April 2025 - The Epidemiology Monitor

Epidemiology for Epidemiologists A monthly update covering people, events, research, and key developments Editor’s Note: With all the changes at HHS in the news these days our first article this month talks about what is happening in U.S. vaccine policy. An interview with a "DOGE'd" epidemiologist gives a close up view on the impact of the chaos in D.C. today. Our friends at Aarhus University have written to provide us with details on their new CLEPAN tool for presenting epidemiological data which is free to use.

This summer marks the 60th anniversary of the University of Michigan Summer Program in Epidemiology and we are pleased to take a look back with them. On top of these pieces, we have also gone back to our 2020 issues to review what we were hearing about COVID-19 in April of that year.

Several of those articles are printed here to show you how our thought process has evolved on COVID. As always, we continue to provide you with our popular monthly word game feature, Notes on People, an overview of what we are reading from the public media, and a listing of upcoming epidemiology events. Finally, don't miss the Job Bank offerings this month. We have some fantastic opportunities advertised on our website.

Did you miss last month’s issue? Read it here: https://tinyurl.com/ycxzb9h9 or here: https://tinyurl.com/2pzhs5hz

In This Issue -2-

What's Happening in U.S. Vaccine Policy?

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Monthly word game

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CLEPAN - A New Free Tool for Epi Learning

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What We're Reading

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Interview with a "DOGE'd" Epidemiologist

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Notes on People

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Celebrating 60 years at the Univ. of Michigan

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Near Term Event Calendar

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From the Archives:

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Marketplace - Jobs & Events

What We Knew About COVID-19 in April 2020

April 2025

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Volume Forty Six •

Number Four

What’s happening in U.S. vaccine policy?

The ACIP meeting was mostly business as usual—with a few notable exceptions.

Author: Katelyn Jetelina, PhD, MPH

2. The content.

The presentations remain solid: comprehensive overviews of risks and benefits, thoughtful discussion, and clear justification for vaccine policies. No conspiracy-laced slides. No manipulated data. Just science.

NOTE: This article was originally published on April 17, 2025 by Your Local Epidemiologist on Substack.

ACIP (Advisory Committee on Immunization Practices)—the external advisory committee to CDC that guides U.S. vaccine policy—finally met this week after a two-month delay imposed by Health Secretary Kennedy. This meeting carried extra weight: it’s one of several levers Kennedy can use to influence vaccine policy in the U.S. Given his long history of casting doubt on vaccines, many closely watched this meeting. Including me.

Still, with four years ahead, there’s plenty of opportunity for Kennedy to interfere. So yes, I’ll keep watching.

Three things that were not business as usual 1. Streaming scramble. After the administration’s sweeping CDC communication staff layoffs, the agency scrambled to meet the legal requirement of live-streaming the meeting. They made it happen, but not without glitches—technical issues interrupted parts of the public broadcast.

Here are your Cliff Notes—and more importantly, what it means for you.

2. A new voice at the table: Tracy Hoeg. While only ACIP members vote on decisions, other government and professional representatives can attend and comment. Typically, the FDA sends an employee to act as a liaison. This time, the administration sent a political appointee, Dr. Tracy Hoeg—a sports medicine doctor known for her vocal criticism of Covid-19 policies and repeatedly misrepresenting science. She made her presence known at the meeting, questioning the safety and effectiveness of multiple vaccines.

Mostly business as usual Let’s start with the good news: the meeting was pretty normal. That shouldn’t be news… but these days, it is.

Two big reasons why this meeting felt (mostly) status quo: 1. The committee makeup.

ACIP members are the same folks who served during the Biden administration.

Despite Secretary Kennedy’s past accusations of members having conflicts of interest, nothing changed. That’s not surprising—ACIP has a strong process for managing COIs very transparently and rigorously. Maybe Kennedy needed to see that for himself. Or maybe changes are still on the way. Time will tell.

3. A shift toward a European-style vaccine policy?

This is worth unpacking. I’ll preface by saying I don’t think this is driven by political interference (yet).

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-Vaccine cont'd from page 2 In recent years, there has been a groundswell movement to shift the U.S. health policy toward a European model (think red dye and fluoride).

We are starting to see this national conversation happen with vaccinations.

vaccination for things like flu and Covid-19— meaning everyone is recommended to get vaccinated. In contrast, many European countries follow a risk-based approach, recommending vaccines only for high-risk groups.

For years, the U.S. has leaned toward universal

Covid-19 vaccination policy across several countries in 2024. Table by Your Local Epidemiologist

There are some good reasons we do universal vaccination in the U.S.: 



high-risk people in the U.S.; however, once this was made universal, coverage increased among everyone including *high-risk* because it became easier for everyone to get a vaccine. However, this is based on very weak data. (It could be increasing for several other reasons.)

Implementation: Implementing and communicating universal vaccination recommendations is much easier.

Possible increased uptake. At first, flu vaccines were only recommended to

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- Vaccine cont'd on page 4

-Vaccine cont'd from page 3 

Insurance and access implications. I’ve made the argument before (see previous YLE post below) that we need to be careful in making the same policy service)

decisions as other countries given the U.S. health landscape (crappy health care, lack of access, paid sick leave, and is so different.

Be careful comparing the U.S. to other countries Katelyn Jetelina and Gavin Yamey / September 19, 2023

In recent weeks, some have been quick to criticize health policy decisions in the U.S. by pointing to decisions made in other countries.

I was surprised that 75% of CDC staff working on this issue supported implementing riskbased recommendations. The ACIP committee seems more mixed.

Read full story

CDC hasn’t decided yet—but they will in June, when they determine who’s eligible for fall Covid-19. I wouldn’t be surprised if this decisionmaking process also extended to flu vaccines.

For Covid-19, a few factors are driving the discussion to move towards risk-based:   



Vaccine fatigue is real.

Many doctors are hesitant to even bring up COVID vaccines due to politicization.

We just came out of a “mild” winter— though let’s be clear, it still meant tens of thousands of deaths.

There’s been a cultural sea change in how Americans think about Covid-19—and vaccine policy reflects culture as much as science.

I honestly don’t know how June will go.

What does this mean for you?

For now: no changes. The science for all vaccines and the integrity of ACIP are holding strong. No red flags, no new data that should change your behavior today.

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- Vaccine cont'd from page 4 There may be changes to the Covid-19 vaccine (and possibly the flu vaccine) on who receives the vaccine if the U.S. adopts risk-based guidance in June. There are a few ways this could play out:

Time will tell.

Should I get a Spring Covid-19 vaccine?

If you’re high risk, this question is top of mind right now. Here’s what ACIP shared this week:

1. Vaccines remain universally recommended. Everyone gets access— just like now.

2. Only high-risk groups are recommended.

(Think the U.K. model.) Or, 3. A hybrid approach. Everyone can get it, but only high-risk groups are told they should. This would mean insurance still covers it.



Yes, this Covid-19 winter was mild—but it’s not gone. It still sent tens of thousands to the hospital and claimed more than 50,000 lives last year, hitting older adults and infants the hardest.

Source: CDC ACIP presentation slide https://www.cdc.gov/acip/downloads/slides-2025-04-15-16/03-Havers-COVID-508.pdf

 

Long Covid still exists (though rates have gone down).

This year’s vaccine worked. It provided ~40% added protection against hospitalization and ~30% against urgent care visits.

Keeping up with vaccines, especially older adults, is really important. All countries agree on this, too. The U.S. and other high-income countries still recommend a Covid vaccine every 6 months for people over 65 (or 75).

- Vaccine cont'd on page6

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- Vaccine cont'd from page 5

That’s why I’ll be telling my 90-year-old grandpa to get his spring Covid-19 vaccine. Go here to find a vaccine near you.

Bottom line This ACIP meeting looked typical on the surface, but some shifts are brewing—especially around Covid-19 vaccine policy (and possibly flu thereafter). We’ll know more in June.

Three small updates regarding other vaccines from ACIP today: 

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RSV vaccination for more at-risk adults.

The eligibility expanded to 50+ year olds who should get a vaccine in fall to cover those with chronic conditions.

Another meningococcal vaccine will be available with another strain for kiddos and young adults.

A new chikungunya vaccine will be available for adults who are traveling to a country or territory experiencing an outbreak, adults before traveling or moving to a country or territory without an outbreak, and lab workers.

In the meantime, stay up to date on your vaccines—including a spring Covid-19 shot if you’re an older adult. I’ll keep tracking all these moving pieces so you don’t have to. ■

This article was originally printed in Your Local Epidemiologist. To read more content from this source subscribe to Your Local Epidemiologist (YLE): https://tinyurl.com/47494ms4

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CLEPAN an interactive learning platform for clinical epidemiological analysis Clinical Epidemiological Analysis (CLEPAN) is a free, user-friendly platform developed by Aarhus University researchers to help medical, Master’s, and PhD students, as well as clinicians, understand the concepts of clinical epidemiology. It offers interactive tools and updated content on epidemiological concepts, study designs, and data visualization, without requiring advanced computer skills

The CLEPAN Interface Background Sound scientific evidence is a prerequisite for any modern health service system to provide safe, high-quality patient care and to take maximum advantage of advances in diagnostics, treatment, rehabilitation, and prevention.

This evidence is derived best from continually updated answers to four key generic clinical questions: 1. Diagnosis: Which tests/examinations should be used to diagnose a disease and predict its course while minimizing false positive and negative results?

2. Prognosis: What is the expected course of a disease — spontaneous cure, untreated progression (natural history), or progression with treatment (clinical course)?

3. Intervention: How effective is a clinical intervention in curing, preventing, slowing progression, or reducing symptoms of a disease?

4. Risk - Harm: What are the risks and potential side effects of selected treatments and the safety and quality of clinical care?

Addressing these questions requires integrated knowledge of clinical medicine, epidemiology, and biostatistics. In recent decades clinical epidemiology therefore has become a core discipline in clinical care, responding to the increasing need for evidence-based medicine, quality assessment, protection of patient safety, resource optimization, meta-analyses, and development of clinical guidelines, all of which are based on clinical epidemiological concepts.

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CLEPAN cont'd from page 7 CLEPAN helps in understanding the basic elements of clinical epidemiology and describes the key concepts and analytical methods needed to develop knowledge for research that contribute to scientific evidence.

Prognosis, where key metrics like incidence, prevalence, risk, and case fatality are explained.

The second major section explores Study Designs, introducing clinical trials, cohort and case-control studies, cross-sectional analyses, and meta-analyses. This is crucial for understanding how evidence is generated and compared across different research contexts.

The section Sample Size Calculations offers guidance on determining appropriate sample sizes for different study types, including superiority, equivalence, and non-inferiority clinical trials. A key challenge in clinical epidemiological research is the presence of bias; therefore, the Bias in Epidemiology section was developed to aid understanding of the types of bias — selection bias, information bias, and confounding — and to offer techniques for controlling bias through stratified analysis or standardization. In addition, the Bias Analysis part covers advanced topics like E-values, misclassification assessment, and sensitivity analysis, helping researchers critically evaluate the robustness of their findings.

The idea of CLEPAN CLEPAN is primarily aimed at medical, Master’s, and PhD students, clinicians without formal research training, and others looking to advance their skills in clinical medicine, epidemiology, and biostatistics. The learning platform introduces its users to the principles of clinical epidemiology without requiring an advanced computer program.

CLEPAN is based on Professor Henrik Toft Sørensen’s notes from teaching medical and PhD students for close to 25 years. The first version of the learning platform was created in 2016.

“I noticed a significant need among students for a learning platform that is easily accessible without requiring a substantial investment of money and time to master an advanced computer program,” says Henrik Toft Sørensen.

Associate Professor Erzsébet Horváth-Puhó says: “During the 2024 update of the platform, our goal was to redesign CLEPAN to be even more user-friendly and easier to navigate. Additionally, we focused on improving the platform’s structure, enhancing the built-in calculators, and adding new features. For example, data visualization tools such as histograms, box plots, pie charts, and other graphical representations were introduced to support better data understanding and interpretation. We also dedicated a section on advanced survival analyses describing the differences between Kaplan-Meier curves and cumulative incidence curves used in the presence of competing risk.”

CLEPAN has been updated continuously based on the feedback received from students and teachers who use the platform. Recently, the platform underwent a major update to include new features.

Henrik Toft Sørensen continues: “I am grateful to the many students and colleagues who have tested and proofread CLEPAN. Their input has been invaluable in improving CLEPAN and meeting the needs of its users.”

CLEPAN’s structure and features The CLEPAN platform starts with a section on Measures of Disease Occurrence, Outcome, and

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CLEPAN cont'd from page 8 For example, users interested in learning the basic concepts of cohort studies can refer to the Study Designs section, where an overview of the design is provided. This is followed by built-in calculators that allow users to calculate key

Relative Risk – calculation formula

absolute and relative measures, including incidence among exposed and unexposed groups, relative risk with a 95% confidence interval, and risk difference with its corresponding confidence interval.

Risk Difference - calculation formula

Consider a cohort study with 120 exposed and 120 unexposed individuals, where 30 and 10 outcome events occur in each group, respectively. Using the built-in calculators, the incidence among the exposed is calculated as 0.25, while the incidence among the unexposed is 0.08. The relative risk, comparing these two

groups, is 3.00 with a 95% confidence interval of 1.54 to 5.86. Additionally, the risk difference is 0.17, with a confidence interval ranging from 0.07 to 0.26.

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CLEPAN cont'd from page 9

Relative Risk

Risk Difference

Relative Risk - 95% Confidence Interval

Risk Difference - 95% Confidence Interval

Overall, CLEPAN offers a user-friendly, easy-tofollow structure with illustrative examples and built-in calculators and a robust framework for understanding and applying basic epidemiological principles.

500 users located around the world, e.g. in Europe, North America, Asia, and Africa.

Want to try CLEPAN? You can sign up for free at http://www.clepan.com now.

CLEPAN is used worldwide - CLEPAN cont'd on page 11

CLEPAN was created by researchers at Aarhus University in Denmark and has been used for many years in clinical epidemiology classes for medical students and PhD students at the university. The learning platform has more than

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CLEPAN cont'd from page 10 Contact CLEPAN was developed by Professor Henrik Toft Sørensen and recently updated in close collaboration with Associate Professor Erzsébet Horváth-Puhó. The team would be happy to receive comments and suggestions for future improvements at CLEPAN@clin.au.dk.

Henrik Toft Sørensen MD, PhD, DrMedSci, DrSci Professor Department of Clinical Epidemiology and Center for Population Medicine, Aarhus University and Aarhus University Hospital, Denmark E-mail: hts@clin.au.dk

Erzsébet Horváth-Puhó MSc, PhD Associate Professor Department of Clinical Epidemiology and Center for Population Medicine, Aarhus University and Aarhus University Hospital, Denmark E-mail: ep@clin.au.dk

Join EpiMonitor on our Facebook page at: https://bit.ly/2U29gUA or on Twitter at: @theEpimonitor

or on Instagram at: @epimonitor -11-

An Interview With An Epidemiologist Who Lost Her Job Because Of The DOGE Layoffs Interviewer: Sabrina Imbler NOTE: This article was originally published on April 4, 2025 by Defector.com and we thank them for the permission to reprint it.

The Trump administration is going full steam ahead on its terrifying project of dismantling the country's defenses against HIV. In February, it gutted the U.S. Agency for International Development, which plays a crucial role in supplying other countries with HIV treatments. On March 21, the U.S. Department of Health and Human Services terminated the Adolescent Trials Network, or ATN, which is the only national research network focused on adolescents and young adults who live with, or are at risk for, HIV. The National Institutes of Health terminated grants related to PrEP, medications that can prevent HIV infection. And this week, the administration laid off scores of workers at the Centers for Disease Control and Prevention who focused on HIV prevention.

Since its formation in 2001, ATN has enrolled more than 30,000 people in over 150 studies, many of which focus on the ongoing HIV epidemic, and expanded access to PrEP. But it has a more expansive remit, also studying the rising incidence of STIs, and mental health and substance abuse disorders in young people.

Nevertheless, the network's termination letter used the same language seen in letters from the National Institutes of Health that intend to eradicate "diversity, equity, and inclusion" in scientific research.

Tara Kerin, Infectious Disease Epidemiologist

focused on the antibiotic doxycycline, which has a growing reputation as a "morning-after" pill for STIs. Last year, the CDC recommended this STIprevention strategy—called doxycycline postexposure prophylaxis, or doxyPEP—for cis men and transgender women, citing evidence that it has been shown to reduce syphilis and chlamydia infections by 70 percent and gonorrhea by about 50 percent. Although evidence suggests that doxyPEP would be effective in other populations, such as cis women or transgender men, the CDC did not yet have enough clinical data to recommend the drug to these other populations.

The ATN study Kerin was attached to aimed to solve that problem—testing if the antibiotic also prevented STIs in adolescent and young cis women. "Women in general are usually left out a lot of studies," Kerin said. "So having this

The infectious disease epidemiologist Tara Kerin had started working on an ATN study

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DOGE'd cont'd from page 12 specifically looking at how we can prevent STIs in women would have been really great." But the study was canceled on March 21.

Kerin was not a full-time federal employee. But this ATN grant, which was already funded and approved, would have covered most of her salary for the next four years. In fact, ATN projects "have been mostly paying my bills since 2017," she said. Now, the grant's cancellation means Kerin will be out of work in a few months. In the U.S., thousands of scientists like Kerin depend on grant money from the federal government to pay their salaries. As federal funding for their research is cut, these scientists risk losing their jobs, their labs, and their careers. I spoke with Kerin about how this study would have given a generation of women more control over their health, her fears of a medication-resistant strain of HIV, and why the health of Americans is inextricable from the health of the world.

This interview has been edited and condensed for clarity.

I would love if you could tell me about how you decided to become an infectious disease epidemiologist.

I actually wanted to be a lawyer. And then I took a couple of classes and decided, no, I don't. I don't want to talk about politics all day! Which is hysterically why I thought, oh, I'll go into science.

I ended up changing my major. I got a degree in neuroscience and ended up going to Penn State, where I got a degree in bio-behavioral health. I was doing a lot of lab work—you know, the pipetting behind the bench. A couple years later, I ended up getting a job at the CDC. I was working in the rotavirus lab. Rotavirus is basically the stomach flu for kids.

In the U.S., [rotavirus] is no big deal. It's a pain. I actually think I remember when me and my siblings got it—we were just all basically stuck in the bathroom. But in developing countries, it was a leading cause of childhood death. You get dehydrated, just because they don't have the same resources that we would have. So it was a worldwide problem, even if day-to-day in the U.S. we weren't bothered by it.

During that time, they also developed a vaccine, which was awesome. I was so excited about this. One thing that is obviously, extremely important is you're never going to get rid of a disease unless you get rid of it worldwide. I think COVID and the Ebola outbreaks that we had more recently have shown that with all of our abilities to travel very quickly, that also means that these diseases travel a lot quicker than they used to. At this point, if there is a disease anywhere, it can be in your backyard within a week.

During that time when [that] great vaccine was on the market, and—I mean, we're thrilled!

Over the moon! You've been working on this virus, and all of a sudden it looks like, in essence you've got a preventative care for it. But as I was driving to work, there would be protest lines.

They were people who were anti-vax. This is right around the time when Jenny McCarthy is getting her platform on Oprah. To me, it was just sort of this mind-blowing, like, what? You guys think these are unsafe? What's going on?

The first ATN study I was on was looking at recently [HIV] infected young adults. HIV is this wildly—I mean, it's kind of cool—wildly smart virus. First it attacks your immune system. It just goes right for the jugular: You can't fight us,

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DOGE'd cont'd from page 13 because I'm directly going to fight what you fight us with. But now we have these antiretrovirals, right? So you take these pills, and it keeps your detectable level of virus gone.

We now know that if you do not have a detectable level of virus—so if you take your pills pretty much every day—you take a blood test and there's no virus. You can't spread it. So you can have sex. You can have babies. You can do all of that stuff that we thought that people with HIV would never be able to do.

There have been reports of some children being able to go off the medication, and the virus doesn't appear to come back. The reason why the virus comes back is because it hides. A section of it will hide away in this little reservoir—HIV reservoirs, we call it—so the medication can't get to it there. It just stays there. And it just waits and waits and waits. It'll kind of pop its head out and be like, "All clear?" and then it will, boom. So children who have had HIV, their immune systems are a little bit more pliable. Those reservoirs might be smaller. The idea is, all right, so what if we catch people right when they get sick, these young adults that still have these moldable immune systems, and see if we can shrink these reservoirs so at some point they can go off medication? Because the meds aren't great. I mean, it's like, just take a pill. But they're not just a pill. They have side effects. They have issues. It is a pill, or a set of pills, that you would have to take every day for the rest of your life.

So you know, you're looking at the way to eliminate that entirely.

Now this new one that I'm doing, or was doing for the ATN, was on doxyPEP. HIV also has what they call PrEP and PEP. Prep is a pre-sex drug— so pre-exposure prophylactic that you can take so that you are less likely to get HIV. This is great. It's sort of like [a] birth control type of

thing. If you can take that, and people who, you know, "Oh, I'm thinking about having sex tonight, I'll take this," then they can be a lot more safe. There's also PEP, and that's the postexposure. That's something you take within 72 hours, that can also help you, kind of like your plan B pill.

They have found in men, when they've looked, that it can actually prevent a whole bunch of STDs or STIs—oh, really cool. There's this postthing you can take in 72 hours, and then you don't have to worry about chlamydia or gonorrhea or syphilis or any of that stuff.

They've also done some things that have shown if you take doxyPEP before sex, much like PrEP, and again, in men, this is shown that it might be effective as a prep as well as a PEP. But this new trial that we were doing was looking at it in women. Because we don't have any data in women, or not much anyway. So that was what we were working on. And it came from the Adolescent Trial Network.

It was a really cool network. It managed to bring sites all over the U.S. If you had an idea for a project and you could get funding, you could also do it within all of these sites. One of the hardest things to do in any study is recruit people. It's a pain. I've tried to be in studies, and I'm like, oh god, this is so hard! This is not worth it! So I understand. And this sort of thing also gets you across the country, so you'll have a population that is more representative. Los Angeles does not necessarily represent the rest of the United States.

There were millions of dollars in these projects.

There are a lot of ATN projects going on over time. There's been a couple hundred since the ATN was formed back in 2008—while ago, - DOGE'd cont'd on page 15

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DOGE'd cont'd from page 14 somewhere in those early aughts. So that was just completely shut down. It wasn't just the ATN that was shut down, I also work on some other HIV projects to pay my bills. All of those were shut down as well too. They're targeting HIV, which is frustrating on levels not just for me, but for science.

The grant that was just canceled—you mentioned it was going to cover the next four years of your work. How long had that been covering your work before?

It basically just got started. We had been working on the first part of the study, [which] is getting it ready. We'd been making protocols and manuals and training for staff, and getting an app made. I'm so sad about that app. I feel like that app was a lot of work for a lot of people, and it was really cool. I'm very bummed about that, not ever really getting out there.

There were three arms. One was standard of care, which is just STI education, condoms, talking about things, testing. The other one was doxyPEP on demand, so they could ask for it within 72 hours of having sex, and they would get that. And then the third one was we were assigning that group to take the doxyPEP every week, regardless of their sexual activity. So that one was the pills. I just started working on that, I guess, at the end of last summer. We were ready to launch, and I got, on Friday: Stop work completely.

Could [you] briefly cover the work that you had done for the grant, all that you had accomplished thus far?

There's a lot of paperwork to do at the beginning. Getting an institutional review board approval. You've already gotten permission from the NIH, but now you also have to go

through another level of scrutiny to make sure that this study is ethical. That you have all of your ducks in a row. You have thought about everything that could possibly happen and making sure you have a plan and a backup plan.

How are you going to deal with adverse events?

The standard of operating procedures—it doesn't sound like a big deal, but, boy, that takes months to get right. Again, all of those things need to be in print, every possible scenario and what you're going to do, and describing the procedure down to the smallest thing. Because, the idea is, if anybody has a question about what to do, they will have an answer. By the time an NIH study gets out and started, it's already been optimized to be a welloiled machine.

So you have the standard operating procedure.

And then every single thing that you're doing has what we call the manual of operations (MOPs) too. I had just written one on all the sample collection. There's one of how to collect hair—how far down? How long does it need to be? Where you need to put it afterward? How does it need to be stored? We were also doing swabs, both throat and rectal or front hole. We had swabs everywhere. We mostly try to encourage those to be self-collected by the participant. But we also need to be able to tell them how to do it. And also be able to tell the staff if they need to help.

There was also another one on counseling— how to counsel people for reproductive health, not just giving scripts, but also how to give the resources to everybody that they need. How to treat the STIs once they're found. Where do they need to go? How quickly? How are we

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DOGE'd cont'd from page 15 making sure that we are keeping these women safe and healthy? We were a little delayed. We were supposed to have launched already, but it got pushed off until April because we had two issues. One, some of our sites were coming from another collective called the HPTN. That's the HIV trials. It's another HIV collective. And for some reason they weren't getting the money from the government. So we were like, OK, we're going to have to pause on them. Then we had another issue with the medication supplier, so we had pushed this off just slightly—which I guess, in hindsight, is for the best. Because it'd have been pretty awful to start people on something and then be like—just kidding!—and take it away. They cut us off right before our launch.

How did you learn that the grant was cancelled?

I was in another meeting, and the [principal investigator] of the study called me, which was odd. I mean, it's not odd, but, you know, a little odd. I was like, alright, well, I'm going to decline because I'm in this meeting. But I also just had a weird spidey sense about it. Then she texted me right after, she was just like, call when you can. And I was like, oh, this is not going to be good.

They told me it was canceled. I'm not gonna lie, I knew HIV would be on the chopping block. It deals with populations that a lot of that administration does not like to admit exist. So not a huge surprise. But it was a surprise how quickly it happened. I assumed it might be something where we might not be renewed.

But I was not quite prepared for stopping on a Friday in March. I had a good cry, and then I got to take the rest of the day off. And then just started trying to get my ducks in a row. The thing that sucks is everybody is on a hiring

freeze right now. And additionally, even pharmaceutical companies that are hiring have got hundreds of people that are super-qualified going through one [posting]. It's tough. Because I know at the end of the day, I'm probably going to end up taking a job that was for someone who has a master's, and they're going to end up having to take a job for somebody who has a bachelor's.

When you stop taking medication, the HIV pops out of the little reservoir, and it takes a look and it's like, oh, the pills are gone. Let's get going again. But it's smarter this time, and it becomes resistant to the medication you were taking.

This is a problem with people who tend to stop and start their medications a lot. They become resistant to the medications to the point that the medications are a lot less effective. Back in January, when USAID was told to stop giving HIV medications to everybody, my first thought was not just that people are going to die, but: Oh crap, we're going to get a medication-resistant strain of HIV. You're not going to get rid of a disease unless you get rid of it everywhere. So all of that work we've done with HIV to get to the point that as long as you take your medications, you can have a really normal life, that just could be totally blown up, which is also very, very frustrating. It's not something you can take a switch and turn it back around.

Is there any recourse for getting another funder to move in [on the grant]?

We will be missing out on that opportunity of having the network. While this grant hopefully will live on somewhere, somehow, it will be different. And we won't have the same reach that we had with the ATN. When these sort of studies are stopped,

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- DOGE'd cont'd on page 17

DOGE'd cont'd from page 16 particularly with this one, we have prevented a generation of being able to have some sort of control over their health in the sexual landscape. And a lot of people, particularly who support the administration, may be like, oh, well, you know, kids shouldn't be having sex anyway. Well, sure. But just like birth control, it's going to happen. And we want to make sure that there's as much safety that goes on—not just with HIV, but syphilis is really bad.

Gonorrhea and chlamydia can get really bad.

We already know that HPV can cause cancer.

These are STIs that can really mess up your life.

Sure, there are treatments for these things now. But a lot of times, it's going to have more of an impact long-term.

into RFK Jr. and all that bullshit—it puts us back for so many years. Because it's not something that, in the next four years, if we get in a different administration, we can just turn this back on. Again, all of these things have been in the works for years. Particularly if we're going to keep going back and forth on this and having an administration that wants to give money, that doesn't, that does, that doesn't—it is going to hurt our chances of research in general.

If the grant were to be picked up by another funder, would you be able to return to that work?

We used to be the best in the world at this.

Without our influence, other places will have the stronger influence. When we lose influence, we lose not just power—we do—we lose ground.

We lose the ability to protect ourselves.

Everybody wanted to be getting the American drugs for COVID. But the next COVID that hits, we'll be begging Europe for theirs.

It depends on how and who picks it up. But the bigger problem is that I won't be around.

Unless it happens next week, which, even if you get money, it's not immediate. You apply for a grant in April, and you hope to get the money by the next January. I will be long gone at that point. I will not be in the study, but hopefully somebody else would be able to. I've already joked about all the data that I have, and trying to find a really lucky PhD student to go to: Here, analyze all of this and get it out to the world, since I will not be a part of the project!

I was curious if there was anything else about this grant or its cancellation, or your fears and concerns that we haven't had a chance to talk about, that you'd want to touch on.

I guess what I don't really understand is how people can look at this and just be, America first and focus on America without realizing how connected we are biologically with the rest of the world.

If you have lost your job as a result of ongoing government cuts and are interested in speaking with me for this series, please contact me on signal at simbler.88 or simbler@defector.com

To subscribe to Defector in order to read more articles like this, please go to: https://tinyurl.com/mvsn4cxt

It's not just the HIV grants. And it's not just all of the other ones that are being stopped. The dismantling of the NIH—and I won't even get

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Celebrating 60 Years of Summer Programs at the University of Michigan It was the summer of 1965 and Americans were just beginning to recover from their grief over the assassination of a young president and the end of Camelot. The British Invasion had begun with the landing of the Beatles in NY eighteen months earlier and the Beach Boys had appeared on the Ed Sullivan Show. American cars were as long as a city block and sported space age fins.

year before moving to the University of Minnesota.

In the midst of all these changes, there were changes happening in quiet, leafy Madison, Wisconsin too but these changes were different - they were academic and scientific in nature.

1965 would mark the first time the University of Wisconsin would host a summer program in epidemiology. It would only stay there for a

In 1988 upon the retirement of Dr. Schuman, the GSS planning committee recommended that the program be moved to the University of Michigan in Ann Arbor. In 2017 the program name changed and it is now known as the Summer Session in Epidemiology (SSE).

Dr. David Schottenfeld, Professor and Chair of the UMSPH Department of Epidemiology proposed what was then known as the Graduate Summer Session in Epidemiology (GSS). For the next 22 years the program would remain at the University of Minnesota.

1977 GSS / SSE Attendees

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- SSE cont'd on page 19

SSE cont'd from page 18 When the program moved to Ann Arbor, Dr. Schottenfeld became the Director from 1988 – 2004. Following his retirement, Dr. Hal Morgenstern succeeded him as Director from 2005 – 2017, when he retired. Since 2018 Dr. Eduardo Villamor has served as Director of the SSE/GSS. In addition to four wonderful directors, the program has been honored to have extremely prominent faculty who are recruited to teach in an area of their renowned expertise. These include, but are not limited to: Helen Abby, Alfred Evans, Philip Brachman, Michel Ibrahim, Ted Holford, Jennifer Kelsey, Robert Wallace, Charles Hennekens, Stanley Shapiro, Philip Cole, Paul Stolley, Lewis Kuller, Warren Winkelstein, David Savitz, Sander Greenland, Mitchell Levine, Stanley Shapiro, Brian Strom, Harvey Checkoway, Nigel Paneth, Richard Goodman, Steve Selvin, Ward Cates, Graham Colditz, Jose Teruel, Jack Colford, Matthew Boulton, and Sandro Cinti.

Courses in the Summer Session in Epidemiology (SSE) are official graduate courses of the University of Michigan (U-M), reviewed and approved by the Advisory Committee on Academic Programs of the School of Public Health. Their credits are valid in various academic programs of the University of Michigan. Acceptance of courses for credit or substitution for similar courses offered by other institutions is dependent on the policy of those institutions.

The objective of the SSE is to provide intensive instruction in the principles, methods, and applications of epidemiology. The continuity of this program for 60 years demonstrates its important role in the education and training of graduate students in public health, physicians, nurses, and health professionals throughout the world. ■

From Our Archives What We Knew About COVID-19 in April 2020 What it means and why it matters EDITOR'S NOTE: As we have now reached the 5th anniversary of the initial days of our awareness of COVID19, it seemed appropriate to begin looking back at what we knew, when we knew it and how our thoughts evolved over the early months of the pandemic. Accordingly, we will be reprinting our articles from that period over the next few months. We welcome your comments and suggestions about what you would like to see.

Multiple Proposals Being Made For Going Forward Against COVID-19 Author: Roger Bernier, PhD, MPH Despite the success of ongoing mitigation or social distancing measures in dampening the spread of COVID-19, the strategy’s high social and economic costs have brought forth a flurry of new proposals for how best to control or even eliminate the disease from this point forward.

How We Got Here After the first appearance of the COVID-19 cases in the US, the initial control strategy was to test ill persons to identify and treat cases, trace exposed contacts, and quarantine persons when indicated. This containment strategy failed to stop the chains of transmission stemming from the earliest imported cases. This occurred for a variety of reasons, including the fact that not all infected persons were symptomatic, and testing with rapid results was not widely available.

As community transmission took hold, the fear that hospitals and other providers would be overwhelmed and that deaths would rise even higher encouraged or even necessitated the use of severe social distancing measures to slow the rate of spread even at the cost of

severe economic impact. This mitigation strategy has been widely referred to as flattening the epidemiologic curve. It sought to buy time for hospitals, health care workers, first responders and other service providers by slowing the demand for services and thereby preventing deaths that would have occurred in a completely overwhelmed health system.

Not all countries bought into these containment or mitigation strategies as the best approaches.

Different Approaches Sweden took a much less restrictive approach with the idea of allowing the population to acquire disease and create a level of population immunity that might become high enough to provide herd immunity against future outbreaks. The United Kingdom also gave consideration to this approach early on until epidemiologic models predicted that this strategy without social distancing measures could produce half a million deaths. The same models predicted over 2 million deaths in the US without aggressive social distancing measures and reportedly influenced the U.S. - Proposals cont'd on page 21

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-Proposals cont'd from page 20 decision to undertake widespread mitigation.

These model estimates of expected deaths have subsequently been lowered to reflect the new realities created by implementation of strict measures in the UK and the US.

such as whether it will exhibit seasonality or whether it will occur in additional future waves of infection.

Crushing The Curve

A recent Wall Street Journal investigation reports that mitigation efforts in the US have saved more than 100,000 lives by mid-April and will have saved 500,000 lives by the end of the month. Putting the statistical value of a life at $10 million, the benefits of mitigation equalled an estimated $1 trillion by mid-month and $5 trillion by end of April. A second estimate in the report is that social distancing is saving 1.7 million lives worth $8 trillion for three months of social distancing. The cost to the economy is estimated at $3 trillion through 2022 and the article calls this trade-off worth it in an accounting sense. These estimates are derived in part from the work of Alessandro Vespignani and his team of modellers at Northeastern University. He told the WSJ, “The decisions that will be made in the next few weeks must include economists and epidemiologists and public health people to find the trade-off between those two viewpoints.”

New Zealand took a more extreme strategy to not merely flatten the curve but to crush the curve. The goal here was to implement such strict measures that the imported virus could actually be eliminated and future importations blocked or new chains of transmission contained through testing, contact tracing, and quarantine.

Current Situation Now that mitigation efforts have proven effective in slowing spread in several of the viral hotspots where SARS-CoV-first appeared, some of the negative impacts on the economy and the quality of life in the US have become clearer.

It is apparent that the restrictions imposed by the social distancing strategy must be eased at some future point and discussions have intensified about what the best way forward might be and what the optimum balance is of public health and economic and social measures. Making these choices will be fraught with uncertainties about the new virus

Lives Saved Do Far

Articles in this issue of the Epidemiology Monitor provide details about some of the new proposals being circulated. ■

Former Head Of The IOM And Harvard Dean Calls For A War-Like Fight To Eradicate SARS-CoV-2 In Ten Weeks The Association of State and Territorial Health Officers, Johns Hopkins and Duke University are not alone in calling for a change in strategy to combat the coronavirus outbreak. In a stunning editorial in the New England Journal of Medicine published on April 1, 2020 entitled “Ten Weeks

To Crush the Curve”, Harvey Fineberg, former head of the Institute of Medicine and former Dean of the Harvard School of Public Health, invokes President Trump to say if we are at war with coronavirus, then “It’s a war we should fight to win.”

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- Proposals cont'd on page 22

-Proposals cont'd from page 21 Crush The Curve

II. suspect cases who have typical symptoms but test negative III. exposed persons IV. persons presumed unexposed or uninfected V. recovered persons

Fineberg calls for “a forceful, focused campaign to eradicate COVID-19 in the United States. The aim is not to flatten the curve; the goal is to crush the curve.” This goal is based on the reported success in Wuhan China and echoes New Zealand’s approach which is also reportedly succeeding in eliminating COVID-19 from the country. Fineberg’s plan has 6 key components to carry out over just 10 weeks.

Once identified, there are different means of treating each of these categories of persons, according to Fineberg.

5. Inspire and mobilize the public.

Fineberg believes there is a role for everyone and that most are willing to do their part.

1. Establish a unified command.

Fineberg wants a commander appointed by the President with full power to target responses to specific places and times because different regions of the country are at different phases of the epidemic in the US.

6. Learn while doing through real-time, fundamental research.

Fineberg concludes his editorial with an exhortation and a bold prediction. “Rather than stumble through a series of starts and stops and half-measures on both the health and economic fronts, we should forge a strategy to defeat the coronavirus and open the way to economic revival. If we act immediately, we can make the anniversary of D-Day on June 6, 2020, the day America declares victory over the coronavirus.”

2. Make millions of diagnostic tests available.

In this regard, Fineberg’s strategy is similar to that of the state health officers reported elsewhere in this issue. He suggests multiple ways of achieving this such as mobilizing the nation’s research laboratories and organizing dedicated clinical test sites. We can’t track if we can’t test is the idea.

3. Supply health workers with personal protective equipment and equip hospitals to care for a surge in severely ill patients.

Says Fineberg: “We wouldn’t send soldiers into battle without ballistic vests; health workers on the front lines of this war deserve no less.” He suggests that regional distribution centers could deploy materials to the hospitals in greatest need.

4. Differentiate the population into five groups and treat accordingly.

These five groups are:

Realistic?

Several objections to Fineberg’s proposal can be raised, perhaps the major one being how realistic it is to make millions of tests available in a very short period of time, and whether or not it is possible to effectively categorize the entire population into the five groups described.

Interviewed on television by MSNBC’s Brian Williams, Fineberg expanded on his plan by emphasizing that social distancing will only be good enough to reduce the - Proposals cont'd on page 23

I. infected persons who test positive

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-Proposals cont'd from page 22 spread of coronavirus and not stop it. For getting ahead of the curve and eliminating COVID-19, aggressive testing, categorizing people into the five groups he described, and acting on that information will be key, he said.

included former Department of Health and Human Services Secretary Secretary Mike Leavitt and former Defense Department head Ash Carter. Fineberg added that the country needs to prevent the miscommunications, misunderstandings, and lack of coherence in the attack on coronavirus. “We need the A team,” he said

Fineberg told Williams that the person to be appointed as commander of the effort needs to have the full confidence of the President, to understand government, the health scene, and federal/state relations, to be decisive and respected. Potential candidates he named

To read the editorial and plan, visit: https://bit.ly/2VjW6WP ■

Hopkins Epidemiologist Recaps Both What We Have Learned And Still Don’t Know About SARS-CoV-2 Johns Hopkins University epidemiologist Justin Lessler was interviewed in the NewYorker to help highlight what we have learned about coronavirus in recent weeks and what still remains uncertain. Here are the key items of information.

What we have learned 







How much immune protection is obtained from an infection



How long does immune protection last



How effective will be the level of community or herd immunity

 

Countries need to combat the virus or health systems will get overwhelmed as happened in Italy and Spain Social distancing stay-at-home orders seems to be working in different places, including the US A path forward for the US could be one focused on testing as learned from South Korea

How fast does the virus spread…what is the reproductive number (R naught)



How well do asymptomatic persons transmit infection



Will there be a marked seasonality

To read this interview visit: https://bit.ly/3erwWNr ■

What we still don’t know  

Historical COVID-19 coverage from our Archives continues on page 24

What percent of the population has been infected The mortality rate per infection

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Epidemiologists in the Spotlight Pandemic Creates a Who's Who in Epi Today No other event in our lifetimes has called upon the knowledge, experience, and expertise of epidemiologists as frequently as the COVID-19 pandemic. Everywhere we turn, epidemiologists are forecasting estimated cases and deaths, being interviewed on television, writing editorials and op-ed articles, and answering questions for a wide variety of audiences. Never have epidemiologists been in such demand, even though we have more uncertainties than facts about the transmission dynamics and other epidemiologic features and parameters of COVID-19 at this point in time.

During these times, some epidemiologists have become darlings of the media and some considered heroes in providing reliable, objective, and trustworthy information to an anxious public in various countries. Some have generated many new followers on Twitter. In monitoring the pandemic for our readers, we have collected a sample of contributions made by epidemiologists around the world. It constitutes an unofficial Who’s Who in Epidemiology today.

Value of Mitigation Applied Early Britta Jewell, research fellow in the department of infectious disease epidemiology at Imperial College London and Nicholas Jewell, chair of biostatistics and epidemiology at the London School of Hygiene and Tropical Medicine and a professor at the University of California Berkeley, provide a graphic display of the impact social distancing can have, even if applied as little as one or two weeks earlier. According to their calculations based on a model developed by the Institute for Health Metrics and Evaluation, an estimated 90% of the cumulative deaths in the US between now and August 2020 might have been prevented by putting social distancing policies into effect on March 2, two weeks earlier than March 16, when there were only 11 deaths in the entire country. They also utilize the natural experiment of a delay of one week in Tennessee compared to Kentucky in implementing lockdown measures to illustrate clearly the impact of mitigation tactics applied earlier than later in an outbreak. https://nyti.ms/2VDEyDZ

On CDC Disappearance Thomas Frieden, former CDC Director published New York Times op-ed on April 12, 2020 writing “The CDC has the knowledge and expertise to limit the spread of the coronavirus, but it needs the authority and voice that‘s been withheld from it the past three months. It is not too late to limit the devastation of our nation’s health and economy. But the administration must support and follow the guidance of the CDC—and it must do so now.” https://nyti.ms/2RNUP7X

- Who's Who cont'd on page 25

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-Who's Who cont'd from page 24

Counting On Herd Immunity Roman Prymula, a respected epidemiology expert in the Czech Republic has made headlines locally for making a surprising U-turn in favor of allowing the population to return to normal gradually to enable a controlled spread of COVID-19 and a gradual building of herd immunity while continuing to protect the vulnerable groups. He based his change of mind, as reported in the Czech media, because he believes China has provided incorrect data and the death rate in Italy is lower than initially calculated (not 15 percent but 2-3 percent). https://bit.ly/2Kggm5c

Straight Talk and Hard Truths Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota writing in the New York Times opinion page stating “It’s too late to avoid disaster, but there are still things we can do. Our leaders need to speak some hard truths and then develop a strategy to prevent the worst.” https://nyti.ms/3eAm93i

Media Criticisms Gregg Gonsalves, assistant professor of epidemiology at Yale, was the subject of an article at Fox News.com for criticizing New York Times reporters for the headline of a story they wrote suggesting there was an unsettled debate about the importance of testing for coronavirus. In an exchange of tweets after the story ran, Gonsalves said “Your collective reporting on the political aspects of this have been off-the-mark. Everything is a Punch & Judy show, and the real story of the absolute and continuing failure of the response to #coronavirus gets obscured in your reporting as “who’s winning the day” in DC.

Need Infection Rate Information Michael Mina, assistant professor of epidemiology at the Harvard School of Public Health and its Center for Communicable Disease Dynamics made a number of observations about the pandemic during a conference call with the media, according to the Harvard Gazette. Part of his advice was to get folks out of nursing homes because he believes the virus is much more transmissible than we have been able to document, and control in those circumstances is “an extraordinary feat.” He added “We have to get to an order of magnitude understanding of how many people have actually been infected. We really don’t know if we’ve been 10 times off or 100 times in terms of the cases.

Personally, I lean more toward the 50-100 times off, and that we’ve actually had much wider spread of this virus than testing…numbers are giving us at the moment.”

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- Who's Who cont'd on page 26

-Who's Who cont'd from page 25

Government Fumbles Larry Brilliant, an epidemiologist who worked internationally on smallpox eradication, co-founded Seva Foundation to treat eye disease in poor countries, led Google’s philanthropic efforts at one point, and helped create the movie Contagion to show what a serious pandemic could do to society was interviewed on April 1 for a podcast by The Economist.

When asked if the governments are taking the pandemic seriously enough, he replied “I would say that governments have been incredibly slow in responding, almost without exception. I think that your government in the UK [...] began on a misguided mission to allow or think that they could allow everybody or a large number of people to become infected, in an effort to reach the epidemiologist’s Holy Grail of “herd immunity”.

I think my government [in America] fumbled, almost unforgivably, in the way they mangled the distribution of test kits; in the way that our leadership pretended that the outbreak could be brought down from five to zero and it would not be a problem after a while. And it continued to underplay how important it was, as “a hoax,” until finally confronted with the stark reality.” https://econ.st/2Kif4GK Brilliant was also interviewed for the podcast Soul of the Nation on a moral response to COVID-19. https://bit.ly/3bjXwpP

High Profile in China Zhong Nanshan, is being called China’s leading epidemiologist sometimes referred to as the nation’s “SARS hero” by Chinese media, according to The Diplomat, a publication covering the Asia Pacific region. In 2003, while SARS left China’s health authorities and government officials struggling to rebuild public trust, Zhong was hailed for his integrity. This was largely due to his public admission that the virus was not as under control as state media portrayed.

The Diplomat reports that “Despite his advanced age (born in 1936) Zhong has been appointed to lead the National Health Commission’s investigation into the novel coronavirus. By extension, he has become the de facto spokesperson for any information related to the illness. Beyond his work tracking and studying COVID-19, he has given multiple interviews to Chinese and English language media. He is an obvious choice for the position, as the Communist Party tries to highlight its efforts to manage the crisis in a transparent, decisive manner…” https://bit.ly/3eAnebm

- Who's Who cont'd on page 27

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-Who's Who cont'd from page 26

Epi Predictions Marc Lipsitch, Harvard professor of epidemiology and director of the School’s Center of Communicable Disease Dynamics has been in the news for the COVID-19 projections his academic group have provided that intermittent social distancing may be needed until 2022. In an informative interview in USA Today, Lispsitch said we’re in a dilemma—if we relax the restrictions we can expect a resurgence, and if we keep the restrictions in place it will be economically disastrous. What to do?

He thinks we can try to bring down cases in each locality to a point where they can be controlled individually. But the epidemic will likely appear in more than one wave and people are confused about that thinking if you stop it once you’re done.

Asked directly, so how long will people have to hunker down? Lipsitch said “It’s not a scientific choice only. It’s ultimately a political choice, and science is one input.” Asked, so how do you see things playing out, Lipsitch gave his longest reply— “If I had to make a prediction about how the interaction between social and scientific and public health factors will play out, I think there's going to be fatigue at some point. Some places are going to let up either after they've controlled the first peak or before they've controlled the first peak.

Cases will reemerge, and because people are so tired of social distancing, it will take until the intensive care units are overwhelmed in that place to get people to crack down again, and then there will be some cycles of that. There are ways to try to avoid that, but they all involve this very long and destructive process of social distancing. It's easy to say as the public health person, this is what we need to do for public health. But I'm acutely aware that there are also other considerations, and I don't see a really good answer.”

Burden Unimaginable After offering to come out of retirement to help with COVID-19 control efforts, Bill Hall's offer was immediately taken up by his former health department. He told local media “I am a roving epidemiologist. What that means is that I’m available to travel to whichever district in the Eastern Region of the state that is in the greatest need of epi manpower. According to the paper Hall spends his days interviewing COVID-19 patients and their contacts; trying to locate contacts who might have been exposed to the virus; and doing patient followups, case reviews, case monitoring, and data entry, among other tasks. Additionally, he provides guidance to health care facilities and physicians about testing criteria.

He said “The burden created on the health care and public health system is unimaginable…My hat just goes off to all the people who are doing all this work.”

- Who's Who cont'd on page 28

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-Who's Who cont'd from page 27

Controversy In Sweden Anders Tegnell, Sweden’s chief epidemiologist and reportedly the architect of his country’s “social distancing light” or “soft” approach (allowing population immunity to develop more naturally) has been fending off critics. Sweden sought to shelter the elderly and vulnerable but has left stores and offices open and waiting to see what happens. According to the European Centers for Disease Control and Prevention, Sweden has reported over 1200 deaths through April 16 compared to only 72 in Finland with half the population which is often used as a comparison because it took more stringent measures in the Helsinki area. Other Scandinavian countries have also reported significantly fewer deaths with rates per 100,000 much lower.

Joacim Rocklov, a professor of epidemiology at Umea University is quoted in the Wall Street Journal saying “this is a big risky experiment with the entire population that could have a catastrophic outcome…It is risky to leave it to people to decide what to do without any restrictions…”

A recent op-ed in one of the important newspapers by 22 physicians urged the government to lockdown the country as is being done elsewhere. Tegnell has rejected these arguments and has debated critics, according to a recent account in Canada’s National Post. It concludes by saying about Tegnell, “One wishes good luck to the temporary helmsman of the Swedish ship of state as he argues that icebergs are not really his department.” https://on.wsj.com/2RKqmru ■

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Advertising opportunities exist in this digital publication, on our website and social media accounts, and in our Epi-Gram emails.

For more information please contact: Michele Gibson / michele@epimonitor.net

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Epi Word Search – April 2025 Pandemic Reminders We know the end of the academic year is incredibly busy for our readers so this month, instead of a long crossword, we are bringing you a short word search. Good luck - don't let the easy words fool you!

For an interactive online version go to: https://tinyurl.com/3w7d9j3u

Words to find: 1. Booster 2. Contagion 3. Coronavirus 4. Crush the Curve 5. Eradication 6. Herd Immunity 7. Home Test 8. Infection Rate 9. Ivermectin 10. Social Distance 11. Stop the Spread 12. Strategy 13. Transmissible 14. Vulnerable

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What We're Reading This Month Editor's Note: All of us are confronted with more material than we can possibly hope to digest each month.

However, that doesn't mean that we should miss some of the articles that appear in the public media on topics of interest to the epi community. The EpiMonitor curates a monthly list of some of the best articles we've encountered in the past month. See something you think others would like to read? Please send us a link at info@epimonitor.net and we'll include it in the next month.

Washington DC Chaos ♦ Epidemiologist Flags Dangers Of Donald Trump’s ‘Deeply Disturbing’ Data Scrub (Huffpost via Yahoo News) https://tinyurl.com/48ymp9b8 ♦ NIH scientists have a cancer breakthrough. Layoffs are delaying it. (WAPO via AppleNews) https://tinyurl.com/3s2cndwm ♦ This Isn’t Efficiency. It’s Erasure. Inside the Grief, Fear, and Fury at the CDC. (Substack) https://tinyurl.com/2p9z5vra ♦ Trump’s Revenge on Public Health (The Atlantic via AppleNews) https://tinyurl.com/yc5vpmxv ♦ “I Am Seeing My Community of Researchers Decimated” (The New Yorker via AppleNews) https://tinyurl.com/3254web3 ♦ Top U.S. vaccine official resigns citing RFK Jr.'s "misinformation" push (Bloomberg via AppleNews) https://tinyurl.com/2t2d47uz ♦ Widespread layoffs, purge of leadership underway at U.S. health agencies (WAPO via AppleNews) https://tinyurl.com/5n8utdup ♦ Public health leaders, distrustful of RFK Jr., stand up project to defend vaccines (STAT News) https://tinyurl.com/mr3akjw3 ♦ White House promotes debated COVID lab-leak theory on web page that was devoted to health information (STAT via AppleNews) https://tinyurl.com/2whkt7ms

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- Reading cont'd on page 31

[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in What Use We're Reading Month - con't from 30 box.] the document. the Text Box Tools tabThis to change the formatting of the pull page quote text

Public Health Topics, cont. ♦ Yale researchers rethink public health data (Yale Daily News) https://tinyurl.com/mpccpyk6 ♦ PAHO issues new epidemiological alert amid rising yellow fever cases in the Americas (PAHO website) https://tinyurl.com/bdeyc57m ♦ WHO Announces ‘Pandemic Agreement’ Years After COVID-19 (Epoch Times) https://tinyurl.com/27kb638v ♦ The world’s deadliest infectious disease is about to get worse (The Atlantic via AppleNews) https://tinyurl.com/3ppprwwc ♦ Is Covid Rewriting the Rules of Aging? Brain Decline Alarms Doctors (WSJ via AppleNews) https://tinyurl.com/2p2mkbd8 ♦ FDA Asks Vaccine Maker to Complete New Clinical Trial for Delayed Covid-19 Shot (WSJ via AppleNews) https://tinyurl.com/4yuj9haf ♦ Health warning for Australians and their pets after rare virus kills 28 in Queensland (The Independent via AppleNews) https://tinyurl.com/4dp6tm7p ♦ Uganda declares end to latest ebola outbreak (Reuters via AppleNews) https://tinyurl.com/mrw3e2px ♦ It Was Once Eliminated From the U.S. Now, We Could Be on the Verge of an Epidemic.

(Slate via AppleNews) https://tinyurl.com/47w5bxnu ♦ Voices: The world is facing a new and devastating frontier in the Aids epidemic (The Independent via AppleNews) https://tinyurl.com/yeyr2zxh

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Notes on People Do you have news about yourself, a colleague, or a student?

Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net

Apppointed: Virginia Commonwealth University today announced that Monica Swahn, Ph.D., has been named dean of the VCU School of Public Health, effective July 1, 2025. The Board of Visitors will officially consider the appointment at its next quarterly meeting.

Swahn comes to VCU from Kennesaw State University, where she served as dean and professor in the Wellstar College of Health and Human Services.

Appointed: Augusta University’s School of Public Health, has announced the addition of Sejong Bae, PhD, as the inaugural chair of the Department of Biostatistics, Data Science, and Epidemiology.

Bae, who spent the last 13 years at the University of Alabama at Birmingham, including his most recent role as director of the Bioinformatics & Biostatistics Group for the O’Neal Comprehensive Cancer Center, will begin in May.

Named: Kiros Berhane, PhD, the Cynthia and Robert Citrone-Roslyn and Leslie Goldstein Professor and Chairman of the Department of Biostatistics at Columbia Mailman School, has been named a Fellow of the American Association for the Advancement of Science (AAAS), the world’s largest general scientific society and publisher of the Science family of journals. Berhane is recognized for his groundbreaking contributions to biostatistics, particularly in the development of innovative statistical methods for environmental health, chronic disease, and public health research.

Passed: Dr. George Tams Curlin of Oxford, MD passed away on March 16, 2025 at home. A renowned epidemiologist, specializing in infectious disease and population health, George devoted his life to his calling to limit suffering and inequalities around the world. In 1977 he joined the National Institute of Allergy and Infectious Disease (NIAID), serving as Chief of the Epidemiology Branch and later as Deputy Director of the Division of Microbiology and Infectious Diseases. He retired from NIAID in 2010. https://tinyurl.com/47tupc75

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Notes on People, con’t from page 32 Do you have news about yourself, a colleague, or a student?

Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net

Passed: Just six days after becoming an American citizen, Dr. Riten Mitra died when he was struck by a pickup truck in a crosswalk. A native of India, he had been a professor and biostatistics researcher at the University of Louisville since 2013. His contributions both to the field of biostatistics and the university were invaluable. https://tinyurl.com/3prfn32j https://tinyurl.com/535zswh4

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Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the upcoming year. Thus an online copy exists on our website that is updated regularly.

To view the full year please go to: http://www.epimonitor.net/Events The events that we are aware of for the next month follow below.

May 2025 May 1-2 Type: Conference Web: https://tinyurl.com/58z2zf37 Title: 7th International Molecular Pathological Epidemiology (MPE) Meeting Sponsor: Multiple Location: Buffalo, NY May 4-6 Type: Conference Web: Title: Health Effects Institute Annual Conference 2025 Sponsor: HEI Location: Philadelphia, PA

https://tinyurl.com/bddezfxu

May 5-7 Type: Conference Web: https://tinyurl.com/4f8f6w8k Title: 2025 Annual Conference on Vaccinology Research Sponsor: National Foundation for Infectious Diseases Location: Washington, DC May 5-8 Type: Conference Web: https://tinyurl.com/mtepy6sf Title: APHL 2025 Annual Conference Sponsor: Association of Public Health Laboratories Location: Portland, OR May 5-8 Type: Conference Web: https://tinyurl.com/4suhn6ef Title: Preventive Medicine 2025 Sponsor: American College of Preventive Medicine Location: Seattle, WA May 7-9 Type: Short Course Web: https://bit.ly/2C4g1PE Title: Quality of Life Measurement Sponsor: Erasmus MC Location: Rotterdam, The Netherlands May 7-16 Type: Short Course Web: http://tinyurl.com/4wkbwcu3 Title: Sustainable Public Health Sponsor: Erasmus MC Location: Rotterdam, The Netherlands May 9-11 Type: Conference Web: https://tinyurl.com/3359hpry Title: The 10th Workshop on Biostatistics and Bioinformatics Sponsor: National Science Foundation & Georgia State University Location: Atlanta, GA May 9-13 Type: Conference Web: https://tinyurl.com/2hh5s3ys Title: 50th Annual Kettil Brunn Society Meeting Sponsor: Kettil Brunn Society Location: Glasgow, Scotland

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May 2025 continued May 9-16 Type: Short Course Web: https://tinyurl.com/2na5343d Title: Low Input Epigenomics Sponsor: Wellcome Connecting Science Location: Hinxton, England May 12-16 Type: Short Course Web: Title: Introduction to Qualitative Research Methods Sponsor: University of Bristol Location: Virtual

http://tinyurl.com/4xwhe3y9

May 13-15 Type: Conference Web: https://tinyurl.com/bdfjzucc Title: 101st Annual Education Conference Sponsor: Texas Public Health Association Location: Brownsville, TX May 13-16 Type: Conference Web: http://bit.ly/2DXzS3d Title: INTEREST 2025 Sponsor: IeDE (Intl Epi Databases to Evaluate AIDS Location: Windhoek, Namibia May 16 Type: Conference Web: https://tinyurl.com/a7ektvku Title: Conference on Neglected Tropical Diseases Sponsor: Academic Medical Education Inc Location: Windhoek, Namibia May 18-21 Type: Conference Web: https://bit.ly/3FBbwf3 th Title: 46 Annual Meeting Sponsor: Society for Clinical Trials Location: Vancouver, BC, Canada May 19-20 Type: Conference Web: https://tinyurl.com/4jhnbjbz Title: Health Equity Conference Sponsor: National Rural Health Association Location: Atlanta, GA May 19-21 Type: Conference Web: https://tinyurl.com/mrvwmakz Title: North Dakota Public Health Conference Sponsor: North Dakota Health Partners Location: Bismark, ND May 19-22 Type: Conference Title: Accelerating Health Equity Sponsor: Multiple Location: Atlanta, GA

Web:

https://bit.ly/3Fz1F9t

May 19-23 Type: Short Course Web: https://bit.ly/32uyVPE Title: Causal Inference for Assessing Effectiveness in Real World Data and Clinical Trials Sponsor: UMIT Location: Tirol, Austria May 19-27 Type: Conference Title: 78th World Health Assembly Sponsor: WHO Location: Geneva, Switzerland

Web:

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https://bit.ly/321Yo2B

May 2025 continued May 19-28 Type: Short Course Web: https://bit.ly/3YwW6kG Title: Missing Values in Clinical Research Sponsor: Erasmus MC Location: Rotterdam, The Netherlands May 19 – June 6 Type: Summer Program Web: http://bit.ly/2P1VUrR Title: Summer Public Health Institute Sponsor: University of Minnesota Location: Minneapolis, MN May 19 – Jun 27 Type: Summer Program Web: https://tinyurl.com/4vhys5vn Title: 2025 Summer Institute in Biostatistics and Data Science Sponsor: Florida Atlantic University Location: Boca Raton, FL May 20-22 Type: Conference Web: Title: 2025 Wisconsin Public Health Conference Sponsor: WPHA Location: Milwaukee, WI & Virtual

https://tinyurl.com/4wj8ht4h

May 20-23 Type: Conference Web: https://tinyurl.com/ys643ycx Title: 48th Annual Rural Health Conference Sponsor: National Rural Health Association Location: Atlanta, GA May 21-23 Type: Conference Web: https://tinyurl.com/8hbsdxtw Title: STATGEN 2025: Conference on Statistics in Genomics and Genetics Sponsor: American Statistical Association (ASA) Location: Minneapolis, MN May 21-23 Type: Conference Web: https://tinyurl.com/y8hynnxz Title: Applied Bioinformatics & Public Health Microbiology Sponsor: Wellcome Connecting Science Location: Hinxton, England & Virtual May 22-24 Type: Conference Web: https://tinyurl.com/8r6wpubm Title: 3rd Intl Summit on Public Health & Preventive Medicine Sponsor: Spectrum Conferences Location: Amsterdam, The Netherlands May 25-28 Type: Conference Web: https://tinyurl.com/4n9vezb8 Title: 2025 SSC Annual Meeting Sponsor: Statistical Society of Canada Location: Saskatoon, Saskatchewan, Canada May 27-30 Type: Conference Web: https://tinyurl.com/mr6jbsxj Title: 2025 SPR Annual Conference Sponsor: Society for Prevention Research Location: Seattle, WA

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May 2025 continued May 28-30 Type: Conference Web: Title: Brain Tumor Epidemiology Consortium Conference Sponsor: BTEC Location: Durham, NC

https://tinyurl.com/2s36x8bn

May – June TBD Type: Summer Program Web: http://bit.ly/38mW6tl Title: 101st Annual Education Conference Sponsor: Summer Institutes in Global Health Location: Montreal, Quebec, Canada & Virtual

Your Ad Should Be Here Do you have a job, course, conference, book or other resource of interest to the epidemiology community? Advertise with The Epidemiology Monitor and reach 35,000 epidemiologists, biostatisticians, and public health professionals monthly.

Advertising opportunities exist in this digital publication, on our website and social media accounts, and in our Epi-Gram emails.

For more information please contact:

Michele Gibson / michele@epimonitor.net

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June 2025 June 1-30 Type: Summer Program Title: EpiSummer@Columbia Sponsor: Columbia University Location: Virtual

Web:

https://tinyurl.com/jxms5vue

June 2-5 Type: Conference Web: https://tinyurl.com/3k3a23w8 Title: 12th TEPHINET Scientific Conference and the Global Field Epidemiology Partnership Forum Sponsor: TEPHINET Location: Berlin, Germany June 2-6 Type: Short Course Web: Title: Fungal Pathogen Genomics Sponsor: Wellcome Connecting Science Location: Virtual

https://tinyurl.com/3kr4ejvm

June 2-6 Type: Short Course Web: https://bit.ly/2zSUnwy Title: Psychopharmacology Sponsor: Erasmus MC Location: Rotterdam, The Netherlands June 2-14 Type: Summer Program Web: https://tinyurl.com/3zecjmk2 Title: Summer Program on Modern Methods in Biostatistics & Epidemiology Sponsor: BioStatEpi Location: Treviso, Italy June 2 – July 11 Type: Summer Program Web: https://tinyurl.com/42c3w8jv Title: Summer Program in Biostatistics and Computational Biology Sponsor: Harvard University Location: Boston, MA June 3-4 Type: Short Course Title: Introduction to Quantitative Bias Analysis Sponsor: University of Bristol Location: Virtual

Web:

http://tinyurl.com/2yw6dpxy

June 5-6 Type: Short Course Title: Analysis of Repeated Measures Sponsor: University of Bristol Location: Virtual

Web:

https://tinyurl.com/zsyycmeb

June 7-10 Type: Conference Web: Title: 2025 Annual Research Meeting Sponsor: Academy Health Location: Minneapolis, MN

https://tinyurl.com/3cyz2d6z

June 7 – July 26 Type: Summer Program Web: https://tinyurl.com/4n8wa2cm Title: UTMB Summer Institute in Biostatistics and Data Science Sponsor: UTHealth Houston & NHLBI Location: Galveston, TX June 8-12 Type: Conference Web: https://bit.ly/2Pkd8Q4 Title: Council of State & Territorial Epidemiologists 2025 Annual Conference Sponsor: CSTE Location: Grand Rapids, MI

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June 2025 continued Type:

Conference

Web:

http://bit.ly/2RyvIGU

June 9-10 Title: 38th Annual SPER Meeting Sponsor: Society for Pediatric and Perinatal Epidemiologic Research Location: Boston, MA June 9-11 Type: Summer Program Web: https://tinyurl.com/5feznckd Title: Summer Institute in Biostatistics and Data Science (SIBS) Sponsor: Boston University Location: Boston, MA June 9-11 Type: Short Course Title: Multiple Imputation for Missing Data Sponsor: University of Bristol Location: Virtual

Web:

http://tinyurl.com/2s34e9y5

June 9-13 Type: Conference Web: https://tinyurl.com/2hh5s3ys Title: 50th Annual Kettil Brunn Society Meeting Sponsor: Kettil Brunn Society Location: Glasgow, Scotland June 9-27 Type: Summer Program Web: Title: 43rd Summer Institute of Biostat & Epi Sponsor: Johns Hopkins University Location: Virtual

https://bit.ly/3xxZn8o

June 9 – July 18 Type: Summer Program Web: https://tinyurl.com/mvpwus3p Title: Pathways into Quantitative Aging Research Summer Program Sponsor: NYU School of Global Public Health Location: New York, NY June 10-12 Type: Conference Web: https://tinyurl.com/5n8wjzvz Title: 2025 NNPHI Annual Conference Sponsor: National Network of Public Health Institutes Location: Minneapolis, MN June 10-13 Type: Workshop Web: https://tinyurl.com/wrw8s7a4 Title: Student Dissertation Workshop Sponsor: Society for Epidemiologic Research Location: Boston, MA June 10-13 Type: Conference Web: https://tinyurl.com/4dc75e9e Title: Society for Epidemiologic Research Annual Conference Sponsor: SER Location: Boston, MA June 10-21 Type: Summer Program Web: https://tinyurl.com/yzps8rth Title: Advanced Statistics Summer Workshop - Biostatistics & Health Data Science Sponsor: Indiana University Location: Indianapolis, IN & Virtual

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June 2025 continued June 11-13 Type: Short Course Web: https://tinyurl.com/yx687wkv Title: Curating the Clinical Genome Sponsor: Wellcome Connecting Science Location: Hinxton, England & Virtual June 12-13 Type: Conference Web: https://tinyurl.com/d24vwhnt Title: International Symposium on Public Health and Epidemiololgy Sponsor: Scisynopsis Conferences Location: Rome, Italy June 13-14 Type: Conference Web: https://tinyurl.com/32h8ndvc Title: 15th Annual Conference on Epidemiology - Infectious Diseases & Public Health Sponsor: Conference Series Location: Rome, Italy June 16-17 Type: Conference Web: Title: 2025 Policy Action Institute Sponsor: American Public Health Association Location:

https://tinyurl.com/2nbxaexw

June 16-18 Type: Conference Web: https://bit.ly/3DNvDDG Title: Assn for Professionals in Infection Control and Epidemiology (APIC) 25th Annual Conference Sponsor: APIC Location: Phoenix, AZ June 16-18 Type: Conference Web: https://tinyurl.com/2chch58s Title: Vaccines 2025 - Global Summit on Vaccines Research and Development Sponsor: Research Connects Location: Rome, Italy June 16-18 Type: Short Course Title: Statistical Methods for Mediation Analysis Sponsor: University of Bristol Location: Virtual

Web:

http://tinyurl.com/2f2ax7jw

June 16-20 Type: Conference Web: https://tinyurl.com/yzdexcdr Title: 2025 Grantmakers In Health (GIH) Annual Conference on Health Philanthropy Sponsor: Grantmakers in Health Location: New Orleans, LA June 16 – July 4 Type: Summer Program Title: 37th Residential Summer Course in Epi Sponsor: EEPE Location: Florence, Italy

Web:

http://eepe.org

June 16 – July 25 Type: Summer Program Web: https://tinyurl.com/84pu8myt Title: Big Data Summer Institute Sponsor: University of Michigan SPH Location: Ann Arbor, MI

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June 2025 continued June 18-20 Type: Conference Web: https://tinyurl.com/453eb8ec Title: International Cancer Screening Network (ICSN) Conference 2025 Sponsor: ICSN Location: Aarhus, Denmark June 19-20 Type: Short Course Title: Machine Learning with Omics Data Sponsor: University of Bristol Location: Virtual

Web:

https://tinyurl.com/mr3d3bc4

June 23 – July 4 Type: Short Course Web: https://bit.ly/2Kxw9QD Title: Epidemiological Evaluation of Vaccines: Efficacy, Safety and Policy Sponsor: LSHTM Location: London, England June 23 – August 8 Type: Summer Program Web: https://tinyurl.com/yc35sbw3 Title: Stanford Population Health Summer Research Program Sponsor: Stanford University Location: Stanford, CA June 24-25 Type: Conference Web: https://tinyurl.com/4u9sj4b4 Title: 8th Annual Conference on Epidemiology & Public Health Sponsor: Conference Series Location: Chicago, IL June 29 – July 5 Type: Summer Program Title: ESCMID Summer School Sponsor: ESCMID Location: Dublin, Ireland

Web:

https://tinyurl.com/mrtrn83w

June 30 – July 3 Type: Short Course Web: https://tinyurl.com/ykdakjje Title: Causal Inference in Epidemiology: Concepts and Methods Sponsor: University of Bristol Location: Virtual June TBD Type: Summer Program Web: Title: Pharmacoepidemiology Summer School Sponsor: Aarhus University Location: Grenaa, Denmark

https://tinyurl.com/bdcufee9

June TBD Type: Summer Program Web: Title: Summer Program in Epidemiology Sponsor: Harvard University Location: Boston, MA

http://bit.ly/368xRgK

June TBD Type: Summer Program Web: https://tinyurl.com/4haz42bs Title: Epi on the Island Sponsor: University of Prince Edward Island Location: Prince Edward Island, Canada

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CARDIOVASCULAR DISEASE EPIDEMIOLOGY AND PREVENTION POSTDOCTORAL FELLOWSHIP The Division of Epidemiology & Community Health of the University of Minnesota has a current opening and is seeking candidates for a postdoctoral training fellowship in cardiovascular disease epidemiology and prevention.

Fellowship Experience Training emphasizes research methods in the epidemiology and prevention of cardiovascular disease. Training can include formal coursework in epidemiology, biostatistics, clinical research, nutrition, physiology, data science, and behavioral science.

Graduates gain competency in designing, administering, and analyzing cardiovascular population studies or preventive programs. The Division provides a rich and collaborative environment for the investigation of cardiovascular disease and related areas, in one of the largest Academic Health Centers in the U.S. Current Division research in cardiovascular epidemiology includes a robust blend of observational studies (e.g., ARIC, MESA, CARDIA, DISCOVERY), pharmacoepidemiology and interventional investigations (e.g., mGlide hypertension control RCT, Stand & Move at Work group randomized trial) aimed at improving public health and engaging a multidisciplinary integration of epidemiology, biology and behavioral science.

Benefits The program provides a stipend, tuition and fees for an MS or MPH degree, if desired, during the fellowship. This paid 2-3 year fellowship is sponsored by the National Institutes of Health.

Eligibility Candidates must have either an MD or a PhD degree and must be either a U.S. citizen or have permanent residency status.

Apply Interested applicants will complete an online application https://tinyurl.com/4e7yzp4c Questions, please contact: Jim Pankow, PhD, MPH panko001@umn.edu or Pamela Lutsey, PhD, MPH lutsey@umn.edu Co-Directors of CVD Epi Training Program

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The Epidemiology Monitor ISSN (2833-1710) is published monthly

Editorial Contributors Katelyn Jetelina, PhD, MPH Editor and Publisher

Operations Christopher Jetelina Operations Manager

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