April 2022 - The Epidemiology Monitor by The Epidemiology Monitor

Harvard Forum Questions Former CDC Directors About How To Fix The Agency CNN Asks Similar Questions To Current & Former Senior Level CDC Officials Five former CDC directors (Bill Foege, Bill Roper, Tom Frieden, Julie Gerberding, and Robert Redfield) serving as far back as 1977 and as recently as 2021 were questioned about the failures and challenges observed at the CDC during the pandemic and asked for their views about how to fix the agency.

part of a Harvard School of Public Health year long series entitled Public Health On The Brink. According to Harvard, the series will examine the urgent challenges facing public health today and explore the most promising ideas for rebuilding and revitalizing the field.

In This Issue -32022 Summer Programs -11Notes On People

- CDC con't on page 7 The interviews took place virtually as

-12Near Term Epi Event Calendar

On The Light Side April Deadline Nears To Enter New Haiku Contest Read Sample Entries Below Our latest haiku contest to bring forth some of the insights and observations about the impact of the COVID-19 pandemic on epidemiology and/or on epidemiologists has received multiple entries. As intended with haikus, many of the poems say a lot with few words. Many are wise or humorous or witty.

of the entries received to date. The deadline for entering the contest is April 30. Winners of the cash prizes of $500, $300, and $200 will be announced in the May issue. As described in previous issues, our goal is to capture both positive and - Haiku cont'd on page 2

Readers can enjoy below a sample April 2022

•

Volume Forty Three •

Number Four

-14Marketplace This Month

On The Light Side, cont from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly by Roger Bernier, Ph.D., MPH at 7033 Hanford Dr,, Aiken, SC, 29803, USA.

negative insights of epidemiologists given the unprecedented attention on epidemiology during the pandemic. What have we learned? What do we feel? What do we think?

Editorial Contributors Roger Bernier, PhD, MPH Editor and Publisher

The author of the “best haiku” will receive a $500 cash prize, and second and third place winners will receive $300 and $200 respectively. All entries become the exclusive property of the newsletter. There is no limit to the

Operations Linda Bernier, PhD, MS Operations Manager

number of entries allowed. In the event that two haikus are identical, the earliest one submitted will receive priority consideration. All decisions made by our panel of judges will be final. Submit your entries now to editor@epimonitor.net. Below is a small sample of entries received so far. Challenge yourself to be even wiser, funnier, or wittier!

Advertising Sales Linda Bernier, PhD, MS Director of Advertising 770.533.3436 linda@epimonitor.net

Oh, pandemic times now everyone an epi Where is your degree?

Have you ever tried Learning ID epi and Yelling on Twitter?

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Oh, when will it end? You are an epi – tell me! Now a household name.

Pandemic, my bane, If only you were safer, I would have more papers.

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What to name my cats? Moderna and Pfizer, or Johnson and Johnson?

The virus revealed Epi is not skin research! Degree affirmed

How to be patient And positive when you're a Positive patient?

Here comes BA.2: Novel COVID variant. New number, who dis?

Vax efficacy Infection, sickness, or death? Try explain outcome

Tell me what this is Black, white and read all over Misinformation

In disguise ‘til now, Epidemiologists Are really rock stars

While we can predict We cannot convince and so We predict the worst

water drop or airborne spread? debates around the campfire words flare then burn out

“It depends” on far Far more than what we all wished It depended on

Epi on the news. No glory in prevention. No-one listening.

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A small number times a very large number is Still a large number

- Haiku cont'd on page 10

Summer Programs In Epidemiology At-A-Glance Each year we provide a short recap of summer programs of interest to epidemiologists and other public health professionals. Before the pandemic in 2019, we reported on 23 different programs available in multiple different locations in North America, Europe, and the Middle East. Many of these programs were suspended during 2020-2021, however, 18 summer programs will take place in 2022. There will be more online or exclusively online course offerings. Readers interested primarily in residential or inperson summer programs should read the descriptions carefully to learn which courses qualify. This summary provides a link to each of the programs so readers can obtain additional information on their programs of interest.

Dates

Summer Programs in 2022

Editor Comments

Two sessions May 9June 3 and June 6-30

Summer Session in Epidemiology and Biostatistics McGill University Montreal, Canada https://bit.ly/3KQabT4

May 16June 3

Summer Public Health Institute University of Minnesota Minneapolis, MN http://bit.ly/2P1VUrR

June 1- 30

Epidemiology and Population Health Summer Institute Columbia University New York, New York https://bit.ly/3OfPKRy

31 courses over 4 weeks in June (17 asynchronous and 14 in person or online synchronous). Wide range of topics. Lots of ways to participate. Heavy emphasis on epidemiology data and methods. Some special topics, e.g., sleep epi.

June 13July 1

Graduate Summer Institute of Epidemiology and Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland https://bit.ly/3xxZn8o

Over a three week period in June. In place for 40 years with a wide offering of topics and formats, including 22 one week, 2 two week, 10 asynchronous, and 5 one day or half day courses. Offers a series of seminars by senior epidemiologists throughout June.

For health professionals and students to gain familiarity with the principles of epidemiology and biostatistics. Heavy on clinical epi and pharmacoepi. In person and online courses. Can receive a Certificate.

As titled, this has a public health focus and is designed for practicing professionals and grad students. It includes 3 weeks with 27 courses to choose from.

- Summer cont'd on page 4

Summer Programs In Epidemiology At-A-Glance, con't from page 3 Dates

Summer Programs in 2022

Editor Comments

June 17July 5

34th Residential Summer Program in Epidemology EEPE (European Educational Program in Epidemiology) Florence, Italy http://www.eepe.org/

This program is one of the original summer programs. Five general modules on epidemiological study design and statistical analysis of epidemiological data offered in first 2 weeks. It includes four specialized courses in the week after the 3 week long main program which can be attended independently.

June 2024

Pharmacoepidemiology Summer School in Denmark Aarhus University Grenaa, Denmark https://bit.ly/3jNQvDv

7th session of a five day residential summer school. Offers seven courses, most of them half day each and one longer day and a half meta- analysis course in 2022.

Causalab Summer Courses https://bit.ly/3rv5p5V

First 4 day course introduces concepts and methods for causal inference from observational data. Second course is focused on target trial emulation.

June 2124 June 27July 1

Summer School on Modern Methods in Biostatistics and Epidemiology Sponsored by Biostatepi Cison di Valmarino, Province of Treviso, Italy http://www.biostatepi.org/

June 2124 & June 27July 1

Summer Program in Population Health The Ohio State University Columbus, OH https://bit.ly/3nQ5zkg

Cancelled for 2022

Four courses in each of two in person sessions between June 21 and June 24 and 3 virtual courses June 27-July 1. The program is organized by the Center for Public Health Practice with courses that appeal to a broad public health workforce.

- Summer cont'd on page 5

Summer Programs In Epidemiology At-A-Glance, con't from page 4 Dates

Summer Programs in 2022

Editor Comments

June 24July1

Urban Health Summer Institute Drexel University Philadelphia, PA https://bit.ly/3KO1BEg

12 courses centered on urban health research and applied methods. All career levels are eligible.

July 4-8

UCL Health and Society Summer School: Social Determinants of Health University College London London, England https://bit.ly/38BugL5

A one-week non-residential program with an in depth assessment of social determinants of health. The week will be led off and closed by Michael Marmot.

Real World Epidemiology Oxford Summer School University of Oxford Oxford UK

Cancelled for 2022

Summer Institute of Advanced Epidemiology & Preventive Medicine Tel Aviv University Tel Aviv, Israel https://bit.ly/2WO6wOg

Four intensive courses offered over a three week period.

July 1129

Summer Session in Epidemiology University of Michigan Ann Arbor, MI https://bit.ly/3Enud4J

Has been around for over 50 years and has a wide variety of offerings for 1 or 3 week courses and online courses as well. Most are 1 week in person or online morning or afternoon courses.. Organizers state “you can get a career boost in just 1-3 intensive weeks”.

July 1127

Summer Institute in Statistics and Modeling in Infectious Diseases University of Washington Seattle, WA https://bit.ly/3EknXe8

16 two and a half day modules to choose from over the time of the institute. All courses online. Participants typically take 2-3 modules.

More info to come

- Summer cont'd on page 6

Summer Programs In Epidemiology At-A-Glance, con't from page 5 Dates

Summer Programs in 2022

July 11Aug 3

Summer Institute in Statistics for Clinical and Epidemiologic Research 17 one to four day modules to choose from University of Washington over the time of the institute. All courses Seattle, WA online. https://bit.ly/3OizBL6

Planned for Mid July 2022

Causal Inference Summer Institute Causality and Pharmacoepidemiology Penn Center for Clinical Epidemiology and Biostatistics + Rutgers School of Public Health + Penn Wharton School New Brunswick NJ https://bit.ly/3uLszqE

More info to be provided after a venue is selected. Last held in 2019 and offered multiple courses

July 25Aug 5

Summer Institute in Statistics for Big Data University of Washington Seattle, WA https://bit.ly/38Xee1S

4 two and a half day modules to choose from over the time of the institute. Courses are online.

Delayed to 2023

30th International Summer School of Epidemiology Ulm University Ulm Germany https://bit.ly/3KOM2MP

In cooperation with the Gillings School of Public Health at the University of North Carolina.

August 8-26 2022

Summer Program Erasmus MC Rotterdam, The Netherlands http://bit.ly/38pSFlY

Program for 2022 to be announced.

Aug 819

Summer Institute In Epidemiology and Biostatistics University of Ottawa Ottawa, Ontario Canada https://bit.ly/3uPG60u

Two courses offered—An introduction to epidemiology in week one and an introduction to biostatistics in week two. Registration opens in June 2022

Editor Comments

- CDC cont from page 1 CDC Review The Harvard event event took place on April 5, just as Rochelle Walensky, the current CDC director, announced a month long review of the agency’s structure and processes due to begin on April 11, 2022. That review, according to Walensky, is designed to make CDC more adaptable while maintaining its existing gold standard processes to protect the health of Americans. The former CDC Directors expressed support for Walensky’s review by outsiders and for making it relatively quick. During the event, the former Directors identified several key problems which became apparent during the pandemic, some of which have been longstanding challenges in how the agency functions. Science & Politics The first challenge is how well the agency manages the tensions created by the fact that both science and political considerations are inherent to public health and should play roles in public policy setting. To think that political considerations should be kept out of public health is a naïve notion, said Bill Roper. Instead, science should be used to guide the decision making and both scientists and politicians should work together constructively as required by good decision making in democratic societies. Foege agreed that we should not separate public health from politics. Instead the question is how do we incorporate politicians into the process of creating solutions. They don’t exist just to give us money, said Foege. That said, Roper was firm in insisting that

CDC’s mission is to be a science agency, not a political one. And Redfield was clear that more independence for CDC is needed. Tension Managing this tension between science and politics in our currently dysfunctional political system was acknowledged to be especially difficult. Redfield, who led CDC under the Trump administration, disagreed with Foege’s assertion that many of the lessons learned by public health over the years were disregarded during his tenure at the head of CDC in the Trump administration. Redfield stated that CDC strove to maintain the public health messages despite substantial pressures emanating from political appointees in the administration. Redfield’s proposed solution for the future is to assure the structural independence of the CDC Director. He would make the job a 7-10 year term appointment similar to what is done with the FBI Director. Just how to maintain the constructive working relationships called for by Foege and Roper while achieving the independence and scientific integrity that all the former directors want was not fully clarified during the forum.

"To think that political considerations should be kept out of public health is a naïve notion..."

"...how do we incorporate politicians into the process of creating solutions."

Senate Confirmation The former directors had different opinions about whether or not the CDC Director position should be one that requires Senate confirmation. Frieden called it “a dangerous idea”. Doing so would add credibility for the person appointed, according to Roper, but - CDC cont'd on page 8

- CDC cont from page 7 given the state of our political system at the moment, such a requirement could make matters worse, according to Gerberding.

"...the nation must answer the question—who is driving the system?"

"...public health professionals always have to be beggars..."

Real Time Data A second challenge that became more evident during the pandemic is CDC’s lack of real time data. Redfield said he was particularly bothered by the fact that current information about COVID 19 was to be found at a medical school (Johns Hopkins) rather than at CDC. He believes the agency needs to be the hub of real time data if CDC as the public health response agency is to actually execute a public health response. A prime reason for CDC’s delay in obtaining real time data is due to the fact that CDC obtains its information from state and local health departments. There is no single standardized data collection system, and individual states can opt out or delay providing information. Fixing this problem would require revamping the information collection system to modernize it and giving CDC the authority to make reporting mandatory. According to Roper, the nation must answer the question—who is driving the system? Resources

A third major problem identified by the former directors is the under-resourced and unsustained level of funding at CDC and in public health generally. Redfield said he believed he was at the top public health agency when he arrived but was shocked by what he learned about funding. He stated that the greatest threat to US security today is not China, Russia, or North Korea. He believes that our greatest threats are

our public health vulnerabilities and the potential for pandemics. As a result, he believes that public health funding must be made more proportional to the threat. We don’t cut military spending in peace time and should not cut public health funding after emergencies. As one director pointed out, no war has ever produced the number of deaths caused by the COVID pandemic and so health security spending should be adjusted to reflect this threat. According to Foege, public health professionals always have to be beggars, and poor people think differently than rich people, he said. For example, if we go 20 years at an airport without accidents, we don’t cut funding for safety, he said. We do cut in public health. It’s not the same mentality. Investment Gerberding pointed out the need to talk about the money for public health not so much as a cost but as an investment. As it stands now, if something is to qualify as an investment, it must repay the costs in the same year. According to Gerberding, any outyear benefits don’t help to offset the initial costs. The approach requiring “annual accounting” needs to change, she said. In support of this idea, Foege pointed out that the US currently recoups its investments in smallpox eradication every 3 months and has repaid 160 times what the US invested. Likewise for immunizations which can return 10 dollars for every dollar spent, he said.

- CDC cont'd on page 9

- CDC cont from page 8 Trust The session also addressed the loss of trust in CDC and the need to reestablish it. This loss was poignantly described by the interviewer who read a question from an audience member. She had lost all faith in CDC and felt as if she had lost her religion. She said she felt completely betrayed. Roper pointed out that the loss of trust is not restricted to CDC but extends to other institutions. He called for giving advice with more humility by acknowledging that any advice given is based on what is known today and that this advice can change tomorrow if the information changes. People may want permanent answers from the powers on high, but that is not possible using a scientific process. Gerberding recalled that during her tenure she created the term “interim guidance” to help communicate the lack of permanence and prepare readers for the possibility of change in guidance. People can handle uncertainty and ambiguity, she said. Closing Redfield reiterated the need for a structurally independent CDC to avoid political pressures and to build trust in the advice given. Asked again about trust and what is the one thing each former director would recommend to regain trust, the answers were increased transparency, a structurally independent CDC Director, and more frequent communication. CNN Report

Directors were different from those highlighted recently following interviews by CNN of twelve current and former senior level CDC officials and four outsiders who have worked for the agency. The principal ideas which emerged from these interviews about needed CDC reforms were: 1. Get CDC scientists out of their silos to broaden their perspectives, including sending them to work in state and local health departments.

"She had lost all faith in CDC and felt as if she had lost her religion."

2. Practice for a pandemic to increase readiness and gauge who can work well under stress. 3. Learn to “keep it simple, stupid” in order to communicate with real people. 4. Escape the “strangleholds” on communication from the White House and get CDC’s voice back. 5. Get a more modern data system. 6. Temper expectations of what can be achieved from the CDC month long review because of the fundamental nature of some of the existing challenges and the lack of flexibility in the CDC budget. According to a current CDC officials, it has 150+ individual disease and risk factor specific lines leaving minimal to no flexibility throughout the year to respond to emergencies

"People can handle uncertainty and ambiguity..."

To listen to the Harvard forum, visit: https://bit.ly/3KPtrA2 To read the CNN report, visit: https://cnn.it/3rvY71t ■

Interestingly, the problems and solutions identified by the former CDC

On The Light Side, cont from page 2 The best webinar All my dishes are clean now Epi tomorrow.

Quell Snow, Koch and Hill Faux experts and science swell Causation skews nil

Recommend a jab Tell them it will keep them well Receive your pink slip

Who you gonna call? Epidemiology Ain’t ‘fraid of no ghost!

One stat to rule all, Mandates lock down or parole. Begone naughty R.

Impressive response Most were saved, some succumbed to Alternative facts

Prior to Covid No-one knew our profession Now, we’re all Covid.

Please put on a mask A mask is a simple thing Why is it so hard?

■

All class examples are just COVID-related. What was used before?

Tell us what to do I recommend a vaccine No, I have my rights

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Named: Kirsten Bibbins-Domingo, as the next editor-in-chief of the Journal of the American Medical Association (JAMA) and the JAMA Network. Dr BibbinsDomingo is professor and chair of the Department of Epidemiology and Biostatistics at the University of California San Francisco School of Medicine. She called the position a “dream job” and pledged to restore the journal as a “trusted voice” in medicine following a recent controversy over a podcast on systemic racism.

Named: Newsha Ghaeli, to Time’s 100 Most Influential Companies list. She cofounded Biobot, a company that is a pioneer in wastewater epidemiology. Her company collects data from over 700 sites representing over 100 million people. “ "Think sort of like a 23 and me kit, but instead of a saliva sample, it gets a stool sampling of sewage samples. It’s like a 23 and me kit , but for cities,” said Ghaeli. She has a degree in Architectural Studies and did a fellowship at MIT where she met her co-founder.

Honored: Quarraisha Abdool Karim, with a Doctor of Science [honoris causa] from Rhodes University in South Africa. Dr Abdool Karim is well known for her research on preventing HIV infection in adolescent girls and young women. She is co-founder of the Center for AIDS Program of Research in South Africa.

8 Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the upcoming year. Thus an online copy exists on our website that is updated regularly. To view the full year please go to: http://www.epimonitor.net/Events The events that we are aware of for the next two months follow below.

May 2022 May 2-5 http://bit.ly/38nmB26 Conference / 71st Annual Epidemic Intelligence Service Conference / CDC - Centers for Disease Control & Prevention / Atlanta, GA May 3-5 https://bit.ly/3pVqzbC Conference / 4th International Conference on Animal Health Surveillance (ICAHS4) / Multiple / Copenhagen, Denmark May 9-11 https://bit.ly/3s6nOXC Short Course / Epigenetic Epidemiology / University of Bristol / VIRTUAL May 10-11 https://bit.ly/3ygdJZa Conference / 2022 FETP International Nights (in conjunction with the EIS Conference) / TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) / Virtual May 10-12 https://bit.ly/3INevll Conference / 2022 ACHI National Conference / Association for Community Health Improvement / Cleveland, OH May 12-13 https://bit.ly/3s2pyBi Short Course / Advanced Epigenetic Epidemiology / University of Bristol / VIRTUAL May 15-18 http://bit.ly/36gZsMC Conference / 43rd Annual Meeting / Society for Clinical Trials / San Diego, CA May 16 - June 3 http://bit.ly/2P1VUrR Summer Program / Summer Public Health Institute / University of Minnesota / Minneapolis, MN May 22-28 https://bit.ly/321Yo2B Conference / 75th World Health Assembly / WHO / Geneva, Switzerland May 23-25 http://bit.ly/33YKQQx Short Course / Cardiovascular Epidemiology / Erasmus MC / Rotterdam, The Netherlands May 24 - June 17 http://bit.ly/38mW6tl Summer Program / Summer Institutes in Global Health / McGill University / Montreal, Quebec, Canada May 30 - June 3 http://bit.ly/2RvLH8H Conference / 46th Annual Kettil Brunn Society Meeting / Kettil Brunn Society / Warsaw, Poland May 30 - June 10 https://bit.ly/3J09R3I Short Course / Principles in Causal Inference / Erasmus MC / Rotterdam, The Netherlands May 31 - June 3 https://bit.ly/31MTaYw Conference / 2022 Annual Conference / Society for Prevention Research / Seattle, WA

Near Term Epidemiology Event Calendar, con't from page 9 June 2022 June 1-30

https://bit.ly/2WdMtIy

Summer Program / Episummer@Columbia / Columbia University / New York, NY June 12-14 http://bit.ly/2RyvIGU Conference / 35th Annual SPER Meeting / Society for Pediatric and Perinatal Epidemiologic Research / Chicago, IL June 12-17 http://bit.ly/2LARbvo Short Course / Evidence Based Clinical Practice Workshop (Last time offered) / McMaster University / Hamilton, Ontario, Canada June 13-15 https://bit.ly/3DNvDDG Conference / APIC 2022 / Association for Professionals in Infection Control / Indianapolis, IN June 13-18 https://bit.ly/3ysXLeD Short Course / Biology of Vector-Borne Diseases / Infectious Disease Society of America / Moscow, ID June 13 - July 1 http://eepe.org/ Summer Program / 34th Residential Summer Course in Epi / EEPE (European Educational Program in Epidemiology) / Florence, Italy June 13 - July 1 http://bit.ly/2rjd9Mu Summer Program / 38th Summer Institute of Biostat & Epi / Johns Hopkins University / VIRTUAL June 14-17 https://bit.ly/3ypUsEX Workshop / Student Dissertation Workshop / Society for Epidemiologic Research / Chicago, IL June 14-17 https://bit.ly/3ENsMfD Conference / 2022 Annual Conference / Society for Epidemiologic Research / Chicago, IL June 15 - 17 https://bit.ly/33kI65m Short Course / Causal Inference in Epidemiology, Concepts and Methods / University of Bristol / VIRTUAL June 15 - 17 https://bit.ly/3oS4dZm Conference / Conference on Epidemiological Birth Cohort and Longitudinal Studies / University of Oulu / Oulu, Finland Hybrid June 15 - 18 https://bit.ly/3DPSRJx Conference / Preventive Medicine 2022 / American College of Preventive Medicine / Denver, CO June 17 https://bit.ly/3GH8MvK Meeting / 47th Topics in Infection 2022 / Royal Society of Tropical Medicine & Hygiene / London, England - Hybrid June 19 - 23 http://bit.ly/2Pkd8Q4 Conference / CSTE Annual Conference / Council of State & Territorial Epidemiologists / Louisville, KY June 20-21 https://bit.ly/3EOdPK6 Conference / ISEE-AWPC & ISES-AC Joint Conference / International Society for Environmental Epidemiology Asia and Western Pacific Chapter & International Society for Exposure Science Asia Chapter / VIRTUAL

Near Term Epidemiology Event Calendar, con't from page 10 June 2022 con't June 20-22

https://bit.ly/3ES4GAg

Conference / BTEC Conference / Brain Tumor Epidemiology Consortium / Lyon, France June TBA https://bit.ly/2INiyE6 Conference / NAACCR Summer Forum / North American Association of Central Cancer Registries / Boise, ID June TBA http://bit.ly/37u0852 Conference / 8th annual Symposium on Advances in Genomics, Epidemiology and Statistics (SAGES) / University of Pennsylvania - CCEB / Philadelphia, PA

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