The Elusive Tuberculosis Case: The CDC and Andrew Speaker


This case explores the ethical and logistical challenges that face doctors when an infectious disease patient does not cooperate voluntarily with advice to stay out of public spaces in order to protect the general welfare. In April 2007, a young Atlanta lawyer, Andrew Speaker, was diagnosed with active tuberculosis. Initially cooperative, Speaker departs without notice for Greece and his scheduled wedding after it becomes clear that his strain of TB is more lethal and difficult-to-treat than anticipated. The Centers for Disease Control (CDC)—the chief US health office—tracks down Speaker abroad, loses him a second time, and is left trying both to devise a public response that informs those who may have been infected by Speaker, and to decide what to do with Speaker when they find him.

Students will come to understand some of the nuances of public health policy on communicable diseases. For example, the CDC cannot detain an individual until s/he proves a flight risk; but after the individual has fled, the opportunity for quarantine is gone. What is the CDC’s responsibility toward the public: to inform it, or to avoid causing panic? How does existing law further or hamper the CDC’s mission, and should the law change?

Ask students to discuss the balance between the personal liberties of communicable disease patients and the health of the general public. Bring in the options for health policy to control communicable disease in general, and tuberculosis in particular, as well as how to interact with, transport, and care for individual infectious disease patients. What are the pros and cons of issuing an isolation order for Speaker? Prod students to design a crisis communications strategy for the CDC? How can it inform the public without causing panic? What about the privacy of the patient? What policy and/or technology changes might avert similar crises in the future?

Use this case in a class/course on global health, tuberculosis, infectious diseases, epidemiology, or global migration and quarantine.


This case was written by Ruth Palmer for the Case Consortium @ Columbia and the Mailman School of Public Health. The faculty sponsor was Prof. William Bower of Mailman. (0613)

For further information: