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MIDDVantage: Exploring Careers in Public Health

Exploring Careers in Public Health is a collaborative series developed by the Center for Careers and Internships and Middlebury in DC with content contribution from members of the Middlebury Professional Network and Middlebury students.

The worldwide coronavirus pandemic is inspiring a new generation extremely interested in public health. Washington, DC is central to the fight against this pandemic as it is the home of the National Institute of Health (NIH), the World Bank, and the nearby Johns Hopkins School of Public Health. This series includes interviews with many different professionals within the career field who will share their perspectives on the challenges within public health as well as the various career roles within.

Public Health Interviews

Episode 1: An Overview of the Global Health Landscape: Issues, Challenges, and the State of Affairs (27 minutes)
Guest Speaker:  Pam Berenbaum, Director Global Health Program at Middlebury College
Interviewer: Fariha Haque, Director, Middlebury in DC

Episode 2: Policymaking at the Centers for Disease Control and Prevention (24 minutes)
Guest Speaker:  Seth Kroop ‘02, Associate Director for Policy in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention
Interviewer: John Carew ‘20

Episode 3: Vaccine Development Experiences from a Private and Public Enterprise Perspective (31 minutes)
Guest Speaker:  Agnes Mwakingwe-Omari ‘02, MD, PhD, Senior Clinical and Research Development Lead, GlaxoSmithKline (GSK)
Interviewer: Guadalupe Vega ‘20

Episode 4, Part 1: The World Bank’s Role in Global Health (41 minutes)
Guest Speaker: Mikail Dastgir ‘10, Public Health Specialist at World Bank Group
Interviewer: Asra Muhammadi ‘20

Episode 4, Part 2: Global Health: From Campus to Career (23 minutes)
Guest Speaker: Mikail Dastgir ‘10, Public Health Specialist at World Bank Group
Interviewer: Asra Muhammadi ‘20

Episode 5: Views from Infectious Disease and ER Physicians (22 minutes)
Guest Speaker: Dr. Andrew Hale ‘06, Infectious Disease Specialist and Assistant Professor of Medicine at the University of Vermont and Dr. Russ Johanson ‘06, Emergency Medicine Physician
Interviewer: Allegra Molkenthin ‘19.5

Episode 6: Preparing for the ‘New Normal’: How COVID-19 will change Healthcare (35 minutes)
Guest Speaker: Chris Bernene ‘90, Partner, Oliver Wyman
Interviewer: Jeff Sawyer, Director of Employer and Professional Network Development

- Hello, my name if Fariha Haque, and I’m the Director of Middlebury in DC. In light of current events, this interview is the first in a series about careers in public health and is part of the MIDDVantage program. It is my pleasure to introduce you to Pam Berenbaum. Pam is the Director of the global health program and professor of the practice of global health at Middlebury College. She is a member of the leadership team for the engaged learning centers. She has taught at Middlebury since 2010, teaching courses on global health, public health policy, and disaster of public health. Pam holds a Master’s of Science in health policy and management from Harvard University’s School of Public Health. She has worked in many sectors, including government, academic, consulting, and nonprofit. For 10 years, she was an infectious disease epidemiologist in the Vermont Department of Health, where she specialized in syndromic surveillance, bio terrorism, and all hazards emergency preparedness, collaborating with personnel from other state agencies, as well as the CDC. Welcome Pam.

- Good morning.

- Good morning. Pam, could you lay out what the public health industry is like and the different types of careers that are available in the industry?

- Sure, the field of public health is completely interdisciplinary and multidisciplinary, and happens at many different levels of society, and government, and organization. So this is really the ultimate team sport. We needs lots of different backgrounds. So at its most local level, there are public health workers on the ground working with communities. And at this point actually I should just interject that public health is really about the health of populations, or groups of people, whereas medicine is concerned with the health of an individual. So in public health, we’re always trying to increase the baseline level of health in a community. So some of that work takes place on the ground in local communities. And then as you sort of zoom out from the local level, then you get levels of government involved, larger NGOs, but the work takes place at all sorts of levels, from both health promotion, like it might be an immunization campaign, for instance, and then way out at the policy level, where we might be concerned with agricultural subsidies and how that impacts people’s access to food. So, for instance, in Vermont, where I live, there’s one public health jurisdiction, which is the Vermont Department of Health, and they have local presences, about one per county. And so they work on all sorts of public health initiatives. They might refer people for HIV testing, they’ll run WIC programs, women, infants, and children, so supplemental nutrition. All sorts of programs, emergency preparedness. And then that work that happens at the state level, happens locally, but is funded through both the state budget, and grants from the CDC. And then the work is also guided by national guidelines, mostly developed by CDC, or perhaps DHHs. So then the state is reporting up to the Centers for Disease Control, which is the public health authority for the United States, and it’s actually part of Homeland Security now, so it’s part of the Federal government. So that’s just sort of the view within the United States, and what I haven’t mentioned is all the work being done by social service agencies that are perhaps not working on health directly, or sometimes they are, but they are helping to work on what we call the social determinants of health. So people have difficulty living a healthy life if, for instance, they’re experiencing violence in the home, or they experience food insecurity, or their housing is not stable, or they don’t have a good enough education to get a well-paying job and pay their bills. So people need all of those social supports to live a healthy life. And lots of local nonprofits work on those other things. They might, for instance, help people overcome an addiction. So although those locally operating nonprofits are not part of the State Department of Health, they’re doing really important work that I consider public health, and that is necessary for public health to succeed. And then if we look at the international picture, public health looks very different in a lot of places. In this country, and in lots of the sort of industrialized, capitalist, parliamentary democracies that are very wealthy countries, there’s a whole separate public health infrastructure that’s different from the healthcare infrastructure, or from medicine. And in more resource-poor countries, there often is not enough of a tax base to support a public health infrastructure. So public health initiatives get folded into healthcare. But again, there are hundreds of millions of people in the world who have never been to a doctor, never seen a dentist. So some countries have some pretty dire medical health needs, and also public health needs. People don’t have access to clean water, for instance. So in more resource-poor areas, a lot of the public health promotion work is carried out by nonprofits. They can be little tiny ones, they can be huge, massive internationals NGOs, and the larger NGOs and INGOs get a lot of contract work and funding from places like the World Bank, the IMF, perhaps UNICEF who developed the very broad range goals for population health, and then provide funding that they’ll contract out to local governments, to local nonprofits, to national, international NGOs. And the work all gets carried out through this very complex patchwork quilt of players and organizations, some local, some national, some international.

- How do you see the current pandemic changing the public health industry?

- I think that the current pandemic is going to change quite a few things. One thing that I actually hope that it changes is the willingness of traditional allopathic medicine to embrace telehealth, which looks kind of like what we’re doing right now where if you were my doctor and I had a complaint, we might have a video call. And then maybe you’ll prescribe me a medication, or maybe you’ll ask for me to come into the office so you can examine me. But in this country, the field of medicine has not really embraced telehealth, but telehealth works really well for a lot of people, people that don’t have access to transportation, or who don’t feel comfortable driving, or in Vermont, where it could snow seven months out of the year, a lot of people don’t wanna drive in the snow. For behavioral health, it helps some people with highly stigmatized conditions. And so I’m hoping that we’re all realizing that we can have really powerful and effective interactions virtually. So I think that that might help that. I think that the pandemic is really bringing into sharper focus the many inequalities that exist not only in our society, but globally. And I think we’ve all been reading lots of articles, or also have friends and neighbors who, there are a lot of people who cannot just quarantine themselves in their house. There are people being laid off, or there are people who’s jobs require them to be out in public, people driving buses, people working in the checkout counters in grocery stores, and these tend to be lower paying jobs. And so all of those folks are going to work every day to make our lives healthy and possible. And so there’s a lot of discussion about that. And inequalities are always of huge importance in public health because health outcomes are closely linked to inequalities. And outside of this country, other countries have even greater inequalities than we do, and the pandemic has mostly hit wealthier nations up to now, China, the United States, Europe, and when the pandemic hits poorer countries in full force, so countries in Sub-Saharan Africa who already have some of the worst life expectancies and health outcomes in the world, I’m really afraid and concerned about what the pandemic is going to do in those countries that have very weak healthcare systems in some places, not everywhere. But this particular disease, when it strikes severely, it requires very intensive levels of nursing and very advanced equipment in a pretty high tech hospital with negative pressure rooms, and a lot of countries just don’t have hospitals that have such equipment and trained personnel. And also, in many parts of the world, people are very sick all the time. They might be malnourished chronically, they might get malaria four or five times a year, they might be HIV positive, they might have tuberculosis. So then when you fold in a severe respiratory disease on top of those underlying health conditions, it’s potentially really devastating. And so I’m hoping that the pandemic will remind us that there’s still a lot of work to be done, and that there are important ways that we can give money, and funding, and effort to help provide more equitable access to healthcare throughout the world. I think, I have sort of a long list here about what the pandemic might do, but I think another thing that I hope will happen as a result of the pandemic is that we’ll all be reminded of how important science is, and communicating science. With a novel virus, there are key critical scientific questions that we have to answer in order to treat people, in order to protect people, in order to know when we can reopen the economy, and the scientific minutia are absolutely critical. And so we need people doing the science, we need people communicating the science, and scientists aren’t always great at communicating their science, but we need to really, as a society and as a world, increase our ability to understand scientific information and translate it into policy. And I feel like it’s never been more important. For example, the confusion over masks. There’s different types of masks, when should we wear them? Who should wear them? What should they be made out of? Why does it matter? If I wear a mask, am I protecting myself, or am I protecting you? These are all completely scientific questions, and I feel like recently there’s been a de-emphasis of science with regard to policy making. And I think this pandemic is showing us that we need science more than ever. And I guess finally I would say that, and this is a bit on a lighter note, I’m hoping that people will be reminded that they can cook, that anybody can learn how to cook. You know, especially in our country, we have such a takeout, and restaurant, and fast food oriented culture, and it’s no coincidence that we also have a Type II Diabetes and an obesity epidemic. And people are not eating out, and people are shopping for groceries, and they are Googling recipes, and I hope that people are realizing that they can save a lot of money, and they can eat more nutritious foods and have less food waste by actually cooking their own food at home. And maybe even getting kids interested in cooking. Most kids are not in school, and I know my kids have been helping me cook a lot. I think they’re learning a lot. So this will ultimately, if we can stick with these habits, we’ll actually have a healthier society, ‘cause eating out and eating fast food is not good for us, even though it’s good for the economy, it’s not good for our health. So maybe we’ll be making home cooked recipes more, and maybe even calling our grandmas more to get those recipes that we remember from our childhood.

- Absolutely. What types of internships or entry level positions are available for our Middlebury students? Next summer, or even during this summer, and for our graduating seniors?

- Well as I mentioned, the field of public health and global health, those fields are completely interdisciplinary and multidisciplinary. So there’s lots of room for students to engage with the work using skills and interests that they already have. And I often, in part because I used to do this kind of work myself, but I often recommend to students that a great starting place is working with data, and doing research, analyzing research and communicating that out. And liberal arts graduates are really great at this. Our students are fantastic at researching, compiling information, making sense of it, and then writing about it beautifully. And there’s a huge need for that. Public health is an evidence-based practice. Public health people love data, we are huge consumers of data, creators of data, analysts of data, and as I mentioned, we need science and information to guide policy. So liberal arts graduates are great at those tasks, and there’s a lot of entry level jobs that utilize those skillsets. And the employers who have jobs like that really vary. There’s university grant-funded research work, lots of consulting companies. And when I say consulting to students, sometimes they kind of, they’re like, “Not that,” because they think it means something financial. But if UNICEF wants to carry out a health promotion project, then they typically are hiring consulting firms to carry out that work. Multiple layers of contractors, subcontractors, so there’s a lot of consulting work, or also local or state departments of public health, all create data, and analyze data, and use it to make decisions. So those are great jobs. But not all students like to work with data. And then I always remind them when they say that that there’s many different types of data, ethnographic data is also incredibly important, and ethnographic research is enjoying a real resurgence in public health and global health. To get at those reasons about why people don’t engage in health promoting behaviors, for instance, that really requires ethnographic work. And then there’s also just, for people who really don’t want anything to do with data, there’s great work to be done at the community level on health promotion. Working with local nonprofits around violence prevention, or serving people with disabilities. There’s many different ways to engage, but students do need to remember that right out of college, they should be looking for an entry level job, and that that’s okay. And I always tell students, “All you need to do “is just get your first job out of college, “not the definitive job of your life, “or you can’t fast-forward to be the chancellor “over the x-checker, you have to start someplace.” And there’s lots of great places to start where then students can find out, what do they like to do? And what do they wanna learn more about? And what do they like or not like about an organization? And I also like to remind students that you actually learn a lot more from a job that you don’t like than one that you do like. It’s really important to find out what you don’t wanna put up with, or what types of organizations you wanna be a part of, or what sort of management style you like to work with. So finding out those tough lessons along the way, that’s all money in the bank for a great job later.

- Is a graduate degree, such as a Master’s in public health, necessary to grow in the field?

- It is, to get to any position of leadership or management, it’s pretty important to have some kind of graduate degree. And a Master’s in public health is a terminal degree. An MPH is widely recognized around the world, everybody understands what that degree means, but it’s certainly not the only graduate degree to work in the field. Master’s of public administration, Master’s of public policy are also great, or Master’s of science, are also great Master’s degrees. But then there’s really lots of different degrees. My professors in public health school, they had PhDs in economics, PhDs in statistics, maybe a Master’s of social work, a JD, because again, public health is an interdisciplinary and multidisciplinary field. It calls upon many different disciplines, so for instance, if a student loves economics and they ultimately wanna work in health economics, they can go get a PhD in economics, and then through their research and their scholarship, they can end up working in public health. And that’s true of many other degree programs as well. And I also just wanna make a distinction now, if I may, about public health versus global health. Global health is the term that’s more often used at liberal arts institutions that have an academic program, but 90, 95% of global health is the exact same thing as public health. It’s about population health, it’s about health promotion at a local level, but the global layer is sort of looking at the way that, for instance, diseases cross borders, or the way that political economy affects health, and also it looks at the role of global governance through the World Health Organization, the United Nations, the World Bank, and the International Monetary Fund to set policy and objectives, and how those policy goals, and how they’re operationalized end up creating either the intended impacts, or perhaps unexpected impacts. So I just wanna make that clarification as well. So students don’t have to decide, “Oh I wanna study public health, or global health,” ‘cause it’s really the same thing, it just depends on what part of the process you wanna look at and engage with.

- I wanted to ask you about your previous career before you arrived at Middlebury. You were an epidemiologist, could you tell us a little bit about what your work was like, and what you did?

- Sure. Well before I even had that job, I was a big quantitative person, I loved biostatistics, I loved epidemiology, statistical programming, and that’s what ultimately got me the job as an epidemiologist, because the unit that I joined, the infectious disease unit at the Vermont Department of Health, was mostly staffed by nurse epidemiologists who would do case investigations for reportable conditions. But starting in the late 1990s, there was a push, actually based on intelligence-findings, there was a push for states to prepare for biological terrorism. And the way that you prepare for that is by launching a syndromic surveillance system that’s constantly monitoring the background noise of emergency department visits, and then analyzing those visits, it’s all anonymized data of course, but it’s analyzing those visits for unusual clusters of signs and symptoms that may indicate a public health emergency in the making. And it could be an act of bio terrorism, or even just an emerging infectious disease, or possibly even a food-borne outbreak. But the idea of these syndromic surveillance systems is that with a biological agent, you have to identify a cluster and start investigating before you even have laboratory results. ‘Cause if you don’t intervene right away, a potentially curable illness could become fatal. So something like anthrax, for instance, you need to catch right away, and the early symptoms present like flu, so people don’t realize that they’re infected. So that’s what the field of syndromic surveillance is about. So I got that job in June of 2001, and all my friends were saying to me, “Well this job is crazy, why are we preparing “for biological terrorism? “I can’t believe my tax dollars paying for your salary.” Then a few months later we had 9/11, and then the anthrax attacks. And then those same friends were like, “You should be working harder,” you know, because there was an actual act of biological terrorism. So then the job after 9/11 and the anthrax attacks was understandably incredibly busy for a very long time. So I built up the syndromic surveillance system, which was basically I wrote a lot of statistical programs, and worked with hospitals to receive their data electronically and process it all automatically, and create charts, and do statistical tests on it, and then create a report every day. So I built up those systems fairly quickly, and also, of course, in cooperation with Centers for Disease Control guidance. And then we also then had to move to a higher level of state preparedness, in general. So I joined a task force of people, and we did a lot of trainings around the state around responding to incidents of biological terrorism, or chemical incidents, or radiological incidents. So I worked with, for instance, the fire academy, the FBI, the local office, the HAZMAT team, the Vermont Homeland Security unit, because the anthrax attacks created a situation where public health and law enforcement had to work together closely for the first time ever. We never really used to work with law enforcement, but now every white powder incident had to have law enforcement response, because of chain of custody, which I can explain if you want me to. But anyway, law enforcement has to be the one to arrive at the scene, and do the risk assessment, and collect a specimen that then public health tests, and then we manage the exposed people. So in 2001, law enforcement and public health were sort of thrown together into this mix, and we had to work out how to work together, what sort of protocols did we need? And then we realized that there was a strong need for training for first responders to understand public health emergencies and what their role was, and how they might be exposed, and how they might be protected in different situations. So that kept me busy for a really long time, and then just basically building up the syndromic system. And then along the way, of course, there’s food-borne outbreaks, and there’s different environmental hazards, and then we also had the 2009 pandemic influenza. So my job was to refine that system and use its products to guide policy for state-level public health. So that’s what I did for 10 years.

- It was a pleasure meeting you and interviewing you Pam. Thank you so much. And for our viewers, we will continue this series interviewing different people and positions that Pam mentioned today on a weekly basis. So thank you so much for joining us today.

- Hello, my name is John Carew, and I’m a senior at Middlebury College. I study comparative literature and public health, and I’m so excited for this opportunity to speak with a Middlebury College grad today. In light of current events, this interview today is part of a series on careers in public health, and part of the Midvantage Program. It is my pleasure to introduce you all to Seth Crew, a member of the Middlebury College Class of 2002. Seth is the associate director for policy in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. Currently, as part of the CDC’s Novel Coronavirus Emergency Response, he serves at the policy lead for CDC’s Health Systems Response and Worker Safety Task Force, and was recently the deputy policy-lead for the CDC Emergency Response. Previously, Seth was the lead special assistant to the CDC director, and he also worked in policy roles in various emergency responses, including the Ebola outbreak in the Democratic Republic of Congo in 2018 to 2019, the Zika Emergency Response in 2016, and West African Ebola Emergency Response in 2014 to 2016. Seth joined the CDC as a Presidential Management Fellow in 2012, and he has a Master’s of Public Administration from the Andrew Young School of Policy Studies at Georgia State University. Welcome, Seth.

- Thanks for having me, I’m looking forward to it.

- Thank you. I was hoping that we could begin with you telling us a little bit about what the public health industry is like, and some of the various types of careers available in the industry.

- Sure, as you noted, my job focuses on the policy aspects of public health, and that involves a lot of interactions with state policy-makers, so governors, state legislatures, as well as congressional audiences, congressional members, congressional staffers. And then working with other US government agencies. So, I highlight that because I think that shows a different non-clinical track to work in public health. Obviously, clinicians, scientists, folks with medical degrees, PhD’s in Epidemiology, Master’s in Public Health, are essential for careers in public health, but I think, just as essential, are other tracks with a policy analysis mindset and a communication mindset with these other decision-makers to work alongside of the clinicians and the scientists. So I think it’s important to highlight that there are both clinical and non-clinical aspects to work in public health, which are equally important at the moment.

- Could you tell me a little bit more about the day-to-day of your position of working on healthcare policy, or health policy at the CDC?

- Sure, right now it’s a little different than my normal day-to-day, as part of the emergency response, which has been ongoing for the last couple months. It’s a fast-paced environment. They are long days, six to seven days a week at the moment. And, what it really involves is a lot of coordination. So coordination with members and staff in congressional offices to explain to them what we’re doing, to answer their questions, to work with them to get the resources we need to do our jobs, coordination with other government agencies, like FEMA, like the White House, like the Department of Homeland Security, like the Department of State for International Issues, to make sure we’re all on the same page and working within our respective lanes to complement the work of others, and then a lot of coordination with state policy-makers as well, governors, state legislators, to coordinate the assistance that they need. So it’s a lot of moving pieces, keeping those pieces moving in the right direction, and making sure we’re aware of what the others are doing to all move in the same direction.

- Mm hmm, okay, why did you choose to go into this field, or do you know, is there a specific moment or a specific experience from which you draw your inspiration to do this kind of work?

- Yeah, it was a bit of a winding path. I did not enter public health right away after graduating Middlebury. I graduated Middlebury in ‘02, and my first job was in DC, and I’ll take a moment to kind of explain how I got to that first job, because I think it’s an important lesson for Middlebury current students and recent grads. I was an international studies major with a focus in political science and Latin American affairs. My thesis advisor at the time during my senior year, Professor Mark Williams, always did a great job of organizing lectures on Friday afternoons at about 4 p.m. That was not the most popular time for people to attend lectures with guest speakers from outside the college, but they were fantastic, so it was a boon to those that did make the time on a Friday afternoon, before getting the weekend started, to go to those events. He told me, you know, I know you’re looking for a career in research once you leave Middlebury, possibly in a think tank in DC. I have such a person coming to speak to us from a think tank in DC called the Inter American Dialogue, which is gonna be right up your alley, so you really need to be here this Friday at four o’clock to go to this lecture. You should come prepared. You should engage and ask some questions. Also, by the way, there’s gonna be a smaller dinner a couple hours later after the lecture, and only a select number of faculty and students are gonna be invited to that. So you’re gonna go to that as well. I’m gonna give you a seat next to our guest, and you’re gonna bring your resume with you, and chat him up, because this is gonna be your ticket to try and get introduced to this field. So I followed his good advice, and I had a great relationship with him from taking advantage of his office hours throughout the years. I attended the lecture, I went to the dinner, I sat next to the guest speaker. I took his business card. He took my resume. And we corresponded a bit, and by the time I graduated, I had a summer internship lined up in DC with that organization, which, at the end of the summer, turned into my first job post-college in DC. So that was on research and international affairs. A couple years after that I changed a bit and started working in direct social service work for another five or six years, and then, eventually, moved with my family down to Atlanta, went back to graduate school and considered staying in the non-profit management sector, or social service sector. But did some more thinking, and kind of was able to marry up the two paths, the research and policy that I had done more early on, and how it directly impacts people’s lives in a community setting. And that’s kind of how I found my way into public health, and it focused primarily at first on preparedness and response and disaster management. So it was a bit of a winding path, but now I’ve been at CDC for the last eight years in similar capacities.

- I so appreciate your mention of the various ways that your work is tied to community engagement, ‘cause I feel like that’s been such a big part of my experience at Middlebury. Were you able to take advantage, or did you have any specific community-engaged, either research projects or volunteer projects that you took on at Middlebury?

- You know, not so much at Middlebury, to be honest, but more post-Middlebury, after that first job, when I became more interested in some of the community engagement work. I managed a couple different non-profit programs that worked with immigrants and youth, both in DC and then later in Atlanta. And I am now, again, a bit removed from that, so I have to kind of keep the lens that the policies I’m working on do impact communities and individuals. It’s just several steps removed. So I just have to keep that in mind a bit.

- Do you keep anything in mind regarding the, when you’re working with a community that’s maybe different from your own community or your own background, what are some strategies, or what do you think are the most important things to keep in mind? And I ask that as someone who’s interested in pursuing public health, and marrying my interest in public health with languages I study, and having hesitation with working outside of the US or in communities that I’m not as familiar with, because I won’t have the same impact, or the same cultural background to be able to work productively with them.

- Yeah, at CDC we’re fortunate that it’s a very large organization with a wide breadth and very deep experience as well. So we have the luxury of having many people with experience working in many different environments. So we can use that to our advantage, and always work in teams on different projects, so that we get the experience of those that have worked in other environments with different communities. So I think that’s something very helpful, always being open to feedback from other people as well. You know, maybe when you’re in college you are working on a thesis or another paper, you might have a couple people edit it over the course of a long amount of time, whereas, at work I write a two-page document and it gets edited by like 15 people. So that’s something to get used to at first, but then you do get accustomed to welcoming that feedback, because everyone does have a different amount of expertise in different areas and different background, which really help whatever product you’re working on reach the broadest amount of people.

- Amazing. I’d like to return a little bit to your path to where you are now. And when I was going through your CV and your background, you mentioned taking part in the Presidential Management Fellows Program. And I think I’d love to hear more about it and how it led to where you are now, and how it can help with careers in government in general.

- Yeah, that’s something I’m very passionate about. I think that the Presidential Management Program or Fellowship is one of the best ways to get into government work. So for those of you that don’t know about it, yeah, you do have to have, or be in the process of completing a graduate degree, whether that’s a master’s or JD, or PhD. You can apply during your last year working graduate school. It’s a two-year program. You apply government-wide. It’s a rigorous application process with many steps along the way. Once you are accepted to this fellowship government-wide, you then go into a more traditional job search within the Federal Government. Most agencies across the government take advantage of it. It’s highly respected, and there’s a great alumni network across the agencies of people that came into government through the Presidential Management Fellowship, stayed in government for 20 years, and are now leaders in their respective organizations. So it has fantastic networking opportunities. And the fellows and alumni tend to really help each other and look out for each other, and it’s meant to groom the next cohort of government leadership. That being said, it is a really competitive program, but I think it’s a great way to get in. You advance quickly, you get a lot of great experience. After your two-year fellowship, you’re eligible to convert into permanent government employment. So you seem mostly just to kind of roll in if you choose to stay, and I think it’s just a fantastic pathway, and much easier than the traditional kind of open application process. So I highly recommend those of you that are thinking about master’s degrees or other higher education after Middlebury, to really consider, once you’re in that last year of graduate studies, to, if you are interested in government work at all, take a look at the Presidential Management Fellowship Program.

- What types of master’s or other advanced degrees are, you think, necessary or important for getting into the line of work you did? I ask that as someone who kind of has had this conception for a long time, or maybe a misconception, that, oftentimes, people who work at the CDC have a type of clinical degree, or have an MPH. So seeing your work as an MPA, could you speak somewhat to that, please?

- Sure, that’s also something I’m pretty passionate about. Obviously, we need the MDs, we need the PhD epidemiologists, we need the laboratory scientists at CDC and other public health organizations. I think it’s equally important we have the people that know how to work on budgets, we have the communicators that communicate with the public audiences, and we have the people that can work with congressional audiences, or state and local decision-maker audiences. So I think really having that breadth of experience makes any public health organization a stronger agency. So I always tell people, don’t be deterred if you don’t have the clinical background. There is a role for you, most likely, at a public health organization in a variety of settings to support the work of the scientists and the doctors that are at the forefront of that work. You might be a little bit more behind the scenes, but it’s still integral to the work group, many agencies.

- Thank you. You mentioned these positions that might be open for people who have advanced or master’s degrees. Are there any entry-level positions that you can think of for people interested in getting in this field? You mentioned your work after undergraduate. Would you recommend that or are there other options?

- Yeah, specifically at CDC, there is a great program called The Public Health Associate Program. It’s sort of like a mini Presidential Management Fellowship Program, but just for CDC, not government-wide, and just for those finishing their undergrad degree. I recommend people take a look at that. It places you for a couple years, either at CDC or sponsored by CDC at a state and local public health department. So that’s a great way to get in a taste of the field and see if it is something that one wants to continue working in. Also, at the moment, if one does go to, you’ll see a big banner that, government-wide, there’s a lot of hiring going on for some permanent positions, and some temporary. So year-long positions, to help in the Novel Coronavirus Emergency Response, but that’s CDC and other agencies. So I would take a look at those, and I think a lot of those will be based, not in DC or in Atlanta, where CDC is, but also out in the field throughout the country to help with that emergency response. So I think those are two good things to check out for someone that wants to take a look at the public health career right out of undergrad.

- And you mentioned that banner advertising positions related to the Novel Coronavirus Response. Do you see longer-term ramifications for the public health industry regarding the current pandemic?

- Yeah, that’s a good question, and to be clear, this would be my own opinion, not the opinion of the CDC or the US government, but I think it’s hard to predict what ramifications there could be. There may be increased focus on the importance of public health and building public health capacity at the state and local level, and at the federal level. I think if that were to be the case, that could be a long-term benefit to the field of public health, to increase the capacity of public health infrastructure to do its job.

- Thank you. I think now, in more of a general sense, I’d like to ask if there are any other pieces of advice that you’d like to offer for individuals at the college pursuing public health or careers in policy, whether you would offer similar advice for people looking for things in both industries, or if they would be the same pieces of advice?

- Yeah, I’ll go back to something I said earlier. One, take advantage while you’re still at Middlebury, of the professors and their networks, and their office hours. I mean, that was purely the way I got my first job out of Middlebury, and since then, that has helped me along the path. So, keep in touch with your professors, get to know them, take advantage of small settings where you can chat with them. That’s extremely important, and I always emphasize that to people. The second thing I would say is, pursue multiple paths at the same time. If, for example, someone is really focused on international relations, and their dream is to work at the State Department, that’s really difficult to do out of the gate. Don’t let that discourage you. There are many other organizations that you can work in and gain experience in international fields, for example, that may eventually lead you to your dream job at the State Department. Same thing with the CDC. If your dream is to work there, but you’re not able to get your foot in the door right out of college or right out of grad school, look at state and local health departments. Look at non-governmental organizations that work in the field, to gain more experience, and then work your way towards your dream or your goal. So don’t get discouraged along the way. Look at multiple paths, and be open to an organization or an agency or an entity that maybe was not the first, at the top of your list where you wanna end up, but will help you get there eventually.

- Thank you. I know, thinking about entering the job market and whatnot, right after undergrad, there are some of my peers and some of my friends, are thinking about pursuing fellowships or other international research or international learning, or international teaching opportunities for a couple of years before returning to the US and diving into a master’s program or a job or a career. Do you have any advice or any thoughts on that?

- Yeah, I think that’s a great path. And that kind of goes along with what I previously said about being open to new experiences. I mean, those are phenomenal programs, all the different fellowships that you just referred to, and research opportunities that will only help someone gain more experience and be a more attractive candidate for whatever they wanna do after that. And I encourage people to take advantage of fellowship-type opportunities while they’re actually working as well, after they’ve joined the workforce. I recently took part in a part-time fellowship run by Johns Hopkins University Center for Health Security out of their School of Public Health, which was a great fellowship that brought together mid-level people across government, across non-profit sectors, and the private sector, that all worked on similar public health preparedness and response issues, and brought us together for a series of networking events over the course of a year, which was fantastic. So I always encourage people to take advantage of things that can further research, give them new experiences, and bring them in contact with other people to expand their network.

- Thank you. Can you speak at all to the intersections between your work at the CDC or government work, in general, and the private sector, or ways that you might have worked with private sector entities in the past, whether in designing responses to the outbreaks you’ve worked on, or in designing policy?

- Yeah, that’s a good question. In the most recent role I held in this current emergency response, was on our, what we call our policy unit within the Emergency Operations Center. And a lot of that work is coordination and communication with the private sector. So whether that is pharmaceutical companies, diagnostic test manufacturing entities, producers of other critical supplies, it really is essential that each knows what the other is doing, and can coordinate. So I think that always comes up. It’s extremely important that the government sector stays in touch with the non-profit sector as well as the private for-profit sector as well.

- Thank you. I think, finally, I wanted to ask about the most gratifying part of your work, or what is it that drives you every day?

- I think at the moment, especially during the emergency response, which is kind of like, the furthest I can look at the moment while working on it, is knowing that, hopefully, in some small way, my individual piece of this massive, government-wide international emergency response, contributes to helping reduce illness and death in some way, due to coronavirus. So sometimes it’s hard to focus on the bigger picture when we’re focused on our very small piece of it, but I just try and kind of remember after the day is over, that, hopefully, something I did today, in some small way, contributes to the larger picture to get to the end of the pandemic and keep people safe and healthy.

- Thank you for that. Is there anything, in closing, that you’d like to share that I didn’t ask about? Any other advice, any other takeaways that someone should take from this?

- I think one of the things that has really helped me in my career is having a liberal arts background, and the education from Middlebury, one of the skills that I rely on most as a non-clinician working among many clinicians and scientists and doctors, is the ability to quickly read lots of information from different sources, synthesize that information, form thoughts and opinions and analyses of that information, and then present that information to a wide variety of audiences, whether it’s the public, whether it’s a congressman, whether it’s a congressional staffer, governor or governor’s office, et cetera, the ability to gather that information, quickly assimilate it, develop my own thoughts about it, and then present it back tailored to the audience that I’m talking to or writing to, I think, is something that I really gained from a liberal arts education, due to the amount of reading that you’re doing, the amount of quick-turnaround writing that you’re doing in a liberal arts school like Middlebury. So I think that is something that people should keep in the back of their mind too. Take advantage of that unique aspect of your education, whether you do go into scientific work or non-scientific work after, it really does form a basis of what I use every day in my role.

- Mm, and then briefly, have you come across opportunities to use languages, or non-English languages in your work, in reading these vast quantities of information, or presenting, or any of your colleagues? Is that involved with the type of work you do?

- Yeah, for me not so much on a day-to-day basis at the moment, not for lack of opportunity in CDC. For example, we have an enormous Center for Global Health that has offices in over 50 countries, with people permanently stationed in those countries. So there is a real need for people that have both the technical skills in public health there, as well as the language to accompany it when they work overseas. Just in my day-to-day role, I don’t use it as much, which I miss a little bit. I do speak Spanish. I studied that at Middlebury. I studied abroad my junior year, which I also highly encourage everyone to do. So I hope to get back to that at some point. It came in handy recently. I went with the CDC director and the secretary of the Department of Health and Human Services to Peru for a couple days for some work, so it was an added bonus that I could help navigate some of the things during our meetings there.

- That sounds amazing. Thank you, Seth, for speaking with us today. And thank you to our viewers for joining us today. And definitely be on the lookout for more episodes in this series. Thank you so much.

- Thanks, it was my pleasure.

- Hello everyone, my name is Guadalupe Vega, and I’m a senior at Middlebury College where I study molecular biology and biochemistry as well as being on the pre-med track. In light of current events, this interview today is a part of series of careers in public health and part of the MIDDVantage program. It is my pleasure to introduce you to Dr. Agnes Mwakingwe-Omari, a Middlebury alumni class of 2002. Dr. Agnes Mwakingwe-Omari is a physician scientist who since August 2019 has been working as a senior clinical and research development lead at GlaxoSmithKline conducting research in vaccines. Dr. Mwakingwe-Omari was born in Tanzania and says she was lucky to get a scholarship to attend high school at United World College of the Atlantic. She emigrated to the US for education where she attended Middlebury College. Matriculating in February Agnes remembers being in shock when she stepped out of the Greyhound bus in front of the old library building to find herself in knee-deep snow. Since graduating from Middlebury in 2002, with a major in chemistry. Agnes enrolled in a medical scientist training program at Albert Einstein College of Medicine in Bronx, New York. And in 2010, she obtained her MD-PhD in molecular biology and immunology, studying hosts malaria parasite interactions. She then went on to complete an internal medicine residency training program at Johns Hopkins Bayview Medical Center in 2013. Before joining GSK, Agnes spent six years at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, as an adult infectious disease clinical and research fellow and staff clinician. Agnes says she was introduced and immersed in clinical research at the NIH, an area that combines her passion for patient care and medical research. Although through the majority of her career, she has worked on the malaria parasite, both in the lab and in clinics, Agnes is now working on a different vaccine at GSK and is excited to learn a new industry and to apply and further develop her skills in a new field. Welcome, Dr. Agnes Mwakingwe.

- Thank you, thanks for the introduction.

- Of course, so I would like to begin by asking what exactly does your job look like? Or what you do on a day-to-day basis? And if there are any current projects you would like to discuss that you’re currently working on with GSK?

- Yeah, so on a day-to-day basis, I’m a clinical research and development lead which really means my main job is responsible for the scientific integrity of the various vaccines that is that we’re doing and what I’m responsible for. So different from if you’re the principal investigator actually doing the study. I’m on the sponsor side of things so I’m a little removed from where the research actually happens. So my work on a daily basis involves talking to a lot of people in different places, different functions, so statisticians, data management, program managers as we’re all trying together to manage the studies we’re doing around the world. Sometimes it’s discussions from a global perspective, sometimes we’re speaking with teams in the local level, sometimes we’re managing some issues that happened at the site where the study is actually happening. So there’s quite a bit of meetings in my daily basis and discussion with different people. I also spend quite a bit of time just thinking about studies, analyzing the data that we’ve already collected, doing literature research and keeping current with what’s going on with the field. So we do quite a bit of that, too. That’s how really my day looks like. It’s a lot of computer work, I’ll say.

- Alrighty and so can you talk to our listeners a little bit I’m sure they’d be interested to hear in what are the steps you took to where you are right now? If someone were to… Students that would like to follow a similar career path that that you took. So regarding after you graduated Middlebury, obtaining your MD-PhD and steps after to get to work for such a well known company like GSK. Any steps between or after all these that you would like to discuss with us?

- Yeah for me, a lot of it was either luck in a way or being in the right place at the right time. So, I had always wanted to understand how the human body works. How all the various systems interact and work together and ideally when I was learning it, they should be working perfectly. It doesn’t make sense why anybody should get sick, so understanding why people got sick and mainly infections. How is it that our systems can be essentially in the these little micro organisms can infect you and cause so much damage? Where are the gaps? Where the holes? So in trying to understand that, there was always a question I didn’t know how do people figure this out? So throughout the education as I got to Middlebury one of my classes was a biology class, microbiology class bio250 I remember specifically. The teacher that taught that class always really concentrated on the experiments that were used and the research that was done to learn a specific aspect that we were learning. And our exams used to be, if this was the question, design the experiments on how you would figure this out. So I got very interested in that and I had an opportunity to do a summer internship with Rick Bunt in chemistry and so I was introduced further into doing research and I was very excited I could design some questions and figure out how to answer them. And by the time I was to almost graduate, I started wondering what I would do eventually because throughout my younger age, before getting to college, I had always wanted to go to medical school, and I still wanted to do that. But now I was getting more interested in research and I wanted to explore that better. But I wasn’t sure how I could do both. Do I have to give up one, go to grad school or go to medical school and forget about research? And so I took a year off, which I think was the best thing I did at the time to be able to figure it out, have some time to evaluate what I really wanted to do. So I took a job as a research assistant at Cornell and there I really took the opportunity to talk to various people who were around, talk to my mentors that were there as well. And as I was really struggling with this question, my boss at the time said, “Well, Agnes you don’t have “to pick actually there are these programs “called medical scientist training programs, “the MD-PhD programs that would allow you to do both.” And for me, that was absolutely amazing because I didn’t have to give up anything. I could actually do both. I get in, so at that point, I really started trying to learn more about the programs and apply to those programs. And that’s how I ended up at a MD-PhD program. And I think throughout that I really learned that there’s a very important piece about being a physician scientist because you understand the medicine, you understand the people, but you also understand the science as well and it really helps to put the two together when you’re doing research in the medical field and trying to improve people’s health. And then after that is really a straight forward path for me, it’s just internal medicine residency, I’d always been interested in infectious diseases and since I really wanted to continue doing research and also clinical care, I was lucky to be able to get into an infectious disease fellowship at the NIH. And if you know anything about the NIH, a lot of research happens there, both on the basic science side, but also a lot of clinical research. And I had always been doing basic science research but when I got to the NIH, my director said, “Well, you can’t go as a clinical person, “you cannot go through NIH “without learning clinical trials.” And so that’s when I started getting to learn about clinical trials and it turned out to be the perfect fit for me because I could combine the things I really liked the most and that’s really how I ended up here. From NIH, the shift for me to industry at the moment, it took me a while to decide whether I really wanted to shift to industry. It’s always tough from academia to go to industry but I had wanted a change at the time and my research, at least of the company it seemed they had quite a bit of things that I believed in that putting patients first and that’s really what I believe people should think about. And so I applied and got that job that I just started doing so far, so good we’ll see how it continues.

- That’s amazing to hear, thank you. And so, following that what advice or recommendations do you have, again, for students looking to follow a similar career path as yours? Right now, especially during this time in the current situation it’s becoming more and more difficult to obtain an internship or a job. So any insights recommendation or advice you have for the current Middlebury students at the moment?

- I think even though like we’re quarantined, and we can’t really go out and interact with people, I think you have to take advantage of the situation we’re in. We have to take advantage of the technology we have, for example. You can still have conversations with people, you can still schedule meetings with people you had intended to meet and talk to before, you can still do that virtually. I think there may be opportunities that may come your way that you can’t at the moment foresee how they may help you in the path that you’ve been thinking about. But I would say you should definitely grab these opportunities because sometimes they open up some other information about yourself that you did not know. They also give you some knowledge that you hadn’t known before and that you could use in a different way later in the future. So I think that’s something I tried to do throughout my time, even with hesitancy some time when somebody suggested you should do this differently. I always wonder, well, is that gonna take me away from the path I’m in. But when I think back now, I think they’ve all been very useful twists and turns that have really guided to where I am nowadays. The other thing, get creative. I always think that the jobs that you guys will have an opportunity to do or will be doing probably didn’t exist 10, 15 years ago. So really have an open mind about that and if you have an idea, you also now probably have a bit of extra time that you can try and work on developing it and you’ll be able to say, you know it was quarantine time but this is what I worked on, and this is what I developed. This is what I learned. I think you should definitely use that time and not let it go to waste.

- And can you discuss a little bit more about the MD-PhD program you were in? Whether it did you do these programs separately or together? What was your experience like going through your MD-PhD and then doing residency?

- So I did them combined. I’m not sure how it works now, but at the time, the way it used to be some universities split the two even though you enrolled into MD-PhD program, you did first year MD complete it then you did a PhD or vice versa. At Albert Einstein, they combined the two. So my first year had medical school classes as well as graduate school classes. They did have to restructure some of the classes so they would fit in the schedules but that was our first year. My second year was all medical school classes with except maybe one graduate school class. But mainly because second year at Einstein, you did systems pathogenesis. So there was really no supplementing that in graduate school, the way medical school requires it. And then when we’re done with that, your third, fourth, fifth depending how many years it takes all those years were spent in a research lab to complete your PhD. And then once you’ve completed your PhD, then you went back to do third and fourth year of medical school. When you complete, there are few people who did not go to residency but most of us went and completed residency, even though quite a number just do research and don’t do any clinical work. There’s still quite a big percentage of people who do both or just do clinical work. So, minimum is seven years, I think. But for most, the average is probably eight or nine years. It’s a strange situation to be because by the time you get, for us the way it was structured by the time I went back to the clinic as a third year medical student, the people I started medical school class were my attendings. So it was quite an interesting situation. And then when you start your PhD years as anybody who has gone through a PhD program will tell you, you’re very excited the first year, second year, you’re really excited things are going well you’ve chosen your PhD projects and the lab, third and fourth year, man, many people getting quite depressed because things are not working. And then things work and then you graduate. So then it’s the end So that’s kind of the typical path.

- Okay, thank you so much for sharing that. And so, now working at GSK and before this working with NIH what differences do you see in working with these two different companies?

- I think the differences mainly have to do with academia versus private company. Private company, of course, there’s a business aspect of things that you have to think about. In academia, usually, the main thing is to really learn and understand the science. The focus is not really to develop an product, that’s a dream at the end of the day, if what you’re studying would end up being a product directly, but really is usually to understand the science. And that’s really the main difference I see a lots of some of the things I was doing at the NIH, I can think that okay, maybe practically, this may not be a product that we can actually use, this is not gonna be a vaccine that I can actually give to somebody because it requires a lot of steps. But we still did the studies and experiments because it gave you an opportunity to really understand the science behind it. So then, now that we understand more of the science behind it, now we can move to the next step to design something that could be used as a vaccine. In the business world, I think there’s that thought process probably becomes a bit earlier in the development or whatever, in this case, a vaccine you’re looking at. I think that comes earlier. One thing that’s for me is very crucial is that regardless of with academia or it’s a pharmaceutical industry, the fundamentals are the same for clinical trial. Safety of the patients, so the participants of the studies is always number one and is paramount. And as long as as soon as you start, what’s the word I’m looking for? As long as there’s that compromising the safety of the patient, you’re in trouble. So that’s fundamental. The second part is safety of your staff, who are doing the studies. And the third, and also most important part is just the integrity of the data that you’re collecting. So those main fundamentals stay the same, regardless really, of where you are. And for the most part, I’m doing clinical trials and that’s what I’m managing. So those fundamentals between the two worlds that I moved from and where I’m right now are the same, so it doesn’t change for me on a daily basis.

- And so now, regarding the COVID-19 pandemic, how do you see that this pandemic is going to change your industry in the future? And also, are there any big changes that you’re currently already seeing due current situations?

- Yeah, I think, however sad and devastating the COVID-19 pandemic is at the moment, and we really don’t know how long it’s going to last. One thing, maybe two main things that I see in what we do is it’s opened up new ways of thinking, new ways of working. There was already an effort to decentralize clinical trials, so clinical trials happen, you have a clinic it’s set up to do a study, you expecting people participating in the study to come to the clinic for the major interventions that you’re doing. So if you’re administering vaccine, you’re expecting people to come to the clinic to get that vaccine. For the most part, that’s how they’re done. In this situation, you can imagine you really can’t have people coming into the clinic to get your vaccine because everybody is at home and is not supposed to go anywhere. It also has limited participation in various diversity groups for various reasons, either people who are really sick or people who are very old, people who are disabled and they cannot go there. And because of that, they have not been represented in research and therefore you don’t really know if there are any differences in the safety or in the efficacy of whatever product you’re studying. So the pandemic has really opened up, and I think is going to speed up the process of trying to decentralize studies, as in instead of having people come to the centers to give us interventions, rather the investigators go to the people and the hope is that more people will be able to participate and more groups that have not been represented before in the studies will also be able to participate. We’re talking a lot more now about using virtual communication, sort of similar to telemedicine. As you can imagine right now, if you’re ill then you need to call your primary care doctor, most clinics are doing telemedicine, so ideally implementing those similar measures in the conduct of clinical trials. But the major thing I think that will also have a lasting impact is just the collaboration between various teams. In academia collaboration is very common, but now we’re seeing even with this big pharmaceutical industries that usually compete very intensely with one another are now collaborating to be able to create a vaccine, I guess the pandemic COVID-19. And I think that’s good because it started conversation between these two groups, they start to get into understanding, we develop those paths that hopefully we can continue collaborating in the future. The competition is good but also, I think it leads to also some waste, especially if like two different companies are working on the same thing that it probably looks a lot similar. That I think will also be diminished. So those things I’m very excited about and I think we’ll have a lasting impact even after the pandemic.

- Thank you. And, again, right now with COVID-19 going on, are you hearing hearing a lot of conversations and a lot of people talking about, “Oh, when is there finally gonna be a vaccine “and why is it taking so long?” And a lot of people don’t seem to understand the process and how long it takes to make a vaccine first going through certain all the clinical trials that must be done. Now, the testing again, you talked about your patient safety when doing all this. So if you can just speak to our listeners about the process of making the vaccine and getting it approved and finally getting it distributed to the general population?

- Yeah, it’s it’s definitely a struggle, even for those of us who understand the procedures that need to take place, that it still takes a long time. We sometimes look at these studies where it probably takes 20, 30 years from when somebody first discovered something in the laboratory until it gets to a stage where it can be given to people by their doctors. And the main reason has to do with exactly what you said is evaluating the safety. So there’s a lot of rules and regulations that are placed in between in order to ensure that anything that’s going to be given to people is as safe as we have been able to evaluate it. So most of the studies start in the test tube, and that may take years. We’re lucky in this situation with the COVID-19 because people had already been working on Corona viruses. They’re not exactly the one that’s causing the pandemic right now, but they’re similar. Therefore, they’ve learned quite a bit about it. They had already identified some good antigens that could be used to elicit very good immune system against the corona viruses. So we already maybe four or five years ahead of the curve at that stage, and they’ll already even so the first part, they still have to do animal work. Make sure that it’s safe in animals. You start with small animals, you move to bigger animals, you have to repeat the study. Experiments always have to be reproducible and so after that’s done, that may take a few months, it may take a year or more before you can get to the first study in people to really be able to show that this is safe when you administer in people. And because of the caution that we really have to take the safety studies they’re called phase I studies. You start with very few number of people and your main goal is to really show that when you administer your products to a person, you’re not causing major problems. You start with a small study, a small number of people, you increase the size of the people that you administer the products and at that point, you kind of have to stop and you have to get your information to the regulatory bodies to really evaluate that, okay, this does seem safe and you can cautionary proceed to looking at whether it’s effective. Be it a vaccine, be it a medication it’s similar steps really. Once you’ve shown that is effective, that’s usually a smaller number of people. phase II studies. Once you’ve shown it’s reasonably safe, it’s reasonably effective then you still need to get approval from the regulatory authorities that, “Okay, now you can move on to the next stage.” Which is really to show the effectiveness in a larger group of people and those are big phase III studies. Those studies can sometimes depending on what you’re looking for, they could be thousands of people enrolled in those studies. We’ve done some studies where they have 30,000 people, you can imagine different with animal, with mice, for example, you can say I need 20 mice. You can get all your mice together in one day and vaccinate them. This is people so it takes a while to get everybody that you need for the study to get enrolled in the study. So it may take a while to even get everybody you need to include and then to follow up to really show whether it was effectiveness that you were showing off your product or whatever it is you were looking for at the time. So that’s why it really takes a lot of years and even after that and the regulatory authority say, “Okay, this product is approved, “and it can be sold in the market.” Your job is not done and you still know that the product is out in the market for everybody to be able to access, you still have to monitor the safety of that product because you’ve only studied a small number of people, when it’s in the market. Now you have a larger amount of people so those rare things that you have not seen in the studies, that’s when they start showing up. Which is why you can see that sometimes you have a medicine that had been approved and it was in market and then later the FDA says, “We have to pull it out “of the market, because we’ve seen that it causes harm.” It’s not because the job wasn’t done properly before. It’s just that those events are very rare and now that it’s out in the market, that’s when they’re seen. It’s a balance between trying to make sure there’s nothing that’s unsafe that’s getting to people, but also trying to shorten the amount of time to get important and effective medications to people. So I think now, it’s a time we have a pandemic we’re really looking for vaccines and medications to be able to manage the infection. It’s really forcing people’s hands to really find ways to make sure they can balance, how long it takes and how safe and effective the interventions are. I hope that helps a bit.

- Yeah, thank you so much. And I believe those are all the questions that I have for you, unless there are any closing remarks that you would like to add on your part.

- Yeah, I think that… As tough as it may seem at the moment, I think we just needs to be hopeful. There’s a lot of devastation but I think there’s also an opportunity that we can take at this time to improve how we work, improve how we interact with people, how we interact with the world in general, it’s a lot of opportunity for people to find other new things to do. Like I said earlier, you guys are the next generation, and you definitely have the opportunity at the moment to change the path and I think this is a good time to do that. So I think we should take the positives where we can and think about them.

- All right, well, thank you so much for joining us today Dr. Mwakingwe.

- Oh, you’re welcome and good luck.

- Thank you.

- Hello, my name is Asra Muhammadi and I’m a senior at Middlebury College where I study economics and global health. In light of current events this interview today is a part of a series of careers in public health and part of the MIDDVantage Program. It is my pleasure to introduce you all to Mikail Dastgir, Middlebury class of 2010, a graduate of the United World College of Southern Africa, UWCSA, Mikail attended Middlebury as a UWC-Davis scholar, graduating in 2010, with a major in International Politics and Economics and a minor in African Studies. During his time in Middlebury, Mikail pursued summer internships in the nonprofit sector in Dar es Salaam, Tanzania, and as an independent researcher with the AIDS and Society Research Unit at the University of Cape Town. After graduating he went on to be selected for the two year Junior Professionals Program with the World Bank Group based in Washington DC, working with the urban and water and health and nutrition and population departments for the Sub-Saharan Africa region, thereby continuing to cultivate his interest and knowledge of the global public health field. Between 2012 and 2014, he attended Harvard University School of Public Health, graduating with a Master’s of Science in Global Health and Population concentrating in infectious disease, epidemiology and maternal and child health. He subsequently returned to the World Bank as a health specialist in 2014, managing the bank’s health sector portfolio in Southern Africa and South Asia. Currently, the areas of focus of the health care programs under his purview include health system strengthening, maternal and child health, HIV, TB and malaria mitigation and the healthcare of internationally displaced populations in Bangladesh and Pakistan. I just love to know more about like your day to day or what the World Bank does in general or what that entails.

- Well, the World Bank’s obviously as you mentioned, it’s a massive organization and we have research divisions and that’s what produces all of the data that students are most familiar with the world development indicators etc. And the Developmental Economic Research Group tends to focus on those areas. Studies and macroeconomic data and then you have the different practice groups, what we call them that actually implement programs they are also generating knowledge at the country level at the project level or operational research that what we call and so those those operational groups are divided into your different content areas, you have health nutrition population, which is where I work, then you have the education group, the energy sector, infrastructure that’s responsible for big infrastructure projects, roads, bridges, energy is responsible for building infrastructure related to energy etc. So in the health nutrition population group, we’re divided into different regions. So I work in the Africa region, which its stuff it’s divided into three teams, the one by region within the continents. So we have Eastern Southern Africa where I work then you have Central Africa and then you have West Africa. Similarly, we have South Asia Group Eastern Europe, Central Asia Group, Latin America etc. And because we’re an umbrella of the health and population group, we’re encouraged to work out of our different regions on various projects. But to varying degrees, that doesn’t always happen. We tend to work, a lot of the time we do work within our regions, and we interact with other project managers that work on different countries within our region. So the projects that I mentioned earlier that I’ve kind of been under my purview have been maternal and child health related projects and HIV/AIDS related programs and a lot of other partners such as PEPFAR, etc, do work a lot in HIV/AIDS. So I think the main the World Bank tends to, where we try our best to work with partners and try to do “gap filling”. We use a gap filling approach, which essentially means that we don’t want to be repetitive of what other agencies are doing. If essentially if HIV/AIDS is a major funded area, so aspects of other organizations such as the Global Fund and PEPFAR funding, we try to sort of work in areas that may be vertical programs, what we call vertical programs, which focus on a specific issue don’t necessarily cover. So that’s why health system strengthening, the overall strengthening of service delivery within a country’s particular health care system and maternal child health was an area that my mentor tended to focus on quite a bit because again, not a lot of agencies are focused heavily on it and it’s something my mentor was passionate about. So improving maternal and child mortality, strengthening the service delivery systems, so that immunization programs function well, supply chains and drugs and vaccinations that are delivered to different parts of the health system are reached in a timely manner and are unexpired are stored in cold storage. There’s refrigerators present and there’s reliable energy supplies for the refrigerators to actually work and store these medications that need to be vaccinated. These are areas kind of we believe I’ve worked heavily on. And overall obviously, as I mentioned, health systems strengthening which essentially means how do we improve overall service delivery, whether it’s deployment of human resources to all parts of the health system, where it’s most needed, supply as well as deployment is key. And then of course, the aspects of service delivery of within the healthcare system itself is there adequate drug availability, equipment availability, infrastructure availability is there adequate knowledge of the providers, are they able to correctly diagnose and then eventually treat the conditions that arrive at their designated level or tier of healthcare service delivery? And if not, how do we promote capacity building to ensure that these doctors and nurses are able to treat and even if they are able to treat then the next level is whether the supplies that they need are actually available to them to be able to treat those conditions. An example I’ll give is, a doctor might say they are able to perform cesarean sections if they need to in a complicated situation, but then if they don’t have the anesthesia available, if they don’t have a functioning operating theater, then it’s very well and good that they’re technically trained to be able to perform a service. But then if it’s not, there’s not effective coverage and there’s not a delivery of that service is not taking place empirically or practically, then that, it’s as good as not having the service available at all, to those areas that have been working on and one memorable project that I would say I’ve really more recently enjoyed working on has been working with the displaced Ranga community here in Bangladesh, where I’m currently based in the context of the current crisis and not having been able to travel. So I’m here but it’s been interesting to work on this project number one, because it is my own country, but I haven’t directly worked here since I left for United World College when I was 15, 16 years old. And this has been a very current crisis for the region and for Bangladesh in particular, and it’s been interesting to see the conditions in the camps, but also be able to give back in a way to a crisis that’s very current within the context of Bangladesh. And what we’ve been trying to do through that program, which has been interesting for me is, there’s been a lot of money going towards helping, obviously the community itself, but as a whole, the district of Cox’s Bazar, where they reside currently hasn’t seen the same level of resources as this particular community has been seeing, because of the different partners that are working in the region. So that’s where again, this gap filling approach where the World Bank, we have our project that is geared towards the ruling of community, but then we thought in addition to that, let us also design a program that’s helping to bolster the health system of the district as a whole and this will impact not just the displaced communities but also the healthcare needs of the host communities because it’s a district that has generally speaking lagged behind the rest of the country in terms of its healthcare indicators, even before this crisis began, but now there has been all this attention on the district, but it’s been focused primarily on this community. So how do we sort of ameliorate that by trying to focus on the overall health system of the district, whether it involves renovating and rehabilitating health centers and the hospitals providing more human resources, more training for human resources, etc. So that, they can deliver health care not just to the Ranga community but also to the overall population of that district. So that’s been a really interesting project, currently, that I’ve been supporting.

- Speaking of the hot topic, the pandemic. I would just love to get a person who’s working in public health, their opinion on it specifically, if you could highlight how you envision it playing out in the developing world, that is an area of personal interest to me and I’m sure people would love to hear your views.

- I’m sure you’ve seen in the news that many organizations, the World Bank included has diverted resources, financial resources towards fighting this pandemic, particularly obviously, in the developing setting. And we are kind of trying to right now evolve our programming to sort of incorporate these areas, whether it involves emergency put projects that we fast track approvals so that we can begin implementing right away, or as I was mentioning, how we can sort of within the purview of existing programs, which are left relatively broad if we can divert resources from our existing projects towards fighting this particular crisis in the context of developing countries, pandemic preparedness and emergency surveillance, these are areas that really need to be bolstered during this time so that you can very easily track where outbreaks are breaking out as and when they happen and trace contacts. So it’s been interesting for me to absorb observe this from the lens of somebody who is a healthcare professional and to see how developed countries and now developing countries are trying to handle this crisis because as you know this originated from China, which is a industrialized country, and then it’s spread to the developed world, and now it’s emerging in a big way in developing countries. And one of the interesting things has been observing whether developing countries and health care, ministries of health within developing countries, leadership in developing countries have been learning from the experiences have developed countries who have all the capacity and resources at their disposal, supposedly to handle a crisis such as this, and what lessons are being learned. And it’s been sad to see that, countries, whether there are capacity constraints in countries like Bangladesh and in Sub Saharan Africa, it’s still sad to see that certain steps weren’t taken early enough to ensure that this could have been contained to as best as was possible given resource constraints and in the developing world, because we’ve seen countries such as in Italy, and in Europe at large, what their experience has been. And now, two, three weeks ago Italy was at the peak of their epidemic, Spain and Italy, France, and now it’s sort of the epicenter is moved to the US. And you have this disparity between countries that have universal health coverage in Europe versus countries like the US where you have the largest economy in the world but lacking universal health coverage. And what that essentially means is not everybody who is affected by this virus is able to access health care within a country like the US versus in Europe where theoretically you have nationalized universal systems where everybody can access it if they need to. But obviously, the discourse around it was trying to flatten the curve, as you must have that terminology has been floating around everywhere, where essentially, we’re trying to help the health system to be able to cope. And just because everybody has access to health care doesn’t mean the health system is capable of supporting the health care needs of every single individual at one given point in time. It’s not designed that way. And so and when you come to resource constraints settings like in developing countries, it’s even more, alarming, and it’s to see, how this epidemic is going to play out because it’s only just now starting to evolve within the context of developing countries, because initially it had spread within, the Western Hemisphere. And now we’re seeing cases in countries like South Africa, here in India and Pakistan, Bangladesh. But these countries were observing the experiences of countries such as Italy and the US and certain steps, even within resource constraints settings might have been taken and the simplest one could have been, stopping flights and trying to contain the people that were arriving from overseas, including your own citizens, making sure that quarantining was adhered to if it’s not possible. Again, we live in resource constrained settings where individuals live in, five people to a small dwelling and it’s not possible to self isolate if one person has been exposed from the remaining family members. So there should have been certain institutional quarantining measures in place in certain developing countries. So that if home quarantining isn’t feasible, in certain low income housing, then you have an alternative available, but these were not as strictly enforced. I’m speaking in this context of Bangladesh as maybe it should have been, people were arriving and they were asked to home quarantine but they’re living in situations where it’s not possible. But the facilities for institutional quarantining were not sufficiently available for the people that were returning and in particular, we have a huge diaspora Bangladeshis living in Italy, and they were returning in their droves when this this pandemic began. And the arriving passengers were not institutionally quarantine, some of them were and then a lot of them refused to remain in institutional quarantine, perhaps the facilities were not adequate for them, or perhaps they didn’t have the knowledge and they didn’t understand why they were being asked to live in an institutional facility instead of going home. And then it started to spread, and now we have a situation where, in the first few weeks of the epidemic, again, testing has been key in the developed world as well as now in the developing world. And every single country didn’t have sufficient testing to really understand the scale of the epidemic in their specific contexts. And one country that I’ve really admired and how their approach has kind of been to dealing with this epidemic has been South Korea, because seeing this experience of China, they very early on began ramping up their testing capacity to be able to really understand what they were dealing with in terms of diagnosis and then being able to target who they were treating. And in the context of developing countries, this has not been necessarily possible. The test for Coronavirus, the COVID-19 virus is a resource heavy test, it requires specialized PCR equipment. And in the context of Bangladesh in the very early stages, there was only one center for epidemiology in the entire country that was testing and they didn’t, they only had a capacity to test a certain number of cases every day. But now in the course of the last month, they’ve deployed equipment to different parts of the country. And now you’re seeing testing figures ramping up, within 300 to 400 daily new infections every day. But this doesn’t mean this wasn’t present some weeks ago. It’s just that we didn’t have the capacity to test. So these are constraints that are very concerning for the developing country context that and the capacity to be able to quarantine institutionally in resource constrained environments where people aren’t able to self quarantine at home in the same way. And, of course you have the situation of people’s livelihoods being affected so many people subsist in developing countries in order to survive and you have situations where people aren’t able to earn their daily incomes through selling their wares or peddling rickshaws or whatever examples you might want to give in there, whether then less concerned about Coronavirus as they are about feeding their families and the quote that I’ve been hearing on the news every day is well Coronavirus won’t kill us before hunger does and that’s something that definitely needs to be dealt with in the developing country context. I know countries are trying to distribute rice, lentils, oil, basic necessities. But again, these are corrupt processes and wares they’re being stolen before they’re reaching the beneficiaries they’re meant to be reaching. And that’s really been very sad to see this sort of situation playing out, you would hope that in the crisis such as this, humanity would come together to help the people that aren’t able to help themselves. But even in these situations, you have people trying to take advantage of the crisis to sort of amass resources, amass for grain food kind and all these type of amenities that are meant to help people in general and that’s been very sad to see as well, I would say.

- What do you think a perfect response would look like from this day forward, if you’ve been directed and had all the resources at your disposal?

- Can you repeat the question?

- So what do you envision a perfect response looking like if the developing to the developed world? But let’s just say you put directive right now, and had all the resources you wanted at your disposal.

- I don’t feel prepared or sort of who am I to be able to answer a question like that as a just to help mid career health care professional, but I’ll try. I mean, I think it’s the first thing that’s really important in dealing with this epidemic is diagnosis and testing. And we’ve been hearing it every day from Anthony Fauci and, all different levels of healthcare administration that testing is key. And because this virus is so difficult to test in terms of the resources that are available, it does make it more challenging in the developing country context, not having the specialized equipment to test. But it’s still highly, highly important because you won’t ever understand the full scale of an epidemic if you’re not able to test. And yes, we have the viral test, which is through this PCR machines, and it’s resource heavy. But there are other alternative tests emerging that are not as sensitive or specific as the viral test should be. But they’re still a very good alternative I feel for resource constrained settings. And these are these antibody testing kits that are also now being used in the US and developed countries to test healthcare professionals, and what it essentially does is rather than test for the virus it tests for the presence of the antibody to the virus, and it’s not a perfect system, I understand that and I’m not a scientist, so I can’t speak to the intricacies of it. But essentially, you will have an antibody in your blood if you were exposed at a given time, even if you’re not positive for the virus currently. So there will be an increase in false negatives as a result of testing using this method. But I still feel that as the overall approach, false negatives are not as alarming a problem as false positives or not testing a sufficient numbers of people. So this is I feel one aspect that developing countries could be ramping up by manufacturing these relatively low cost testing kits. They know in Bangladesh, they’ve manufactured an alternative that’s meant to cost around $3. These testing kits were all you require is a prick of blood and then you can test for the antibody to Corona virus and while it’s not ideal, it’s a very effective means of gauging at the country level, what exactly you’re dealing with in terms of diagnosis. That’s definitely the first aspect I would have tried to sort of address is testing and number two, I would say that given that this virus has been spreading in our globalized community through travel, I think countries should have taken steps very early on to sort of limit travel outside and within international travel into their countries. Yes, there is a moral obligation to bring your own citizens back to your countries from wherever they might be stranded. But in doing so, you also have to have facilities in place to institutionally quarantine people who have not just… It’s very difficult because you have people who are symptomatic and asymptomatic and if you ideal circumstances with all the resources available as you mentioned, I would have quarantined asymptomatic and symptomatic people. But, of course in constrained settings that’s really not practical. So you’re only able to quarantine those who have exhibit certain symptoms at the time. But in bringing people who are stranded overseas into your countries, you have to have a means of quarantining institutionally, those who are most affected or at risk of spreading this virus within their communities and within their families. And also limiting travel from external citizens of other countries into your countries. It’s really Paramount and I don’t feel that a lot of developing countries didn’t take that measure early enough. Maybe they weren’t able to foresee how this was going to evolve, between March and April, but I feel that, a country like Bangladesh should have taken this measure much earlier than they did. But they were operating under the assumption that, they had low testing, and therefore, they had low case numbers, but they were operating under a false pretension that this meant that it wasn’t a huge problem in their country, whereas, in fact, as healthcare professionals and epidemiologist, we know that just because you have low case numbers isn’t reflective of what’s actually happening on the ground, if you’re not even testing, of course, you’re gonna have low test numbers if people are not being tested. So that was kind of what I think, been a common thread in many countries that low test numbers, low case numbers tended to low countries into a false sense of security that maybe this hadn’t reached their borders as yet, when in fact, it might have have already and certain decisions were delayed lock downs were delayed border closures were delayed, when it should have been done maybe in the beginning of March, end of February even as low as that as early as that. But they still were thinking of it as having spread from China to Europe to the US and Canada, but not yet within Sub Saharan Africa and Latin America in the developing country context. So definitely earlier action, but hindsight, as they say, is always 2020. So it’s easy for someone to make these prescriptions now. But in reality maybe at the time, there were reasons why certain steps weren’t taken early enough, particularly in the context of the developing world.

- My follow up question to that would be and it might be a slightly repetitive question, but in terms of how normally when you have outbreaks or diseases, they have tend to happen either in the developing world where we are able to effectively transfer resources from the more developed nations to these developing nations and kind of contain it. But given the sense that everyone is globally struggling, and given Trump’s recent decision to cut funding to the UN. How do you envision that particular decision and the fact that these regions constrained have even less resources now potentially, to fight this? How do you envision that playing out or affecting the public health scene?

- It’s definitely gonna be a very challenging time, you’re right, because it’s a good example, would be like, for instance, the Ebola epidemic. It was something that was sort of, yes, there was a huge concern in the West about Ebola but it was more along the lines of we don’t want it to spread from Sierra Leone, Liberia, Guinea, the DRC, to our countries, so we need to make develop treatments and make sure it’s available so that it doesn’t affect us. But it seems something that honestly felt more far removed than Coronavirus did because it was affecting these very low resource settings and countries that aren’t very frequently traveled to so it was easier maybe to contain them because it’s not something that started in a country like China, which is inextricably linked to every single country in the world and something starting there, it will not take very long for it to spread everywhere else. Whereas if something starts in, in a country like Sierra Leone, it’s more far removed because you can imagine that there is not gonna be as much travel in and out of a country such as that for it to affect the globe. And yes, we have situations now where developed countries are struggling to meet their own domestic healthcare needs, number one, number two resources in terms of importing of testing kits, importing of raw materials and reagents to manufacture testing kits. There’s gonna be, I imagine bidding wars between countries to import these products like testing products and kits, raw materials to manufacture testing kits. So how do developing countries compete with countries like the US and European Union and other countries to import the raw materials they need to manufacture these tests? So yes, it’s definitely gonna be a very challenging time because every single country developed and developing are now going to be struggling with this pandemic. And yes, the recent decision of the US administration to pull funding from the WHO was very disappointing to see. But I’ve also been seeing within, the press conferences given by Dr. Ted Ross, his daily briefings, that there have been resources that are rallying globally to sort offset the potential of losing the US funding to the WHO, whether it’s through private individuals, whether it’s through foundations like the Gates Foundation, and whether it’s through other developed countries and the European Union. There are resources being mobilized, and I’ve seen that within the World Bank contexts as well, where we’ve mobilized, I think $190 billion, and last I checked, but don’t quote me on the figure. But we have mobilized some resources that are specific for developing countries and we’re not the only organization. There’s the UN agencies, and there’s other foundations, Gates Foundation and other organizations that are mobilizing resources for the developing country context. And, of course, I think bilateral funding from government to government is definitely gonna be affected by this because you can’t expect countries such as the US, as well as European countries that are dealing with the epidemic within their own borders to have as much resources or make as much resources available for the international needs of developing countries. But I’m hoping that, the global community sort of we’ll pull together and whether it’s private individuals and foundations, as well as individual governments, if they’re pulling together, whatever limited resources are possible. We can sort of deploy them to where it’s most needed. And in terms of the public health community, I think there is a lot more kind of opportunities in our field. There are more jobs in this field now because there’s such a immense need for it. So I think the jobs wouldn’t be there if the resources weren’t available to sort of finance the employment of different health care professionals in different aspects of responding to this virus. So I think there will be definitely a lot of opportunities in the field because resources are indeed being mobilized for existing healthcare professionals like ourselves, but as well, there’ll be a growing interest in this field, a lot more people pursuing healthcare qualifications, whether it’s public health qualifications, whether it’s medical qualifications, research qualifications, etc. So there will be I feel, this has been certainly a wake up call for the global community in terms of this is… Yes, the death rates may not be as high as other epidemics that we’ve seen in the past. But in terms of its reach, and in terms of how it has slowed down in the entire global economy, we’ve certainly not seen anything like it in the lifetime of ourselves as well as our parents even. And I think the memory of this I hope will make people and organizations better prepared and sort of mobilizing financial resources and decision making at all levels of policy not just from healthcare professionals, but also decision makers within the policy framework of various countries to really have an impact on how a healthcare system might be run, but they’re not necessarily working directly on health care ministries, specifically, but hopefully they’ll make better decisions and deploy more resources in kind and financial to pandemic preparedness and to surveillance systems and so that in future outbreaks, there’s better kind of surveillance systems and measures in place to really pinpoint where an outbreak starts, how it starts and trace contacts and then better able to contain it particularly in resource constrained settings.

- It’s everything that I’d hoped to ask you today, unless there’s any closing remarks on your end.

- No, I think all I’d like to say is thank you very much for the opportunity. I hope I haven’t rambled too much in my responses, but I am optimistic for the field of public health. I do feel that there’s gonna be a lot more interest and hopefully more focus and resources diverted to the health care’s healthcare sectors and in the context of both developed and developing countries so that there will be opportunities for people to engage and really prevent sort of future outbreaks from taking place. I really hope for countries such as the US with all the resources at its disposal really takes a strong and hard look at their healthcare system and its imperfections and really tries to sort of engineer and design a system that’s more equitable, and more able to serve the needs of its entire population, not just those who have the financial resources to afford health care, because as you’ve seen in the news, this pandemic has certainly affected minority communities in the US and the UK, and Europe much more strongly than it has, other communities and that’s simply a factor of not just access to health care, but also the types of essential work that is done by minority communities, whether it’s public transport, whether It’s delivery of mail services, Amazon, supermarket jobs. These are all fulfilled by minority communities who do not necessarily have access to adequate health care, but they’re putting themselves at the highest risk of contracting this. And that’s why it’s no surprise that the spread of this virus in those communities has been higher. So I hope that countries like the US take a stronger look at their healthcare systems where they have the resources, but it’s not serving the needs of their entire communities. And hopefully something can be done about it within the next year or two, as we kind of learned from this experience.

- It’s everything that I’d hoped to ask you today unless there’s any closing remarks on your end.

- No, I think all I’d like to say is thank you very much for the opportunity. I hope I haven’t rambled too much in my responses. But I am optimistic for the field of public health, I do feel that there’s gonna be a lot more interest and hopefully more focus and resources diverted to the healthcare sectors and in the context of both developed and developing countries so that there will be opportunities for people to engage and really prevent sort of future outbreaks from taking place. I really hope for countries such as the US with all the resources at its disposal really takes a strong and hard look at their healthcare system and its imperfections and really tries to sort of engineer and design a system that’s more equitable, and more able to serve the needs of its entire population, not just those who have the financial resources to afford healthcare because as you’ve seen in the news, this pandemic has certainly affected minority communities in the US and the UK, and Europe much more strongly than it has other communities. And that’s simply a factor of not just access to health care, but also the types of essential work that is done by minority communities, whether it’s public transport, whether it’s delivery of mail services, Amazon, supermarket jobs. These are all fulfilled by minority communities who do not necessarily have access to adequate health care, but they’re putting themselves at the highest risk of contracting this and that’s why it’s no surprise that the spread of this virus in those communities has been higher. So I hope that countries like the US take a stronger look at their health care systems where they have the resources but it’s not serving the needs of their entire communities. And hopefully something can be done about it within the next year or two, as we kind of learn from this experience.

- Thank you Mikail, for sharing your insights and views with us. We really appreciated that and your time.

- Thank you for having me.

- Those are pleasure entirely and thank you to our viewers as well for joining us. Be on the lookout for more episodes of this series.

Public Health Guest Speaker Biographies

Pam Berenbaum is Director of the Global Health Program, Professor of the Practice of Global Health, and a member of the leadership team for the Experiential Learning Centers. She has taught at Middlebury since 2010, teaching courses on global health, public health policy, and disaster public health. Pam holds a Master of Science in Health Policy and Management from the Harvard School of Public Health. She has worked in many sectors, including government, academic, consulting, and non-profit. For ten years, she was an infectious disease epidemiologist in the Epidemiology Field Unit at the Vermont Department of Health, where she specialized in syndromic surveillance, bioterrorism, and all-hazards emergency preparedness, collaborating with personnel from other state agencies as well as the CDC.

Chris Bernene is a Founding Partner in Oliver Wyman’s Health & Life Sciences Practice. His expertise spans a broad range of strategic issues facing health plans, including consumer strategy, digital healthcare, healthcare financing, distribution strategy, and ancillary product strategy. Chris has been with Oliver Wyman for over 20 years and started the healthcare practice with three other Partners in 2004.  Chris received a BA in English (Summa Cum Laude) from Middlebury College in 1990, an MPhil in English literature from the University of Oxford, and an MBA from the Amos Tuck School of Business at Dartmouth College.  In addition to being involved in his class year’s reunion planning, Chris has also been very active within the Middlebury Professional Network as a participant in CCI on-campus career programming, recruiting, and in the Consulting Case Interview Mentoring Program.

Mikail Dastgir is a Public Health Specialist at World Bank Group. A graduate of the United World College of Southern Africa (UWCSA) in eSwatini, Mikail then graduated from Middlebury College in 2010 with a major in International Politics and Economics, and a minor in African Studies. After Middlebury, he went on to be selected for the two-year Junior Professionals program with the World Bank Group, based in Washington, DC, working with the Urban and Water, and Health, Nutrition and Population departments for the Sub-Saharan Africa region. Between 2012-2014 he attended Harvard University’s School of Public Health, graduating with a Master of Science in Global Health and Population, concentrating in Infectious Disease Epidemiology, and Maternal and Child Health. He subsequently returned to the World Bank as a Health Specialist in 2014, managing the Bank’s health sector portfolio in Southern Africa and South Asia.

Andrew Hale, MD is an infectious diseases specialist, medical educator, and researcher. He graduated from Middlebury College in 2006 and then went to medical school at Tufts University in Boston, MA, then completed residency, chief residency, and fellowship training at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. He now is assistant professor of medicine at the University of Vermont Larner College of Medicine.

Russ Johanson, MD is a practicing emergency physician at MatSu Regional Hospital in Palmer, AK. He graduated from Middlebury College in 2006 and is Vice President of MatSu Emergency Phycians, and on the Board of Directors for the Alaska Chapter of the American College of Emergency Physicians. After graduating Middlebury, Russ attended the University of Connecticut School of Medicine, and then the University of Massachusetts Emergency Medicine Residency Program before moving to the great white North. He and Andy have teamed up to teach three J-Term classes on Emerging Infectious Diseases and hope to return for many more.

Seth Kroop is the Associate Director for Policy in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). He graduated from Middlebury College in 2002. Currently, as part of CDC’s novel coronavirus emergency response, he serves at the policy lead for CDC’s Health Systems Response and Worker Safety Task Force and was recently the deputy policy lead for the CDC emergency response.
Previously, Seth was the lead special assistant to the CDC Director, and he also worked in policy roles in various emergency responses, including the Ebola outbreak in the Democratic Republic of Congo in 2018-19, the Zika emergency response in 2016, and West African Ebola emergency response in 2014-2016. Seth joined the CDC as a Presidential Management Fellow 2012, and he has a master’s of public of public administration from the Andrew Young School of Policy Studies at Georgia State University.

Agnes Mwakingwe, MD, PhD, is a physician scientist who since August 2019 has been working as a senior clinical and research development lead at GlaxoSmithKline (GSK) conducting research in vaccines. Dr. Mwakingwe-Omari was born in Tanzania and says she was lucky to get a scholarship to attend high school at United World Colleges of the Atlantic. She emigrated to the US for education where she attended Middlebury College. Matriculating in February, Agnes remembers being in shock when she stepped out of the Greyhound bus in front of the old library building to find herself in knee deep snow! Since graduating from Middlebury in 2002 with a major in chemistry, Agnes enrolled in a Medical Scientist Training Program at Albert Einstein College of Medicine in Bronx, NY and in 2010 she obtained her MD/PhD in molecular biology and immunology studying host – malaria parasite interactions. She then went on to complete an internal medicine residency training program at Johns Hopkins Bayview Medical Center in 2013. Before joining GSK, Agnes spent 6 years at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH) as an adult infectious diseases clinical and research fellow and staff clinician. Agnes says she was introduced and immersed in clinical research at the NIH, an area that combines her passion for patient care and medical research. Although through the majority of her career she has worked on the malaria parasite both in the lab and in clinic, Agnes is now working on a different vaccine at GSK and is excited to learn a new industry, and apply and further develop her skills in a new field.