Dr. Christine Hahn looks back on a career of service
- Few DHW employees have had such a sustained public role as Idaho State Epidemiologist and Public Health Medical Director Dr. Christine Hahn. From disease outbreaks to COVID-19 through more than 30 years, she has been a leading voice for Idaho public health.
For many Idahoans, Dr. Christine Hahn became a familiar face during the COVID-19 pandemic, appearing regularly in the news and helping explain a new virus and an unprecedented public health response.
But by the time COVID-19 arrived in Idaho, Hahn had already spent nearly a quarter-century as the state epidemiologist, investigating outbreaks, building public health programs, and becoming one of DHW’s most recognizable medical experts.
Now, after more than 30 years in Idaho public health, Hahn is retiring at the end of September.
The evidence of those years surrounded her recently as she cleaned out her office. She went through piles of paper, page by page, deciding what belonged in the recycle bin, what needed to stay for her successor, and what she’d take home.
Among the keepsakes was an old newspaper clipping about one of the stranger disease investigations of her career: Idaho’s first locally acquired human case of West Nile virus. It wasn’t traced to a mosquito bite, but to an infected alligator brought to the town of Hagerman from Florida.
“Going through all of this has been very sentimental,” she said.
The clipping is only one artifact from a career that’s included contaminated drinking water, anthrax scares, emerging diseases, rare cases of rabies, and, eventually, the largest public health emergency of Hahn’s career.
And that career began with an outbreak almost as soon as she arrived in Idaho.
Investigating an outbreak
Hahn grew up in Michigan and trained in internal medicine and infectious diseases before spending a year in Tanzania studying HIV transmission.
“I just didn’t see myself in a hospital setting,” she said. “I wanted to do more on the public health side.”
Three mentors at Duke independently suggested she consider the Centers for Disease Control and Prevention’s Epidemic Intelligence Service (EIS), a two-year training program in applied epidemiology.
She took their advice and arrived in Idaho in 1995 as an EIS officer assigned to the Division of Public Health. Within weeks, she was in the field investigating what would become one of the first major outbreaks of her career.
More than 200 people became ill during a Shigella sonnei outbreak associated with contaminated drinking water at a resort in Island Park. With no epidemiologist at the local public health district at the time, Hahn was sent to eastern Idaho to help investigate.
Hahn’s investigation was published in CDC’s Morbidity and Mortality Weekly Report, and she was invited to Atlanta to present the investigation to the CDC.
It was an early introduction to the work that would occupy much of the next three decades.
Hahn initially trained under Idaho’s state epidemiologist. When he left for another job while she was still an EIS officer, Hahn stepped into the role in 1997 and has remained in that position ever since. In 2013, she also became medical director for the Division of Public Health.
“I never would have thought I’d be in the same job for 30 years,” she said, “but I think what kept me here was that it has changed, and it just keeps changing and changing.”
From disease outbreaks to anthrax
Early in Hahn’s career, much of her work involved helping Idaho’s public health districts respond to communicable disease outbreaks — Salmonella at a restaurant, influenza in a nursing home, pertussis in a community, or hepatitis A linked to food.
Some of those outbreaks that once seemed routine have become much less common.
At the same time, Idaho’s public health infrastructure and the threats facing it grew more sophisticated.
Then came Sept. 11, 2001, followed a month later by anthrax attacks conducted through the U.S. mail.
Idaho ultimately had no anthrax cases, but the threat produced hundreds of suspicious samples requiring evaluation and testing. Envelopes, unidentified powders, and other potential threats poured into the response system.
For Hahn, the response demonstrated the value of systems that often operate outside public view until an emergency occurs. Epidemiologists, the Idaho Bureau of Laboratories, StateComm, first responders, and others worked together to assess potential threats and protect Idahoans.
A few years later came another emerging threat: West Nile virus. And that’s where the alligator comes in. A fish farm near Hagerman had brought young alligators from Florida to Idaho. The operation raised the alligators in hot spring heated water using byproducts from its fish production.
But the alligators began dying.
During an attempt to determine what was killing them, a worker cut himself while handling an infected alligator and contracted West Nile virus, later recovering.
“Our first Idaho-acquired West Nile was from an alligator,” Hahn said. “It’s a cool little trivia question.”
A career that kept expanding
Over time, Hahn’s work expanded. She helped develop disease surveillance systems and public health programs, including Idaho’s early work to secure dedicated public health funding for drug overdose prevention. She served on a dozen or more state and national boards and committees addressing tuberculosis, immunization, Medicaid, and other health issues.
More recently, she joined the Idaho Traffic Safety Commission, bringing a public health perspective to data about preventable injuries on Idaho’s roadways. And her interests expanded along with her responsibilities to include overdose, suicide, injury, and other causes of preventable death.
“If I had multiple lives to live, I would do one doing drug overdose prevention,” Hahn said, indicating a desire to dig deeper into different areas of focus. “I would do one doing suicide prevention and another studying tuberculosis.”
The pandemic everyone had prepared for, and no one could fully anticipate
For decades, Idaho public health officials had planned and exercised for the possibility of a pandemic. Then came COVID-19.
For Hahn, it became the defining event of her career.
“That’s because of how visible it was and how it changed so many things,” she said.
Hahn had done media interviews throughout her career, but COVID changed her visibility. She repeatedly appeared in news coverage and at public briefings. Idahoans who had never heard the term “state epidemiologist” came to recognize her.
Behind the public appearances was an enormous collaborative response involving DHW, Idaho’s seven public health districts, the Governor’s Office, schools, healthcare providers, and many others.
Hahn remembers that collaboration as one of the successes of the response.
She is particularly proud of Idaho’s work to distribute COVID-19 vaccines when initial supplies were scarce and decisions had to be made about how limited doses could be allocated fairly. A statewide advisory committee brought together public health officials and representatives from healthcare and other sectors to help guide those decisions.
“I felt like Idaho handled that vaccine distribution really well,” she said.
The pandemic also reinforced a key lesson: Public health measures only work when communities understand and are willing to follow them.
Plans written before COVID could make a response sound almost mechanical: a pandemic arrives, certain measures are implemented, and people follow them. Reality was far more complicated.
“We weren’t sure what the right thing to do was,” Hahn said, “and the public was not in full agreement either.”
For Hahn, the experience underscored the importance of both protecting health and understanding the people public health is trying to serve.
The rare cases that stay with you
Not every event that shaped Hahn’s career affected thousands of people. Some involved only one at a time.
Idaho went about four decades without a diagnosed human rabies case after 1978. Then the state experienced two in recent years. Both reinforced how a seemingly minor encounter with a wild animal can have devastating consequences if the possibility of rabies is overlooked.
One case involved an Idaho man exposed to a bat. Another involved an organ donor who had been exposed to a skunk. The latter case required a complex, multistate response involving transplant recipients.
Those investigations are part of what has kept the work interesting for Hahn after so many years. New pathogens emerge. Old diseases return. Technology improves. Public expectations change. And an epidemiologist never quite knows what the next phone call will bring.
Public health should serve the public
As Hahn prepares to leave DHW, public health is again in a period of change.
She believes there’s still broad common ground around some of its most fundamental responsibilities: preventing disease where possible, detecting outbreaks, investigating them, and helping communities respond.
But she also now describes the role of public health in simpler terms.
“Public health should do what the people expect them to do,” she said. “I think public health needs to do things sometimes because the public has nowhere else to turn, and we should be supporting that.”
That might mean investigating a suspected cancer cluster, helping a school address an outbreak of head lice, or responding when a community is worried about rats.
And that idea of service extends beyond her profession.
She and her family have served as foster parents, an experience she counts among the things she is most proud of. She has also devoted time to volunteer trail work, including a week this year camping along the Middle Fork of the Salmon River and clearing trails.
She plans to travel, ski, spend time outdoors, and do more trail work. But she has little interest in a retirement devoted exclusively to recreation.
“I have friends who are in retirement, and they’re having fun every day,” she said. “I’m like: I don’t think I’d find that satisfying enough. When I turn 80, sure. But I feel like I’ve got good years of giving back still.”
For three decades, Hahn’s job put her at the intersection of science and people, and much of that work happened quietly. For a few extraordinary years, almost none of it did.
And now Hahn is leaving her office, sorting through the artifacts of a career she never expected to spend entirely in Idaho, and deciding which pieces of that history to take home.
The alligator clipping made the cut.
The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.
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