Good evening, everyone.
It's great to see a packed house tonight.
From where I'm standing, it looks like
there are about 12,000 people out here,
so it looks really fantastic.
There's no comment here, no.
I'm Roger Casey. I'm the President of McDaniel,
at least I was until that joke. (laughs)
And it's my privilege to welcome you tonight,
this is our third SmartTALK event
of the academic year, and during these
conversations we obviously have a chance
to catch up with some of our most accomplished
alumni and to learn about the myriad ways
that their liberal arts education has fueled their careers.
And I'm proud to be able to introduce
tonight's SmartTALK guest, Nicki Pesik,
who's a proud member of the class of 1986.
You guys can all cheer now, yeah.
(audience cheers)
An outstanding leader with the Centers
for Disease Control and Prevention.
And I also want to say hello to Taya and Sam,
Nicki's parents, it's wonderful to
have you here with us as well.
(audience applauds)
Two and a half years ago, the World Health Organization
declared the outbreak of the Ebola Virus
a public health emergency of international concern.
The epidemic killed more than 11,000 people
in Sierra Leone, Liberia, and Guinea.
Worries about a possible global pandemic
bordered on hysteria, and public officials
in the United States debated radical safety measures,
from compelling travelers from West Africa
to don tracking devices on entering the United States,
to even prohibiting travel in
or out of the effected region.
Dr. Pesik, head of the Global Migration Task Force
at the Center for Disease Control and Prevention
strongly advocated against border closures
and other extreme responses, stemming out of
more fear than science.
And this was a public health issue,
and although she and her colleagues
were well positioned to put in
effective screening, education, and follow up systems
to protect our communities while limiting
the impact of the traveling public,
just four confirmed Ebola cases resulting
in one death were identified in the United States,
and no cases were contracted within our border,
thanks in large part to the efforts of the CDC,
who's Emergency Operations Center
was at its highest ever level of operation,
with several thousand CDC personnel deployed to west Africa,
the epidemic was contained and ultimately stopped.
So, when she's not in major response mode,
Nicki's official job title is Senior Advisor
for Global Health Security in the CDC's
Center for Emerging and Zoonotic Infections Diseases,
where she oversees a $40 million budget
and the work the center supports in 17 countries
to improve their capacity to respond
to infectious disease outbreaks.
Of course, the past couple of years
presented one looming crisis after the other.
In the past year Nicki has spent much time
in Puerto Rico as the Senior CDC official
dealing with the Zika virus,
and as Deputy Incident Manager for CDC.
Dr. Pesik is well prepared to perform
in high pressure situations and to coach
her team to do the same.
Why is that?
Because she was a biology major
and a five-time academic all-American
athlete in softball and volleyball.
She graduated from Western Maryland College,
summa cum laude, before serving three years
of military service with the Virology Division
of the U.S. Army Research Institute of Infectious Diseases.
Nicki earned magna cum laude honors
from the University of Maryland School of Medicine
and completed her residency at the University
of Cincinnati Department of Emergency Medicine,
before being recruited as an Assistant
Professor at Emory University's Department
of Emergency Medicine, where she taught
in the domestic preparedness program.
At the CDC, she's now applying her
emergency medicine skills to treat
not just one patient at a time,
but an entire population as a whole
on the national and the global level.
And tonight she will share insights
about her work in emergency medicine and public health.
Then after her remarks, she and I will
join together to have a conversation
including the questions that you filled out on your cards.
And afterwards, if you wanna continue the conversation,
I invite you to reception in the room immediately behind us.
So, please join me in welcoming Nicki back to campus.
(audience applauds)
Hey, great to have you.
Well, good evening, and thank you.
You know, I feel a lot older about two hours ago
because I had to take a golf cart to get to this building.
So, apparently they thought I might
have a hear attack walking from Harrison over here.
But also, it's a pleasure and an honor to be here.
I have to admit, it's been a very long time
since I came back to the Hill.
And if I do say Western Maryland College,
sorry, that's where I went to school.
It's only a name change in my opinion.
The spirit is the same.
I'm gonna spend a little bit of time
reminiscing about some stories,
and I have to digress a little bit from my notes,
because a really big surprise this evening,
Dr. Brown is here, was my biology 101,
as we called it, big biology.
I got to see a teammate of mine Lynn Habeck,
and we toured campus, and my roommate Meg,
and Cindy, a biology classmate of mine are here.
So, it really feels a lot like being back 30 years ago.
Okay, I'm really getting old I have a feeling.
But anyway, for you all, again, it's a real honor,
and it's a pleasure, and I'm excited to be here.
When I was 17 and trying to figure out
what I wanted to do after high school,
I knew I wanted to have a liberal arts education.
I get bored easily, and I wanted
to study various disciplines,
and I also wanted to continue to play sports.
That was really important.
I wanted to participate in athletics,
and Western Maryland College at the time
had a wonderful biology program.
It did very well in placing its graduates
in graduate school, and it seemed like the right fit.
And Rebecca Martin will tell you,
'cause she and I were reminiscing earlier,
and I knew from a very early age,
and also when I went here that
I wanted to go to medical school.
I did not have a plan B, which I probably should have had,
but I didn't really have a plan B if that didn't work out.
And so, I knew I wanted to get good grades.
Now, while I ultimately did very well here academically,
my career here did not start off on a high note.
Biology 101, Dr. Mike Brown, big biology,
we were three weeks into the semester,
four weeks, and he gives us a 10 point quiz.
I did not pass that quiz.
I don't think I got two points on that quiz.
Meg, a music major, did way better
on that quiz than I did.
And I gotta tell you, I felt like
my world was about to fall apart.
I had never done poorly on an exam, ever.
I was like oh my God, I failed this 10 point quiz.
Now, looking back at it, you guys are
probably thinking, "What an idiot, it's 10 points.
"There's like a thousand more points
"in your entire class.
"This is not the end of the world."
For me, it was the end of the world.
But I sucked it up, and I went to Dr. Brown,
and I said, "Help, what did I do wrong?
"Can you tell me how to better
"prepare for college and exams."
And he spent the time with me explaining
how to study, what I should do,
not only for his class, but for
every other class I took here.
And that really provided a foundation,
at least for me, academically.
I didn't fail any more quizzes.
I didn't feel a whole hell of a lot better after that quiz.
But I didn't fail any more quizzes.
So, back then, getting good grades
was really, really, important as you can tell.
And I started coming late to volleyball practices.
And my coaches were Dr. Carol Fritz,
who I know many of you know, and Dr. Rebecca Martin.
I tell you, Dr. Fritz didn't say anything,
but there was a look on her face
that could burn a hole through
the back of your head and into the next wall,
and I knew she was not happy.
Eventually, she came to me and said,
"Nicki, you can't worry about
"your grades and study all the time.
"You're not going to enjoy school.
"And frankly, you're not gonna remember
"what grade you got in what class.
"You'll remember the experiences if you take the time."
Now, I can tell you, I didn't believe a word she said,
(whooshes) over my head.
And I have to admit she was right.
I don't really remember any grades I got.
Majoring in biology, having a minor in European history,
I don't remember them.
But I do remember experiences.
And what she was trying to tell me
in here own way was, you've got to
balance work and life, studies and athletics.
And for me, I think being a student athlete
made me a happier student and a better student.
So, I encourage those of you who are in athletics here
at Western Maryland to find that balance,
because the athletic part of it is
equally important as what you're studying in school.
So, my goal of getting into medical school
also caused me to make another decision
which I don't regret, but it was the wrong one.
Actually, Rebecca Martin remembers,
I transferred out of Western
Maryland College my freshman year.
I went to Hopkins, and I thought,
because my goal of getting into medical school,
I would have a better chance if I went to Johns Hopkins.
Oh boy, what a mistake.
Now, my parents had told me, "You shouldn't do this."
But I was bound and determined and stubborn, and I went.
It only took about four weeks,
and I regretted that decision.
Fortunately, Hopkins semester starts
a little bit earlier than Western Maryland,
and I called back to the Admissions Office here,
and I said, "I'd like to re-enroll."
And thankfully, the College said yes.
'Cause again, I didn't have a plan B.
So, what I found was that I missed
the atmosphere, I missed my friends,
I missed the interaction and the mentorship
and the way the professors here teach,
and instruct, and mentor the students.
You don't get that everywhere,
and I would ask you all that are
here in school now, do not take that for granted,
and also thank them.
Because honestly, it's probably 29 years too late,
but this is my chance to thank
the professors and the school,
and I wanted too long.
But I'm gonna tell you that
the atmosphere here, and the learning environment
here was what I was comfortable in
and should've recognized, and maybe I was
a little too young, but that was a decision I made.
My parents could've told me, "We told you so."
They didn't.
Now, the education on the Hill
isn't just about the coursework,
it's life lessons that you take with you
throughout your career.
They teach you, hopefully still,
to ask lots of questions, to be inquisitive,
to seek advice, to find somebody you look up to
and ask them to help mentor you.
And I would say don't let mistakes
as you see them define who you are.
I look at some of the challenges
I've had along my career, some which
didn't go quite as planned as opportunities to learn.
Another lesson I took from the hill,
or McDaniel, Western Maryland College,
is service to others and service to community.
It was never all about yourself.
It's always about how do you make your community better.
Following graduation, as you heard Dr. Casey,
I enlisted in the U.S. Army.
I was interested in service in the military.
I cannot repeat the words that my mother used
when she found out what my plan was, okay.
Not happy.
But I wanted to serve, and I wanted
a way to pay for graduate school.
My father died when I was 14, and my stepfather
and my mother helped me at McDaniel College
or Western Maryland, but I was going to
take care of graduate school,
and this was the way I was going to do it.
And I was stationed not very far from here
at Fort Detrick Maryland, at United States
Army Medical Research Institute of Infectious Diseases,
which is a big way of saying it's
the military equivalent of CDC.
That is the DOD infectious Disease Research Institute.
And I was an E4, and I was getting to do
bench and basic research with some of
the most dangerous pathogens in the world,
the kind they make movies about,
the kind you have to wear a spacesuit.
And I can tell you, my mom held
her breath for three years straight.
She's in fact, part amoeba in that sense.
But it was a great experience.
In addition to the research experience,
the military also provided opportunities to lead.
And again, I would not characterize
all of my opportunities as success stories.
At one point in basic training in Fort Dicks, New Jersey,
as 7' 10" drill sergeant came up to me
an said, "Pesik," 'cause they don't
call you by your first name, he said, "Pesik,
"you're going to lead this squad
"through a life fire exercise drill."
That, by the way, is when people
are shooting bullets at you, and you have to
go from one end of an obstacle course to another end.
Now, even before that, I was nervous enough
trying to think, "How am I going to get through this?"
And now, I've got eight or nine people
that I'm responsible for.
So, I turn to them and say, "Let's go."
It was really clear in my mind what the objective was.
It was to get to the other end of this obstacle course
with no additional holes in my body or in my uniform,
and I figured everybody else had that same goal.
So, when I get to the other end, I think,
phew, thank God, that's over with.
And here comes that very tall drill sergeant,
and he is looking like Dr. Fritz, not happy.
(audience laughs)
And he, "Pesik, where is your squad?"
Hmm. (audience laughs)
Yeah, not sure.
So, you know, my only objective
was getting to the other end.
When it really should've been
trying to figure out how to help
the rest of the squad get to the other end.
I didn't know the people very well in my squad,
I knew their last names.
I didn't know what they were scared of.
I presumed it was the same thing I was,
the bullets, but who knew?
Maybe it was the roaches or something crawling in the mud.
I don't know.
I didn't let them know what my plan was
to lead them successfully to the other end.
And I certainly didn't give them
an opportunity to help inform
how we're all going to get to the other end.
Now, did I figure all this out at the time at Fort Dix?
No, I had no reason why that little drill
was not a very good outcome for me at the time.
But I have with many, many, years of
management experience now under my belt,
understand that when you're trying
to get a unity of action in a public health response,
you have to have everybody on the same page,
and you have to understand everybody's perspectives.
They may not be what your perspective is.
Maybe the person just doesn't like crawling in the mud,
and the bullets didn't phase them, I don't know.
But I do know that to be successful in a team
and to be successful in getting a unity of action,
particularly in a public health response,
you have to do it as a team, and you have to
include people's perspectives and their own goals.
So, as you heard in the introduction,
I did ultimately make it to medical school,
and start emergency medicine training,
and went to Atlanta at Emory University.
Well why emergency medicine?
Honestly, one, I am an adrenaline junky,
but two, emergency medicine to me
is sort of the liberal arts of medicine.
We have to train across many, many, disciplines.
So, we know enough about pediatrics,
enough about obstetrics and gynecology,
orthopedics, sometimes psychiatry,
a lot of times social work, trauma, neurology.
You don't know what you're going to see
in the emergency room.
Every day is a different day.
If you had a good day the day before,
it doesn't mean you're gonna have a good day the day after.
So, in a way, emergency medicine
for adrenalin junky was a perfect fit,
and for somebody that like the various disciplines.
So, how did I get into public health?
Well, proximity had a little bit to do with it.
Emory and CDC, you can throw tennis balls at
each other's buildings, so they're very, very, close.
My focus, at the time when I started at Emory,
was on hospital preparedness and disaster preparedness.
I began consulting with the CDC
around the time of the anthrax attacks in 9/11.
And a new program at CDC was standing up,
which is the National Strategic Stockpile,
and that's the program at CDC that
houses and stores about six billion dollars
of medical countermeasures, so vaccines,
and antitoxins, ventilators, IV fluids,
beds, for natural and, potentially, deliberate disasters.
And I was offered their Chief Medical Officer position.
And I'm like, wow, what a great opportunity.
But I wasn't ready to leave clinical medicine.
I mean, I'd just spent 12 years
trying to get into clinical medicine,
and I'd been at Emory for about seven or eight.
I was very fortunate that the program
allowed me to do both jobs.
So I basically did 30 a week at Emory,
and 30 hours a week at CDC,
and I continued that pace for about three years.
And then, in 2005, Hurricane Katrina happened,
and I was asked to take the first public health team
down to New Orleans to re-establish public health services.
We were there a day after the floods.
And I started off with a team of 12 people,
and probably within two or three weeks,
I had about 50 people in New Orleans with me.
And it was a wonderful, challenging, experience.
We slept in tents, we slept in abandoned warehouses,
we slept on church floors, and on military ships,
or carriers, I'm not sure, it's big,
big, tin bucket in the river.
We were there to try to get the people
that remained in New Orleans public health services.
We didn't know where most of these people were.
And the public health personnel from New Orleans,
many of them were displaced, had lost family.
So, they're torn between their own families
and having to provide greatly needed services
in this city that was completely devastated.
And I spent about two months down in New Orleans,
and came back, and sat down with my
chairperson at Emory, and said,
"I've made the decision that
"I've been avoiding for three years,"
and I've decided to leave clinical medicine full time
and apply emergency medicine to public health emergencies.
And I don't regret that decision.
It was the right decision at the time,
but it took a long time for me to make.
So, public health, Meg's in public health.
Public health is about protecting communities.
It's not an individual life at a time,
it's a community at a time.
And it doesn't matter whether you're
developing guidelines for the clinical care
of women infected with Zika virus,
or you're developing a communications campaign
to try to get people to stop smoking.
It's always targeted the high risk populations.
I'm very fortunate to work at remarkable agency,
because its focus is on saving lives.
We protect communities, both from domestic
and international public health threats,
and as our former director,
Dr. Frieden once stated in a meeting,
the world is safer than ever before
from global health threats, but the world is
at greater risk than eve from global health threats.
So, my one history lesson for you all,
historically, diseases in other places
was seen as an impediment to exploration
and a challenge to winning a war.
Cholera and other diseases killed
at least three times more soldiers
in the Crimean war than the actual conflict itself.
Malaria, measles, mumps, typhoid,
smallpox, killed more combatants
in the American Civil war than bullets.
And the Panama Canal went over schedule
because of tropical diseases, at the time unknown,
untreatable, and often fatal.
So, public health challenges today
are not just local, they're not just regional,
they're not national, they're global.
We've seen new viral and bacterial pathogens
which continue to emerge in today's world
of increasing connectivity, and mobility
accelerates this shared global risk.
Global transportation and commercial air travel
usually is more seamless than ever.
And this increased connectivity and mobility
brings increased risk of infections disease spread.
There are numerous public health
challenges that face us today.
Some of these include the emergence
and spread of new pathogens.
If you recall, HIV spread for decades
before being recognized.
SARS, severe acute respiratory syndrome,
spread to 37 countries,
across three continents in four months.
The globalization of travel, and food, and medicine,
provides new public health threats.
We see contamination of our food supplies
regularly from food imported to the US.
And rise of drug resistance, this is when
a bacteria doesn't respond to an
antibiotic designed to kill it.
This is perhaps the single most important
infections disease threat we face today.
And reemergence of known pathogens.
Yes, Zika and Ebola are known pathogens
that caused outbreaks before
the most recent outbreaks that we've dealt with.
Some noninfectious disease public health challenges,
climate change, the weather gets warmer,
the vectors that spread these diseases,
mosquito born diseases come further north.
Climate change and heat, you have the heat illnesses,
you have changes in water,
perhaps agricultural production is impacted,
and then you have problems with malnutrition.
Climate change is huge.
Other issues we talked about already,
tobacco use, and unfortunately,
the opiod prescription drug overdoses
that we're seeing in the country today.
So, are we better prepared for infectious diseases?
The international health regulations
which were established by the World Health Organization,
required that member states in 2005
be prepared to detect through surveillance
and laboratory capacity new diseases,
be prepared to report new diseases,
and be prepared to respond.
And unfortunately, only about a third
of countries self reported that they
were ready for a new outbreak.
And that really hasn't changed in the last three years.
There are also always challenges in
convincing the U.S. government to invest
in preparing for outbreaks and supporting
international countries in these efforts.
But compare these costs with the costs of responding.
The World Bank estimates that a
single severe pandemic is likely
to cost three to four trillion U.S. dollars,
and some estimates as high as six trillion dollars.
The cost of the Ebola outbreak in West Africa
was two to three billion dollars lost
in gross GDP of the three most effected countries.
And the response cost for Zika
are approaching 15 billion dollars.
World Bank estimates that another
tens of billions of dollars in long term damages
to the children being born will occur.
We learned a great deal in Ebola.
The speed of the response is critical,
and every day counts.
And it was very unfortunate that World Health Organization
and the world moved far too slowly
in response to the Ebola crisis.
Every country should be prepared
to find a threat when it emerges
and stop it promptly when they identify it
and prevent it whenever possible.
But as a world community, we must be
ready to surge and help another country
if their capacities are overwhelmed.
We have to move from a time of non accountability
and no assistance to mutual accountability
and partnership in dealing with these crisis.
To better ensure global preparedness,
to fight the next epidemic,
the world must close the gaps in global capacity
to prepare and respond to these events.
A functioning national public health system
and a health system are fundamental
prerequisites for safeguarding against
outbreaks of disease with pandemic potential.
Recent major outbreaks, such as Zika and Ebola,
remind us that a communicable disease
has the potential to have serious
humanitarian crisis that can severely impact
political and economic stability.
As a senior advisor in global health,
when not in a response, I work with other officials
at CDC and other agencies to implement
the U.S. governments global health security agenda.
It's seen as a unifying framework
to improve global response to disease outbreaks.
The global health security agenda
can really be summed up in three short bullets:
prevent avoidable outbreaks, detect and treat early,
and respond rapidly and effectively.
But global health challenges cannot be
resolved by the health sector alone.
To address these challenges will
require a comprehensive commitment
across all sectors of government, private partners,
NGOs, international agencies, and communities.
So, for those of you that are thinking
about careers, if you're interested
in public health, you don't have to
go to medical school to be in public health.
Our agency is made up of professionals
from across numerous disciplines.
We work with environmental health specialists,
policy and communication experts, nutritionists.
We work with lawyers, operations and budget experts,
veterinarians, and yes, physicians
with specialties and backgrounds
in psychiatry, neurology, pathology,
OBGYN, infectious diseases, and yes, emergency medicine,
and all of those disciplines have to
come together in a public health emergency
to respond and protect.
And just like a liberal arts education,
I've had the privileged of learning
from all of these experts every day when I go to work.
So, I'd like to end by saying this.
Every career will have, as you move through college,
as you move through graduate school,
or your next steps in your career,
you're going to meet challenges and
roadblocks, and you're gonna have
some mistakes along the way,
and encourage you to learn from those mistakes,
to take them as an opportunity
to figure out what you could have done better,
and to understand that not every decision you make
is gonna be the right one,
but you always have the opportunity
to reassess and change course as needed.
I've told you about some of the
decisions I've made when I was here on the Hill.
But the two best decisions I've made
in my career so far, one was to come back
after transferring out of Western Maryland College,
and the second was to focus in public health.
And so, with that, I look forward
to a conversation tonight, thank you.
(audience applauds)
There are so many places
we could start this conversation.
You folks have come up with some great questions tonight.
So, I'm going to pick up with something you said
in your final remarks about roadblocks.
So, very curious to hear about a really
good example of some major roadblock
you encountered in your CDC work,
how you overcame it, how you feel good about that.
I'll go back to Ebola and talking
about different perspectives.
In public health we try to focus
and make decisions on science,
and make it an evidence based decision,
but unfortunately, often times many decisions
can be driven by fear and or politics.
And we have different perspectives,
we work with many different agencies at CDC.
During the Ebola crisis, there were agencies
and departments that wanted travel restrictions
to prevent people from traveling back into the country.
Their perspective was security, security of the nation,
but it wasn't based on science.
And so, what we really had to do was work with our partners,
understand what their perspectives were,
understand what their fears were,
and try to address those and come to what we felt,
as the agency to have to make the recommendations,
recommendations that were, to the extent possible,
based on scientific evidence and knowledge
of the disease that we had.
So, we live in a world now in which science is
being challenged in and of itself on the public front.
How do you respond in a public health environment
when the very essence that you sort of take
as the stable truth is being questioned?
I think you stick with science as
the basis for your recommendations.
And I think that is one of the reasons
why the CDC bases its recommendations,
its guidance, on known facts.
When we don't know something about
a disease very early on in Zika,
it's very important to say what you don't know,
what you're trying to understand, and what you do know.
And we've been successful.
I feel as if our reputation relies
on the fact that we try to stay out of
the political fray to the extent possible,
that we try to base public health on science,
and I think you have to stick to that,
regardless of whether people believe you or not.
So, you said you're a self professed
adrenaline junky, and that's what
got you into the world of emergency medicine.
Tell us what a day looks like
for a senior advisor at the CDC.
Oh my God, it's so boring.
(laughing)
Unfortunately, I've gone from adrenaline junky
a little bit too much to a bureaucrat.
But basically, I would say that
my focus now is looking at the 30,000 foot level
at the strategic picture, programs that,
under the purview of my responsibility and others
at the agency have similar contributions to
a particular program, such as global health,
we're looking at the strategic issues of
global health received a fair bit of money,
about $600 million over five years.
But if you look at 17 countries that are
in dire need, that's just not a lot of money.
Compare that to something like PEPFAR,
which is the global AIDS program
that receives that amount of money every year,
and we're trying to stretch this
over five years, over 17 countries with such
significant public health capacity building needs.
We struggle with we can't do it all,
and we can't let perfect be the enemy of good,
and then we have to make some very
difficult decisions on how we prioritize.
And even within our own agency,
we may or may not have agreement
on what the priorities are, we generally come
to some general agreement of the general priorities,
but I won't say we always come to consensus.
So, as an American culture, we are kind of
obsessed I think in our pop culture
with the notion of this invisible thing that destroys us.
Which might explain why zombie movies are so popular.
Or on the other extreme, why everyone's
carrying around their antibacterial hand creme
so that we don't have any germs here.
So, you talked about how fear motivates us.
What do we really need to be afraid of?
What is the great public health fear
that's really out there that we should be worried about?
I would say, from an infectious disease standpoint,
I would say antimicrobial resistance.
You know, it's unfortunate, there have not
been for decades any new drugs other than
maybe some modifications in classes of drugs.
We've not seen a new antimicrobial
agent or class in decades.
Without throwing too many statistics,
we know that about 30% of antibiotic
prescriptions are unnecessary.
And so, antimicrobial resistance,
while we in the United States,
we are focusing, we have a large national
program on antimicrobial resistance now,
we're supporting state and local departments
with detecting antimicrobial resistance,
reporting antimicrobial resistance,
lots of training on infection control.
The same cannot be said throughout the world.
Case in point, MDRTB, or multidrug resistant TB,
decades ago it used to be that those
were US born citizens with MDRTB.
Now the converse is true.
60 to 70% of MDRTB that we see in the U.S.
is from a foreign born individual coming in.
And so, drug resistance in India,
drug resistance in Ethiopia effects the U.S.,
and we can't turn a blind eye to that.
And I would say that we, as a community,
have to understand antibiotics are not always the answer,
and that if we do use antibiotics,
we should use them appropriately.
How many of you got an antibiotic prescription
and didn't take all of the pills?
Okay, I'm gonna raise my hand, okay.
Okay, I lost, but I didn't finish it.
And that happens.
And then, unfortunately, in many countries
that even have access to antibiotics,
sometimes you don't need a prescription.
In an African country if you have a UTI,
you can ask for an antibiotic, they'll give it to you.
And in some countries, they'll give you
an antibiotic, but many times because of
the depth of poverty in these countries,
people will buy two or three pills
'cause that's all they can afford.
So, guess what?
They get better for a few days,
and if you really needed an antibiotic,
you will get worse, and now you've got a bug
potentially that's become resistant to a first line agent.
And so, I think, from my perspective,
as a healthcare worker and in public health,
I think we have to recognize that
antimicrobial resistance will not
just affect people that have infections now,
but can you imagine in 10 or 20 years
if you need an organ transplant,
it may be too dangerous to do an organ transplant,
'cause we may not have the antibiotics
to deal with an infection should you get one,
or cancer patients that are receiving cancer
become immunocompromised, and there's no
antibiotic that may or may not
be able to fight the infection.
So, for me it's not so much the fomites
that are everywhere, but rather,
I think the antimicrobial resistance I think is huge issue.
Zika, certainly has probably had
more press than any major disease lately.
Can you assess, where are we right now
in terms of response to Zika?
Well, one, I think Zika got more press
because it's easy to spell.
Can you imagine if it was like chickengunia?
Nobody can spell it, the press would stop talking about it.
And I'm actually hoping that's the last one,
because I've been through anthrax, now I'm in Zika.
So, I've got through A to Z.
I'm hopeful that I'm done for at least a few years.
I think we've learned a lot with Zika.
If I look back, in January when I first
asked to start working on this response,
or even before the Emergency Operations Center activated,
we didn't know that Zika caused congenital infections.
We thought it could be a problem,
but we didn't have the scientific evidence
to conclusively say there was a causal effect.
We do now.
We didn't know at the time that it also
is a sexually transmitted disease.
But I remember sitting writing guidelines
when we found out we had our first
conclusive case of sexual transmission.
So, I think we've learned a great deal about Zika.
I think we're learning public health strategies
that didn't work, and public health strategies,
particularly around communications.
We're looking at evaluating those efforts and targeting.
People get tone deaf too, right.
How many times can you say it, and then it's yeah,
whatever, it's a mosquito born disease,
it'll be like West Nile, it'll go away.
So, we're gearing up for the next mosquito season.
We have no idea what it's going to bring.
I do feel like we're at a point in time
with Zika where, unfortunately,
we're going to start to see the babies being born.
And like most infectious diseases that are new,
you usually see the severest outcomes,
those are ones that hit you in the face.
Look, these babies are being born with
skull collapse, or these babies are being born
with eye abnormalities, or joint abnormalities.
So, you see the severest impacts early on.
But what we don't know, what are the long term effects?
So, we have starting to see children
that did not have microcephaly or small heads,
but now, in their third, or forth, or fifth month,
they're falling way behind in the growth curve.
And so, by definition, they're microcephalic babies,
but they didn't look like it when they were born.
So, we just don't know what all
the impacts of this particular congenital disease,
and it's the first one in decades,
over 50 years, to be identified with an infectious disease.
So, I think we're in a much better place now
than we were when we were in the first mosquito season,
but ultimately, I think we want to
try to avoid complacency because
I truly feel like we're going to see
the longer term impacts now.
We didn't have a chance,
babies weren't being born here in the U.S.,
and I think we're just gonna have to wait and see.
And on the vaccine front?
My understanding is that's going to be a ways away.
I don't think we are going to
have a vaccine in the near future.
There are clinical trials starting up,
several vaccine candidates,
but nothing that I would anticipate
being able to use this summer.
So, it's back to the same precautions,
please wear long sleeves, avoid mosquitoes,
the DEET repellent, and if you're pregnant
do not travel to areas where there are Zika transmission.
I worked hard on the A to Z joke,
but you all ready used that,
so I wanna take you back to anthrax.
You worked very much with anthrax,
and particularly, at a point in time that,
our students might not remember it as well,
but right after 9/11, when anthrax
was on everybody's mind.
Tell us a little bit about your work with anthrax,
and where are we now with that?
So, my work involved the Strategic National Stockpile.
If you all recall, I think was one of
the very few times in history
where the FAA grounded all flights to a halt.
And in fact, I was actually in Micronesia
doing hospital preparedness work,
and I'd come back about two days before
they stopped the planes from coming in.
So, a couple of my colleagues were actually
stranded, oh darn, in Micronesia, on an island
where you could scuba dive and snorkel all day.
But I was in the Emergency Operations Center.
My work around anthrax there was
determining giving antibiotics,
not giving antibiotics.
And again, I think the agency learned a great deal.
At the time there was a lot of confidence
about you can't get anthrax through the mail.
Well, we know that was wrong.
And I think one thing that we do,
I believe, well at the agency,
is we learn from each public health response.
And it really came very clear,
if we're not sure, we need to say, we don't know,
we're trying to understand what is happening.
I think from an anthrax standpoint,
since those times, the Strategic National Stockpile
now has tens of millions of doses
of antibiotics against anthrax,
three or four monoclonal antibodies
now exist against anthrax,
antitoxins which we didn't have at the time,
we now have an approved and licensed
FDA vaccine against anthrax.
By the way, that one hurts 'cause it's got
a little formalin in it, and my God,
that hurts when you get that sucker.
You've had it, then?
I've had that vaccine, not pleasant.
But I will say that I think we're in a better spot now.
I personally feel like, sure, it is my
personal opinion, for anybody if there's press here,
I personally think that we are much more
at risk of these emerging infections
in antimicrobial resistance, and frankly,
drunken drivers on the road, than anthrax.
I don't stay awake at night because of anthrax.
Where are we with Ebola now in the world?
As far as Ebola in the three effected countries,
I think it's very well under control.
They have their surveillance systems in place,
and they're quickly, when they identify a new case,
are quickly going to it, finding the source,
and stopping the spread.
Unfortunately, that's taking a lot
of international support and resources.
Whether or not these communities
and ministries of health will have
sufficient resources and capabilities
to continue those efforts long term,
I think is something that we have to wait and see.
I'm hopeful that the world as a whole
learned a big lesson around Ebola.
I know our agency was screaming
at the top of our lungs early on
that this is a problem, and that the
outbreak was a rising concern to us.
But again, I think this goes to
the public health capacities.
There's a significant amount of funding
that went to stopping that outbreak,
and those countries suffered a great deal,
both economically, and obviously,
personally for many, many, families.
But whether or not as international aid
begins to pull back, the capacities
will be retained at a level that it needs to be,
you know, we're gonna have to see.
When we're looking at global health issues,
or issues actually that are happening
in certain parts of the world,
where do you have the most concern?
Is it densely populated areas,
is it areas that have fewer doctors
or places where there's no research going on?
What are the big hot places in the world
that keep you awake at night?
Unfortunately, any country can have an emerging infection.
I think some countries are certainly better
prepared to identify what they are.
I think the, certainly in the continent of Africa,
and Asia, especially around influenza
and respiratory viruses are always of concern,
whether they'll jump from an animal host to a human host.
And it's unfortunate, I think even in the U.S.,
we have Zika here, we can have an emerging infection
whether that is a cause of concern
for the rest of the world, probably not.
We have the health systems and
the public health systems to contain it.
And we also we will report it.
But many countries don't have,
they're very concerned about reporting
public health events.
Well, why, you say.
Well, because they're concerned about
trade and travel restrictions being placed.
They're concerned about tourism.
If we say, if we report we have a
mosquito born disease on this
lovely tropical island, and you're looking
at four tropical islands to go on a honeymoon,
you're probably not going to pick
that one tropical island.
So, there's significant economic impacts
to countries to report public health diseases.
And then at the local level,
even many countries, if you think about
the respiratory viral diseases and influenza,
for instance, where if you start to see
influenza in the chicken population,
what do you do?
You recommend culling those chickens,
or slaughtering the chickens.
Well, if you're a farmer and your livelihood
is based on growing chickens,
many people are not anxious to comply
with public health recommendations,
'cause on a personal level this means
it has a significant economic impact.
So, I think one of the things
we're doing with our partners
such as World Bank, is trying to
incentivize our communities international communities
to report and to take on public health actions
that have economic impact to their countries,
because the World Bank will provide funding
to mitigate and lesson that impact.
Moving from global issues to your own careers.
So, you talked to us about this transition
from Emory and from emergency medicine
and teaching into the CDC.
But what got you noticed?
What is it about your work,
or about your work ethic or leadership?
Why did they say, "Ah, this is
"the person we want working with us?"
I bribed somebody?
(audience laughs)
Okay, next question.
(laughing)
You know, I don't know.
What I would say is this.
I think you will find that folks in public health,
also in medicine and other careers, are very passionate.
What I will say, or what my colleagues have said,
is I'm not afraid to make a decision.
And you'll know, I've told you
I've made some doozies in my time.
But I think what emergency medicine
trained me to do, is that you have
a certain amount of information
when a patient comes in.
Sometimes you know their past medical history,
and sometimes you don't.
But you have a person who you may
need to stabilize, and you're going
to make the best educated decision
and clinical care decision based
on what you know at the time and your training.
You may be wrong, but you have to
be able to make a decision.
And I would say that, at least in the agency,
we have scientists that are very data driven,
very evidence based before they'll make a decision,
and often times, they have a very
difficult time making decisions
with incomplete information.
They want to wait a little longer.
Let's wait a day, let's wait a day,
let's go get some information, let's check this rumor out.
And I think in emergencies, you have to
have a little bit of a comfort level
of making decisions with some unknowns.
And so for better for worse, I feel like,
at least my training in emergency medicine
makes me a little bit more comfortable in doing that.
Also they know that I'm an adrenaline junky,
and I don't mind being there 'til 10 PM at night sometimes.
But I would say that,
we're looking at our management staff,
and training up the younger generation
of public health that's coming into CDC.
I think there are some statistics now
that about 50% of our agency
will be able to retire in five years.
So, our agency is looking, and will be in need
of younger public health passionate professionals.
And we're looking at not just what
the education is, but I think some of
the personalities for response.
Some people really like response,
an some people don't.
And we have to recognize that and
sort of drive people's passions.
They can all help, but some people just may not
wanna be in the operations center or in the field.
You might wanna be doing something
different in support of the agency.
So, what's you advice to some
of our students who are looking up
here going, "Hey, I'd like to be her one day."
What would you tell them, both in terms
of career path, and also other skills
they should focus on developing?
What I would say is be a good listener.
You'll learn a lot just by sitting in a room and listening.
I would say from a career standpoint,
whether it's medicine or public health,
you don't have to be a biology major.
You can be a European history major.
I minored in European history, I love history.
You can be a language major.
We need communicators, we need policy people,
you can go into law if you wanna do public health.
But I would say is think about
where your strengths are and what you enjoy doing,
and find a career that gets you excited
to get up in the morning.
And then I would tell you that
don't be afraid to learn new things.
I started off as a clinician, and I still
did clinical guidance development in CDC,
and now I'm managing budgets.
I have about $400 million of budgets that I deal with,
and I have to deal with how to appropriate funds
and learn this new lingo.
And I'm like, I didn't get an MBA,
it got an MD, what am I doing with
$400 million spreadsheets?
But you have to not be afraid to take on new things.
And I think that's what I enjoy about CDC,
is I don't have an MBA, but yet they're like,
"Nicki, here's the Zika budget.
"We need you to help support the agency with this."
And figuring out how you do that
with transparency and ensuring
that the right priorities for the response
are being funded, and working with
a lot of smart people that do have MBAs,
and I go, "I have no idea what that object class is.
"What does that mean on that budget?"
And willing to say, "I don't understand what that that is."
Don't be afraid to ask questions.
In seven years of putting people in that seat,
phenomenal alumni in all kinds of careers,
one common story has emerged from every single one of them,
and that is, they talked about failure
and how they learned from failure.
And yet I think when we, particularly talk
about today's students, they're probably
the biggest fear of failure that
I have ever seen culturally here.
How did you get over your fear of failure,
or did you have a fear of failure?
Oh my God, I had a fear of failure.
All right, Rebecca can probably say, yeah.
Look, that 10 point quiz that Dr. Brown gave me,
that was like, oh my God, I need a plan B.
But I think you have to... if you skirt away from it,
and try to avoid what you're scared of,
it will follow you like my dog does everywhere in the house.
I would say that I've learned so much
by the times that I wasn't successful
or I didn't quite get the outcome I wanted,
maybe not at the time, but certainly
as I look back on those times when I,
boy, I which I had done that differently,
they're probably the most impactful
and most powerful learning experiences you can have.
You may not recognize it at the time,
but step out on the ledge a little bit
and I think you'll be surprised how far
you can actually go before you fall.
But then if you do fall, get up and try it again.
And go ask Dr. Brown for how to study.
(laughing)
So, we know why you came back here
when you made your foray to Johns Hopkins.
Why'd you come to Western Maryland in the first place?
'Cause I wanted to figure out what that mascot was,
and I still to this day...
(everyone laughs)
Could somebody please tell me what a Green Terror is?
I thought it was cute.
You know, I have to say that I'm actually a very shy person.
I knew I wasn't going to be
comfortable at very large school.
And I knew I wanted to be able to go up to a professor,
and ask a question, and not feel intimidated.
I really loved volleyball, and softball, and basketball,
and I tried to play all three,
and that was just an utter failure, by the way.
So, I had to give up basketball.
Rebecca's probably very thankful about that.
Western Maryland at the time really provided
the opportunity to have a breadth of
experience across different disciplines,
and to be able to play sports.
Yeah, my mom's cooking's pretty good,
and I wanted to stay close to home.
(laughs)
Here's a couple of one sentence answer questions.
Who was your favorite roommate here?
(laughs)
Sorry, I had to put the plug in.
Meg?
[Meg] I have to say, I tell the story often
that the semester we took big bio together,
I got the only D of my entire educational career,
and she got an A plus.
So, clearly I did not go talk to Dr. Brown.
(everyone laughs)
Another important lesson in failure.
I have to tell the story of Meg.
Meg was a music major here at Western Maryland.
She took typing in high school.
I didn't know that was an option.
I didn't have that in my school.
So, I'm aging myself for those young folks in the back,
if you don't whiteout is, it was like something
you had to have here.
We didn't have computes, we had typewriters,
one letter at at time, and very thin onion paper,
and all of that, right.
And we drug our typewriters everywhere.
I know you guys are laughing,
but this is how we had to do term papers
for Dr. Brown, and Dr. Iglich, and all.
Well, my typing was horrid, and it would
take me hours to type a term paper.
So finally, I did my term papers,
wrote them out, and I bought Meg dinner,
and she typed 500 words a minute,
and could crank out a term paper
in 30 minutes that took me six hours.
So, be glad that you have computers nowadays.
You have no idea how much time
and how many volleyball practices
I was late to because I was on a typewriter.
When you look back at your undergraduate experience,
can you remember, was there a moment when you
thought for sure, yeah, I can achieve this dream,
it's gonna be mine, I can be this doctor that I wanna be?
Was there a class, was there an experience,
was there a professor, when did you gain that confidence?
You know, I think actually, it was sort of
toward the end of school here.
I knew I wanted to go to medical school.
I wasn't sure if I wanted to do a Ph.D. on top of that.
And being in the Army, I decided after
working on basic research that there
was no way I was going to make a living
writing grants for a Ph.D.
I just knew that that was not in the cards for me.
And then I also felt like that experience
on top of my educational experience
gave me the confidence to do the applications
and go for the only plan I had,
which was go to medical school.
Did you do undergraduate research?
Was that going on then?
Actually, I don't think I did.
I did a lot of research on the ball fields and what not.
(laughing)
But not much else, no.
And I will say that I fed the squirrels Pop Tarts here.
And do they still spray paint the squirrels?
No, no.
By the way guys--
[Woman in audience] They do now.
- Yeah, they do now. - Cindy, do you remember?
There was a biology professor somewhere
around this campus who's job,
it wasn't GIS tagging squirrels,
but we had squirrels running around
with pink mohawks, and green mohawks, and red ones.
They spray painted the squirrels,
and they were doing some sort of study on them.
I got bit by the red spray painted one, he was not pleased.
I knew we would go from A to Z,
from anthrax to Zika.
I did not expect painted squirrels tonight,
so I do wanna thank you.
They used to paint the squirrels here, yes.
Well, having given our students
a new opportunity to explore,
(everyone laughs)
I'm hoping everyone here can join with me
in thanking someone for an outstanding career.
We deeply appreciate your coming back.
We're incredibly proud of what you achieved.
So, please join me in thanking
Nicki for being with us tonight.
(speech drowned out by applause)
Thank you.
And we know she's a proud Western Maryland graduate,
but we wanna make sure you've got
a McDaniel diploma you can hang up
in the WMC as well. - Wonderful.
- So, it's great
to have you here. - Thank you.
- And please, join us in the back
for refreshments if you'd like to
have further conversation with Nicki.
Thank you so much for being here tonight.
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