Man, hearing you be so confidently wrong about 30 Rock made me so happy.

Ordered 3 copies to give out for gifts! I really want the sequel! Asunder is the best book I’ve read in years and thats even with eating through the entire Locked Tomb Series this year.

Thank you for this, and I love seeing Vincent Racaniello as part of this. His podcasts helped convince me to move into science and have been an avid fan since 2012. Would love to see public health experts working at state and local health departments involved too.

Been hungry for a paper like this for years. 🧑‍🍳💋

I loved this book so much. Thank you for it. After I read it I ate my way through everything else you’ve published. You’re amazing and I love the worlds you build.

DIS are the under-recognized backbone of public health, providing direct support to people with an STI and HIV. They help facilitate testing and treatment. They are also undervalued and underpayed. The only way at the state level can provide the CDC with high quality data is bc of this workforce.

It hasn’t been getting enough attention, but at the same time they closed the Disease Investigation Resource Branch, which provides investigatory support to outbreaks and advises on disease interventions specialist (DIS) best practices.

I wanted to highlight this for you as the impacts of similar cuts on the state and local efforts will also impact the representativeness and completeness of data you rely upon, while further hamstringing prevention efforts.

Disease intervention specialists at the state and local levels. We at the state level collect and submit data and specimen which your work depends upon. This work and the necessity of these staff is not often reflected in analyses.

Dr. Grad, I love and respect your work. I want to call your attention to the closure of the disease intervention and response branch (DIRB), which provides investigatory support for communities experiencing an outbreak of STIs. This, combined with other funding cuts are harming capacity for…

I have not seen any journalists with a large megaphone meaningfully address this or try to make it clear to the public. This will impact local vaccination campaigns, outbreak identification and response, free testing, and jobs at every level.

Funding levels for state governments are all public. If you dig into this you will see how reliant states are on federal funds for ALL infectious diseases. Many states are entirely dependent upon federal funds and receive nothing from the state budgets for these conditions.

Please connect this to state and local impacts. The CDC funds health departments to collect those samples. We in turn depend on public clinics who (usually for free) partner with us to actually collect the samples. Clinics are dying due to funding cuts, impacting communities with low access to care.

Limited funding means we have fewer staff to be effective. This also means we lose support to cover the costs of testing and treatment for those who can’t afford care. Even further, fewer funds will be available to clinics or to support testing events. (Done)

I want to make it clear that public health funding at the state and local level depends on federal support. As more outbreaks of TB, measles, and other infectious conditions pop up, we will need more sufficient funding. (8/?)

The team was cut in half, with most of those remaining having funds expiring at the end of this year. In the year following the loss of these positions, syphilis rates started to increase again. (7/?)

In my state, we were able to secure funds for an actually sufficient DIS workforce. This led to a reduction in syphilis cases in the state. Unfortunately, a Biden-era shutdown resulted in the revoking of funds necessary to support this workforce. (6/?)

We’ve had physicians who refuse to follow treatment guidelines or even take on patients with severe presentations of syphilis. DIS are the ones who go to war with health systems to do what’s right for a patient or help to connect patients to providers they know and trust. (5/?)

When I see an MD put forward as a public health expert, I wish they could be replaced with a DIS or public health nurse. Those are the people intimately familiar with failures of health systems, difficulties of access, interpersonal dynamics, and work directly with folks to help them navigate. (4/?)