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Your story (continued)
I left the Pediatrics internship at Johns Hopkins after finishing my first year and moved to Atlanta. After the summer course training program, I was immediately deployed to Cairo, Egypt, as an Epidemic Intelligence Service Officer (EISO) for the CDC. The best thing about my experience was that I was deployed with Dr. Marion Kainer, at the time a second year EISO, who became and is to this day my best work friend. Our assignment was to investigate an outbreak of bloodstream infections killing infants in a neonatal intensive care unit.
We arrived on September 7th, and the infection control problems were enormous and overwhelming. There were issues everywhere (no soap at many sinks, no paper towels) and we could see why no one had figured out the most immediate cause of the outbreak. The majority of babies in this unit were infected with a treatment-resistant strain of Klebsiella pneumoniae, a nasty bacterium. A research project led by John Snow International (JSI) and Johns Hopkins had uncovered the fact that these kids were becoming bacteremic within 24 hours of admission to the unit, but they were not equipped to investigate why. Marion and I were deployed to sort this out. Career-wise that was a tremendous opportunity, and a stark lesson in being practical—reviewing the very limited data available and thinking about what you can do with what you have and how can you focus on the right pieces of information to help you put this all together. We could not allow ourselves to be distracted by all of the problems we saw or by the data we did not have. That’s a very challenging skill and we were developing that skill. CDC’s healthcare-associated infections legend, Dr. Bill Jarvis, was our willing, if unofficial, mentor throughout the investigation. We would have 3am phone calls with him, and then would call our supervisor and outline next steps.
We arrived on September 7th, 2001, and 9/11 followed a few days later, just as we began our work. The first six months of my public health career as an EIS officer, beginning with this, were some of the most tumultuous times in public health history. In Cairo, we collaborated with the medical and laboratory experts at the U.S. NAMRU-3 laboratory there, managing to identify the source of the outbreak, which was IV fluids contaminated by ward practices. We worked with the team at the hospital to establish protocols to screen fluids and to prevent further contamination. Infant mortality rates began to drop immediately. We flew back to the US and prepared to be deployed to New York City to help our fellow EISOs respond to the aftermath of 9/11. Marion had a stellar reputation and was more senior. She was asked to go to New York City and wanted to bring me with her. That’s another lesson—when you have the chance to help someone younger who needs more experience, it is wonderful to turn around and pull them along with you. Marion made sure I was on the front lines in New York alongside her for the next three weeks.
I was later deployed to Washington, DC, as part of CDC’s massive field team responding to the anthrax attacks and worked on the “postal team”. Even though it wasn’t global, there was a real issue with health equity and disparities because most of the postal workers were from the Black community, uncertain of their risks (CDC didn’t understand them either) and without the influence and power of the potentially exposed federal officials in the city. There were assumptions made early on (remember – ‘never assume’) that turned out not to be true, and a few people died in part because public health assumed they were not at risk. One of the important lessons learned at that time was to say ‘I don’t know’ when you don’t. If you value the public’s trust, when you don’t know something, say that, and then talk about the process for getting the answer. People will understand and accept that, and the honesty demonstrates respect for those you’re working with and for, no matter where you are. I saw how more senior public health officials felt pressure never to admit not knowing an answer. I was young and inexperienced so I could easily say that, but we’ve seen over and over how dangerous it is in public health to give in to the pressure to project certainty when there is none. It provides the public with a cheap form of confidence that crumbles into distrust when the ruse is revealed.
During our work with the postal team, we identified a huge need for education for other people who process, sort, and deliver the mail. The USPS pushed out information to postal workers, but there was no one to educate all the people who weren’t in postal facilities and yet still delivered mail for major corporations and faced risk. A small CDC team put together an educational video for people who process, sort, and deliver the mail with a producer in Atlanta. I was the EIS officer serving on the project and helped draft the script and create the video for people who wanted to know how to protect themselves in a mail facility that wasn’t a part of the postal service.
Major changes during my first year of EIS within my assigned division at CDC made my EIS experience tumultuous. My mentor Bill Jarvis was about to retire. Marion was leaving. They both facilitated my move to a new part of the agency in the Office on Smoking and Health where I spent my second year. Having that unexpected exposure to a whole new aspect of public health was incredible. I’m an infectious disease and vaccines expert and yet here I was in tobacco, with wonderful people. Even though I knew I would never have a career in chronic disease, I’m so glad I had that year learning from field epidemiologists, health educators, and economists in a totally different area of public health. I even helped design and teach a smoking cessation program for physicians practicing across Russia, spending time in Moscow as part of an international health alliance. As a professional, the straightest route is not necessarily the best route. You want those detours into areas that challenge you, that aren’t where you’re going to be forever, but will teach you to look at problems through a different lens.
Always be willing to grow, put yourself in new situations, don’t feel like you have to stay on a linear path in order to advance. Allow yourself to step back and say, ‘Does this opportunity offer me a chance to reframe the way I think about problems? If so, when I come back to my ‘true love’, I’ll be a stronger and better thinker and leader.’ If you only stay in your ‘true love’ path, you may only learn to think the same way everyone who shares this love thinks. A fresh perspective or opportunity can shake you up; however, you don’t want to take just any position that’s different. Take one where you can learn from the people you’ll be working with. Don’t feel that you have to finish your development before you start your first job.
I finished up EIS and was accepted into the preventive medicine residency program at CDC, assigned to the Tennessee Department of Health (TDH). I loved Nashville, so that was exactly where I wanted to be. I got involved with lawyers and policy development heading up a big project to review and modernize communicable disease control rules of the state of Tennessee that hadn’t been touched in 20 years. We were also dealing with SARS at the time: in one case a person who was quarantined ignored us and went on a camping trip in North Carolina and we had no apparent recourse. We used model legislation developed by public health experts to help us write and promulgate new rules to strengthen the capacity of public health to control disease. Those new rules went into effect, and thus began my love affair with public policy.
When I finished the policy project, my mentor Dr. Allen Craig said, “What would you like to do? We’d love to keep you on.” At the time, the state had received CDC money for pandemic planning because of avian H5N1 influenza and he thought I could take that on. I said yes and began pandemic planning as well as overseeing their immunization program, a tiny program with no epidemiologist except me. It was primarily an administrative program that oversaw operations of the Vaccines for Children (VFC) federal entitlement program. I provided medical oversight and direction, taking over from their recently retired manager. That role turned into 14 years of building the state immunization program for Tennessee (“TIP”). I was fortunate the first four years to have a wonderful mentor in the state epidemiologist, Dr. Craig, to help. During his tenure, I worked on pandemic planning and learned how to write grants, hire staff, and build capacity in a program. By the time I left in 2018, TIP had about 32 people on the team, including seven epidemiologists and six nurses, among others, all doing a huge amount of work in program operations, quality improvement, disease surveillance and outbreak response. We even designed and implemented the mass vaccination program for the 2009 H1N1 influenza pandemic. We managed all of that and the state immunization registry which grew dramatically during that time. Over the years, I grew in experience and confidence, learned how to manage and build my team through good times and bad. And then, I inadvertently offended a political appointee.
During my tenure, the state had changed its employment laws, and my position was transferred into an executive service at-will position, meaning that I could be replaced at will without cause or explanation, and I was.
The political appointee had very different ideas than me in areas of program direction, outbreak management, and different ideas about the relationship between the state and the CDC. Sometimes you encounter a leader who really wants his or her own personal vision to be the organization’s mission. I had always viewed my work as focused on what was best for the people of Tennessee, even if that put me at odds with leadership. That experience was really hard after so many years. There was no explanation, and I just got a letter with “best wishes, we want to end your service.”
Hard as it is, it’s important to talk about this, because I had this stellar career that anyone would look at and say, “Wow, you’ve done the right things. This is incredible,” but anyone can run into someone who could just end that because they can and because you don’t fit with them. What you do next is what’s most important and is what will distinguish you for the rest of your career. Even as I was being told my job was ending, I was thinking about how my team would react and how I needed to comport myself with class and honor. In the coming days, I held onto the importance of the cohort of young women professionals whom I mentored. I needed to show them how to respond to such a blow. Life is unfair. It could be other terrible things happening that upend your expectations in a moment, like a devastating diagnosis or family tragedy. I coped by shifting into what I’d want my young mentees to see, recalculating my path with the coolness of the GPS when a turn is missed.
Hard work and diligence are necessary but not sufficient for success. There are variables that lead to success that you can’t control, and that you don’t need to feel personally responsible for.
Sitting at the table, absorbing the end of my 14 years of devotion to building the state immunization program, work that had led to national awards for excellence, and to my federal appointment to the CDC’s Advisory Committee on Immunization Practices and to my appointment as chair of the World Health Organization’s Immunization Practices Advisory Committee, I determined to behave like I was the Queen of England. I wasn’t going to engage the ‘crazy’ in that moment and although I was angry, there was no remorse or guilt because there was nothing to feel remorseful about. I wanted my mentees to see that and to know where to go mentally in response to something like this.
What next? Beginning the very next day I started walking 6 miles in the woods every day at nearby Percy Warner Park. I was going to walk until I figured this out. I had wonderful, supportive friends who walked with me. The first thing I needed to do was to figure out how to explain what had happened. I worried people would think that I had done something wrong but I knew that arguing my case or casting blame or allegations would simply be “engaging the crazy” and might make people question what part I had played. I worked with an executive coach and other professional women friends outside of public health who came from my strong social network. They helped me put my experience in a broader context and to find my words. Once I knew how to explain what had happened in a straightforward, truthful, and neutral manner, I became more confident facing the rest of the world.
Then, I focused on next steps. I was a national and a global figure in the immunization policy world because of my roles in the CDC and the WHO. I did not want to hide, so I kept showing up, going to everything I was invited to, contributing as I always had, and just plugged away. I made the most of the opportunities I already had with CDC and WHO, remaining as friendly as ever and not allowing my experience to derail what I knew of myself and my capacity to contribute to public policy in important ways. As new opportunities came up to teach and to advise and consult professionally, I said yes to them. In a situation like this, say yes to everything, you just don’t know where you’ll end up.
I channeled my energy into being the sort of person people would respect for handling setbacks with grace. You can emerge stronger than you have ever been having gone through unfairness and adversity and grow in compassion for others whose paths are not easy.
At the beginning of 2020, I had caught the attention of the Immunization Action Coalition (IAC)’s founder who needed someone to lead the ‘Ask the Experts’ section of their website (www.immunize.org); she wanted me because of my years of experience in vaccine policy and program implementation. IAC is known in the US and globally as a leading immunization education and advocacy organization focused on supporting front line immunizers. I also created my consulting company, The Vaccine Advisor, LLC. The COVID-19 pandemic forced me to move my global policy projects online and ended my travel, but it only forced us to learn new ways to engage globally. By mid-2020, I was approached by IAC’s founder and asked to succeed her after her retirement. I accepted and my new role leading IAC will begin on July 1st, 2021. I’m figuring out how to take the work IAC is doing can have more global impact in the long term. I have always felt that there are lots of lessons we can learn from each other when it comes to vaccine program implementation around the world. We need to be talking more regularly with each other to share and promote promising ideas and resources no matter where in the world they originate. When it comes to immunization, all programs have similar goals, tools, and challenges.
As I learned during my two years as an independent consultant, your value is not your title. It’s in the skills you have, your attitude. People will see that and resonate with it. In recent months, I’ve been on several advisory committees on vaccines, advising Pfizer on the COVID-19 vaccine and other vaccines, and continue to do so. Often I was the only person on the committee without a lofty title or endowed academic chair, yet the industry executives emphasized strongly how important my contributions were and kept inviting me back. Your measure of success is not a title, but whether you’ve contributed a fruitful life and did things right – after all, many people in the world now are more intelligent and more hard-working than I am, but, by accident of birth, they will have no opportunity beyond their community or home. Think of them and what their lack of opportunity deprives this world and say yes with gratitude to the opportunities you have to blaze your trail.
Inner Lantern glow-up (continued)
- What job would you be terrible at: Anything requiring unquestioning submission to the direction of another person.
- What age do you want to live until: I’m grateful for every day. There are some reasons I am unlikely to experience a normal life expectancy. That’s why I don’t put off pursuing the experiences I want to have in life.
- Health equity is, in your words: the opportunity to live with the same quality of health and well-being as others.
- What makes you happy: Digging into a challenging vaccine policy or program problem that needs solving and making consequential decisions. Walking in the Bernese Oberland of Switzerland in June. Watching giant tortoises in the Galapagos. Eating beautiful food.
- Favorite place to eat in your hometown/area you’re currently living in: Etch
- If you could live anywhere, where would you live: Somewhere looking over the Mediterranean with the Alps nearby.
- What could you give a 40-minute presentation on with absolutely no preparation: Several vaccine policy topics.
- What do you wish you knew more about: Being a great leader.
- Favorite artists: Botticelli, Magritte, Frida Kahlo, Van Gogh, Japanese wood block print artists.
- Why is decolonizing global health necessary, in your view: Self-determination is essential. People with the capacity to solve their own problems are everywhere. We must realize that capacity and support and learn from one another.
- What lifestyle changes are you trying to make: Maintaining good mental and physical health habits in pandemic isolation while learning how to become a CEO.
- What fictional place do you dream of going to: Hogwarts.
- What is worth splurging on every time: A piece of art that completely captures you. Great food made with love by people who are passionate about it. A whole day of utter relaxation, preferably involving a massage.
- Most memorable gift that you’ve ever received: A tiny wooden elephant given to me by an Indian teenager who I took out to dinner one night in Hyderabad in 1995 when I was staying with her sister’s in-laws. It turned out it was the first time she’d ever been to a restaurant with a friend and she gave me this token so I would not ever forget the impact this experience had on her.
- If magic was real, which spell would you try first: Something that would allow me to talk with my ancestors and some of the great men and women of history.
- What do you think makes a good friend, and how much do you live up to your standards: Staying engaged, being there for one another. I fail all the time, but still have some wonderful friends in my life.
- Best trip of your life thus far: South Africa (Cape Town and a short safari near Kruger National Park) and a long weekend hiking in Kandersteg, Switzerland.
- Who do you go out of your way to be nice to: Service people who expect you to disregard them or be rude.
- What really makes you angry: Hatred, cruel comments and mistreatment of the vulnerable.
- Favorite candy/snack/dessert: Fantastic cheese, beautiful bread, any pie made with sweetened condensed milk, extra toasty Cheez-its.
- Role models: Jesus, Allen Craig, Paul Farmer, Mark Roberts, Kathy Edwards, Dennis Burkitt, Robert Deaver Collins, John Tarpley, my grandfather (Floyd Moore) and great-grandfather (Arthur Lee Moore), Inspector Gamache (the fictional detective created by Louise Penny).
- You dream of a world where: Everyone has a life free of vaccine-preventable diseases and the opportunity for a meaningful life where they feel loved.