Postcards from IDWeek: Infectious disease specialists say they remain dedicated to improving lives, despite challenges
Liz Szabo, MAToday at 10:39 a.m.
Public Health
Infectious disease specialists and public health professionals from around the world gathered in the nation’s capital last week, just over a mile away from a White House that has canceled billions of dollars in research funding, repeatedly cast doubt on the safety of vaccines, and eliminated international programs that provided medical aid to some of the world’s most vulnerable people.
Among those attending or speaking at IDWeek, an annual conference focused on infectious diseases, were people who were fired from their roles on a vaccine advisory panel to the Centers for Disease Control and Prevention by Health and Human Services Secretary Robert F. Kennedy Jr.
Yet several healthcare providers who attended IDWeek said they remained largely optimistic, in spite of nearly two years of attacks on their profession and public health.
“The people in the infectious diseases community have always been fighters,” said Hilary Babcock, MD, MPH, the past president of the Society for Healthcare Epidemiology of America, one of the organizers of IDWeek, told CIDRAP News. “Nothing that anyone does is going to change our commitment to our patients.”
Allison Liddell, MD, an infectious diseases specialist from Dallas, said talking to other health professionals at IDWeek buoyed her spirits.
“It’s hard to sit at home and do nothing,” Liddell said. “Coming here makes me feel better.”
Despite the challenges, a rewarding profession
Annie Gbedji, MD, an infectious disease specialist from Côte d'Ivoire, said she faces many of the same challenges as her colleagues in the United States.Rampant misinformation prevents many people in Africa from vaccinating their children, said Gbedji, who works in Abidjan, the largest city in Côte d'Ivoire.
“There are some things, like immunization, that people don't believe in,” Gbedji said. “They think that we are doing something to sterilize them. There is misinformation, disinformation, and it's really hard to get across all these barriers.”
Yet Gbedji said she is glad to work in infectious diseases.
During a coffee break between sessions, Gbedji told CIDRAP News, “I’m not discouraged, because I like what I'm doing. I always wanted to be a doctor, and I help people.”
Gbedji said certain patient encounters keep her motivated.
She recently saw a woman who felt tired and sick, with no appetite. The woman was losing weight and developed fevers every evening. Her husband brought the woman to see Gbedji.
“I said, ‘I know what your wife has, but I need to prove it,’” Gbedji said.
Gbedji performed additional tests, including a procedure in which she inserted a tube in the woman’s stomach, collected gastric liquids, and cultured the bacteria. The results showed that the woman was suffering from peritoneal tuberculosis, a rare but serious condition in which bacteria spreads from the lungs to the abdomen’s protective lining.
When caught early, the disease can be treated with antibiotics.
“I was very proud of myself,” Gbedji said.
‘Exactly what I wanted to do’
Although doctors and nurses remain some of the most trusted professionals, US politicians in recent years have circulated false claims that they have financial incentives to offer vaccines to children.Texas Attorney General Ken Paxton announced an investigation of pediatricians who recommend vaccines earlier this year, even as the national measles epidemic, which began in Texas last year, has climbed to nearly 7,000 reported cases.
In fact, pediatricians sometimes lose money by providing childhood vaccinations.
“No one goes into infectious disease for the glory or the money,” said Justin Klucher, MD, an infectious diseases fellow at Washington University in St. Louis (WUSTL). “It's entirely because they want to do right by people.”
Several infectious disease specialists mentioned that their field is among the lowest-paid medical specialties, which can make it harder to pay back student loans.
“When I first came in, this was my dream job,” said Harsha Akula, MD, also an infectious disease fellow at WUSTL. “This was exactly what I wanted to do. But I was a little discouraged when I joined the field, just by the huge pay scale difference.”
Measles, mistrust are new challenges
None of the doctors who spoke to CIDRAP News expected to be treating measles.“I definitely was not expecting to go into an infectious disease career and see things like measles,” Klucher said. “I remember seeing a slide in medical school on measles and being like, ‘Oh, okay, I'm glad I don't have to deal with that.’ But actually, I do need to know how to diagnose measles and how to manage it, so that part is stressful. Obviously, just the national environment around it is very stressful.”
Some physicians say that talking to vaccine-hesitant patients and parents can be difficult.
“I feel like I have to spend a lot more time trying to convince people that what we're doing and why we're doing it makes sense,” Klucher said at a reception for infectious disease fellows. “I feel like I'm constantly having this uphill battle of just trying to get basic primary care for people. Like, ‘Hey, you know, you should really get your flu vaccine, or you should really get your COVID vaccine,’ or ‘You know, you have HIV and you would really benefit from getting your meningococcal vaccine.’”
Some of the most frustrating days, Klucher said, are when he sees patients with conditions that could have been prevented if patients had better access to education and care, such as medications that prevent HIV infection or keep the disease under control.
“There is no reason for someone to have AIDS in today's age, and we still see it,” Klucher said. “When it happens, it's tragic, and a lot of it still comes down to things like stigma, availability, lack of resources.”
Many people who attended IDWeek mourned the loss of funding to the US Agency for International Development (USAID).
At the opening plenary session of the conference, Atul Gawande, MD, delivered a somber assessment of the impact of the Trump administration’s dismantling of USAID, noting that more than 700,000 people have died because of the loss of medical care.
Reflecting on the USAID cuts, Klucher said, “I just feel like we're regressing as a society, and I find that very difficult and frustrating.”
Yet Klucher said he plans to remain in the field of infectious disease. “I find it also very rewarding in the few times where I feel like I can make a difference and convince people on things,” Klucher said. “It's just hard.”
Still finding joy
Sometimes, it takes effort to say upbeat, Akula said.“Am I discouraged? Honestly, my answer changes depending on the day,” she said. “I try to encourage myself all the time, and I try to reinforce positive statements to myself. You get to see what a difference you're making in families' lives.”
Jessica Howard-Anderson, MD, said she still “can still find joy” from treating patients.
“ID is the best job. I love ID,” said Howard-Anderson, using the common abbreviation for infectious disease. She is an associate professor of medicine at Emory University School of Medicine and hospital epidemiologist at Emory University Hospital Midtown.
“The fact that the world is harder has not made me think that people should not go into ID,” said Howard-Anderson, who spoke on a panel about cultivating supportive networks for women in infectious diseases.
“In fact, it’s just the opposite,” Howard-Anderson said. “We need great people to go into ID… I try to focus on my hospital and the people I work with, and not get too tied up in what's going on outside, for better or worse.”