This Podcast Will Kill You - Special Episode: Hep B Stigma & Discrimination

Episode Date: February 1, 2022

Blood tests and liver function results can only tell us part of the story when it comes to the impact that hepatitis B has on people living with the virus. Far too often overlooked is how stigma and discrimination, which we only briefly touched upon in our last episode, contribute to the substantial global burden of disease. In this bonus episode, Dr. Chari Cohen, Senior Vice President of the Hepatitis B Foundation, comes on the pod to chat about the different forms stigma and discrimination can take, how we can get a better sense of their impact, and the key tools in the fight against them. We also seized this opportunity to pick Dr. Cohen’s brain about what it’s like to run a public health non-profit, how much of the job is accurately reflected in the job title, and advice for someone who might be interested in pursuing a career in public health. See omnystudio.com/listener for privacy information.

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this is not your typical TPWKY episode. For one, you didn't hear Aaron Allman Updike say, and I'm Aaron Alman Updike. But don't worry, she'll still be there for all of our regular episodes. And you won't just be hearing me ramble on all by myself in this episode. I've got a friend joining me. So what exactly is going on? Well, this is a bonus episode, the first in what will be a mini series of bonus content over the next few months. If you've listened to the podcast before, you know that we love a deep, deep dive on a topic. After all, that's basically what our podcast does and why we started doing it. But you also know that we can't always make that dive ourselves. Instead, one of our favorite things to do is to get someone else, an expert, to help us

explore those dimensions of a disease or a topic that we can't quite reach on our own. Many of our episodes have featured these expert interviews, and I always have so much fun talking with them about their research, and I get sad when the interview is over because I feel like there's still so much to discuss, especially about the experts themselves. Which brings me to the second aim of this bonus episode. For a long time on the podcast, we've talked about doing a careers episode where we discuss the unbelievable number of different and exciting things that you can do in public health. We get a lot of the incredible number of different and exciting things that you can do in public health. We get lots of emails and messages from listeners asking what an epidemiologist does on a day-to-day basis,

or what the difference is between a Masters of Science and a Master's of Public Health. And frankly, I feel like the world has maybe never been as interested in what actually goes on in the wide world of public health as they are these days. So we thought it would be so much fun to try to get a better sense of what this amorphous umbrella term of public health really means. We envisioned this episode as covering everything from how to choose a graduate program, disease ecology, epidemiology, public policy, etc., to all of the many diverse opportunities open to people who want to pursue a career in public health, conservation biologist, infectious disease physician, biostatistician, entomologist, clinical trials researcher. But we pretty quickly realized that this couldn't possibly be done in just one episode or just one

mini-series even. So in these bonus episodes, I'm combining my love of an even deeper dive on a topic with my love of picking a public health expert's brain on what it is they do and how they got to be where they are. Graciously offering to be the first to have their brain picked is Dr. Sherry Cohen, senior vice president of the Hepatitis B Foundation, which is a nonprofit institution that is dedicated to finding a cure for the virus and improving the lives of those already affected. by the disease. Last week, Aaron and I covered the hepatitis B virus, and if you haven't listened to that episode yet, you definitely should, because it'll give you a nice backdrop of knowledge about this virus and the disease that it causes. But to recap, hepatitis B is an extremely prevalent

infection, with nearly 300 million people around the world chronically infected. The hepatitis B virus, which is transmitted through blood and body fluids, can cause an acute or a chronic infection, and it can progress to severe liver disease and liver cancer in some people. The good news is that we do have both a vaccine as well as antiviral treatment. But the bad news is that despite having these tools to help prevent and control the infection, a million and a half people are newly infected every year. Part of that might be due to the lack of access to timely vaccination or treatment, But another big component to this is the stigma and discrimination faced by many people living with hepatitis B.

As we discussed in our regular season episode, the hepatitis B virus carries with it a substantial amount of stigma and discrimination, which can take a large emotional and mental toll on someone who may already be experiencing physical health challenges from their infection. But unlike screening for antibodies or examining liver function numbers, the impact of stigma is much. more difficult to measure. In this episode, I'll be asking Dr. Cohen to fill us in on what that stigma looks like, what is being done about it, and what it's like to run a public health nonprofit. I had such a great time chatting with Dr. Cohen and I learned so, so much. I will let her introduce herself and get right to the brain picking right after this break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron,

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with code this podcast 50. Terms and conditions apply. Visit blue apron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands, Hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly.

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and each piece is made with premium materials in ethical trusted factories and priced far below what other luxury brands charge. I recently got a pair of Quince's Bella stretch wide-leg jeans, and they are now in constant rotation. They are so comfortable. The fit is amazing, and they come in a bunch of different washes, so I'm about to go order some more. Refresh your wardrobe with Quince. Go to quince.com slash this podcast to get free shipping on your order and 365-day returns. available in Canada too. That's QI-N-C-E.com slash this podcast to get free shipping and 365-day returns. Quince.com slash this podcast. Hi. My name is Dr. Sherry Cohen. I am Senior Vice President at the HepataseB

Foundation, and we are located in Doylestown, Pennsylvania. Wonderful. Thank you so much for taking the time to chat with me today. Thank you. I'm really excited to be here. Well, I am also very excited, especially to learn more about stigma and discrimination in hepatitis B, because it's such an important topic, as you know, and it's one that we only touched briefly upon in our hepatitis B episode. Over the past couple of decades, we have made some pretty substantial strides in reducing the global burden of hepatitis B through prevention and treatment, but we still have a long way to go. And there are several barriers that keep these preventative tools from working, such as, a lack of timely access to vaccines or a lack of understanding about the virus's transmission.

But can you talk about the ways that stigma can also contribute to the persistence of the hepatitis B virus? Absolutely. It's a great question. And stigma is a big problem. And one that is, unfortunately, a major barrier to eliminating hepatitis B around the world. What we have is a misunderstood disease. And so hepatitis B is so common. that chronic hepatitis B impacts 300 million people, yet every person that has it, I think, feels isolated and alone because we don't talk about it. Because hepatitis B is kind of a condition of the shadows, and people are often afraid to talk about it, and they're afraid when they have it.

And I think that lends itself to a situation where when people get hepatitis B, they tend to self-isolate because they're afraid of others judging them. they're afraid that they may be discriminated against because they have it. And so they keep it to themselves and they kind of pull back a little bit from family and friends in society. And then you also have societal stigma where we might actually be promoting stigma in communities. And so it's unfortunately a major barrier. And I think I think some of it has to do with how hepatitis B is transmitted in that it is an infectious disease. And of course, there's always stigma with infectious diseases. But I also think hepatitis B has been around for, you know,

hundreds or thousands of years. And what comes along with that is these sort of deep ingrained beliefs that are passed down from generation to generation about hepatitis B. And that also, I think, has lent itself to deep misperceptions about the virus and about how it's transmitted and about how it's treated. And it serves, unfortunately, to promote fear, which means that people don't want to get tested and don't want to tell anyone when they have it. Right. Absolutely. Can you talk about some of what these common misperceptions are around the hepatitis B virus? Yes, absolutely. We hear, so we've done quite a lot of research among communities that are highly impacted by hepatitis B. And worldwide, that's frankly, almost everyone. But in particular, it's Asian American Pacific Islander and African. And

working communities. And what we often hear is that people think that hepatitis B is genetic. That's a big one. Because it is passed down from mother to child during the blood exchange that happens at childbirth, you often wind up with family trees that are highly impacted by hepatitis B, where you'll see grandparents and parents and kids and aunts and uncles and cousins impacted by it. And so people think hepatitis B is genetic and that only families are impacted if they have weak genes or that something's wrong with the family because everybody has hepatitis B. And so that definitely promotes stigma. And it makes families, frankly, feel bad and makes people not want to say that they've been infected with hepatitis B or that they've been diagnosed. So stigma and discrimination are often discussed together, sort of in just lump together. But they represent these separate things, right? So in the case of hepatitis B, stigma is when someone sees you negatively. because of your diagnosis or you see yourself negatively, self-stigma, while discrimination

is when someone treats you differently because of it. What do stigma and discrimination look like for people with hepatitis B, and why is it important to make a distinction between the two? Oh, I'm so glad you're distinguishing them. I think a lot of times we lump them together, and it's really important to understand the differences, and you defined it really well. So I think when people feel stigmatized because of hepatitis B, whether it's self-stigma or stigma that's coming from external sources, it means that they pull apart. So we often see people, maybe a family where one person has hepatitis B and they're not allowed to eat with the rest of the family. Or they don't share the family meals, shared bowls, for example. We do see that quite a bit where families sometimes will shun people who have hepatitis B.

are where we see a lot of times people who are really concerned about transmitting the virus where they will pull back. And so you'll see people who they don't go out with their friends very much. They are scared to date. So it impacts their relationships. They may not go for a specific job because they're afraid that they'll put others at risk or afraid that they won't be able to handle it in case they start having symptoms or they don't feel good. And so it does, it really impacts people's emotional life and their social life as well as their professional life. So the impacts of stigma are great. And one of the ways that we're trying to get around that is just to get people to talk about it more. You know, the more people can talk about their experiences and the more that

we as communities can see people just like us talk about their hepatitis B. I think it will help. It will help to open it up. Yeah. I'm so glad that you brought up this story. aspect. And that's one of the things that I really love that the Hepatitis B Foundation does is fighting stigma through storytelling. And so can you talk a little bit more about how important storytelling is and what these storytelling events are like? And also, I think there's one coming up. Is that right? Yeah, we do have our next training session. So yeah, so storytelling is, it's part of almost every culture has an aspect of storytelling to it. So when you think about how do you educate people to overcome myths and misperceptions and try and promote screening and get people to get tested

and get people to see their doctor and get into care. Well, you know, brochures, you know, we've done all kinds of things in public health over the past decade, a number of decades, brochures and websites and things like that, they don't necessarily cut it. But when you have stories, when you have people who have been impacted by hepatitis B talking about how it has affected their life and how they've overcome issues and what they're dealing with, that is incredibly powerful. And it actually can change people's perceptions and it can promote people to get tested and, or it can promote them to stop feeling bad, maybe, and to stop self-isolating. Or maybe it will promote a health care provider to look differently at their hepatase B patients or at their community.

So storytelling, we think, is very, very impactful. We do have about 40 storytellers around the country. are storytelling videos, which are three minutes long and they're in, I think they're in nine languages now. They've been viewed almost three million times online. And so we're able to use technology to get the word out, which I also think is very powerful. And we do have a workshop coming up. So we work with our storytellers and we train them on how to most effectively and impactly tell their stories. And then we help them, we connect them with ways to share their stories, whether it's giving testimony at the FDA or working to write an article with a newspaper or a blog or we've

had folks do Facebook lives. I mean, they're incredible and very, very dedicated. And we also have, some of our storytellers share stories specifically about their discrimination experiences, which is very, very important too. And I think outside of stigma, what we tend to see around the country or around the world where there are no protections in place for people who have HepB, is that we see policies that are discriminatory. So in many countries around the world, if you have been diagnosed with Hepatitis B, you can't get a job, or you can't work in a certain industry, or you can't immigrate. There are certain countries that won't let you in if you test positive for Hepatitis B.

And so discrimination is real, and it impacts millions of lives. I mean, in the U.S., we're very lucky. The Hepatized B Foundation actually was at the forefront of working to make sure that people who have been in the U.S. are protected and actually are now included under the Americans with Disabilities Act. So you cannot discriminate against someone who has hepatitis B in the U.S. That doesn't mean it doesn't happen. It just means that technically you're not supposed to do it.

But around the world, people don't have those same protections. And I think it becomes very difficult because if you're a person living with hepatitis, B, all of a sudden, you know, Hep B and the possibility of developing liver cancer is not your first concern. It's putting food on the table because you can't get a job. Right. No, that's such a good point. And I think you brought up this really also crucially important point earlier, too, that although hepatitis B is a globally, extremely prevalent disease, the virus is not equally distributed around the world. And so can you talk about some of the drivers of those global disparities in hepatitis B prevalence, maybe they're historical drivers or current drivers, and how

perception of hepatitis B varies around the world, not just in these discrimination or lack of protection, but also in the way that people view like stigma in hepatitis B. Yeah, that's a great question. We do see, we've done, we're doing some research on this now and we do see stigma differ and perceptions differ around the world. So I think historically, the driver has been the virus itself. It is an ancient virus. And so when you have communities and cultures that have been around for a very long time, you're just going to see more hepatitis be there. I think more modern drivers is vaccine access. I mean, that is a really big issue. In areas of the world where we've been able to implement universal vaccination among babies when they're born, you're able to actually stop the transmission

to future generations. And so some places around the world do better with vaccine and have implemented good vaccine programs for 20 or 30 years in some areas, you know, implementing vaccination universally is a bigger challenge. And so you can't stop the spread there. The birth dose is critical. We have the capacity to stop every single infection of hepatitis B in the world. We can make it so that no baby is ever infected with hepatitis B again. It's just that we don't prioritize it, right? So, you know, childhood infant vaccination is incredibly important. No one misses when possible a polio vaccine, for example. For some reason, the same kind of priority and importance isn't given to making sure that babies are protected from hepatitis B. So as you mentioned, there are nearly 300 million

people around the world living with chronic hepatitis B, but this disease receives so much less attention compared to other diseases with similarly high or not even as high global prevalences. So can you share your thoughts on why it seems to be overlooked and how that's reflected also in funding rates for research into this virus. Absolutely. I think a lot of it has to do with, again, the communities that are impacted by hepatitis B and the fact that it's so stigmatized, we don't, unfortunately, have a really strong advocacy voice globally.

People are not demanding that they give access to vaccines and that governments are giving access to treatments because they're afraid to speak out. But outside of that, I think the fact that we don't have a cure is a really big issue. You know, our colleagues in the hepatitis C world, who we work with very closely, they have a cure for hepatitis C, and they have faced tons of challenges in terms of access and getting governments and funders to prioritize that. Once they found a cure for hepatitis C, it really did become priority. And you can see countries and governments paying for hep C cure and governments that are actually implementing hepatitis C elimination plans. They're getting rid of all hep C in their country,

and it's wonderful. If we had a cure for hepatitis B, I suspect, and I hope that we would see the same kind of excitement. I think the fact that we have really good treatment, but not a cure is holding us back. However, I'm not sure how it's any different than HIV, right? So there's no cure for HIV. In fact, treatment for HIV and treatment for hep B are identical.

You take antivirals forever, essentially. And yet we see, you know, huge uptake and push to get everybody who is diagnosed with HIV on antivirals as well they should. I'd like to see that same excitement and prioritization to make sure that every person with HepB gets their antivirals as well. And I just think, you know, I'm not sure that people really understand the link between Hep B and liver cancer and the fact that one in four people with Hepatise B will die if they don't get treatment.

I mean, that's huge. And if you've ever seen anyone die of liver cancer, it's awful. And if you can prevent it, you know, you absolutely should. But maybe we just aren't strong enough in our messaging. What do you think is the challenge in getting a cure for Hep B? Great question. And it is something we spend a lot of time thinking about and talking about, I think, as public health scientists and as bench scientists. So hepatize B is a tricky virus. And one of the things that the hepatized B virus does that other viruses don't do is it integrates its DNA. into the host genome. And so once a person has that happen, it's really, really hard to get rid of. It's a very complicated virus. And, you know, we've made great strides. There are actually a number

of drugs right now that are in phase three clinical trial. And some people are cured, by the way, their immune system just fights it off. It's just that most people aren't able to do that. And so what we have to figure out is for those people who are able to fight the virus off and be cured, you know, what is it that makes them special? And how do we, how do we work with targeting the virus and also boosting the immune system at the same time to make sure that people can get rid of the virus? I, you know, I'm not, unfortunately, a bench scientist, or an immunologist, it's not my area. But my understanding is that it's just a really tricky virus. So going back a bit to the discussion of stigma and discrimination, you talked about the ways that we can try to address those

things or try to put in place measures to protect against discrimination or use storytelling as a way to reduce stigma. How do we measure both the impact of those types of programs, whether it's like to reduce stigma and discrimination? And also how do we measure the impact overall of stigma and discrimination? Like, what does that look like? What is what do those studies look like? Great question. So I think, and we, we do quite a lot of this. now is measuring the impact. And a lot of that is done qualitatively. And so doing things like focus groups and interviews, in-depth interviews with essentially hundreds of people living with hepatitis B around the world and asking really in-depth questions. You are able to tease out how stigma and

discrimination impacts people with Hep B. And then you publish on it. Right. And so we've done that working with people living with Hep B in multiple countries, in multiple languages, is asking, just really asking them, how does hepatitis B impact your life? And we ask it from multiple perspectives, things like professional impact, social impact, physical impact, psychological impact. And you're able to do, in doing that, you're able to tease out how stigma and discrimination impacts people. You know, quantitative data collection has a role, too, and doing things like online surveys. You may not get as in-depth information, but it does give you a broad picture of perhaps how widespread the issue is and how important.

and it is in different groups compared to others. And then I think in terms of assessing impact of programs, you know, if you're trying to impact discrimination, I think one of the keys to look for is policy change. If you're able to change policy at a governmental level, that's a huge win, and that's a really nice way of knowing whether your program or your project worked.

But some of it is also looking at your data. So we have a hotline, it's essentially a helpline, a helpline at the Hep B Foundation. We get about 10,000 people contact us a year. We document every single contact and what they're calling us about. So over time, you can see if less people are calling you about stigma or discrimination. And for example, over the last three years, we have seen a huge uptick in the people who are reaching out to us about medication access, being able to afford their medications. So sometimes that's the kind of data where it may not be as rigorous as sort of

quantitative data collection, but it does give you a picture of what the needs are and how they're changing. Yeah, that's really interesting. I think it's like you said, it's, it takes so many different approaches to measure the impact. And that kind of leads me into my next question, which is sort of the million dollar question. What do you think are our best tools to stop or reduce stigma and discrimination when it comes to hepatitis B? I think, I think the power of the people. You have, can you imagine if 300 million people raise their voice? I mean, it would be overpowering. I think that, that's our biggest strength, that we have 300 million people who are impacted with hepatitis B. And if we can help even a small percentage of them to create a grassroots advocacy movement and get people demanding that they have access to hep be testing and happy treatment, that that would be incredible.

So you've talked now about multiple different ways that the health. Hepatitis B Foundation is addressing these issues of stigma and discrimination. Can you talk a little bit more about the other missions that the foundation has? So overall, our mission is to find a cure for hepatitis B and to improve the quality of life of everyone living with Hep B worldwide. And so I have to mention our research arm. So we do have about 50 bench scientists, immunologists, phorologists, and chemists who are working to find a cure for hepatase B. And they are at our biotechnology center in Doyle's Town, Pennsylvania. In fact, one of the great privileges of my life is that as a public health scientist, I can walk down the hall and speak with leading scientists who know

everything about the virus and are looking for a cure. So we do do that. We fund that research. And also, I think from the public health perspective, I think our biggest issue is getting the world ready for a cure. At least that's how I see it. So if we, found a cure for hepatitis B tomorrow, and wouldn't that be incredible? I'm not sure who would get it because you have a situation where worldwide, only about 10% of people are diagnosed with Hep B and even less access care. And so my job and the job of the team at the Hep B Foundation is to get the world ready so that when we have a cure and hopefully a functional cure in 5, 10, even 15 years, everyone who needs it can get it. And so we do a lot of work figuring out,

what the challenges are to what are the barriers to testing and care and treatment and then overcoming them. And that, that I think, is the big picture for us. So we're going to take a quick break here. And then when we get back, I want to hear all about how you got involved with this super cool, wonderful, very important work. Okay. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions.

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So in the first half of this interview, we learned so, so much about the impacts that stigma and discrimination have on people living with hepatitis B. But now I want to shift talking more about what it's like to be involved with this type of work. So, Dr. Codagh, Cohen, can you start us off by talking a bit about your job? Like, how much does your job title actually reflect what you end up doing on a day-to-day basis? That's a great question. I have no idea. Okay, so I think in any given day, I do administration, right? Because I have to run the organization, so it's budgeting and grant writing and report writing, making sure that my staff and the team have everything they need to do their job. So, you know, training and administration and just checking

in with people. And then, of course, you know, working on the programs themselves. And so I try and do a little bit of research every day if I can just because it's what I love to do. So doing a little bit of research, probably a little grant writing, probably working on an article or a public journal article or a publication, answering consults for people. And right now, of course, I'm the COVID-19 safety officer for our campus. So a lot of my time right now is actually contact tracing and setting policies for preventing the spread of COVID-19. So I don't know how much my title reflects my job.

But I think perhaps my title is global enough that it does reflect the fact that I think, and that's one of the great things about public health. I think I do 12 different things every day. Some of it I like more than others, but I do it all. What are some of those things that you like more than others? Oh, the research. I love doing the research, whether it's qualitative research. In fact, just today I was working on some focus group analysis and absolutely enjoyed it.

In fact, I hated when I had to stop it. I love working with the staff when we do, like our team, when we get together and we do strategic planning or when we have a new exciting idea that we want to flesh out. And I did that this morning, in fact. So I was meeting with one of the team members, and we were talking about hepatitis Delta and some exciting new program ideas for that this year. So that part, I love. Anything that has to do with working with partners, I love. But of course, for me, it's all about the research. So when you tell someone, I work with hepatitis B and I help run this nonprofit, what do you think some of the aspects of your job that may not come to someone's mind immediately when they hear that that's what you're,

what you do? Like, what do you think that they would be surprised to learn that you do? Oh, wow. That's a great question. I think budgeting is something, you know, that we all have to do in public health because you wind up getting grants or some kind of funding for your programs and projects. And then you have to, so you have to kind of first figure out how much you think you're going to spend on something and then and then actually spend it like you said you were going to. So I do think that's probably something people don't realize that we do a lot of in public health. I also, I'm not sure people understand the idea of, you know, all the different ways that we have to try and get funding. So grant writing and advocacy work and fundraising, event planning.

I mean, all of it goes into public health and you can't do anything without it. You know, I think people today have a little bit more of an idea of what public health means than they may have a few years ago because of the COVID-19 pandemic. Although I think when people think of public health right now, they may think of epidemiology and not understand, you know, all the thousands of other things that we do like developing communications campaigns to help people understand health issues. That's a big part of it too. And people may not not understand that. Public health is such an enormous and difficult to define field that there seems like endless things that you can do, which is really cool. I mean, it's amazing. Yeah, I agree.

And it's one of the things that attracted me to public health in the first place, I think, was that there's just so much you can do. Yeah. So talk to me a little bit more about that. How did you get started in public health? And, you know, what was your journey from your early days of your educational career all the way to how you got involved in Hep B work? Sure. So I think I fell into public health in a similar way to a lot of other public health scientists. I was pre-med in undergrad, and I really thought that I thought that I was going to go to medical school.

And so after I graduated with my undergrad and with my bachelor's, I took a year off. And I did a fellowship at the National Cancer Institute where I worked in a lab for a year. And I really enjoyed it. And while I was there, I took a public health class at GW. And I had no idea what public health was and was still committed to med school. And man, did I love that? class. And so I just, you know, I started thinking more about public health than about medicine. And at some point, what I wanted to do just switched. I spent some time interviewing clinicians

and I spent some time interviewing public health practitioners. And it became clear to me over time that really that's where my heart was. It was working in communities and not working in a lab and not doing clinical work. So much to my parents chagrin, I gave up the idea of going to med school and I got my MPAH instead. That's that's so fascinating. I feel like that story resonates with a lot of people who only discover public health later on or later than they thought they might have. Yeah, I agree.

And in fact, one of the things I try and do, so we do some education at the foundation. We bring in high school students and college students. And I always try and worm my way in and let them know that public health is an option. Because I think you're right. When you're young and you like science, you think I'm either going to go to med school or I'm going to work in a lab. And I think public health just doesn't get enough. We don't, we don't promote it enough to young people because I do think that a lot of people would, would go for it. I think, so when I, when I first made the switch, I was nervous myself.

I was thinking, I love science, love science. I'm a biology, you know, biology nerd. And I was worried that I was going to have to give that up in public health. And you really don't. I, I, you know, if you stay up on the science, I consider myself a scientist and I, I stay up on the latest research. And I don't think you have to give up science to do public health, which I think a lot of people don't understand. Right. Absolutely. And, you know, on that, there are so many different ways you can do public health or do science in public health. You know, there's an master's of science or an MPH, Masters of Public Health. There's a doctor of public health and a PhD. There are so many different degree options here. So can you share a little bit about why you chose the different graduate programs that you chose?

Absolutely. So I started with, I chose the MPH program. I got my master's in public health at Temple University. We were living outside of Philly at the time. And I really enjoyed the program. I liked that it was applied. I didn't necessarily see myself going into epidemiology, although I did concentrate in epi. I liked concentrating in it, but I didn't know that I wanted to practice. this epi. And I felt like the MPH gave me that flexibility. And they paid for me, which was the best part. I got a teaching assistantship and they paid for my master's, which that, of course, helped me make my choice. I do think that this is good advice. I took time off in between getting my master's and my doctorate. And I worked for a while because I think before you commit to a doctorate program, you should try and work in the field and really think about what it is you want to do. because if you do want to stay in academia and you want to practice public health through an academic lens, then, you know, there are PhD programs out there that are excellent.

Or you can get your DRPH, but I will say a DRPH, a doctorate in public health, it is supposed to be more of an applied degree, meaning it should give you everything you need to go out and practice public health. Not that you can't be in academics because you could, but it is meant to be more applied. And so I do think I was lucky in that I took some time off in between to decide what I wanted to do and which degree I should get. When I started in the doctorate program, I could have gone two ways. They had the epidemiology program and then the community health and prevention program. And I was not sure which one I was going to do. And this is where the power of mentors come in.

I had one of my most amazing mentors. His name was Dr. Tom London. He said to me, Shari, if you do. do the epitrack, you will always be an epidemiologist. That is what you're going to be doing. And he said, if you do community health and prevention and you're going to get epi, but it will open you up and allow you to do other things for the rest of your life. And so that's what I did. And I guess another thing that I'm incredibly grateful for over the years are the mentors that I've had. And they've helped me make some really difficult decisions.

So can you talk about how you went from grad school to the Hepatitis B Foundation? What was that experience like. My experience might be a little bit unusual in that I started somewhere and never left. So when you get your MPH degree, you have to, part of the training is to complete some kind of research project or practicum. You have to go out and practice what you've learned. And most schools have, now it's online, but when I was there, because I'm old, it was a binder, right? So most schools have a list of organizations that you can look at to do your research project. And the hepatitis B, Foundation was listed in the Temple book. And I said, oh, you know, I did a little bit of research on it. And I always have been interested in infectious diseases. Even when I was in the lab,

I worked on infectious disease. I worked on cancer. And with hepatitis B, I was like, well, you've got both. You've got the infectious disease component and you've got the cancer component. So I just gave them a call one day. I was halfway through my MPH program. And I said, I need to do a research project. Would you be interested in having an intern? And I, wow, of doing my research project there. And when I graduated a year later, they said to me, well, why don't you just stay? Let's see what we can do. We don't have a public health program. Maybe you can help us build one. And that was in 2000. And I just never left. That's amazing. I love that. And so with a degree in public health, like we've both said,

you can do so many different things. And there are so many different places or types of places you can work, right? You can work in academia. You can work for the government. You can work in you can work for nonprofit. And so can you talk a little bit about what some of the pros and cons are of the nonprofit world and some of the general ways that it differs from academic, government, or industry careers in public health? Sure. So I think the nonprofit world has pros and it has cons. I think we have the flexibility of setting our own strategic plan and and being on the ground and doing what we want to do and what we know needs to get done. And we can do it with very little red tape.

We know we're small organizations for the most part. We don't have the same kind of policies and red tape that you might see in large academic institutions or in government entities. You know, when we, if on Monday, we realize that something is important to do, we can plan it on Tuesday and do it on Wednesday. We don't really have to, we don't have to go through the same kind of process as that other organizations do. I also think a problem for nonprofits, of course, is funding, right?

We are always chasing the dollars and trying to make sure that we have enough funding and we will never have enough funding. So it's about, you know, what kind of funding can you get to make sure you're meeting your mission and how do you spend it in the wisest way? So, of course, you know, fighting for the dollars is always very, very difficult. So I think also in the nonprofit world, we think about who our stakeholders are. that's how we work towards our mission. So for example, I have to answer to a board of directors. I have to answer to my funders. And then, of course, we have to answer to our constituents,

the people who we're trying to meet their needs and the people who our mission is for. And so because my stakeholders are different than the CDC stakeholders or Drexel University stakeholders, you know, I think it impacts how you can get your work done. I think that being in the nonprofit world does give us the flexibility for those kinds of, partnerships. And, you know, the one thing I love about us as a nonprofit is we're neutral. So we can play with everyone, right? We can partner with government agencies and multiple academic institutions and multiple researchers and pharmaceutical industry and other corporations. And we remain neutral throughout, which makes, that's a strength for us because it means that others feel safe partnering

with us too. And we can sometimes bring groups of people together that others can't because we have no skin in the game. So we get a lot of listeners who are interested in the field of public health, but don't know maybe how to get started or what options are available to them. And so I wanted to ask you what one piece of advice is that you would give to someone who's in this boat. Oh, I think your best bet is to find a couple of people and email them. Reach out, find a few exciting people who, you know, you find maybe online or maybe you find them at an academic institution, go on their web page and just email them or call them. I have found in doing this myself, public health practitioners are really open and want to share this kind of information. So, I mean, I could tell you to go take

a course and see if you like it, but that's only going to give you one piece of the pie and it also is expensive. So I think talking to people, it's the best thing you can do. Do you have any personal public health heroes? Oh, I love that question. Yes. So, and I, and I think my, the first person that springs to mind is Dr. Sue Wong. She is an absolute hero of mine. She is a mom and a wife and a public health professional and a doctor and a person living with hepatitis B and also the outgoing president of the World Hepatitis Alliance. I think she must find 48 hours a day somehow. I don't know how she does it, but she, she is a hero of mine who very, very creative. and loudly shouts to the world, but the need for hepatitis B treatment and cure, but she does it in a way that's loving and welcoming and just so brave. I love her. Oh, I love that so much. That's such a good answer. So what do you hope this next year brings in terms of hepatitis B research or

awareness? We have some really exciting things happening at the end of 2021. The ACIP, which I know, Everyone in the U.S. now knows the ACIP because of the COVID-19 vaccination. So the ACIP recently approved and CDC is signing off on universal adult hepatitis B vaccine guidelines. And that means that for the next year, we are working really hard to implement those. And that means that right now, so previously people were recommended to get vaccinated for Hep B in the U.S. when they were born or if they were in a particular risk group. And what that means is that only 25% of people in the U.S. are protected against HEPB. Now the ACIP is recommending that all adults between the ages of 18 and 59, 19 and 59 get vaccinated, which is going to give us a

huge opportunity to protect people. So we are very excited for the next 12 months to implement this. And now we have to make it happen, right? Because the policy is on paper. Now we have to, we are charged with making this happen. So I am excited about that, and I think great things will happen with it over the next year. Well, that was simply wonderful. Thank you so much, Dr. Cohen, for taking the time to chat today. If you want to learn more about the Hepatitis B Foundation, check out HepB.org, and I'll also link to the website and include social media links on our post for this episode. Speaking of our website, on our website, you can find all kinds of good stuff like the sources for all of our episodes, transcripts, quarantini and placebo-rida recipes,

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