Joshua Hughes, Class of 2021
I took Public Health 150, Contemporary Health Issues, with Dr. Shira Shafir in Winter 2020 at UCLA, and I can say with absolute certainty that it was one of my favorite classes that I have had the opportunity to take during my college career. Dr. Shafir is a professor with a PhD in Epidemiology from UCLA and an MPH in Infectious diseases from UC Berkeley. Over the years she has conducted research on parasitic diseases, neglected tropical diseases, and STI’s.
Joshua Hughes (JH): What were some experiences that influenced you to become interested in public health and become an epidemiologist?
Shira Shafir: I liked to say that my brain was science, but my heart was social justice. So for me, once I became aware of the existence of public health, and that didn’t happen until my junior year of college, because prior to that nobody told me it was a thing and I didn’t know anyone who worked in Public Health... once I became aware of it, I started reading popular literature books about infectious diseases. I became so convinced that this was my perfect path, because it was the way to combine the way my brain worked, which was very science, with the way my heart worked, which was very social justice.
Until my senior year, I thought I was going to do my PhD in genetics. In between my junior and senior year, I went and visited a bunch of campuses that had graduate programs in genetics and talked to the students about what they were studying. I had this moment, where I was like “OH, I do NOT want to do that, that's not it!”
JH: What additional advice do you have for current undergraduate students at UCLA? Is there any specific advice you would give to students who wanted to explore public health as a possible career route.
Dr. Shafir: I think some of the best advice I could give, that's sort of specific to UCLA, and for other larger research institutions, is to take the opportunity to get to know some of your faculty members, and do what we are doing right now [i.e. informational interviews] throughout the course of the academic quarter. Ask if you can come and talk to them about their career journey, how they ended up working where they are, what they learned, and in particular be mindful of the fact that if you are thinking you want to go into any career that involved graduate education, you need professors to write you letters, and from my perspective [as a professor], I always want to say “this student came and talked to me, asked for book recommendations, and we discussed all of these interesting things, because otherwise, like in Public Health 150 where I met you [interviewer], there were 175 students. If someone just gets an A in my class and asks “can you write me a letter,” I dont have the ability to say anything about why they are uniquely capable of doing well in a graduate program or professional program. Getting to know faculty, in particular, giving faculty the opportunity to get to know you, is hugely important at a place like UCLA.
Specific advice for students who want to explore public health: don’t wait until senior year to take a public health class because it fits in your schedule. We have a public health minor, a global health minor, and we are hoping at some point to have a public health major. I think these are really exciting opportunities to bring a population-based perspective to your work and really think about how you can consider the entire community rather than thinking about a single individual.
JH: What was the main focus or topic of some of your past research? (feel free to explain in any amount of detail on one or more of your previous research projects)
Dr. Shafir: My specific area of expertise… There's the umbrella which is epidemiology, and the next layer is infectious disease epidemiology. I focused very much on the interactions between the agent, the host, and the environment. The thing that causes people to get sick, the people who get sick … who’s at increased risk and the factors that impact that, and the environment or the background against which this all occurs. I look at all of those interactions, and then the next level down is I focused on parasitic diseases, and then the very most granular is I’ve studied diseases that have been classified as neglected. So neglected tropical diseases and neglected infections of those in poverty. It’s very much about these diseases that don’t get enough attention and that don’t get enough research dollars when we consider the impact they have on populations. If I had a piece of advice to give, choosing to be an expert, choosing to focus on diseases and conditions which are defined by the fact nobody cares enough about them to pay for them… it's a tough road to walk. I think to be a scientist you also have to listen to kind of what calls your passion and calls your heart, and for me it was working on these diseases which disproportionately affect those individuals who get the least amount of resource, compared to what is needed. I’ve done everything from trapping snails in Jamaica to try and see if they had rat lung worms and working with populations in Uganda, to see what they understood about sleeping sickness. I've also worked here in the United States with Sexually Transmitted Infections that disproportionately affect the black population here. It's really all been about trying to figure out how transmission happens, what increases the risk for an individual to get infected, and what can be done to break that chain of transmission.
JH: How did you initially become interested in and decide to focus on this topic[understudied infectious diseases]?
Dr. Shafir: When I first started the PhD program at UCLA, the professor I came to work with was focused on bioterrorism, I started in 2001, which was right after 9/11, and I really thought that was the biggest way to have an impact. My second year into the doctoral program I took a class in parasitology, in the school of public health, and realized “THIS is it!” To be a good infectious disease epidemiologist, specifically in parasitology, you have to understand the biology and ecology of the organism, you have to understand the risk factors of the people, and all of the context in which a disease might occur. It certainly helped a lot that the professor who taught the class, who ultimately became my doctoral advisor, was the most brilliant professor in the classroom that I’ve ever seen. He could come and give a 2 hour lecture on parasites with details like “this parasite is 25 microns by 45 microns” and he didn’t even need notes. He just knew it. From there, I just realized I need to work with him. I asked him to take me on as an advisee. As I began to do a lot of work with these different parasitic diseases, I realized that the big thread, for many of them, was that they were under this umbrella of neglected tropical diseases, and the ones that weren’t were in the group, neglected diseases of poverty. My foray into NTDs [Neglected Tropical Diseases] really started by realizing that my heart belonged to parasites.
JH: Do you think that once this pandemic has ended, healthcare and public health fields and associated government agencies will change in any significant way (for the long-term)?
Dr. Shafir: I think that's a great question, and one of the things that we’ve seen over the course of this pandemic, is that the CDC has largely been sidelined. Those of us who have spent our lives in Public Health have always thought of the CDC as a sort of crown jewel of public health. I think because of the ways the CDC has been sidelined and some of the mistakes the CDC made very early on in this pandemic, I think there is and will continue to be a massive erosion of trust in the CDC and in the public health infrastructure. I think it takes a very long time to build trust, and it takes a very short time to lose trust. Unfortunately, I think its going to be a long time before the general population has faith in the CDC again. I also think, on a plus note, that this is the first time in my career that I haven’t had to explain what an epidemiologist is, so I certainly think there is more awareness of the existence of public health. We often say when public health is working, people don’t know that we exist. So if food inspections are working, nobody is getting Salmonella, and you have no reason to think about the different agencies that are responsible for ensuring that the public’s health is being protected. I think we are seeing increased awareness and that will linger for a while, people will understand the importance of public health infrastructure, the importance of handwashing.
I also, unfortunately, think it may change the way we interact with other people for awhile. People now remark that when they are watching television, and they are watching something produced before the beginning of the pandemic, they get a little agitated. It may seem like people are standing too close together, or there is a crowded concert scene … because even though we have all only been in Safer at Home for 3 months, it has changed our collective Psyche. We now think about the risk of social interactions in a very different way than we did in early February 2020.
JH: Do you think it likely the government will make public health and disease prevention a higher priority?
Dr. Shafir: That's a really great question. It's important not to think of the government as a monolith. What I can answer right now is… Do I think this administration will make public health and disease prevention a priority? Without being overly pessimistic, I think the answer to that is no. When I think about past administrations, on both sides of the isle, both democratic and republican administrations, they placed a huge priority on public health and disease prevention, and on appropriately funding the Centers for Disease Control and Prevention and making sure local health jurisdictions and health departments had the resources and infrastructure that they needed. So under this current administration, where there were massive cuts [in funding] to the CDC before the pandemic happened, I think the answer is no. I think under a different administration, absolutely. Collectively people are beginning to embrace “an ounce of prevention is worth a pound of cure.” As we are sitting here, we don’t have a cure for COVID-19, it's going to be months, if not years, before we have a vaccine. Think about all the things that could have been done in January and February that we see happen successfully in South Korea and New Zealand. There have been success stories, it's just incumbent upon the administration of that country to have prioritized { ].
JH: Do you suspect a resurgence in COVID-19 cases as a result or any other potential consequences?
Dr. Shafir: Unfortunately, I think the answer to that question is yes. We are already seeing that happen in a number of states around the country. I was born and raised in Phoenix, Arizona. A lot of my family is still there. The largest health system in Arizona just told all of their hospitals to activate emergency plans, they are running out of ICU beds, there are no more ECMO (extracorporeal membrane oxygenation) machines available. That's when, even if you put someone on a ventilator, their lungs are still too damaged to oxygenate, so you take the blood out, and oxygenate the blood out of the body. From my perspective, thinking about this as an infectious disease epidemiologist, nothing about the virus changed. Nothing changed about its ability to be transmitted from person to person or people’s abilities to transmit the virus. We don’t have any miracle treatment yet. We don’t have a vaccine yet. Really the only thing that changed is that we started to have more capacities at hospitals, so more open beds, saying we can treat the people who get sick and come in. Everything we were doing, that was flattening the curve and keeping the number of cases low, it was only working while we were working it. I think with all most certainty we are going to see an increase in the number of cases, and the only question will be, when that happens...
JH: How long do you think the U.S. can and/or should hold out in maintaining lockdown precautions and social distancing recommendations, in terms of balancing the risk of COVID-19 with the potential consequences to the economy, etc?
Dr. Shafir: I think the decisions that have been made to reopen society, to relax social distancing, those have all been made based on economic and political justifications. They haven’t been made based on Public Health. With respect to how long can people hold out, that really comes down to an idea in Public Health called harm reduction. A lot of our attitudes here in the United States can be based on the country's Puritanical roots, and we have this approach that abstinence is the only way. So “strict social distancing is the only way from a Public Health perspective that we know will reduce transmission of the virus.” That’s true, but people can’t forget politics, forget the economy… people and their mental health can’t do this forever. I think that is why it is important to think about a shift to harm reduction, which is a theory that came out from the body of research on drug use. Obviously it is best for people to not use IV drugs, that would be our preference in any circumstance. And yet we know there are people who are struggling with addiction, and we can think about things that can be done, that can minimize the risk of them dying as a result of using IV drugs. Those are things like needle exchange programs and safe injection sites. It's not harm elimination but it is harm reduction. When we think about COVID-19, we have to switch to a mode of harm reduction rather than harm elimination, because the economy cannot survive with people not able to work. Far more importantly, we are starting to see people are having significant mental health consequences, as a result of isolation. They’re having anxiety, they’re having depression. We have to figure out how to continue minimizing the risk of transmitting the virus while also allowing people to be in contact with one another. That can mean taking socially distant walks, or it could mean spending time outside and not sharing food, but having a meal together, where everyone brings their own food and uses their own utensils and we can minimize the risk of viral transmission, while not eliminating it like we have tried in the past few months.
Joshua Hughes (JH): What were some experiences that influenced you to become interested in public health and become an epidemiologist?
Shira Shafir: I liked to say that my brain was science, but my heart was social justice. So for me, once I became aware of the existence of public health, and that didn’t happen until my junior year of college, because prior to that nobody told me it was a thing and I didn’t know anyone who worked in Public Health... once I became aware of it, I started reading popular literature books about infectious diseases. I became so convinced that this was my perfect path, because it was the way to combine the way my brain worked, which was very science, with the way my heart worked, which was very social justice.
Until my senior year, I thought I was going to do my PhD in genetics. In between my junior and senior year, I went and visited a bunch of campuses that had graduate programs in genetics and talked to the students about what they were studying. I had this moment, where I was like “OH, I do NOT want to do that, that's not it!”
JH: What additional advice do you have for current undergraduate students at UCLA? Is there any specific advice you would give to students who wanted to explore public health as a possible career route.
Dr. Shafir: I think some of the best advice I could give, that's sort of specific to UCLA, and for other larger research institutions, is to take the opportunity to get to know some of your faculty members, and do what we are doing right now [i.e. informational interviews] throughout the course of the academic quarter. Ask if you can come and talk to them about their career journey, how they ended up working where they are, what they learned, and in particular be mindful of the fact that if you are thinking you want to go into any career that involved graduate education, you need professors to write you letters, and from my perspective [as a professor], I always want to say “this student came and talked to me, asked for book recommendations, and we discussed all of these interesting things, because otherwise, like in Public Health 150 where I met you [interviewer], there were 175 students. If someone just gets an A in my class and asks “can you write me a letter,” I dont have the ability to say anything about why they are uniquely capable of doing well in a graduate program or professional program. Getting to know faculty, in particular, giving faculty the opportunity to get to know you, is hugely important at a place like UCLA.
Specific advice for students who want to explore public health: don’t wait until senior year to take a public health class because it fits in your schedule. We have a public health minor, a global health minor, and we are hoping at some point to have a public health major. I think these are really exciting opportunities to bring a population-based perspective to your work and really think about how you can consider the entire community rather than thinking about a single individual.
JH: What was the main focus or topic of some of your past research? (feel free to explain in any amount of detail on one or more of your previous research projects)
Dr. Shafir: My specific area of expertise… There's the umbrella which is epidemiology, and the next layer is infectious disease epidemiology. I focused very much on the interactions between the agent, the host, and the environment. The thing that causes people to get sick, the people who get sick … who’s at increased risk and the factors that impact that, and the environment or the background against which this all occurs. I look at all of those interactions, and then the next level down is I focused on parasitic diseases, and then the very most granular is I’ve studied diseases that have been classified as neglected. So neglected tropical diseases and neglected infections of those in poverty. It’s very much about these diseases that don’t get enough attention and that don’t get enough research dollars when we consider the impact they have on populations. If I had a piece of advice to give, choosing to be an expert, choosing to focus on diseases and conditions which are defined by the fact nobody cares enough about them to pay for them… it's a tough road to walk. I think to be a scientist you also have to listen to kind of what calls your passion and calls your heart, and for me it was working on these diseases which disproportionately affect those individuals who get the least amount of resource, compared to what is needed. I’ve done everything from trapping snails in Jamaica to try and see if they had rat lung worms and working with populations in Uganda, to see what they understood about sleeping sickness. I've also worked here in the United States with Sexually Transmitted Infections that disproportionately affect the black population here. It's really all been about trying to figure out how transmission happens, what increases the risk for an individual to get infected, and what can be done to break that chain of transmission.
JH: How did you initially become interested in and decide to focus on this topic[understudied infectious diseases]?
Dr. Shafir: When I first started the PhD program at UCLA, the professor I came to work with was focused on bioterrorism, I started in 2001, which was right after 9/11, and I really thought that was the biggest way to have an impact. My second year into the doctoral program I took a class in parasitology, in the school of public health, and realized “THIS is it!” To be a good infectious disease epidemiologist, specifically in parasitology, you have to understand the biology and ecology of the organism, you have to understand the risk factors of the people, and all of the context in which a disease might occur. It certainly helped a lot that the professor who taught the class, who ultimately became my doctoral advisor, was the most brilliant professor in the classroom that I’ve ever seen. He could come and give a 2 hour lecture on parasites with details like “this parasite is 25 microns by 45 microns” and he didn’t even need notes. He just knew it. From there, I just realized I need to work with him. I asked him to take me on as an advisee. As I began to do a lot of work with these different parasitic diseases, I realized that the big thread, for many of them, was that they were under this umbrella of neglected tropical diseases, and the ones that weren’t were in the group, neglected diseases of poverty. My foray into NTDs [Neglected Tropical Diseases] really started by realizing that my heart belonged to parasites.
JH: Do you think that once this pandemic has ended, healthcare and public health fields and associated government agencies will change in any significant way (for the long-term)?
Dr. Shafir: I think that's a great question, and one of the things that we’ve seen over the course of this pandemic, is that the CDC has largely been sidelined. Those of us who have spent our lives in Public Health have always thought of the CDC as a sort of crown jewel of public health. I think because of the ways the CDC has been sidelined and some of the mistakes the CDC made very early on in this pandemic, I think there is and will continue to be a massive erosion of trust in the CDC and in the public health infrastructure. I think it takes a very long time to build trust, and it takes a very short time to lose trust. Unfortunately, I think its going to be a long time before the general population has faith in the CDC again. I also think, on a plus note, that this is the first time in my career that I haven’t had to explain what an epidemiologist is, so I certainly think there is more awareness of the existence of public health. We often say when public health is working, people don’t know that we exist. So if food inspections are working, nobody is getting Salmonella, and you have no reason to think about the different agencies that are responsible for ensuring that the public’s health is being protected. I think we are seeing increased awareness and that will linger for a while, people will understand the importance of public health infrastructure, the importance of handwashing.
I also, unfortunately, think it may change the way we interact with other people for awhile. People now remark that when they are watching television, and they are watching something produced before the beginning of the pandemic, they get a little agitated. It may seem like people are standing too close together, or there is a crowded concert scene … because even though we have all only been in Safer at Home for 3 months, it has changed our collective Psyche. We now think about the risk of social interactions in a very different way than we did in early February 2020.
JH: Do you think it likely the government will make public health and disease prevention a higher priority?
Dr. Shafir: That's a really great question. It's important not to think of the government as a monolith. What I can answer right now is… Do I think this administration will make public health and disease prevention a priority? Without being overly pessimistic, I think the answer to that is no. When I think about past administrations, on both sides of the isle, both democratic and republican administrations, they placed a huge priority on public health and disease prevention, and on appropriately funding the Centers for Disease Control and Prevention and making sure local health jurisdictions and health departments had the resources and infrastructure that they needed. So under this current administration, where there were massive cuts [in funding] to the CDC before the pandemic happened, I think the answer is no. I think under a different administration, absolutely. Collectively people are beginning to embrace “an ounce of prevention is worth a pound of cure.” As we are sitting here, we don’t have a cure for COVID-19, it's going to be months, if not years, before we have a vaccine. Think about all the things that could have been done in January and February that we see happen successfully in South Korea and New Zealand. There have been success stories, it's just incumbent upon the administration of that country to have prioritized { ].
JH: Do you suspect a resurgence in COVID-19 cases as a result or any other potential consequences?
Dr. Shafir: Unfortunately, I think the answer to that question is yes. We are already seeing that happen in a number of states around the country. I was born and raised in Phoenix, Arizona. A lot of my family is still there. The largest health system in Arizona just told all of their hospitals to activate emergency plans, they are running out of ICU beds, there are no more ECMO (extracorporeal membrane oxygenation) machines available. That's when, even if you put someone on a ventilator, their lungs are still too damaged to oxygenate, so you take the blood out, and oxygenate the blood out of the body. From my perspective, thinking about this as an infectious disease epidemiologist, nothing about the virus changed. Nothing changed about its ability to be transmitted from person to person or people’s abilities to transmit the virus. We don’t have any miracle treatment yet. We don’t have a vaccine yet. Really the only thing that changed is that we started to have more capacities at hospitals, so more open beds, saying we can treat the people who get sick and come in. Everything we were doing, that was flattening the curve and keeping the number of cases low, it was only working while we were working it. I think with all most certainty we are going to see an increase in the number of cases, and the only question will be, when that happens...
JH: How long do you think the U.S. can and/or should hold out in maintaining lockdown precautions and social distancing recommendations, in terms of balancing the risk of COVID-19 with the potential consequences to the economy, etc?
Dr. Shafir: I think the decisions that have been made to reopen society, to relax social distancing, those have all been made based on economic and political justifications. They haven’t been made based on Public Health. With respect to how long can people hold out, that really comes down to an idea in Public Health called harm reduction. A lot of our attitudes here in the United States can be based on the country's Puritanical roots, and we have this approach that abstinence is the only way. So “strict social distancing is the only way from a Public Health perspective that we know will reduce transmission of the virus.” That’s true, but people can’t forget politics, forget the economy… people and their mental health can’t do this forever. I think that is why it is important to think about a shift to harm reduction, which is a theory that came out from the body of research on drug use. Obviously it is best for people to not use IV drugs, that would be our preference in any circumstance. And yet we know there are people who are struggling with addiction, and we can think about things that can be done, that can minimize the risk of them dying as a result of using IV drugs. Those are things like needle exchange programs and safe injection sites. It's not harm elimination but it is harm reduction. When we think about COVID-19, we have to switch to a mode of harm reduction rather than harm elimination, because the economy cannot survive with people not able to work. Far more importantly, we are starting to see people are having significant mental health consequences, as a result of isolation. They’re having anxiety, they’re having depression. We have to figure out how to continue minimizing the risk of transmitting the virus while also allowing people to be in contact with one another. That can mean taking socially distant walks, or it could mean spending time outside and not sharing food, but having a meal together, where everyone brings their own food and uses their own utensils and we can minimize the risk of viral transmission, while not eliminating it like we have tried in the past few months.
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