Nancy Cox, Former CDC Influenza Division Leader, Dies at 77 from Glioblastoma

Nancy Cox, a virologist who headed the influenza team at the Centers for Disease Control and Prevention for 22 years, died on Thursday from glioblastoma. She was 77 years old at the time of her death. Under her leadership, the influenza team at the CDC grew from a branch of 14 people to a division of over 100.

Cox served as director of the World Health Organization’s Collaborating Center for the Surveillance, Epidemiology, and Control of Influenza at the CDC. She led the CDC’s efforts to respond to seasonal flu and prepare for pandemic influenza. Cox and her team contributed to the current surveillance system that underpins the annual updating of flu vaccines.

A colleague who served as deputy director of the flu division under Cox took over as director when she retired. Scientists who worked for and collaborated with Cox were quick to praise her dedication, her diplomacy, and her efforts to expand global flu surveillance.

“There are a lot of really great scientists involved in influenza. ... But nobody had the kind of respect and breadth and reverence that Nancy had. And it was really clear why,” said a former colleague who was chief of influenza epidemiology under Cox before moving to the WHO’s influenza program in 2005.

“Part of it is that she just knew so much about influenza — the science, the history, the contemporary milieu. Part of it was because she was kind of at the nexus of science and public health. ” People who knew Cox describe a scientist who was deeply knowledgeable about influenza but also a strong and supportive leader.

“She was a terrific boss,” said the former colleague, who is now retired. “She could be goofy. She could be funny. She could be girlish. And she could be very stern when she was upset,” he said.

Cox was born and raised in rural Iowa. She received a bachelor’s degree in bacteriology from Iowa State University, attended the University of Cambridge in the United Kingdom on a Marshall fellowship, and received a doctorate in virology from the University of Cambridge.

Cox joined the CDC in 1975 and was named head of the influenza branch in 1992. In 2006, Cox was named Federal Employee of the Year by the Partnership for Public Service. That same year, she made the Time Top 100 list.

Interest in influenza research exploded in the late 1990s and again in the mid-aughts when the H5N1 bird flu virus began infecting and killing mass numbers of poultry in China and other parts of Southeast Asia, as well as infecting and killing some people.

In the early days of detection of human H5N1 infections, roughly half of confirmed cases died. Despite the fact that H5N1 continues to this day to wreak havoc on poultry operations and infect an astonishing array of mammals — including the occasional person — it has not triggered a pandemic.

In an article published in 2019, Cox warned against complacency towards this virus. “We don’t know how the story’s going to end,” she said.

Still, influenza scientists were taken by surprise in 2009 when instead of the feared bird flu pandemic, the world was hit with a pandemic caused by an H1N1 virus that had evolved in pigs. The 2009 H1N1 virus was thought to have emerged in Mexico, with the first two confirmed cases being children in California who had no connections to pigs or to each other.

During the 2009 H1N1 response, Cox's house was struck by lightning and burned to the ground.

No one was hurt in the incident. Cox was back at work the day after her house burned down in 2009, wearing clothes that smelled of smoke. “It was devastating,” she said. Cox is survived by her husband, a daughter, a stepson, and four grandchildren.