RETROspective

As the semester comes to a close, we wanted to take a look back at some of our favorite PROspectives over the last few months. As the COVID situation developed from an isolated outbreak to a full-blown pandemic, we have gotten insights from faculty, staff, and alumni on topics both pandemic and non-pandemic related. Here are some of our favorite articles from Spring 2020:

1. In Keep Calm and…, Dr. Timothy Lash started off the semester with a discussion about performing under pressure, be it for school, work, or almost any other context. Given the pressure that many of us are feeling now to turn our skill sets towards the global crisis or maybe just to survive final exams, the strategies laid out in this article have probably never been more applicable. The quote:

“Learning to use stress to your advantage is healthy and will give you a competitive edge. Like many career skills, it requires introspection and a commitment to being intentional about the goal.”

2. Next, we heard from Dr. Jodie Guest about the value of reading outside the classroom in The EPI-Curious Society. The quote:

“Learning from our past and talking about our different perspectives is fundamental to doing good work.”

3. At the beginning of February, Dr. Lauren Christiansen-Lindquist helped us to think about APEs differently in her article, Internships: Not just about fulfilling the APE requirement. The quote:

“You may have heard this from me before, but my motivation for pursuing a career in public health was driven by wanting to make a difference. The reason why I love the APE so much is that it affords our students the opportunity to make their mark on public health even before graduation.”

4. In a 3 part series, we heard from alum Roice Fulton (GLEPI, 2014) on careers in global public health with multinational organizations. In Part 1, Roice shared his path from GLEPI student graduating at the height of the 2014 Ebola outbreak in West Africa (more relevant now than ever), to a full-blown career at an unexpected employer. In Part 2, the focus turned toward the nuts and bolts of the global NGO industry and how to navigate your own entry post-graduation. Finally, Part 3 uncovered the role of teamwork and leadership in public health. The quote:

“You may be faced with a call to lead from unexpected places and at unexpected times, especially as we reckon with a pandemic that touches every facet of our work. We’ve got to be ready for the call when it comes.”

5. Epidemiology is not just about the 2×2 tables and the regression coefficients – in our profession, we will also be called to translate science into policy and action. To do that, writes Dr. Lash, we will need to Tell Influential Stories. The quote:

“To be influential, one must change minds. To change minds, those minds must be open to change.”

6. With our schedules packed and mid-semester productivity waning, ADAP Farah Dharamshi introduced the term single-tasking in her article Juggling 101. The quote:

“Our days are filled with a constant barrage of distractions, unexpected challenges and increasing responsibilities. But, the science and experience are clear – by doing less all at once, you will likely be able to accomplish much more.”

7. As Emory, along with nearly every university and employer nationwide, transitioned to remote learning and working, I shared my how-to guide for executing that transition in my article WFH: New Challenges & New Opportunities. The quote:

“This experience is likely to teach you a lot about yourself, your ability to self-manage, your discipline, and your needs as an employee – knowledge that will help you better understand your own strengths and weaknesses going forward.”

8. This Spring, the word ‘epidemiologist’ entered the public domain and left a lot of people outside our profession itching to learn more about what exactly we do. In Dr. Guest’s article The ‘Rockstars’ of 2020, we gained a new way of thinking about our role in society. The quote: 

“In our work, the forgotten past and the unrealized outcomes are our principal indicators of success. Long, healthy lives, not fanfare, signal our victory.”

9. As the need for (and public misunderstanding of) COVID models increased throughout the Spring, Dr. Samuel Jenness provided us with a background on modeling and its application in infectious disease epidemiology in his article Modeling COVID-19. The quote:

“In one sense, models prove their utility in the absence of bad news if they stimulate public action towards prevention, which may have an effect on the shape of the future epidemic curve. In the short-term, public consumers of models may not be able to fully determine the technical quality of that research. But it is important to understand that priorities of newspapers and politicians, and what they find useful in some models, may differ substantially from strong scientific principles.”

10. As the economic impact of COVID became clearer, students wondered what the pandemic meant for their career opportunities. In her article, Job Hunting in the time of COVID, ADAP Noni Bourne gave us some of her insights into the current hiring atmosphere. The quote:

“Human connection is taking on a completely different role in our lives. More than ever, it will be critical to know the person behind the email and to forge relationships that might not have otherwise been so central to success in the workplace.”

11. In Work and Study Efficiency in Difficult Times, Dr. Lash helped us understand that all days are not created equal and, especially today, challenges with motivation and work efficiency are both normal, and acceptable. The quote:

“It might also be helpful to envision what success will look like for you in the long term. We will all one day tell the stories of what happened to us and what we did during the COVID-19 pandemic. You will want to say that you did your part and put your shoulder into it as best you could. Imagine your future self and the story you will want to tell, and then make it so.“

12. In our final PROspective article of the semester, Dr. Christiansen-Lindquist helped trace a path towards identifying APE opportunities during the pandemic in her article APEs: The Best Laid Plans… of 1st-Year Spring. The quote:

“Although your APE might not look like what you had planned, I would encourage you to view this as a speed bump, rather than a roadblock. Our capacity for resiliency is far greater than any of us can comprehend, and these challenging times have the potential to bring out creativity that we didn’t know that we had.”

From all of us on the editorial team, thanks so much for reading PROspective and congratulations for completing another semester! As we transition to our Summer publishing schedule, keep an eye out for more from PROspective going forward.

What was your favorite article this semester? Tell us in the comments!

Modeling COVID-19

From Dr. Samuel Jenness, Assistant Professor, Department of Epidemiology:

The global pandemic of COVID-19 has raised the profile of mathematical modeling, a core epidemiological approach to investigate the transmission dynamics of infectious diseases. Infectious disease modeling has been featured in routine briefings by the federal COVID task force, including projections of future COVID cases, hospitalizations, and deaths. Models have also been covered in the news, with stories on modeling research that has provided information into the burden of disease in the United States and globally. Along with this coverage has also come interest in and criticism of modeling, including common sources of data inputs and structural assumptions.

In this post, I describe the basics of mathematical modeling, how it has been used to understand COVID-19, and its impact on public health decision making. This summarizes the material I discussed extensively in a recent invited talk on modeling for COVID-19 global pandemic.

What Are Models?

Much of epidemiology (with many exceptions) is focused on the relationship between individual-level exposures (e.g., consumption of certain foods) and individual-level outcomes (e.g., incident cancers). Studying infectious diseases break many of these rules, due to the interest in quantifying not just disease acquisition but also disease transmission. Transmission involves understanding the effects of one’s exposures on the outcomes of other people. This happens because infectious diseases are contagious. Sir Ronald Ross, a British medical doctor and epidemiologist who characterized the transmission patterns of malaria in the early 20^th century, called these “dependent happenings.”

Dependent happenings are driven by an epidemic feedback loop, whereby the individual risk of disease is a function of the current prevalence of disease. As prevalence increases, the probability of exposure to an infected person grows. And prevalence increases with incident infections, and this is driven by individual risk related to exposure.

These dependencies create non-linearities over time, as shown in the right panel above. At the beginning of an infectious disease outbreak, there is an exponential growth curve. This may be characterized based on the doubling time in cumulative case counts. Epidemic potential can also be quantified with R₀, which average number of transmissions resulting an infected individual in a completely susceptible population. The 0 in R₀ refers to the time 0 in an epidemic when this would be the case; colloquially, people also use R₀ to discuss epidemic potential at later time points. Therefore, R₀ might shrink over time as the susceptible population is depleted, or as different behavioral or biological interventions are implemented.

Mathematical models for epidemics take parameters like R₀ as inputs. Models then construct the mechanisms to get from the micro-level (individual-level biology, behavior, and demography) to the macro-level (population disease incidence and prevalence). This construction depends heavily on theory, often supported by multiple fields of empirical science that provides insight into how the mechanisms (gears in the diagram below) fit together individually and together in the system.

Because of the complexity of these systems, and the wide range of mechanisms embedded, models typically synthesize multiple data streams from interdisciplinary scientific fields. Flexibility with data inputs is also important during disease outbreaks, when the availability of large cohort studies or clinical trials to explain the disease etiology or interventions with precision may be limited.

Fortunately, there are several statistical methods for evaluating the consistency of the hypothesized model against nature. Model calibration methods that test what model parameter values (e.g., values of R₀) are more or less consistent with data (e.g., case surveillance of diagnosed cases). Sensitivity analyses quantify how much the final projections of a model (e.g., the effect of an infectious disease intervention) depend on the starting model inputs.

Putting these pieces together, models provide a virtual laboratory to test different hypotheses about the often complex and counterintuitive relationships between inputs and outputs. This virtual laboratory not only allows for estimation of projected future outcomes, but also testing of counterfactual scenarios for which complete data may not be available.

How Are Models Built and Analyzed?

There are many classes of mathematical models used within epidemiology. Three broad categories are: deterministic compartmental models (DCMs), agent-based models (ABMs), and network models. DCMs divide the population into groups defined, at a minimum, by the possible disease states that one could be in over time. ABMs and network models represent and simulate individuals rather than groups, and they provide a number of advantages in representing the contact processes that generate disease exposures. DCMs are the foundation of mathematical epidemiology, and provide a straightforward introduction to how models are built.

Take the example in the figure below of an immunizing disease like influenza or measles, which can be characterized by the disease states of susceptible (compartment S), infected (compartment I), and recovered (compartment R). Persons start out in S at birth, then move to I, and then to R. The flow diagram, kind of like a DAG, defines the types of transition that are hypothesized to be possible (and by an omission of arrows, which are hypothesized not). Movement from S to I corresponds to disease transmission, and the movement from I to R corresponds to recovery. There may be additional exogenous in-flows and out-flows, like those shown in the diagram, that correspond to births and deaths.

The speed at which transmission and recovery occur over time is controlled by model parameters. These flow diagrams are translated into mathematical equations that formally define this model structure and the model parameters. The following set of equations that correspond to this figure. These are differential equations that specify, on the left-hand side, how fast the sizes of the compartments change (the numerators) over time (the denominator). On the right-hand side are the definition of the set of flows in and out of each compartment.

One flow, from the S to I compartment, includes the λ (lambda) parameter that defines the “force of infection.” This is the time-varying rate of disease transmission. It varies over time for the reasons shown in the epidemic feedback loop diagram, shown above, and formalized in the equation below. The rate of disease transmission per unit of time can be defined as the rate of contact per time, c, times the probability that each contact will lead to a transmission event, t, times the probability that any contact is with an infected person. The last term is another way of expressing the disease prevalence; this is the feature of the feedback loop that changes over time as the epidemic plays out.

The overall size of transitions is therefore a function of these model parameters and the total size of the compartments that the parameters apply to. In the case of disease transmission, the parameters apply to people who could become infected, or people in the S compartment. Once all the equations are built, they are programmed in a computer, such as the software tool for modeling that I built called EpiModel. To experiment with a simple DCM model, check out our Shiny app. 

More complex models build out the possible disease states, for example, by adding a latently infected but un-infectious stage (called SEIR models). Or they add another transition, by adding an arrow from R back to S in the case that immunity is temporary (called SIRS models). Or they add extra stratifications, such as age groups, when those strata are relevant to the disease transmission or recovery process. By adding these stratifications, different assumptions about the contact process are then possible; for example, by simulating a higher contact rate for younger persons or concentrating most of the contacts of young people with other young people. These additional model structures should be based on good theory, supported by empirical data.

How Have Models Been Used to Understand COVID-19?

Mathematical models have been used broadly in two ways in the current COVID-19 global pandemic: 1) understanding what has just happened to the world or what will soon happen; 2) figuring what to do about it.

In the first category, several models have estimated the burden of disease (cases, hospitalizations, deaths) against healthcare capacity. The most famous of these models is the “Imperial College” model, led by investigators at that institution, and published online on March 16. This is an agent-based model that first projected the numbers of deaths and hospitalizations of COVID in the U.K. and the U.S. against current critical care capacity under different scenarios. In the “do nothing” scenario, in which there were no changes to behavior, the model projected 2.2 million deaths would occur in the U.S. and over 500,000 in the U.K.

The model also included scenarios of large-scale behavioral change (an example of the second category of use, what to do about it), in which different case isolation and “social distancing” (a new addition to the lexicon) measures were imposed. Under these scenarios, we could potentially “flatten the curve,” which meant reducing the peak incidence of disease relative to the healthcare system capacity. These changes were implemented in the model by changing the model parameters related to the contact rates; in this case, the model structure and the contact rates were stratified by location of contacts (home, workplace, school, community) and age group.

After these models were released, the U.S. federal government substantially changed its recommendations related to social distancing nationally. There was subsequent discussion about how long these distancing measures needed to be implemented, because of the huge social and economic disruption that these changes entailed. One high-stakes policy question was whether these changes could be relaxed by Easter in mid-April or perhaps early Summer.

The Imperial College model suggests that as soon as the social distancing measures are relaxed (in the purple band) there will be a resurgence of new cases. This second wave of infection was driven by the fact that the outbreak would continue in the absence of any clinical therapy to either prevent the acquisition of disease (e.g., a vaccine) or reduce its severity (e.g., a therapeutic treatment). Particularly concerning with these incremental distancing policies would be if the second wave occurred during the winter months later this year, which would coincide with seasonal influenza.

An update to the Imperial College model was released on March 30. This model projected a much lower death toll in the U.K. (around 20,000 cases, compared to over 500,000 in the earlier model). This was interpreted by some news reports as an error in the earlier model. But instead, this revised model incorporated the massive social changes that were implemented in the U.K. and other European countries over the month of March, as shown in the figure below. Adherence to these policies were estimated to have prevented nearly 60,000 deaths during March.

This is just one of many mathematical models for COVID. Several other examples of interest are included in the resource list below. There has been an explosion of modeling research on COVID since the initial outbreak in Wuhan, China in early January. This has been facilitated by the easy sharing of pre-print papers, along with the relatively low threshold in building simple epidemic models. With this explosion of research, much of the world has become interested with modeling research as the model projections are very relevant to daily life, and fill the gap in the news coverage in advance with clinical advances in testing, treatment, and vaccine technologies. Because pre-prints have not been formally vetted in peer review, it can be challenging for non-modelers (including news reporters and public health policymakers) to evaluate the quality of modeling projections. We have seen several cases already where nuanced modeling findings have been misinterpreted or overinterpreted in the news.

As the adage by George Box goes: all models are wrong, but some are useful. This applies to mathematical models for epidemics too, including those for COVID-19. Useful models are informed by good data, and this data collection usually takes time. These data inputs for models may rapidly change as well, as was the case for the updated Imperial college model, so earlier model projections may be outdated. This does not mean that the earlier model was wrong. In one sense, models prove their utility in the absence of bad news if they stimulate public action towards prevention, which may have an effect on the shape of the future epidemic curve. In the short-term, public consumers of models may not be able to fully determine the technical quality of that research. But it is important to understand that priorities of newspapers and politicians, and what they find useful in some models, may differ substantially from strong scientific principles.

Resources

There are many resources for learning more about modeling, including my Spring Semester course at RSPH, EPI 570 (Infectious Disease Dynamics: Theory and Models). We use the textbook, An Introduction to Infectious Disease Modeling, by Emilia Vynnycky & Richard White, that provides an excellent overview of modeling basics. We also have open materials available for our summer workshop, Network Modeling for Epidemics, that focuses specifically on stochastic network models. 

In addition, here is a short list of interesting and well-done COVID modeling studies:

• Original Imperial College model: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
• Updated Imperial College model: https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-03-30-COVID19-Report-13.pdf
• Model of social distancing in Wuhan: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30073-6/fulltext
• Social distancing model for repeated episodic distancing measures: https://dash.harvard.edu/handle/1/42638988
• Interactive model on the NY Times: https://www.nytimes.com/interactive/2020/03/25/opinion/coronavirus-trump-reopen-america.html
• Age profile of the COVID epidemic: https://dash.harvard.edu/handle/1/42639493
• Model of outbreak on the Diamond Princess cruise ship: https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm/taaa030/5766334

Samuel Jenness, PhD is an Assistant Professor in the Department of Epidemiology at the Rollins School of Public Health at Emory University. He is the Principal Investigator of the EpiModel Research Lab, where the research focuses on developing methods and software tools for modeling infectious diseases. Our primary applications are focused on understanding HIV and STI transmission in the United States and globally, as well as the intersection between infectious disease epidemiology and network science.

WFH: New Challenges & New Opportunities

Let’s take a poll: What is it called when you perform tasks at home that are normally accomplished at your company’s office or the library?

a) Working from home (WFH)

b) Working remotely

c) Teleworking

d) Digital Nomading

e) Pajama Executive

In English, we have a few different ways to say it, but ultimately they all mean the same thing; and represent a practice that many of you are just now trying for the very first time as workplace standards of the last 100 years suddenly, maybe irreplaceably, get upended by a global infectious disease pandemic. 

Working remotely means a lot of different things. While you have probably spent an hour at a coffee shop catching up on email, or taken a conference call from home once or twice when sick, it’s more likely that a permanently remote scenario is new to you. Personally, I’ve been fortunate to travel and work remotely in some capacity for several years, but have been fully remote for the last 11 months – now residing semi-permanently in Medellin, Colombia while continuing multiple jobs from afar.

During this time, I’ve either encountered, fallen victim to, or narrowly avoided many of the classic pitfalls of the Pajama Executive, and today I would like to share some suggestions to help you transition into your new situation. While it may seem disruptive at first, my opinion is that remote work – if designed well – can provide enormous opportunities for professional growth and increased productivity. My hope is that by the end of this article, you, like me, will find more upside in your newfound situation than downside. 

Your Workspace

You’re going to be spending a lot of time here for the foreseeable future. In public health, a common approach to behavior change is to make good habits as easy as possible to accept and maintain. Designing your workspace involves some of the same principles: make your space as comfortable and easy to work in as possible. 

1. Get your technology in order: Identify a dedicated workspace (ideally not in your bedroom, if possible) and arrange your setup with the goal of returning to the same spot every day. The idea is to mimic the conditions at your actual desk in the office. Position your laptop to give you the most ergonomic functionality and appropriate angle and background for video conferences. Test out your call/video conference stability over your wifi network. If your wifi isn’t very stable, do you need to upgrade your internet service? Now is a good time to set up the appointment with your service provider. Strong reliable internet will improve your productivity and, by doing so, ultimately pay for itself. This is why organizations tend to invest a lot in their in-office connectivity. If you are not already required to by your school or employer, consider using a VPN to protect your internet traffic and test any existing connections you might need to access files on the internal servers (Click here for information on Emory’s VPN access). 
2. Routine: How do you normally start your day? Workout, shower, eat a meal (read: drink coffee), get dressed, etc. Repurpose your normal routine to the new context of remote studying or working, and stick to it. Obviously, its reasonable to make more use of your casual wardrobe while working remotely, but for some of us, overdoing it on the casual attire leads to an overly casual disposition – the Pajama Executive might be prone to falling asleep on the job. The best approach, I have found, is to strike a balance and work in clothes that I can feel at least moderately professional in, even if I’m at home. 
3. Food: Working or studying from home can present another insidious challenge – sticking to a healthy diet. At the office or at school, there are socially acceptable times to eat. To break this routine would be difficult, which makes it easy to maintain consistently when you’re in public. However, at home, the (dining room) table is turned – culinary discipline is now 100% in your hands. There are two easy ways to avoid over-snacking, or eating lunch at 10:30am. First, skip the snack foods at the store, and stock up on the healthy stuff. You can’t eat what you don’t buy. Discipline in the store creates discipline in the home. Second, if possible, build your primary workspace somewhere away from the kitchen, and stock it with the essentials you’ll need for the day. We pack our lunch when we go to the office, so why not do the same at home. Ultimately, this strategy works because the less you walk near or through the kitchen, the less likely you are to be tempted. 

Design Your Day

Be deliberate about how you want your days to look. How much time can or should you really dedicate to work versus play. How can you design a situation that will maximize your productivity?

1. Work hours vs. non-work hours: Working remotely can be tricky because your work notifications can go off at any time, even if your work day is over. Most of us now get work email directly on our phones, so this isn’t new. The difference now is that you will have to decide when it is appropriate to respond. Keeping steady, dedicated work hours (communicate them to your superior and your team) can help set the right expectations for you and everyone you work with. Experiment with your “on” allotment and break times, and commit to NOT logging on when you are not scheduled to. This will ultimately help you remain the most efficient when you’re on and the most relaxed when you’re not. The same goes for classwork and studying – make a schedule and stick to it, then maximize your relaxation time when the workday ends. 
2. Daily To-Do list: Distraction starts with not knowing where to start on your work. To-do lists are an excellent solution to this problem. However, one major mistake with to-do lists is forgetting to stop when you’ve finished your list. Sometimes you don’t want to stop the roll you’re on, but it’s better to stick to the list you made a priori because burnout can sneak up on you fast when there is no one else setting the agenda for you. It was the classic American author, Ernest Hemingway who said, “Stop when you’re going good.” He is describing a common existential fear, among authors especially, that if you are on a roll that it won’t last until tomorrow, or that if you don’t take advantage you’ll miss out on some crucial productivity that won’t last until the next day. I personally find this the hardest to do well when I am performing programming tasks. Either way, try not to get sucked into this notion. Hemingway’s approach is based on the idea that if you are in the middle of a productive session towards the end of your day, leaving that inspiration on the table gives you the opportunity to pick it right back up in the morning tomorrow. What inspired your initial productivity will probably inspire subsequent productivity, especially if you return to it with fresh eyes the next day. 
3. Single-tasking: Two weeks ago, ADAP Farah Dharamshi authored an outstanding analysis of multi-tasking and it’s shortfalls. This wisdom is especially relevant for the remote student or employee. Of particular importance, is the idea of single-tasking. Close the tabs on your browser that aren’t immediately necessary for the task at hand, and commit yourself to a single, attainable objective, over a shorter period of time. You will almost certainly notice an improvement in productivity once you start to practice a more focused approach to individual tasks. 

A good employee is…

How would you finish this sentence? 

… is productive.

… is a team player.

… answers emails promptly.

These are all correct answers, all of which are necessary, but probably not by themselves sufficient, to describe a “good” employee. So, let’s try to redefine what this means in the context of remote work. Ultimately, being a good employee doesn’t mean you’re never distracted, or you respond to every email immediately – it means you do your job well and help make the team feel like no one is really remote.

1. Over-communicate: Being remote means we have to compensate a little for the reduction in face-to-face interaction. Be a little more detailed in your emails. Prioritize phone calls over emails, and video conferences over phone calls.
2. Independence: For better or worse, you are probably now going to be asked to perform tasks with less explicit direction than you were used to getting when you worked in the office. This isn’t universally true, because some managers naturally expect more or less independence from their employees. However, this provides a huge opportunity to take on more responsibility for your tasks and remove roadblocks to your success through resourcefulness and determination. This is the kind of initiative every manager dreams of, and will help you become a more productive, low-maintenance employee at home or in an office in the future.
3. Be Flexible: Working or studying at home will inevitably lead to more variability than you may be used to. Expect variability, and roll with it. Your work hours and your co-workers hours may not align perfectly. Everyone is transitioning now, so some people may face challenges that are different than yours. There is a learning curve for everyone, so you might as well embrace it!

WFH: A new normal for the 21st century

It’s hard to say what exactly the workforce of the post-COVID-19 era will look like. Remote work has been popular for the last 15-20 years among a group of backpackers and travelers who coined the term “digital nomad“. This isn’t necessarily what remote work has to look like, but it’s the very first blueprint we have to compare against. Ultimately, as COVID-19 pushes huge swaths of the economy into the home office, it’s very possible that we could be seeing the beginning of a more mainstream revolution in the relationship employees have with their employers and their workplace environment. If this is the case, then now is the time to embrace the new normal and master the WFH lifestyle and workstyle. Either way, this experience is likely to teach you a lot about yourself, your ability to self-manage, your discipline, and your needs as an employee – knowledge that will help you better understand your own strengths and weaknesses going forward. 

Further Reading:

If you are interested in doing a deeper dive into WFH tips and tricks, take a look at some of the articles below:

• Forbes – The art of working remotely
• Vox – Working from anywhere: the good, the bad, and the lovely
• NPR – Tips for making working from home work for you
• Forbes – Building positive habits for full time remote work

Breaking Into – and Surviving In – the Global NGO Sector: Part 3

From alum Roice Fulton (GLEPI, 2014):

On Leadership in Public Health

In the long run democracy will be judged… by the quality of its leaders, a quality that will depend in turn on the quality of their vision. Where there is no vision, we are told, the people perish; but where there is sham vision, they perish even faster.

Irving Babbitt, Democracy and Leadership

As the young leaders of tomorrow, you have the passion and energy and commitment to make a difference. What I’d like to really urge you do is to have a global vision. Go beyond your country; go beyond your national boundaries.

Former UN Secretary General Ban Ki-Moon

Leadership is a tough concept to nail down. It’s a term that, in my experience, seems most readily defined in its absence. Everyone has had the misfortune of witnessing a project or organization falling apart due to lack of leadership.

Though I won’t try to offer a concrete definition of leadership, there are two lessons I’d like to share. One is understanding how leadership roles can suddenly emerge along your career path, and how those experiences can inform a vision for positive change that starts locally, but reaches globally. The second lesson is simply recognizing that you, as young public health professionals preparing for the greatest public health crisis of our time, are each leaders whether you like it or not – because the world as it is today demands it of you.

~~~

While preparing to write these posts, I read through everything on PROspective to see what might help frame my own thoughts on leadership in public health. Every piece of advice given on this blog thus far resonates with my experience – but none so strongly as Lauren Christiansen-Lindquist’s treatise on setbacks (not failures!).

In her article, Dr. Christiansen-Lindquist speaks plainly and effectively to that lingering impostor syndrome that seems to plague our entire generation. What’s more, she offers a strategy for moving forward, and recognizing that moving forward is itself a victory worth celebrating. The qualities she describes reflect qualities I’ve appreciated both in my own fleeting experiences in leadership, and in those whom I consider among the greatest leaders of our generation.

One of Lauren’s suggestions is to share those setbacks. For today’s lesson, then, I’ll share the story of how my biggest setbacks led to some of my most valued leadership experiences.

~~~

In 2007, as part of (what I recognize now as) a futile, years-long effort to atone for a middling undergraduate pre-med performance, I moved to Missouri to volunteer as a member of AmeriCorps St. Louis’ Emergency Response Team. After two weeks of training, I was pulled aside and asked to serve as one of a handful of team leaders, tasked with managing a rotating five-person crew during our deployments to conservation and disaster relief projects.

The year that followed would see us respond to ice storms in Missouri, wildfires in Montana, and tornadoes sweeping across the Midwest – with each new crisis demanding that I balance the welfare both of my team and the communities we raced to support. It was a seminal year that instilled in me a vision of how I could be a force for change in communities beyond my own.

Three years later, I returned home to North Carolina to re-center and re-assess my future. I touched base with friends back home, including attending an alumni reunion at a summer educational program I had attended years prior in high school. After volunteering to build a website for the program’s supporting foundation, it wasn’t long before I found myself installed as its vice president – mere weeks before the program suddenly faced an existential funding crisis.

Working together with about a dozen fellow alumni and supporters aged eighteen to near eighty, we were not only able to scrape together the hundreds of thousands needed to keep the program open – we managed to convince the North Carolina legislature to restore funding in perpetuity. That vision I had in AmeriCorps of being a force for change was suddenly realized at a scale I had scarcely imagined. It remains my most cherished life experience.

Today, I’m almost relieved to hold no overt leadership position. My recent attempt to create a research nonprofit here in Geneva exposed the limits of my leadership ability and credibility at this point in my career. It showed to me that in a high-pressure environment, I’m much more comfortable in a support role, rather than at the head of the table.

And so, I moved on to CEPI, quietly keeping its core business sailing smoothly as the organization navigates the burgeoning coronavirus pandemic. But leadership comes in many forms, and that vision for positive change that I first developed in AmeriCorps and actualized in North Carolina remains and grows – and anchors me firmly to the global community which I now serve. In due time, I expect that I’ll be asked, here or elsewhere, to take on more responsibility – at which point I hope to be ready to deliver that vision to the fullest.

~~~

What I want to convey in sharing this story is that my leadership experiences wouldn’t have even happened were it not for some truly existential-level setbacks. Similarly, you may be faced with a call to lead from unexpected places and at unexpected times, especially as we reckon with a pandemic that touches every facet of our work.

We’ve got to be ready for the call when it comes.

With global leaders now facing a public health crisis partly of their own creation, it’s more important than ever that we, as young professionals, anticipate the leadership duties with which we will inevitably be tasked. We must be champions of reason in our workplaces and in our communities. We must forge strong bonds as teammates and across organizations in overcoming the challenges that face us. We must each craft and test our own vision for change locally, drawing thoughtfully from our lived experience.

And, most importantly, we must execute our vision globally and collectively – and conduct our lives in service to those in greatest need of that vision.

We must do all these things because the world as it is today demands it of us. We must answer that call. We must be leaders.

Roice Fulton, MPH (GLEPI, 2014) is currently an independent consultant for the London- and Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), where he manages projects in CEPI’s epidemiology portfolio. Roice currently lives and works near Geneva, Switzerland.

Breaking Into – and Surviving In – the Global NGO Sector: Part 2

From alum Roice Fulton (GLEPI, 2014)

Observe, Infer, and Engage 

I’m an almost willfully naïve person, for reasons better explained over pints somewhere within a few tube stops of CEPI’s London office. What matters for this post is how that naivete seems to underpin my career strategy: at every turn, it forces me to ask the most basic of questions, and think critically about how the answers affect my understanding of my own place in the public health world.

Case in point: I’d long held this picture of the global NGO community as some distant, impenetrable entity. What do they all actually do? How do they work together? I’m totally new to this scene – how do I fit in?

For years, the barrier to entry seemed prohibitive. Entry-level posts at places like Gavi were sparse, incredibly competitive, seemed only loosely matched to my new epi skillset, and took months of screening and interviews to get through. And at 30, I wasn’t keen on taking up an internship somewhere to try and get a foot in the door.

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A few factors would change the whole equation. One was my introduction to the world of independent consulting, which began with a short-term remote contract to conduct a systematic review for the WHO post-graduation. Another was learning that global NGOs sometimes use independent consultants to cover line work when they can’t hire full staff (which happens more often than they’re willing to admit).

A third factor was understanding just how quickly NGOs’ needs can change – and figuring out how to identify and seize work opportunities as new needs arose. In my case, that naivete I mentioned required me to build a picture of the immunization NGO scene from the ground up in order to understand my potential role in it.

I’d love to lay out everything I’ve learned, including the full history of the global immunization NGOs and their evolution toward the current landscape. But it’s not appropriate here, and it’s less than useful for those of you not interested in vaccines. Suffice to say that organizations such as Gavi and CEPI are mission-driven, highly impactful, and brimming with brilliant people whom I am incredibly lucky to count as colleagues.

What I will do is try to distill my experiences into a set of guidelines, to help you bridge the divide between your skills and the emergent needs of the global NGO community – or really, any employer. As it turns out, it’s an extension of an approach I took in grad school: observe, infer, and engage.

Observe

Find an organization doing something interesting and meaningful to you, and research the hell out of them. Look at all their job postings and RfPs, not just the ones that have an epi slant.

Ask fundamental questions about their mission, vision, and strategy – why does this organization exist? – then anchor your mindset to the world they work in. If you can, ask those questions to current employees – you’re bound to get some insightful answers informed by their personal experiences.

Infer

Apply inductive reasoning to what you learn about the organization. Your observations about what the NGO is doing, where, with whom, and why, will create a mental picture from which you can quickly infer organizational needs that may map to your skills.

Now, allow yourself to think big for a moment. Without targeting a specific job posting or title, think about what your ideal job in this organization would look like, both now and in five years. Be honest with yourself about what you can and can’t do now – but consider your full range of skills and experiences, not only those associated directly with epi. Make a list of the skills you lack but want to develop. This exercise helps shape your career trajectory into a practical narrative to share in an interview.

Finally, the hard part: identify opportunities to slot in. This is where you channel your big-picture ambition into a concrete career progression, with your target NGO as the first major step.

Unfortunately, most job postings won’t often immediately suggest a role for you; there wasn’t a single mention of epi skills in the first contract I took at Gavi. But if you parse job descriptions with an open mind, and think laterally about how to translate your epi background into adjacent fields or in unorthodox ways, you might suddenly find yourself screaming at the monitor: “I can do this!”

It’s all about context – which is why all the observational legwork is essential. If you know innately where an organization is, and where they’re headed and why, you’re already thinking along the lines of what they need and where you fit in.

Engage

Whether by traditional job application, introduction via a colleague, or a cold email – or, better yet, all three – put your best foot forward to the organization, and jam it in their door. Your objective is to familiarize your name and reputation for good work with them, one way or another (but always politely!).

Clearing the familiarity hurdle is harder with distant global NGOs than with, say, a state or local organization. But it remains a function of networking, timing, and yes, luck.

Be patient – job hunting is the ultimate test of patience – but utilize all the resources you have. Utilize your mentors; utilize your PIs; utilize your friends; utilize me. Be clear about your availability and adaptability to the needs of the work, and broadcast that to everyone who might help you get noticed.

If you score an interview, get the name of the hiring manager (not just the HR intermediary), and send a direct follow-up email. If you can’t find their address, maybe do what I did and email every permutation of their name you can think of until one gets through.

In the end, it was my thesis advisor who got me in the door at Gavi; a department head was his classmate at Hopkins, and had forwarded him the posting. From there, it was the usual CV/cover letter, then an interview, then that shot-in-the-dark follow-up email – then ten days later, I was packing my bags for Switzerland.

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Once you land your first global NGO gig, be it a contract or a full-time job, the process has only begun. Continue to observe, infer, and engage, taking full advantage of your insider knowledge. For short-term contracts, the first thing to find out is whether your role was really intended to be temporary, or if there’s a long-term gap they’re trying to fill (they may not even realize the gap until you point it out).

Act accordingly with what you learn and with what you want from the organization, whether that’s the flexibility of continued short-term consultancies or the security of a full-time position with benefits – or a move to a different organization working in a similar space. Either way, congratulations – you’ve broken through!

In case you missed it, check out Breaking Into – and Surviving In – the Global NGO Sector: Part 1, where I shared my path from GLEPI student graduating at the height of the 2014 Ebola outbreak in West Africa, to a full-blown career at an unexpected employer.

In Breaking Into – and Surviving In – the Global NGO Sector: Part 3, we’ll look at how cultivating strong leadership and teamwork skills can help you manage the dynamism of life and work at a global NGO, particularly in this time of emergent threats to public health – including, yes, COVID.

Roice Fulton, MPH (GLEPI, 2014) is currently an independent consultant for the London- and Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), where he manages projects in CEPI’s epidemiology portfolio. Roice currently lives and works near Geneva, Switzerland.

Breaking Into – and Surviving In – the Global NGO Industry: Part 1

This is the first of a three part #PROspective series from alum Roice Fulton (GLEPI, 2014) on career paths with global NGOs and the creative application of epidemiology skills for public health practice. In Part 1, Roice shares his path from GLEPI student graduating at the height of the 2014 Ebola outbreak in West Africa, to a full-blown career at an unexpected employer. In Part 2, the focus turns toward the nuts and bolts of the global NGO industry and how to navigate your own entry post-graduation. Finally, Part 3 will cover the role of teamwork and leadership in public health work. We hope this series will help stimulate a creative approach to the post-graduate job hunt and reiterate the broad applicability of your epidemiology skillset. Enjoy!

Part 1

So, full disclosure: I’m not what you might consider a practicing epidemiologist.

It wasn’t for lack of trying. The GLEPI program granted me a fantastic epi skillset, coupled with a few publications in vaccine research, all in two short years. With my 2014 cohort graduating amid the West African Ebola outbreak, there was ample opportunity to put those epi skills to work. Like many of my classmates, I’d planned on heading straight into the field, and had lined up as many interviews as I could to put myself into the mix.

Yet as Rollins’ newly minted epis went their separate ways, I quickly found myself at a crossroads. Gavi, the global vaccine alliance, had offered a short-term contract based at their Geneva headquarters to provide analytical support for their upcoming fundraising conference.

I’d done fundraising work in the past, but nowhere near the amount Gavi was targeting – a massive $7.5 billion to keep their programs going through 2020. But Gavi just needed someone who could conduct a variety of analyses to help their donors understand the impact of their investments in vaccines. Surely, I thought, between all the spreadsheet jockeying and SAS coding over my two years at Rollins, there was a toolset I could gin up to help Gavi get the resources they needed.

And so, instead of joining my friends in the field, I embarked on a journey as an independent consultant for Gavi. One contract led to another, and I found myself working on everything from fundraising analyses, to tech innovation initiatives, to program monitoring and evaluation.

In my three years at Gavi, I never so much as glanced at a 2×2 table or an epi curve. I’m working now with the epidemiology team at CEPI, Gavi’s new sister organization. And although I’m managing an epi study, I’m still not doing any hardcore epi work. So why in the world did I agree to write for an epi career advice blog?

I decided to write because I believe the lessons I learned in adapting my skills to the needs of my employers might help those of you looking to apply your own newly-acquired epi skills in unique ways. And in my experience, this sort of adaptability seems better suited to what organizations like Gavi and CEPI are looking for in their new employees – particularly as they leave much of the epidemiological heavy lifting to groups like WHO and academic partners.

Frankly, if I couldn’t find a way to channel my epi (and other) skills into a non-epi work product, my career at Gavi would’ve been over before it started. Surviving the first few months would have been much more difficult without the gifts of an analytical background and enough tenacity to spend hours buried in spreadsheets working against hard deadlines. Likewise, succeeding at CEPI meant quickly learning the contours of a complex and ambitious scientific study in a region fraught with difficulties from poor infrastructure to political instability. The work can be intimidating, but the payoff is tremendous – both in personal satisfaction and in human impact.

It’s been more than five years since I first set foot in Geneva. Since then, I’ve gradually developed an understanding of the global NGO community that suggests a wealth of opportunities exist for aspiring young epidemiologists and public health practitioners.

As I figure out my own place in this community, my hope is to identify – and create – such opportunities for you all, just as my mentors did for me. More than ever, we need talented, passionate young thinkers to shepherd the global health and development community into the next era. And more than ever, we need a diversity of perspectives to inform how we can build strong, evidence-based global health interventions. This is where you come in.

You’ve already got a leg up on the competition. Each of you will leave Rollins with an analytical and lateral mindset holding immense potential value to the global NGO ecosystem. But the complex and changing needs of these organizations will rarely perfectly match up with your classwork – so we need to dig deeper to learn how to unlock that potential.

As we’ll explore in Part 2, standing out from the sea of candidates will depend both on how well you understand the global NGO you’d like to work for – and how you can demonstrate adaptability in, and compatibility with, a dynamic work environment.

Roice Fulton, MPH (GLEPI, 2014) is currently an independent consultant for the London- and Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), where he manages projects in CEPI’s epidemiology portfolio. Roice currently lives and works near Geneva, Switzerland.