Lab Matters Summer 2017 | Page 18

partner profile

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 .