A Conversation with Alyson Rose-Wood
by Benjamin Collinger & Cristian Vargas
Lieutenant Commander Alyson Rose-Wood is a U.S. Public Health Service officer serving as the senior Policy Advisor in the Office of the Director of the Division of Viral Hepatitis (DVH) and the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. In this role she serves as the policy lead for hepatitis B and C elimination in the United States and for the global and laboratory work of DVH. The Division serves as a world Health Organization Collaborating Center for Reference and Research on Viral Hepatitis. In addition, Alyson volunteers regularly as a docent for the David J. Sencer CDC museum, a Smithsonian affiliate. She spoke to Benjamin Collinger and Cristian Vargas about her career in public health, global experiences and the disparities in U.S. health infrastructure.
What inspired you to pursue a career in public health?
After Trinity, I became an international white water raft guide and I picked up malaria while working internationally [in Ethiopia] and this prompted me to have a lot of questions about my case, how it was handled, and malaria in general. That prompted me to figure out that I had enough questions, so I might as well go to grad school for them. I began grad school with a selfish focus on my malaria experience, but I finished with a public health focus and have continued to work in public health ever since.
How do you feel that your interdisciplinary studies in college affected your career goals?
When I arrived at Trinity, I had dreams of pursuing a career as a war photojournalist. I studied English literature, I studied photography, and I studied political science. The mentorship I received from the Political Science department really gave me a good foundation professionally that has helped me with every iteration of myself.
You have been a volunteer in the Peace Corps, can you comment on how your experiences in Morocco influenced the passion you have for public health?
I applied for Peace Corps at the beginning of my senior year at Trinity, and I applied because my parents had done Peace Corps, my grandparents had been involved in Peace Corps, and both of my parents were career diplomats. Growing up in different countries, I was always around Peace Corps volunteers. It almost seemed to me that this was what you did when you finished undergrad. Peace Corps (in 2003), looked at your skillset and offered you positions based on that. They assigned me to be a water and sanitation volunteer—one of several types of health volunteers that Peace Corps has. I think they said that because they saw white water rafting on my résumé, they figured I could work with water. I loved being a Peace Corps volunteer; I loved everything about it.
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In fact, my husband was another volunteer whom I met in Morocco; we were serving at the same time. For Peace Corps in Morocco, you had to arrive with French already, and they taught you Arabic [Dharija] and Berber [Tamazighet]. When I finished Peace Corps in Morocco, I had a really good foundation of languages which set me up really well for a public health career, particularly one focused globally. I was a [late] bloomer to the reality of public health and what it was because I didn’t realize that’s what I was doing in Peace Corps, to be honest. I always thought I was going to be a career white water raft guide and go on to own an international adventure company. It was getting malaria while white water raft guiding and being a Peace Corps volunteer that laid the foundation for my public health career.
In your work experience, what roles do faith-based organizations play in terms of health care access in developing countries?
Faith-based organizations and faith leaders quite often—in the United States and developing countries—are often the most trusted members of the community–more than political or military leaders. Most other countries recognize that to do public health, you need to work through the trusted leaders in the community. But in the United States—in particular–we grow up very aware of the separation of church and state; your first instinct is not to work with faith leaders and organizations. Over the last ten years, there has been a growing recognition on the part of the United States [government] of the role of faith-based organizations to get the message out–to affect behavior change in public health–which is the hardest part. I am currently working on the opioid and heroin epidemic and it’s really the faith leaders that are helping to get [health[ messages out, especially in rural Appalachia.
Are there initiatives where local governments partner with faith leaders to solve public health problems?
It happens every day, and there are hundreds of examples. It happens so often that in the Office of the Secretary of the U.S. Department of Health and Human Services there is an office called the Center for Faith-Based and Neighborhood Partnerships [formerly known as the Center for Faith-Based and Community Initiatives]. This office exists to help local [and state] governments link with faith leaders and groups in their area. In the south, one group that comes to mind is the African Methodist Episcopal church. The state of Tennessee works with them to get [public health] messages out across the state.
You are a Senior Policy Advisor at the Centers for Disease Control and Prevention working on viral hepatitis; injecting drug users and males who have sex with males (MSMs) are the demographics who are most at-viral risk for contracting hepatitis. What policy advice would you give to decrease risk of contraction and increase access to healthcare for these populations?
The most basic issue for injecting drug users and MSM is stigma. If they are able to access care, it’s having people on their side throughout the care beginning with primary care physicians. The policy issues for injecting drug users are that right now, many states will not pay to treat injecting drug users. [Note: As of 2013, there are therapies for hepatitis C virus that have few serious adverse events and result in >90% virologic cure following completion of 8-12 weeks of therapy.] About 70 percent of injecting drug users have the hepatitis C virus, which is more contagious than HIV, but the majority don’t know they have it. [Note: Among persons who inject drugs (PWID), HCV is ~10-fold more transmissible than HIV; 50-90% of HIV-infected PWID are co-infected with HCV.] Some states will not treat injecting drug users until they have shown that they have been clean for six months to a year. There’s no evidence that they need to be clean to be treated, so that’s stigma and is subject to state regulation. If you are an injecting drug user and have been treated for hepatitis C and are cured—and you get hepatitis C again– there are few protections [for you] to be treated again. If you are an injecting drug user and a pregnant woman, there are challenges for you and your fetus/newborn [see Neonatal Abstinence Syndrome and the legal and public health debate regarding the criminalization of pregnant PWID.]. Only recently has Congress said that federal money can go to states to implement syringe services programs, but they [syringe services programs] are the first link for injecting drug users [to the health system] and it’s only been in the last two months that money has been available to set them up. (Note: Prevention of HCV among PWID is most effective when syringe services programs (SSP) are combined with other prevention services.) Incidence of viral hepatitis is a rural problem and syringe services programs are few and far between in those areas. Where you have them is not where the needs are. A lot of the issues around access to care and treatment deal with policymakers, which is why they need [sound] information to make good policies.
You have experience working with Haiti after the 2010 earthquake. What lessons can the health care system in Haiti teach us about the United States where we have the privilege of accessible health care?
The United States has some of the biggest disparities in access to health care in the world. While it’s true that certain demographics have access to health care especially through the Affordable Care Act–more folks are getting access to basic health care services–we still have tremendous disparities. In Haiti, a lot of work is needed. I was there working [with the Haitian Government] on mapping the health infrastructure, something they didn’t have before the earthquake in January 2010. I was there helping to get health facilities into a map that had the names of health facilities in several languages so that the first responders could respond. Haiti is one of the first countries to map out its health facilities. Once the first responders to Haiti came back to the United States they started to work on a similar system here. What we were doing in Haiti has led to some innovations in the United States. USAID and the World Health Organization are writing guides for any country to create a master health facility list with a visual interface to help other countries do exactly what was done in Haiti.
Can you give us a bit more context to the health disparities that populations in the United States face and policy recommendations in order to alleviate those disparities?
In the United States, we don’t recognize access to health care as a right. Many other countries do so, and it’s becoming more frequent such as the Brazilian constitution guaranteeing health care as a basic human right. The only place in the United States where health care is a right is if you are in the corrections system. That is the only place you are ensured treatment and access to care. [Note: Persons incarcerated in jails and prisons have a constitutional right to healthcare; for more information see, look into the following two Supreme Court decisions: 1) Estelle v. Gamble, and 2) Farmer v. Brennan.] In the United States, we offer Medicaid to help populations who can’t otherwise afford access to health care, but it’s up to each state to decide what is covered under Medicaid and how. The Affordable Care Act is going a long way to ensure that folks have insurance to cover health needs so they aren’t paying out of pocket, but it still has a long way to go. Until federal, state, and local government recognize that access to health care is a right, or at least something that should be guaranteed to all, we aren’t going to be able to ensure the access that folks need. Right now, we are seeing the increases in prescription drug abuse and heroin—in rural areas, affecting new demographics (e.g., young, white, and rural America). There is very little health infrastructure for those populations right now. One of the things we could do better as a country is providing funding when we need it; to be proactive, rather than reactive. I think the hard part is convincing the press, public, and policymakers [of where we need the resources and attention.]
What do you think are the biggest challenges and successes in trying to control malaria?
If you talk to a lot of malariologists, their interest is not in stopping transmission [necessarily], but in stopping deaths. In the 1950s, the world undertook a large effort to eradicate malaria [i.e., the malaria-transmitting mosquitoes] but when Rachel Carson’s Silent Spring came out about DDT, the world stopped its program. [As a result], the world can never recreate that program because of the way DDT resistance has built up [and the changing behavior of the mosquito]. In this country, we have, similar to the vaccine debate with parents opting out, states have stopped funding mosquito programs entirely that would others help prevent Zika, West Nile, chikungunya, and dengue. We’ve grown a little complacent, and I think Zika might be the virus that will help restart those programs. But the programs can’t restart very quickly because the experts are gone, so it’s going to take a few years to get things in place.
How would you compare the work you did in malaria with the work you did in the Office of Global Affairs concerning health challenges in Latin America especially with mosquito-borne diseases?
What I was doing in West Africa was looking at trends over a number of years looking at what was happening with malaria and children in an area with a really high number of children dying before they reached five years old. What I discovered was that mosquitos were adapting quickly and were starting to breed and live in urban areas in a way that we hadn’t seen before. That [adaptive] behavior, you see everywhere. In most of the Americas, the mosquitos tend to bite during the day and outdoors, so bed nets aren’t as effective [as an intervention]. I think that the general public health trend of looking at mosquito behavior is what needs to be done, and is being done by experts in the Americas. In the Office of Global Affairs, I was doing policy work and providing strategic direction for the department [U.S. Department of Health and Human Services] and how we engage in the Americas, but I wasn’t working with mosquitoes directly, just with the experts working on mosquitoes.
Do you have any policy recommendations on how to handle the Zika virus, especially because the mosquito that transmits it is endemic to the southern United States?
I would advise people to speak to experts and –while I can’t as a federal employee lobby Congress for money– [I should say that] funding is needed to allow the experts to do what they need to do to control Zika and to do it now before the peak of mosquito transmission in the summer.
What advice would you give to students with a passion in public health?
I would encourage them to go out and get experience working in public health, and maybe not immediately jump into public health [graduate] programs. The Master of Arts in Public Health degree is becoming much more ubiquitous, and therefore a little less valuable. The question now is: What work experience, other degrees, and technical skillsets do you have? Getting work experience helps you to figure that out. I would encourage students to think outside of the box. If they have a public health and law interest, they could become a lawyer with a public health focus, which is a very niche and needed skillset. The same goes for a health economist or a health trade lawyer. Definitely get technical skills in addition to the soft skills because that will help you get the jobs you want.
What books would you recommend for everyone to read?
A few books I like: Making Data Talk and The Checklist Manifesto. Those are the two books I ask my interns to read over and over again. They’re both really well-written. One is about people practicing public health while the other is about communicating the science of public health. These two points [the practice of public health and communicating the science of public health] are foundational if you want to work in public health.
The views expressed in this interview are those of Alyson Rose-Wood, and are not representative of the United States Government.