Lab Matters Summer 2017 | Page 18

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Jeffrey Engel, MD, is executive director of the Council of State and Territorial Epidemiologists( CSTE). Before joining CSTE in 2012, he oversaw public health activities in North Carolina, first as state epidemiologist( 2002-2009) and then as state health director( 2009-2012). He has been a professor of medicine and chief of the Division of Infectious Diseases at East Carolina University, Brody School of Medicine, and hospital epidemiologist at Pitt County Memorial Hospital in Greenville, NC. Engel received his undergraduate and medical degrees from Johns Hopkins University and completed a residency and fellowship in internal medicine and infectious diseases at the University of Minnesota. During 2010-2011, he served as co-chair of CDC’ s National Biosurveillance Advisory Subcommittee, and from 2005 to 2009, he served on CDC’ s Health Care Infection Control Policy Advisory Committee. He is currently on the board of the National Foundation for Infectious Diseases.

How did you segue from medicine to public health and then to CSTE?

When I started to learn the discipline of infectious disease medicine at the University of Minnesota, I learned about the power of public health. As part of my training, I took summer courses in epidemiology and biostatistics and rotated through the Minnesota state public health department. I soon became involved with the then-burgeoning HIV epidemic and STDs generally— clinical worlds closely associated with public health.

At East Carolina University, I did a research project focusing on the genes controlling neuropathogenesis in herpes simplex virus. It was very lab-oriented, actually. I was making my way in that discipline, but NIH funds were drying up in the late‘ 80s and early‘ 90s. I saw the writing on the wall, and I became the first physician-epidemiologist at our big academic medical center.

I quickly discovered that mainly two disease processes made up the bulk of our infectious disease practice: HIV and healthcare associated infections.

It was frustrating to see these entirely preventable diseases on the clinical side and not be able to address the problem upstream. I also became the bioterrorism point-of-contact at the medical center.

So, you see, infectious disease medicine is saturated with public health. When the opportunity came to work in the field directly, I took it and moved to Raleigh, where I became NC’ s state epidemiologist. By that time, I was president of the NC chapter of the Infectious Disease Society of America, and I knew the state’ s entire infectious disease community.

In 2009, I was offered the state health director position— a political appointment. I stayed in that position until the political winds changed, and a new health director was appointed. At the time, CSTE’ s executive director was retiring. I said,“ If you need an interim director, I can do that and work from Raleigh, but I can’ t relocate to Atlanta.” Nevertheless, they hired me permanently. So now I live in Raleigh part of the week and have an apartment in Atlanta.

Tell me about the state of epidemiology today. How is it changing?

Epidemiology is the core science of public health and always will be. The change is in methodology and data sources and maintaining relevancy in a real-time world. Still today, many [ disease ] reports come over fax and telephone. Because of this problem with timeliness, it’ s almost as if we’ re working ourselves into irrelevancy. And we recognize that. If a patient goes into the ER, the insurance company knows about it probably within six hours. And here’ s the epidemiologist working on reports sometimes a year or two after the event. It’ s no longer tenable in our profession. So, it’ s the modernization of public health surveillance that poses our biggest challenge.

What other modern-day challenges do epidemiologists face; for example, functioning in a“ post-truth” society?

Yes that is a challenge. But when it comes to credibility, nothing beats an epidemic. People will not deny that they’ re getting sick. And they will also know that it might have been the food they ate or the water they drank or the person they had sex with. And the public still looks to government as a protector. That’ s what epidemiologists have going for them in the field: outbreaks maintain our street cred.

Another challenge is community engagement. For example, consider immunizations. Some people talk about anti-vaxxers; we use the term vaccine hesitancy. Reframing the issue puts the focus on why people are hesitating to get their children vaccinated. It really involves getting into their shoes.