward if he would be willing to leave his Division of Reproductive Health position to be the Director of the STD Division in 1982. Simultaneously, the HIV/AIDS epidemic was emerging as a significant public health problem, and Ward soon found himself responsible for CDC's STD and HIV prevention programs until 1992. Using the lessons, he learned in the family planning world, he worked to integrate HIV prevention into CDC's STD control programs. But the HIV epidemic became a global crisis, and many moved on to focus solely on HIV. Although Ward led early, landmark clinical trials that showed antiretrovirals could be used for HIV prevention as well as for treatment, he never abandoned the STD ship. He led the charge, educating all who would listen about a phenomenon called STD/HIV epidemiologic synergy, and he believed that our STD/HIV prevention models should focus on sexual health rather than individual diseases; it has taken decades for the STD/HIV field to catch up with these prescient concepts. But, equally important, he led by example, with a striking mixture of scientific rigor and clarity about doing the right thing for those most in need. Ward was the most positive force of nature I have ever met (Fig. 1). I know many colleagues who agree. He was one of the first to congratulate me on my first public health job in San Francisco running the STD control program for the San Francisco Department of public Health. I had never met him previously, but we did have colleagues in common through our medical training at UVA and what Ward like to call the “CDC's scientific farm system”—the Epidemic Intelligence Service. I was immediately struck by his energy, can do attitude, extreme optimism, and passion for everything he did.Figure 1: Dr. Ward Cates and his engaging smile.If you ask those who worked with or for Ward during his 10 years as the CDC STD Division Director, “what was Ward like?”—all describe many amazing attributes. The Ward stories are too many to detail here, but I would like to share a few to summarize Ward's legacy of inspiration and generosity of spirit that he gave to the STD/HIV prevention field in the United States and beyond. He was— Very organized: He cleared every manuscript or EPI-2 within 48 hours and focused his comments, written in a blue sharpie pen, on the important points. He advised to never touch a paper twice if you can help it and to never stay in a job longer than 7 years. Inveterate optimist: Ward definitely found most glasses half full, but also was able to quickly identify problems and ways that these might be solved or averted. Extremely funny: He had a fabulously wicked sense of humor, was the best source of good gossip ever, and loved practical jokes and pranks. Once a company sent him a pair of lovely bright red boxer shorts (“Safety Shorts”) with a small pocket to hold a condom. He was so excited! He put them on, on top of his Public Health Service uniform trousers, and went out to get into his car to go to a high-level meeting. Some DSTD folks were almost crying, worrying that he might be fired or reprimanded. Inspirational and motivational as a mentor: Ward introduced junior staff to so many STD leaders. He invited Epidemic Intelligence Service officers to review journal papers with him to discuss and learn at his side. He was happy to provide guidance to his staff about work issues, usually including a confidential story involving some fatally flawed endeavor he'd been part of that ultimately had a silver lining. One of the funniest stories he shared was about a bet that he had with Alan Hinman on whether voicemail or email was a faster way to communicate—they set up some scheme to measure and compare. Can't remember which side he took, but email ultimately won and all were a little sad about that. Passionate and involved colleague: Ward was energetic, encouraging, and involved in even the smallest meeting discussing epi methods. His smile, great comments, and wry humor always lit up the room or a meeting. He was a fantastic role model in engaging colleagues and effective collaboration. He connected with so many people. He had a remarkable intellect and clarity of thought. At the same time, he was pragmatic and realistic. He was a leader in the field yet fundamentally genuine and approachable. Strong epidemiologist: Ward had a lasting impact on the Division and field of STD prevention—he was likely the first Director to insist that “epidemiology” was different from “contact tracing.” And, he always said that epidemiology was the “basic science” of public health. About finding a “win-win” solution: He always sought wins for everyone involved—from the scientists developing new methods, to public health practitioners implementing the interventions and to communities in need of the prevention services. A great example of his win-win mantra was when he encouraged me to apply for a CDC STD Prevention Training Center. After the grant was awarded, I was told all PTC clinics had to have a 3-stop model of service delivery. At City Clinic, because of space limitations, we had a 4-stop model. Changing to 3 stops meant we would have to turn away one-third of patients daily, so I declined to accept the award. Ward arrived in California with his team for a site visit, and by the end of the visit, it was clear that a one-size model for STD clinical care wouldn't work for all. The CDC said that we didn't have to change our service delivery model, but when trainees came to precept in the clinic, we had to show a 3-stop model to comply with the grant announcement. A win-win for all. Lastly, I would like to end with these Haikus that were written by CDC staff about Ward. A little something new for the STD journal. Lunch at Freeway Park. Tuna salad and sex talk. Other tables gasped. He was confident. Rules were flexible, fuzzy. He was not afraid. “Let me edit that.” Blue felt tip cursive throughout. The pages loved him. A room starts to glow. Is it the sun rising? No, Ward Cates has entered. Ward was a renowned leader and mentor who inspired over 2 generations of leading scientists, public health officials, and clinical practitioners. He provided guidance for those in the fields of family planning, STD/HIV prevention, and epidemiology to think beyond siloes of institutional thinking and funding, and to foster more collaborative, multidisciplinary, and integrative approaches focused on sexual health of communities. There is still much work to do in Ward's honor, and his story is fitting for the STD journal's 50th anniversary.