HEAL Spotlight: Kelly Moore (Pt. 1)

• Name: Kelly L. Moore, MD, MPH
• Originated from: Huntsville, Alabama
• Global public health area(s) of expertise: Vaccinology, medical epidemiology 
• Features in recent news articles:
  • In The Atlantic: Where Year Two of the Pandemic Will Take Us by Ed Yong
  • In USA Today: States were left scrambling after finding out they’d get 20-40% less vaccine than they expected. Here’s why. by Elizabeth Weise
  • On Marketplace Morning Report: How do we prepare for a COVID vaccine distribution system? Hosted by David Brancaccio
  • In The Atlantic: A Vaccine Reality Check by Sarah Zhang (fun fact: Kelly provided lots of input on this article, retweeted by Barack Obama)
• Educational background: BS, Interdisciplinary (Neuroscience), Vanderbilt University; MPH, Harvard T.H. Chan School of Public Health; MD, Vanderbilt University; Pediatric Internship, Johns Hopkins School of Medicine; Preventive Medicine Residency, CDC
• Jobs before your current position: Epidemic Intelligence Service Officer (EISO) 2001-2003, Director, Tennessee Immunization Program, Tennessee Department of Health, 2004-2018; Consultant and President, The Vaccine Advisor, LLC; Deputy Director, Immunization Action Coalition
• Best advice you’ve ever received: I’ll share a few rules for living that people have given me that are really important, and I go back to all the time.
  • Never assume.
  • Don’t engage the “crazy.” People around you won’t be able to figure out where the “crazy” started. If someone is being unreasonable or unfair and you confront the person because you feel you need to defend yourself, bystanders may think you may share some of the blame and won’t necessarily see where the “crazy” started. Those people stirring up the crazy gain power by dragging you down to their level. They’re trying to stir up a fight, and you don’t want that.
  • You only get to choose one hill to die on. Words of a wise mentor at CDC, counseling me about a bad supervisory situation I needed to exit that was caused by organizational issues well above me. Moving positions during EIS is not typically done and it could reflect badly on me, depending on how well I did in my next post. I embraced that and wanted to demonstrate to people that I left the previous post because of what was going on above me, not because of me. One of the things my mentor shared is “You only get to choose one hill to die on,” and if you’re moving out and into a new EIS position, then that’s the hill. You’re saying ‘I’m getting out of here,’ but you can’t go to the next place and say, ‘Well, I’m getting out of here, too.’ Then it becomes a problem. Same thing with resigning. You can resign, but you only get to resign once, so make sure it’s worth it.
  • Be a good observer. This has been my dad’s advice always. He was a basic scientist in graduate school, and one of the things he always told me as I’ve found myself on the front row of some major events is, ‘Just be a good observer.’ Because you’ll find yourself in all kinds of positions, and it’s vital to pay close attention to what’s going on around you and observe how people are interacting and what’s happening.
• Mentorship advice and career development: Just ask! Don’t assume people will say no. And don’t be discouraged if someone does say they don’t have time at the moment, follow up at another time and be intentional.
• Twitter handle: @VaccineAdvisor

Inner Lantern glow-up

• Lessons learned over the last year or so: I love working in the vaccine policy and program arena so much that I’ll do it for free as long as I can earn enough to pay the bills. And when you love it that much, people seek you out to make it possible to pay the bills. Say yes to opportunities that will either showcase your strengths, push you to grow in new ways, or take you out of your comfort zone, at least until you feel comfortable enough to be able to choose or reject those opportunities in the future on your own terms.
• What’s your current life motto: Say yes.
• What’s your favorite global health organization/agency and why: The best NGO I have been exposed to professionally was the Child in Need Institute of Calcutta (now Kolkata). I spent a month with them in 1995. They demonstrated incredible intentionality in their work with the poor of Calcutta and the surrounding area. Every moment of every encounter with a family or child was put to use (even health teaching and demonstrations while mothers waited for a visit to the clinic). They also were the first to show me how to calibrate interventions to an individual’s life, incorporating the support they provided into a sustainable context. 
• If you didn’t have to work what would you do: Volunteer to help craft vaccine policy and program implementation strategies.
• What is one of your proudest accomplishments: The first six months of my public health career. As a first year Epidemic Intelligence Service (EIS) Officer, I was deployed on 9/7/2001 to Cairo, Egypt, where my colleague and I found and controlled the cause of a devastating bacterial sepsis outbreak in a neonatal intensive care unit (IV fluid contamination). The outbreak was affecting the majority of admitted infants within hours of admission and had a 50% mortality rate. We managed this before being recalled to the U.S. on 9/20 following the attacks of 9/11. After returning, I served on the front lines of the public health response to 9/11 and the anthrax attacks of 2001 alongside incredible EIS officers and CDC career service professionals as we faced an unprecedented series of deliberate attacks and deployed our epidemiology and surveillance skills to understand and manage the man-made disease outbreak.
• Coolest global public health specialization to be in: Vaccines!
• What’s one thing everyone in the global public health field should know: Relationships are everything. Even in global public health, the community is small.
• Currently reading/listening to: Refreshed my spirit recently by revisiting some favorite poems by Rabindranath Tagore (1913 Nobel Prize Laureate)
• What’s the hardest lesson you’ve learned thus far: You can do everything right and work very hard, but you can get on the wrong side of a powerful person who can derail everything you have worked for. Public health is political, even if you think you are not. Work hard, work honestly, develop trusting collaborations, but be savvy.
• Favorite work memory thus far: Working alongside a brilliant team willing to do anything necessary to get a good result for the public in a crisis.
• How would you define global public health: Improving the health and well-being of humankind as a whole organism made up of essentially interdependent parts, instead of individuals or nations. 
• What is special about the place where you grew up: Growing up on a farm, I was especially close to my parents and grandparents. I learned that the only thing that matters is the outcome–if you don’t put in the work, you can’t expect a good result. And the good result may not happen even if you do put in the work. There are forces outside your control and you must learn to make peace with that fact.

Your story

When I look back at my personality type, I never really fit into a traditional path career-wise. I’ve always been interested in more things than people expected you to be interested in. I looked for ways to customize opportunities to get those experiences that weren’t necessarily available in ordinary structures. When I look back at my time in college, I designed my own major. An interdisciplinary neuroscience major that was a combination of molecular biology, psychology, and specific neuroscience course work within the psychology department. I found a passion for biochemistry and the history of medicine, and I wove all those things together to create the experience I wanted.

Between undergraduate and medical school, I had an opportunity to apply for the Keegan Traveling Fellowship (then known simply as the Vanderbilt Traveling Fellowship), which allowed me to design my own travel experience around the world investigating the art of healing in different countries, with a focus on the healer-patient relationship. That was incredibly challenging, because I’m by nature an introvert and rather risk-averse. In addition to the topic, a lot of what I learned was how to really be alone and take care of myself anywhere (e.g., getting food or traveling from point A to point B in a country where I don’t speak the native language). I ended up traveling to 19 countries with incredible experiences around the Pacific Rim, India and continental Europe. This experience gave me confidence in my ability to problem solve, but I also recognized that I missed companionship and that I didn’t need to be by myself all the time. A word of advice about this—you should say ‘yes’ to experiences but be honest with yourself and others about which parts of those experiences worked for you and which ones didn’t. You won’t benefit as much if you feel you have to embellish your story to impress yourself or anyone else.

I applied to medical school while on the Traveling Fellowship, and one of the first things I did as a first-year medical student at Vanderbilt was explore opportunities globally. There was an opportunity to get a small stipend to travel and study child nutrition. I applied for the fellowship and didn’t get it, but I had figured out what I wanted to do and decided to do it anyway. I went to the Child in Need Institute (CINI) in Calcutta (now Kolkata), and the experience was transformative, but I had a really hard time personally. I was glad I went, but I wasn’t prepared for all I experienced. The young doctors I was volunteering with didn’t know what I didn’t know. They asked me, ‘How do you treat malaria in Tennessee?’ and we didn’t have malaria in Tennessee. Infants there died of malnutrition and dehydration fueled by misunderstandings and myths embraced by families. CINI staff leveraged every encounter with a mother and child to banish these deadly myths and customs. I sat in on these clinical visits and I was overwhelmed, because I had just finished my first year in medical school and didn’t yet grasp technically all that I was seeing. Most people there spoke no English; there was no one with whom to debrief. I learned as much as I possibly could and recognized my own limits and that I needed to be part of a team to be successful.

I’ve never forgotten following the rehabilitation of a toddler in an emergency ward for extreme malnutrition: while there, the mother delivered another baby. I was irritated with the young doctor supervising that night because he didn’t call me to attend the delivery (I had yet to witness a birth). He just shrugged and said, ‘It’s another girl child. It’s just going to end up the same way as the first one.’ He may have been right, but that was an awful thing to recognize and process by yourself. My processing involved long letters to friends and daily candy bars.

From CINI I learned that it was important to test my limits, understand them, and work within them. In global health, that’s extremely important. You need a social support network and the ability to be honest with yourself about what you need. And it is fine if your needs are different from others–avoid comparing yourself. If you’re going to make global health work sustainable, the idea that you would be a superhero and never let anyone see the challenges that can be overwhelming to you is a very unhealthy approach. For students thinking about a global public health career, be honest with yourself. Put yourself in situations that push your limits and grow from that, but also realize that you don’t have to master everything, or enjoy the same things that others you respect enjoy, to contribute to global health in valuable ways. Figure out your lane—where is it that you thrive? That you can contribute the most? Your experiences can build resiliency, but each person’s limits are different. Give yourself grace and honor your boundaries. Know and accept yourself. Become comfortable expressing who you are and understanding what you need to be successful.

One of the challenges with having a mentor, and one of the reasons why it’s important to have an array of mentors, is that mentors are people too. Recognize that just because there’s something you admire in them, including work they love and are fantastic at, doesn’t mean that you’re a failure if you’re not loving that or fantastic at that particular thing. When you’re working hard to be successful, there’s a lot of pressure to try things, and even after you recognize that it’s not your thing, you may continue in that path because you feel people expect you to do that. Parker J. Palmer wrote in The Courage to Teach a statement that I copied many years ago into my personal book of inspiration: “A vocation that is not mine, no matter how externally valued, does violence to the self–in the precise sense that it violates my identity and integrity on behalf of some abstract norm.”

I learned during my MPH program at Harvard that some physicians made a career out of what I thought were the fun, extracurricular aspects of medical school, so when I got into the Johns Hopkins pediatric fellowship, I was supposed to finish residency, but it became very clear to me within just a few months that this was not my path. When I visualized my future, I couldn’t visualize myself as a third-year resident. I talked to my mentors and regrouped. One of them wrote me, “I would never suggest dropping the option of clinical medicine by leaving your residency for anyone else, but for you, I would recommend applying to the Epidemic Intelligence Service [EIS] at the CDC and they will take you after you complete your internship year.” If my desire was to go into public health, I could do a preventive medicine residency there and be board-certified and lead in public health. I had to be honest, my way of thinking was at the systems level and I would not miss clinical practice. I spoke with my residency director that fall and told her I was applying to EIS, and that if I got in, I would be leaving in six months at the end of the internship. It was important to manage my transition well. If you find yourself in a situation like mine, be honest with the people who are counting on you so that if your decision lets them down, you’re thinking about timing and communication in a way that demonstrates respect for their situation. You don’t want to burn bridges.

…To be continued!