Kim Bonner

Q: All right. Today is 4/18/2022, this is Heather Rodriguez for the COVID-19 Oral History Memory Archive Project. I'm in Newnan, Georgia, and I'll be talking to Dr. Kim Bonner, who is in Portland, Oregon. We are recording through Zoom. Dr. Bonner, welcome to the project.

BONNER: Thanks very much for having me, Heather.

Q: Great, thank you. Do we have your permission to interview you and record this session?

BONNER: Yes, you do.

Q: Awesome, thank you. Okay. Well let's begin with some background information then. Where and when were you born?

BONNER: I was born in Connecticut in 1986.

Q: So how did you first get interested in public health? Was it, you know, during high school, or during college? You know, I guess like how did you wind up at the CDC [Centers for Disease Control and Prevention] and in the EIS [Epidemiology Intelligence Service] officer program?

BONNER: I think two things brought me to the CDC and into public health. One was 00:01:00a book--I had been really interested in conservation and climate change and had an opportunity in college to do an internship at the House of Representatives. But those are unpaid internships, and so got funding from a program that's only stipulation was I needed to read a book, a specific book, which was Mountains Beyond Mountains, about the late Dr. Paul Farmer. And reading that book dramatically changed my life, it changed the trajectory of where I wanted to focus attention, because I had, before that, been pretty unaware of the extent of health inequities that were ongoing, and really wanted to shift my focus to help to rectify some of those inequities.

And then the thing that brought me to the CDC is that my first job sent me to 00:02:00Dar es Salaam, Tanzania, at the National Malaria Control Program. And sitting in the Tanzanian Ministry of Health, I saw a lot of people from a lot of organizations, many different countries, coming in and out. And the person who really stood out to me was the CDC resident malaria adviser, because he made a point to greet people in Kiswahili, which was the national language. He had built strong relationships, he was trusted, and he really worked as a partner, and as a technical support for the Tanzanian Ministry of Health to do the work that they wanted to do. And for me, I thought this was a really beautiful way to use the skills that I was starting to build in order to be able to support 00:03:00countries, or states, or any sort of public health programs to really be able to achieve their goals. And so, then I started looking into options at the CDC.

Q: So when you were in Tanzania, you were in, you were a professional by then, or were you still in college? So-- BONNER: Yeah, so I moved to Tanzania right after college, and I had received a two-year fellowship that would put me, would second me to USAID [United States Agency for International Development], and then seconded me to the Tanzanian Ministry of Health, followed by a two-year master's degree. So I was working, I was working full-time, and was really struck by seeing the CDC team working with the National Malaria Control Program.

Q: Okay. So you start looking into the CDC. So did that lead you to the EIS 00:04:00officer program, or did that just, you know, get you kind of in another center where you started to work, kind of how did that happen?

BONNER: Yeah, great--

Q: Oh, and what year--oh, I'm sorry! In what--

BONNER: What year was it?

Q: Yeah, what year was it?

BONNER: So this was 2008 to 2010.

Q: Okay. Thank you.

BONNER: So at the time, I had an undergraduate degree, I was planning on getting a master's in public affairs, so policy and economics, but had had a mentor in college suggest EIS to me, this resident malaria adviser had been an EIS alum, he really recommended it, but for me personally, I didn't see myself going for more school, or the schooling that'd be required for the program. So it was another five years where I was working for Doctors Without Borders when the Ebola outbreak hit in Western Africa, and made me realize that I really wanted 00:05:00to gain the technical skills that I would need to support as an epidemiologist rather than in a more programmatic space.

So I went back to school, and with that goal of going back for a PhD was to do EIS, because I knew that my PhD training, or my goals, would not be complete without this training opportunity that would allow me to learn and to contribute in applied public health, and applied epidemiology.

Q: So you're really interested in epidemiology, so that was your primary focus for public health? Or was it--

BONNER: Yeah, exactly! I had, when I worked for Doctors Without Borders, I worked on access to vaccines, access to HIV [Human Immunodeficiency Virus] diagnostics, and looked at adaptability of these products, because many of them 00:06:00are developed with certain consumers in mind, many of whom are not the consumer profiles of the populations that Doctors Without Borders serves. So I was looking at opportunities to rectify access and adaptability issues or needs. I was also really interested in vaccine confidence, so what drives someone to choose to take or not take a vaccine? Once access is, once there is access, do people really want to seek vaccination? And so that's what I ended up studying for my PhD, both in Uganda and in Minnesota, in fact, was what motivates people to take a vaccine, or not take a vaccine? And in Uganda, we had looked at a new vaccine against a new emerging disease. And this was in 2018, we didn't have any 00:07:00idea of COVID, but that was what we had ended up studying. And in Minnesota, we had looked at influenza vaccine.

Q: Okay. Was that, for the new emerging disease in Uganda, was that--well I guess it wouldn't be influenza, but which disease was that?

BONNER: So, we specifically kept it open, because we know that one of the things that is prone to happen is as we have these emerging diseases, we don't always know the profile, and as vaccines are developed, there's a need to see real people choose to take a fairly new vaccine. So, in the back of our minds, we were thinking of Ebola, given the number of Ebola outbreaks in Uganda over the last thirty years. However, when we did the study itself, we did not specify any 00:08:00disease. We kept it open to see how people react to the--and so that actually ended up melding fairly well into looking at decision making for COVID-19 vaccines.

Q: Yeah, I would imagine so. It's like what a, almost a perfect study for later on. So, and that was in--so that was all in 2018. So, you become an EIS officer in 2019, or 2020?

BONNER: Twenty-twenty. So, I did my field research 2018 to 2019 in Kampala, Uganda, and Minneapolis, Minnesota, graduated in March 2020, and was admitted to the class of 2020. So, I began as an EIS officer in July 2020.

Q: So early on in the pandemic, so I mean just a little bit before your EIS 00:09:00officer training, so when did you first hear about COVID? Did you--

BONNER: Yeah, the first time I heard about COVID was actually from my second cousin, and I was, he's always looking out for his family, he has young kids, his wife is immunocompromised, and so he reached out to me, asking about this new disease they had found, which they weren't calling COVID at the time, I forget what it was called. But he wanted to know, is this something to be worried about? And my response at the time was there are so many, so many respiratory diseases, so many spillover events, so many emerging diseases we really didn't know, and it's unlikely to be something of concern, but keep an eye.

Within two weeks, so now within, by mid-January 2020, I remember having a 00:10:00conversation with one of the professors about how to pronounce COVID-19, after we had listened to the WHO [World Health Organization] that had recently come back from their investigation in China, I remember that we were all still in the office, it was all epidemiologists, no deep concern, I was supposed to do an in-person dissertation defense, and then I saw how things were changing in Northern Italy, and that was really what alarmed me was reading the articles in the news about wartime triage procedures being put in place.

And from that point, as I started looking on the CDC and government websites, 00:11:00there was a page, I think it was pandemic.gov, or something of that nature, that was encouraging people to have a two-week supply of food, of water, making sure they had what they needed. And so, I had been asked to speak at my faith community about this, about this new disease, and so I remember encouraging people not to panic, but to be prepared, keep looking at the CDC website for updates, because there was a lot we still didn't know yet. And then within about two weeks, we--the day I turned in my dissertation was the day I saw the state of New Jersey declared a state of emergency, and a number of other states started declaring their states of emergency, and started their respective "stay 00:12:00home, save lives" campaigns.

Q: Yeah. Were you in New Jersey at the time, is that why it was--?

BONNER: No, I'm from New Jersey--

Q: Oh, got you!

BONNER: --so it was easy for me to remember New Jersey's process, because I had been in touch, myself and I think many, many people in the space had become, became coronavirus hotlines. And so depending on where our social networks were, we were taking calls from certain parts of the country, or certain parts of the world, trying to be as up to date as we could be for the changing situations in those locations. And the Eastern Seaboard, as well as Seattle, had been hit early for COVID-19.

Q: So after, I mean that must have been in March, or maybe early February?

BONNER: Yeah.

Q: So yeah, so between March and July, what were--I mean because that was when 00:13:00the pandemic was really, I mean going through, I guess like its first little crest for everyone to where it's really kind of hitting home, you know, stay at home orders, and it becomes like this first kind of chaos, kind of thing. So, with your clinical--what were you doing? Were you, you know, just still wrapping up your PhD, or I mean, kind of what was going on?

BONNER: So, I am not a clinician, so I do not have any clinical skills to offer. What my colleagues and I did who have some epidemiology training, is we really were searching for information. I think the contrast between this pandemic and H1N1 [H1N1pdm09 virus] and Ebola was really the difference in public communication from the CDC. I remember, I believe it was Nancy Messonnier's 00:14:00press release, where she had been asked a question about how things would change in day-to-day life, and she gave a pretty stark and in retrospect a very realistic response about significant disruptions. But aside from that, we didn't have a lot of information that was coming from the CDC.

So, my friends and colleagues and I were on Twitter quite a bit, because that's where we were seeing many, many pre-prints, that's where we were looking at what do we know, what's the current conversation? And then conveying that to those in our communities, whether that was faith communities, whether that was local government, whether that was family and friends. But essentially that first 00:15:00month was a series of conversations with people encouraging them to stay home.

I remember specifically talking to my grandma about stopping her Bingo league, which was being held in the basement of a church, and I was encouraging her not to go grocery shopping and was so relieved when she showed up for Bingo and found out it was closed. But it was, those were many of the conversations, as well as trying to translate the science of what does it mean to flatten the curve? And so, trying to explain to people who were struggling to--who were experiencing significant change in their lifestyle, or significant economic upheaval, why we were trying to tamp down when there weren't that many cases 00:16:00yet. It felt like there were many, but in retrospect, as we look back over two years, we do see that that was just an initial crest.

Q: Yeah. So that kind of brings us up to your EIS officer training. So, or actually, I have another question. Can you kind of describe, because you were on Twitter pretty early on. So that's kind of unique, not many people are talking about like, their social media presence. So, what was the conversation like on Twitter, you know, what--who were you kind of following, you know, what was the overall climate, can you remember?

BONNER: Yeah, I think that one of the things that we were really trying to figure out, so my colleagues who are, many of whom are academics, were trying to understand, was what's the next step? Can we see ahead for how this is moving? 00:17:00And so, one of the things that really stood out to me was when I saw on Twitter, Imperial's modeling projections. And so Imperial College in London had released projections of I think upwards of two million deaths in the US should there be, I think, no, if there was no change in policy or nonpharmaceutical interventions, as well as, I believe, an eightfold difference in what, in the hospital needs versus hospital capacity.

So things like that were the materials I was looking for, and trying to understand, we were also trying to understand masking, and whether or not that 00:18:00was beneficial, given that we knew that this, particularly in the US, it's not a population that typically masks, if this was spread by transmission through touch, would we increase the risk of transmission as people are incorrectly, or struggling to put on their masks in a proper manner. Now obviously at this point, in retrospect, we know that masks obviously reduce transmission. But I do remember that being an initial conversation, as well as trying to figure out what was the fatality rate, because we had such a lack of testing availability, what was the severity of COVID-19? And what were the implications of that?

Q: That's interesting, thank you for sharing that. Like I said, not many people share about like, what they were looking at, they just say like, I saw X on Twitter, so I appreciate it. So, yeah.

BONNER: Of course!

Q: So, can you tell me a little bit about when you first started your EIS program? So, it's obviously a very different class, the class of 2020. You know, you don't have the same kind of EIS procedures that other classes did. So, tell me about that.

BONNER: I think that one thing that really struck me in this class was-- how much less interaction there was with the CDC itself. I know that many of my classmates who were based in Atlanta spent almost the entirety of their EIS 00:20:00working from home.

I think that that difference gives us, gave me a little bit less of an intuition for how things move at the CDC, what the culture is like. But I also recognize that the context that we were operating in, in July 2020, was a very challenging one. I know the day I arrived for the EIS training, which was held remotely, but we needed to be in Atlanta to receive our badges, I know the day I arrived, the mayor of Atlanta at the time tested positive for COVID-19. I know that right across the street from the CDC, there was a gym that was open for indoor high-intensity workouts, no masks needed, and just a sign at the door saying if 00:21:00you have COVID-19, no need to come in.

I know that the context in encouraging behavior change for an entire population is not an easy one, and particularly in the wake of the murder of George Floyd, and how we were seeing such incredible, just dramatic inequities in the burden of disease, hospitalizations, and death by race and ethnicity, as well as by professions, it was just very clear that there was going to be a lot of work to do, and it was less clear to me how to operate, how to do that. And if we were really acknowledging, as an organization, where we stood, and how much further 00:22:00we had to go to be able to deliver solid public healthcare, and prevention, to the full population of the US.

Q: So, tell me, was that like, some people have pointed out that from, they had worked on the Ebola response previously and then had said like how, that it was a challenge during the Ebola response to try to implement these, you know, changing of habits in this large population. But--and then they were surprised when that happened again in the US, you know, kind of like in a weird way, they were surprised. Tell me, were you, was your experience similar when you were working in West Africa during the Ebola response with Doctors Without Borders? 00:23:00You know, did you experience this same kind of surprise? You kind of touched on it a little bit, but just can you elaborate?

BONNER: Yeah, absolutely. I think that behavior change is a really challenging thing. And I think without trust, if a government or a public health system hasn't earned visibility or trust with a population, then it can be hard to expect any population to be making changes that impact their daily lives. And so, I remember in West Africa, in Sierra Leone, during the Ebola outbreak, one of the key things was to encourage healthcare seeking, particularly when the symptoms of Ebola are so similar to malaria. And so, what we did to try and 00:24:00encourage that, one was to have a hotline that individuals could call, but we saw challenges with that, particularly with network, where the majority of calls didn't make it through, or were dropped, or were considered prank.

And so, what we opted to do, to complement that work was to invite local journalists to take tours of the Ebola treatment center, and that was my role, was to bring these local journalists around the outside of the Ebola treatment center, which just had a fence about maybe waist-high, and a plastic netted fence, so they could see what conditions were like, that they could see the individuals who were improving. They weren't taking their photos, we wanted to protect confidentiality, but we also wanted to break down some of the stigma and fear.

I think for COVID-19, I think the current arena of challenge can really be on vaccination. And when I had the opportunity to work on this domestically last year, what we had were quite a few early adopters, people who were getting up at 4:00 a.m., doing whatever they could to sign up for an appointment as soon as possible, and then we had a substantial portion of people who were in that wait and see category, who either wanted to see how other people fared, or prioritize that sort of vaccination, or maybe had some concerns. Then we also had a category of people who were pretty certain in an intent not to vaccinate.

I think what was really interesting in that space was to see, for the individuals who were in what we call the moveable middle, we saw that certain 00:26:00things seemed to be effective. One seemed to be really having a broad coalition of partners who are trusted. So, when we have faith leaders, when we have arts leaders, business leaders, when it becomes a social norm to vaccinate, when it becomes something that respected members of the community do, and it's just an expected practice, that can really yield, that can help people to shift their intent to vaccinate themselves. Making it accessible, very, very easy to vaccinate, because we know that at the start there were some real challenges to access vaccination sites. I think the easier we could make vaccination we also saw real benefits there.

Then finally, once those things were exhausted, we had options for incentives, 00:27:00as well as options for vaccination requirements, and those do have impact. What we saw for incentives is, it depends on the profile of the person, but someone who has a positive intent to receive the vaccine, but hasn't yet gotten it, we see a strong association with their eventual uptake. But for those who did not intend to receive the vaccine, what we see is an association with low trust. We don't know I that means the low trust followed, or the low trust preceded those incentives, but we do see that it's not a one size fits all. Same with requirements, we do see substantial associations between vaccination 00:28:00requirements, workplace vaccination requirements, or school vaccination requirements, and vaccine uptake. But we also recognize that that can be challenging to implement, and we want to make sure there are opportunities for communication, that there are opportunities for people to share concerns, and that it's, these things are implemented in an equitable, and thoughtful, and well-outlined manner.

But those are some of the things that we learned from, that I learned from, the domestic COVID response, that then we were able to carry into supporting some of the work in the Afro Region, as vaccination access is increasing in that region, what are some of the options for increasing vaccine demand and increasing the norm of COVID-19 vaccination.

Q: Okay. Thank you. All right, so going back to July 2020, when you're at the CDC and you kind of see, you know, this mixed message, not mixed messaging, but you know, kind of different takes of the pandemic, you know, you have really strict social distancing, but then the workout gym across is fine with people as long as they have a mask--as long as they don't have COVID-19. Then you matched with the Oregon Health Authority, so--

BONNER: Yes, I did.

Q: Yeah! So tell me about that matching process, because that has been something that's a little different too, normally that's at the EIS officer conference, but it wasn't held in person that year. It hasn't been since, right?

BONNER: Yeah, that's a great point. It was such a privilege to have the opportunity to speak with these absolutely incredible people all over the country who were so busy with the COVID-19 response, but yet were willing to 00:30:00take time out of their schedules to talk about what they were interested in, how they'd like to work together with an EIS officer, and really where support would be needed or beneficial.

That really struck me, that investment that many of these sites put into recruiting EIS officers. My experience had been entirely internationally focused before EIS, but given the context of COVID-19, given the needs that were clear domestically, I knew that for me, and during this time, I really wanted to learn how the US public health system works at a local, state, and federal level, and 00:31:00I also wanted to help any way that I could, could use the skills that I had worked so hard to achieve, any way that I could use those to help, to have a strong COVID response was my goal. And so, I moved to Oregon, and am just so grateful for the team in Oregon. The three supervisors have been excellent, and I'm just struck by the time that they've put into mentoring me, and to doing so much, so much not only in the COVID response, but in all other communicable disease areas that have not let up during COVID at all.

Q: Excellent. Can you tell me about, because you matched with the Oregon Health 00:32:00Authority, tell me a little bit about like, the Oregon Health Authority in general, for people who, you know, don't live in Oregon, just really are not familiar with it. What's kind of its role, how does it fit within the public health structure in Oregon? And then do you also feel comfortable naming your three supervisors that you were under?

BONNER: Absolutely. My three supervisors are Dr. Richard [F.] Leman, Dr. Paul [R.] Cieslak, and Dr. Rebecca [A.] Pierce. They've all been at the Oregon Health Authority for a number of years, both Richard and Paul are former EIS, and have been supervisors for a number of years. And Becca had become a supervisor with the previous EIS officers, and she leads the healthcare-acquired infections group at the Oregon Health Authority. So, the Oregon Health Authority itself is 00:33:00the state level public health structure for Oregon. Oregon has thirty-two counties, and each of those counties, or it's sometimes a combination of the counties, have a local public health infrastructure. So, in Oregon, local public health leads, leads public health responses. So, whether that's an outbreak investigation, or a case investigation, or disease reporting, and some of the implementation, some of the regulations, it can really be at a local level.

Because of emergency orders that came out, and because of some of the executive rules that came out of COVID, some of the decision making was, on COVID-19 00:34:00policies in general, was held at the state level. That was either the Oregon Health Authority, or the Oregon Health Authority in consultation with the governor's office, or sometimes in consultation with the Department of Education, or whoever the relevant authorities would be to collaborate with.

The Oregon Health Authority has made, I'm not sure how many employees they've got, I think less than 1,000, but I'm not certain. But the Oregon Health Authority has roles in not only vital records, but also some environmental health, also in really any sort of communicable disease space, for violence prevention, for cancer registries. Really what they're able to do is collate all 00:35:00the information that's coming from the local public health authorities, they're able to look at trends over time, they're able to see, for example, with regards to emergency department visits, they're able to see if there's been a spike in certain conditions or symptoms in their syndromic surveillance system. But they're really able to have that more bird's-eye view, and also to support the counties to do, if they need support in outbreak investigation, if they request that.

The Oregon Health Authority also works in consultation with tribal authorities as requested or needed by tribal authorities, obviously these are sovereign nations, and so they set their public health priorities and their public health 00:36:00policies, but there is definitely communication and collaboration. Then the Oregon Health Authority is responsible for reporting some of this data that's collected to the CDC, so that we're contributing to some of the national information that the CDC collates on certain reportable diseases.

Q: About decisions being made for COVID-19 kind of at the state level, was that unusual, or was that pretty par for the course for Oregon? Because I know like you said, like it's pretty, local public health departments are really leading their own responses. But I guess was COVID-19 kind of a special case? Or was that par for the course?

BONNER: Yeah, I mean that's a great question. I think that probably the closest 00:37:00comparison would be H1N1, and I think that there was substantially more rulemaking in place for COVID-19. But I can't tell you exactly how much, I'm not certain how much, but typically at the state level, these rules are made, or policies are made, but there's often flexibility for how those rules are implemented at a local level.

Q: Got you. Okay. Where did you fit in with Oregon Health Authority's response? So, what was your role in this?

BONNER: Within the Oregon Health Authority, I was based within the public health division, within the acute and communicable diseases prevention department. My 00:38:00role was really quite small, the COVID-19 response ended up being its own structure over the course of my time in Oregon, so I spent some time with that team, but certainly am not someone who was a lead in those spaces. So, my role was often to support, in terms of data analysis, for questions that we had that we were trying to understand. For example, we really wanted to understand the benefits of contact tracing. We know that for many diseases, contact tracing is the norm, our databases had been set up to do contact tracing, we had hired, I think, over 1,000 people to be contact tracers. But the question was, given the 00:39:00time period between when someone has a symptom onset and a positive test, and gets contacted by public health, is the, is the juice worth the squeeze? Are we really able to slow down transmission chains, given how testing was working at the time?

Because in general, we saw that at the time we were looking at this, which was September and October 2020, local public health was really quite good about calling individuals within twenty-four hours of receiving a positive test result and trying to elicit their contacts. But if it took about five days from the time someone had symptom onset to the time a test was reported, then how much of their transmission period, that transmission window, were we actually catching? 00:40:00What we saw was about two thirds of the contacts who would later become cases had already developed symptoms by the time the index case was getting a phone call. So, what we were seeing there is while there was some benefit to contact tracing, we, especially for those who needed workplace letters, especially those who needed wraparound support, so food, or rental assistance, so that they could stay home, we weren't really seeing a substantial impact in potential transmission.

That was a helpful thing to identify, obviously contact tracing continued, but there was flexibility under surge conditions at how aggressively that needed to 00:41:00be followed up. So, whether the three phone calls were needed, or if in surge conditions, if local public health authorities could opt for recommending a single phone call, and then moving onto the next person so that they could complete their case investigations.

Q: Got you. Okay. Tell me about, because you worked with some of the, I mean you were there in July, but some of the earlier cases, and worked with the Oregon Authority surveillance databases. Was that a little bit, that was separate from what you were talking about with the contact tracing, right? Yes.

BONNER: So, this is actually quite similar. So, this was--

Q: Okay. Got you.

BONNER: --this was looking at the surveillance database of cases in Oregon, and contacts in Oregon, and what was really pretty excellent that Oregon had done is, they had established, about twenty years ago, this excellent database 00:42:00through what's known as the file maker system, so that database is called Orpheus, and it collects person-specific and case-specific information, allows you to follow contacts, is really excellent. So, the Oregon, my colleagues in Oregon created a duplicate database specific for COVID. And that was what they used to be able to trace both cases and contacts. But given how many contacts were identified, it wasn't possible for that many users to be using a system that hadn't been set up for that volume. And a secondary database was developed for those COVID-19 contacts.

But given the structure, given the thoughtfulness that my colleagues had in setting this up, we really had a pretty unique advantage in being able to do 00:43:00that trace back as to the proportion of contacts that became cases, and when they became cases. Which I think can yield some learnings as we look forward, and as we reflect on the COVID-19 pandemic.

Q: So, let me ask about the database. Because one thing that has been kind of a noticeable phenomenon, I guess is like a really weird way to describe it-- but is that public health was just underfund--so like, they didn't have these, like you said, the database was a great structure, but it couldn't handle the capacity-- and that I mean, it's twenty years old. Was that maybe kind of a symptom of like, maybe where public health had been underfunded, and you know, you have this kind of antiquated data system that couldn't handle this pandemic 00:44:00kind of thing? That was something similarly experienced in other health departments, is this kind of a similar experience here, too?

BONNER: That's a great question, Heather. I think that you're exactly right in noting the ways that public health has been underfunded.

I believe that now, dollar for dollar, we're funding at a level that's maybe consistent with the 1950s funding for public health, so we do have many state and local health departments that are working out of shortfalls. I think what has happened during COVID-19, and just from my perspective, is substantial funding has come in through different federal mechanisms that is geared towards 00:45:00response. But what I don't see as much of is funding for recovery, and funding for public health infrastructure. And so, when those COVID-19 response funds end, I am not certain what sort of structures will be getting bolstered, or what sort of recovery will be supported. And we would anticipate that there will be long-term consequences, not only within the public health sphere, not only in preventable diseases that had not been identified during the pandemic, but also in education spaces and in the economy. I am curious and hopeful that there would be opportunities to support some of those long-term needs, rather than 00:46:00focus so closely on response funding.

Q: For helping to increase the digital capacity for this database, did that really fit in with like your epidemiology training, or not really? I mean, did that, where does your epidemiology training kind of come in, into the response?

BONNER: I think for my epidemiology training, there were a few opportunities where I was able to really leverage that skillset. One was in exploring a quite large COVID-19 outbreak within a hospital, where thirty-six healthcare providers and all thirteen patients in a particular inpatient setting had contracted 00:47:00COVID-19 prior to vaccine availability. What we were trying to understand there is what was associated with contracting COVID-19? What were some of the risk factors? What we looked at there were interaction types.

This is where I had an opportunity to leverage that epidemiology background in partnership with the healthcare system in which this outbreak had taken place, as well as with the healthcare-acquired infections team, was to understand what were some of the potentially higher risk interactions, what were some of the lower risk interactions, and did we see associations, or did we see profession groups that perhaps either needed more support, or more training, given the higher incidence of COVID-19. What we saw in that outbreak was those who were 00:48:00engaged in interactions with patients who could not be masked, so those would be feeding, or showering, or respiratory therapy. Those interactions were associated with a much higher risk of contracting COVID-19 among the healthcare providers, as opposed to a patient assessment, or a bed bath, or physical therapy.

We also saw that within profession types, we saw a much higher proportion of the CNAs, the certified nursing assistants, who had contracted COVID-19, as well as the physical therapists and occupational therapists. We also saw that night, those who had worked night shift were more likely to contract COVID-19 than those who didn't. That, you know, yes that moved forward, and it is under peer 00:49:00review right now, but I think the more important part of this learning was the opportunity to have that conversation with the hospital so that they had opportunities to consider training for specific groups, and to consider consistency in some of their policies.

That many of those practical and pragmatic points actually came from the healthcare-acquired infections team's infection prevention consult that happened on-site. But we worked in tandem, the infection prevention team, as well as epidemiology, to be able to support this healthcare system and I really appreciate the way that the healthcare system was so open and transparent, and so eager to learn. It really looks like a best practice to me.

Q: I have two questions, kind of relating both to health equity. So, in this study, was health equity kind of a focus? It seems like it kind of had some health equity outcomes with CNAs and physical therapists being the ones who suffered higher diseases. Then my other question regarding to health equity was with this, was with the surveillance databases. Kind of how, I mean even databases can be, can have kind of a health equity focus, or you know, it can be kind of caught up in health equity, I guess is what I'm trying to say.

BONNER: Yeah, that's a great question. I think with regards to the outbreak at the healthcare system, equity definitely comes to the fore when we think about 00:51:00staff that are working night shift, when we think about staff that have just different educational backgrounds, so certainly opportunities to shore up training and to support individuals in those spaces helps to address inequities. I think where I saw the importance and power of data was within the surveillance system, when along with some of my colleagues on the COVID-19 response, I had the opportunity to do the first age-adjusted cases, hospitalizations, and death assessment by race and ethnicity for Oregon, and presented that data in January 2021, just as conversations were coming onboard about sequencing vaccine prioritization.

Because what we saw was with the unadjusted rates, we saw stark inequities by race and ethnicity, but when we do an age adjustment, an age adjustment recognizes that there are different distributions of populations within different groups. And so, when you set all of those groups to have a similar age adjustment, or the same age adjustment, you see just how stark the differences can be in cases, hospitalizations, and deaths. So we were seeing three to five times the case, hospitalization, and death rate for Black individuals, for Hispanic individuals, compared to White individuals, as well as for American Indian/Alaska Native. But it was for the Pacific Islander population where we 00:53:00saw kind of staggering differences, a tenfold difference.

Compared to white individuals in Oregon. What came out of that data was sparking conversations on what could be done to redress some of these inequities. So not only was this data shared at the highest levels of the Oregon Health Authority, not only was it shared with the COVID-19 team, but it was shared with partners, it was shared with communities, and what came out were many conversations with different communities in Oregon trying to increase access to COVID-19 vaccination, trying to address concerns about COVID-19 vaccination, because recognizing the disproportionate impact of COVID-19 in different communities in 00:54:00Oregon really helped, or really sparked the prioritization of engagement with these communities as vaccination became more available. There were strategies, and there were, I think, over a hundred, maybe over 150 community conversations with groups coming from these communities, really trying to address some of these concerns.

Q: Yeah. So that kind of bridges us into your next role, where you were working with the Vaccine Confidence Team. And was that with the Vaccine Confidence Team at CDC, like the task force? Or was that at the Oregon Health Authority?

BONNER: Yeah, so I ended up doing a remote deployment with the Vaccine Task Force [VTF]. And so shifted focus from Oregon-specific, although a lot of 00:55:00Oregon-specific activities were occurring, and a lot of leadership and creativity was occurring in Oregon for this and shifted to the national level. And we had a few priorities at the national level on vaccine demand. One of those was really trying to use data for action. And so what we had is this pretty stellar national survey, it's nationally representative, state representative, at a monthly basis, but collected weekly. This data got, asked people questions about what they thought about COVID-19 vaccines, the risk of getting it, if they had confidence in the safety, in the importance, if most of their friends and family were vaccinated, if a healthcare provider had suggested 00:56:00they get a vaccine, if they had difficulty accessing the vaccine.

We were able to look at this data, and the first priority was to get it publicly available, because this is data that is collected for the US population, we want it accessible, we want people to be able to view the data, respond to the data. We worked with the COVID-19 data tracker team to get that online. Then the second priority was to make sure that states and jurisdictions had what they needed from this data to respond. I can think of two examples where this data was really helpful. Our team offered what we called data for action consults, where state or jurisdiction could reach out and have a conversation with the 00:57:00team that led the survey, as well as some of the individuals on the Vaccine Task Force, and look at what the data was showing, and try and identify opportunities to increase vaccination uptake.

One of the states, when we spoke with colleagues from that state, they were quite surprised to see the reports of difficulty in accessing COVID-19 vaccines, because from their perspective, because from their perspective, quite a bit of work had been done to make these vaccines very, very easy to access. And so it gave them pause to consider how they were communicating about where vaccines were accessed, and also where their gaps might be in physical access sites, or times.

Another example is in another state, we saw that the provider recommendation rate was very low, so I think it was about a third of the survey respondents had 00:58:00said that a provider recommended the COVID-19 vaccine to them. What we know from the data is that if someone receives a recommendation from a provider to get vaccinated, there's a very high likelihood that they will get vaccinated. So, to have such a low provider recommendation rate helps the state to see their need to reach out to professional networks and really encourage much more emphasis on encouraging COVID-19 vaccine uptake. These were the ways that we were trying to, both from a public facing perspective, as well as individually tailored conversations, to use the information that we were collecting to be able to help states and jurisdictions target where additional emphasis could really support uptake.

Q: Yeah. So, I imagine that a lot of these conversations really centered upon like health equity, and increasing health equity between these gaps, correct?

BONNER: Exactly. Yeah.

One of the things that really did help with this as well were what we call rapid community assessments, because we know that survey data can give us a lot of information on the prevalence of certain patterns, whether it's on vaccine confidence, or on vaccine access, or social norms. But what it may not give us is the reason why. So, in tandem with these, with the national level surveys, this CDC team, the Vaccine Task Force, offered these rapid assessments, and these took place in maybe fifteen different states, but this was a three-week 01:00:00process meant to generate data really quickly, meant to understand reasons why vaccination might be low in certain communities.

For example, in Oregon, there was a team that was, that supported two of the rural counties in Oregon to understand the barriers and facilitators for vaccine uptake in migrant and seasonal farm worker communities. What they were able to identify really was in part that access was driving low uptake, and that helped to expand access, it also helped to have conversations to see concerns about asking about insurance, or immigration status, or the language in which vaccines were offered. So those things, based on community conversations, speaking to 01:01:00individuals who worked at some of these workplaces, led to some employer-based vaccination sites, so that individuals could more easily access vaccination.

It also led to conversations among other counties in Oregon about how to do these rapid community assessments on their own to understand barriers within their respective communities of interest, to see how to increase vaccine uptake. So that was a bilingual, bicultural CDC team that deployed to support this, in partnership with the Oregon Health Authority colleagues in population support, as well as epidemiology and food chain, as well as the local public health. So really, three levels of government supporting, and some helpful insights not 01:02:00just for that specific community, but for how to do this more broadly from a local level.

Q: So, tell me about like, so we've talked a lot in general about like, what the task force that you were on, and like, kind of what was the goal, and how you were working together, but what were you specifically doing? Like, what was like, your job, like on a granular level, I guess, is kind of what I'm asking here?

BONNER: Sure, so on the task force, I started as a survey subject matter expert, so one of the things that came our way pretty frequently from either internal CDC teams or external colleagues was a desire to understand the drivers for vaccine uptake. They would ask our support in setting up surveys in such a way that they could really ask these questions in a way that was actionable, and 01:03:00also consistent with other surveys. So, I provided input for a number of surveys that way.

I was also deployed to a music festival in a state that had, at the time, had the highest prevalence of Delta [variant] in the US, and my role was to understand some of the COVID-19 mitigation practices that were being put in place at that festival, and to give feedback to CDC teams that were trying to develop some guidance for festivals like this, knowing that, you know, at 25,000, this was likely to be the largest festival since the start of COVID-19. So, I had opportunities to observe what was done, and to share inputs at both the local, state, as well as federal level for ways to set both local public 01:04:00health and some of these festival teams up for success in really being able to mitigate COVID. So did that, and then shifted, maybe within about two weeks, and ended up being a co-lead for the Vaccine Confidence and Demand Team.

So, what that entailed was support to each of the sub-teams, or each of the teams within my team who were either working on translating data for action, so they were looking at the different data sources that were coming in, they were developing new surveys, there was a monthly survey that was assessing, it's called the pulse survey, assessing what people were thinking about COVID-19. Then there were also, there was a team that was looking at infodemic 01:05:00information. So, trying to understand what were some of the information gaps, and how were they being filled? For example, the infodemics team was able to detect a real spike in conversations about ivermectin long before they were detected in other spaces. So, in terms of utilization, as well as just providing some of that general support.

Q: I imagine your PhD, and your background, really came in handy here with kind of inspiring vaccine confidence?

BONNER: I think that the passion for it definitely came from opportunities with my PhD, and I think that what was incredible for me is during the process of my 01:06:00PhD, as I was searching for models and frameworks to understand what drives vaccine uptake, I stumbled across this behavioral and social drivers of vaccination framework that had been made by the World Health Organization, and thought it was just amazing. It made sense, it was comprehensive, it included not only what people think, but also social norms, as well as intentions, and then the practical issues that can really influence whether or not someone gets a vaccine. That was the framework that we were using for the CDC team, and we had the individuals who helped to develop that framework as subject matter experts, academics who were lending their time and expertise to the COVID-19 response to be able to support us to really be able to understand what was 01:07:00happening. It was pretty incredible to see that continuity, and unexpected, but really amazing.

Q: Yeah. You were deployed to Colorado. Was that shortly after your work with the task force, or did you go back to Oregon to kind of like, have like a break, I guess? You know, working in Oregon for a little bit, and then you're deployed to Colorado?

BONNER: So, the deployment to Colorado was with the Vaccine Task Force, so my time--

Q: Understood.

BONNER: --with the Vaccine Task Force was entirely remote, except for going to Colorado.

Q: Yeah, so when you were in Col--you were, that wasn't remote, you were on-site?

BONNER: Correct.

Q: Yeah, and you had already touched on your deployment to Colorado. Do you want 01:08:00to talk a little bit more, anything you, like unpack it a little bit more?

BONNER: I think what really struck me in that deployment to Colorado was the CDC team that had been sent, and the relationships that I saw with members of that team, with the state public health authorities. It was an example of some of the best of CDC, because our team lead had worked federally for a number of years but had really strong relationships with the state of Colorado public health, and so I think that is one of the things that made the difference in being able to have an effective deployment, is her longstanding relationships. She was looking at a somewhat different topic than me, but we were able to work 01:09:00together, and she was able to really ascertain what we could know from the data that was currently available on Delta, and what still remained to be seen.

Another colleague had gone to look at severity of some of the Delta cases within long-term care facilities, so this was a team that, our team was able to get the information that we could in a way that was fairly rapid, and also aiming to be very collaborative with the needs of the state, as well as the local public health authorities.

Q: So, tell me a little bit more about how the variant really affected your time on the public health response. I know that you had touched a little bit, I think it was with the contact tracing survey ones, or maybe it was with the data 01:10:00survey ones, about you know, that was during the Alpha variant. You know, so January 2021, February 2021. But you know, and then just again with Delta. So, but just tell me a little bit more about your work, and how this really affected it.

BONNER: Yeah, I think one of the things that was very interesting for the surveillance of variants was getting to see how this was structured from the ground up. This was not something that I led, this is something I had a very, very small role in, but really benefited from seeing how the team in Oregon was able to integrate this very quickly. So, what initially happened is the CDC would request a line list every time we identified a new variant case, if it was 01:11:00a variant of concern. So at the time, there were not that many cases being sequenced, so I would send a line list every couple of days as we received new variants. However, as we had an expansion of capacity to sequence, especially at the state and the federal level, our colleagues who worked on the database itself found ways to be able to get that automatically, or to get that automatically reported from Oregon data, but the federal information that we were receiving on test results would come to me, and I would have the opportunity to look for that person in our database, and then manually add what variants they had.

That process has since been entirely automated thanks to our informatics team. 01:12:00But seeing how many people need to weigh in on the process of tracking these things, from lab to epidemiology, from federal, state, to local, to providers, even with regards to reporting rules, these things really take time, and it was helpful for me to recognize, or just to learn from the leadership of my colleagues in this process. I think for Delta, for Omicron, what we have seen there, certainly our highest case rates in Oregon came as a result of Delta, but then of course with Omicron, we do estimate that the case rates were higher. But we also have less certainly, given the expansion of at-home testing.

Q: So, let's switch to talking a little bit about, or actually you guys had a, you just got back from another, was the deployment with CDC?

BONNER: The deployment was with CDC with the international task force, and I was sent to WHO Afro Regional Office in Brazzaville, Congo.

Q: Yeah, so you had mentioned how a lot of the lessons from COVID-19 had really, domestically, had kind of interesting, you know, that your international experience made you want to learn about domestic, and then your domestic is now helping out your international experience. So can you touch on that a little bit, can you tell me about your deployment? I mean, was it COVID-19 related, response related? You know, and if it wasn't, did COVID-19 really impact it?

BONNER: Yeah, so this was COVID-19 related, and so I was working, I had been remotely deployed to the international task force, and the Global Vaccine Task Force, and then was working with the demand for immunization team within the Global Immunization Division, and they have strong relationships with a number of colleagues globally, different partners on vaccine demand.

The WHO Afro region has a COVID-19 vaccination, essentially IMT structure, incident management team. And within that team, there was a vaccine demand group. So, my role was to support the team lead for that vaccine demand group. 01:15:00She was working on several things, including a community champion's project that was being implemented in Tanzania, Sierra Leone, and Burkina Faso, and she was looking at ways to provide guidance for how to assess it, how to conduct it, how to conduct focus group discussions, how to support these community champions to advocate for COVID-19 vaccination.

We were also working on an orientation to vaccine demand for some of the World Health Organization deployers, as well as the expanded program on immunization managers at a country level for the World Health Organization. So these are individuals who are long-term in roles on immunization, have great relationships with their ministries of health, and who in many different spaces probably 01:16:00interface with aspects of vaccine demand. But trying to make sure that we're sharing some of the lessons from COVID across all vaccines, obviously each vaccine, each context is different, but there is, there's so much more to vaccine demand than just vaccine hesitancy. So our goal in this training is to help build a vocabulary for other things to consider, so we can do a differential diagnostic on what's actually needed to support vaccine uptake in a given community, for a given vaccine.

Q: Understood. So, let's talk a little bit about like, the broader aspects of the pandemic. Because you were here during two different leadership points, correct?

BONNER: Correct.

Q: You started with, yeah, you started with Dr. [Robert] Redfield, and now we have Dr. [Rochelle] Walensky. And those are kind of two different leadership styles, did you notice anything, I mean you were remote with the Oregon Health Authority, but you were still tied to CDC, you know? Yeah, did you notice anything between the two?

BONNER: Yeah, I think in part the context of being seconded, or stationed at a state public health authority does limit my visibility on different leadership styles. But I do think that some of the differences between the leaders that I 01:18:00have observed were in the space of communications. So, I remember receiving one email from the director, from Director Redfield, I think in November 2020, that was very triumphant, and there was reason for that, there were vaccines right on the horizon. But the spirit of the email didn't quite resonate with me and some of my colleagues in Oregon who received it, given that we were about to face our largest surge to date in COVID-19 cases, and the environment felt very different than that sunny email. So, I do think in terms of communications, at times I've 01:19:00seen a little bit more acknowledgement of the challenges in the context, or the challenges in the CDC response, from Dr. Walensky.

That being said, I also wonder at times, when I think about April 2021, when there was the statement that vaccinated people no longer needed to mask. This statement, I could be wrong, but I think I saw it first on CNN, before it reached any of our state colleagues. So, I think that that type of communication was at times challenging, because it meant that state and local public health 01:20:00was receiving information at the same time, or sometimes if they weren't following the news to the moment, after the public, and so it was hard, from my personal perspective, this was not my role, but I think could be hard to be responsive, or proactive, rather than reactive in that sort of a communications context.

Q: Yeah. So that kind of brings me to another question, to the, when you're talking about the role of the state public health officers, so they've--I mean CDC has faced a lot of backlash, but so has just local public health authorities, you know? People talking about death threats, and you know, kind of 01:21:00calls for them to resign, you know, all of this, they've gone through the gamut, it's been very grueling, I would say. So, did you see that when you were working in Oregon? Because you were there, you've been there for almost the entirety of the pandemic, hoping, you know, that it ends soon.

BONNER: Yeah, absolutely, and you know, I don't want to speak for any of my colleagues, so I'll speak in general terms, but I do-- I do know of colleagues who talk about their fan mail, or who have mentioned that EIS was mentioned in some of their fan mail. I do know of a colleague who would receive hand-delivered fan mail to their door, which is a little troubling, meaning that someone knew their address. So, one of my colleagues was featured on a network news station with some negative feedback from that commentator about the way he 01:22:00was expressing a fairly nuanced change in one of the Oregon rules, and so I do think in terms of context, I have seen my colleagues in Oregon work incredibly hard, incredibly late hours, and in the face of context that can be at times quite challenging. So you know, I think the CDC and some of the recent surveys they've done have been looking at mental health impacts of the pandemic, and I think that that is something that anecdotally as well, I have also seen.

Q: So, when you say fan mail, are you being sarcastic?

BONNER: Yes. Yeah, yeah, yeah.

Q: Okay. I wanted to make sure, I'm like, was it actually people who were--

BONNER: No, it is not fan mail, it would be hate mail.

Q: Oh goodness. Yeah. I thought so, but I wanted to double check. Yeah. So, I mean, that bounces off to how the media has really kind of portrayed the response, and you know, the CDC is getting a lot of backlash here. And sometimes it's deserved criticism, you know, in terms of like, I would say, the faulty test early on the pandemic, and stuff like that. But then other times it can be just really like, morale destroying, I guess. How do you, so what do you think about the media response that has taken place? So, do you think like, how has it really impacted your work, did it, you know, did it not really factor in or, you 01:24:00know, what do you think?

BONNER: Yeah, I mean I think it depends on who your media sources are. I can think of some really excellent, thoughtful journalists whose work I look forward to reading, because I want to hear their thoughts.

So, there was a piece in The Atlantic some months ago about how did we get here, or how did it go so wrong, by Ed Yong, and I think pieces like that, to me that sort of reflection and perhaps criticism is really important. It's something I wish I actually heard more of internally at the CDC, and I'm hoping that in this one-month review that Dr. Walensky has called for, as well as for future after action reports, that that reflection of where we've fallen short, where we could 01:25:00do better, I hope that that will be present.

That being said, I do wonder the extent to which we at the CDC, as well as in the media, have prepared the American public for understanding how science changes, that science isn't just the law of physics, or the law of gravity, and everything is static and certain, but that science is always a conversation, it's always a process of updating assumptions, updating information, that the default is change. I think in failing to communicate that effectively, whether that is from our public health authorities, or whether that's from the media, 01:26:00but in failing to make that understood, I think we risk losing trust from the public if we can't convey that we do expect things to change. That what we see right now in April 2022 is unlikely to be the same thing that we're going to see in August 2022, and that makes sense, that's okay. So that's something I would love to see reflected a little differently in the media.

Q: Yeah. So, do you mind if we talk about your personal life?

BONNER: Sure.

Q: Okay, great. So how has COVID-19 really impacted your personal life throughout this entire pandemic? You know, going from becoming a COVID-19 hotline to working long hours on this response, so, doing multiple deployments, stuff like that.

BONNER: Yeah, I think a few things. I think like everyone else who has experienced this pandemic, there has been substantial changes to my lifestyle. When the pandemic began, I was living in Minnesota, I probably saw three or four hundred people a week, I probably hugged a hundred of them. My life was very, very full of people, activity, community. And as a result of the pandemic, that circle drastically shrunk, and in part it was because it was necessary, and in part it was really to try and set an example of these are the practices that we want to adhere to, to protect one another. So personally, that shift was quite challenging, as well as moving to a brand-new place in the middle of a pandemic.

I think that the things that really weighed on me, or sat with me as I was, throughout this pandemic were one, what could we do differently, what needs to be done better, what changes need to happen? So that desire to whatever would be done to mitigate the impact of this pandemic. I think that -- I don't know, I think that for each person, that reflection probably takes place, and it can be sobering to not have an answer of what else could I have done? But that's something that has sat with me. I think another is looking at the impact of 01:29:00COVID-19 on lives, on families, on livelihoods. I know that what I often do when I look at the daily press release of those who've passed, or some of the obituaries of those who've passed, is I mourn, I mourn for that person, I mourn for their family, and I just wonder what else could have been done?

So those are things that have really stayed with me, you know, long hours, I think most of us are familiar with that, hard work, most of us are familiar with that, deadlines, we're familiar. But I think being surrounded by COVID, that 01:30:00there is no off hours, that outside of work, there are people who have questions about COVID, people on our networks that we're trying to guide, and support, and help. I think that was challenging.

Q: How did that differ, being surrounded by COVID is kind of an interesting thing. Because certainly, you must have felt like that when you were on the Ebola response, right? Because it's similar. I mean, it's everywhere kind of thing. Or did it differ?

BONNER: It differed, and I think what was different, and I remember thinking about this in Sierra Leone, was as I was leaving--it was a short-term deployment. As I was leaving, I realized that the strain of Ebola was very different for me as an outsider, that I knew that I was going back home, I knew 01:31:00that it was a short time, that I was going to be, you know, changing my behaviors to try and mitigate the spread of Ebola, and I knew that I wasn't necessarily going to know any of the people who had been impacted, unless I happened to get to know them while they were at the Ebola treatment center. Whereas for COVID-19 it's quite different, in that there is no place that we can easily go to, to escape the reach of COVID-19. There's no time to necessarily tap out from that, and the day to day, I think all of us know people who have 01:32:00had either severe COVID-19, or who have passed from COVID-19. So those things really do make this experience quite different, personally.

Q: Have you known anyone that's passed away from COVID-19?

BONNER: Yes, but not within my immediate circles.

Q: Okay. Well let's talk about kind of your reflections. So, you've talked about it a little bit, so I mean, what do you think is going to be the COVID--the lasting impact upon COVID-19 and public health? Because it's really changed a lot, you know? And you've talked about it a little bit when you talk about funding, you know, that it's really, we see a lot of emergency funding, but maybe not so much infrastructural funding. So I mean, what is going to be, I 01:33:00guess, the legacy between COVID-19 and public health?

BONNER: Yeah, that's a great question, and I think that some of the things that are likely to change with COVID-19 are a recognition that it is possible, from the identification of a new virus to the availability of vaccines, it is possible to do that in a very short time window. I think that some of the things that will come out of this are investments and capacity building in very rapid vaccine development, not just in the Global North, but also throughout the world. And I think that that is crucial, because vaccine supplies at the outset were so constricted, but if we have many vaccine manufacturers that have the capacity to produce mRNA vaccines, then we have a very different timeline for 01:34:00the next pandemic. So, I think that that is a potentially positive, I think that that is a potential change, and a positive one.

In terms of public perception of public health, that I think could go a number of ways, and I do wonder what the impacts will be on public trust in how the public health response has been perceived, as well as individual experiences with the public health infrastructure. This is probably the first time that many people in the US have received a call from the local public health authorities, and I wonder about those case investigators, they're probably the first voice 01:35:00that some individuals have heard from public health. So they have an opportunity to be ambassadors, but I also think, you know, in a space where there is polarization on COVID-19, there is potential for longer term diminished trust in public health institutions.

Q: What about on your EIS officer training? So, because there's been several classes that have been, I mean it's changed so much, it feels like. Do you think that COVID-19 will have a lasting impact on EIS officer training, or do you think it'll maybe not?

BONNER: I think probably not. If we didn't waive the surveillance requirement, 01:36:00the surveillance evaluation requirement in 2020, I don't anticipate much will change.

Q: Yeah.

BONNER: But I do think that what has changed, rather than the contents of the curriculum, is the class size, and I think that's a real positive. So, we went from I believe sixty-two in my class to I think ninety-something in this incoming class. So, I think opportunities for expanding EIS classes, expanding this training, are very positive. I also know that some of the classes before us focused on reaching out to certain schools that had a higher proportion of students from underrepresented groups to talk about public health. I actually have a class this Thursday that I'll be speaking to. But trying to put this on 01:37:00people's radars early, so that many, many different kids can catch a dream of working in public health and working with EIS.

Q: Well, what about like CDC in general? Well CDC work culture, I guess, because you were remote for the vast majority of this pandemic, correct? Remote working?

BONNER: Yeah, you know I really hope so. I think we're all looking at the new return to work policies, I think there are many things that we're going to be learning in the next few months. My hope was that the CDC would take on policies consistent with other organizations and companies that have shifted to be very permissive of remote work, and I think it remains to be seen if the CDC will do 01:38:00that, or to the extent to which the CDC will do that. But I hope that given these two, two and a half years of pretty rigorous work that people have done almost entirely from their living rooms, and hallways, and basements, that it's really been proven that CDC employees can do a great job remotely.

Q: Yeah, but there's drawbacks to that too, right, with the--

BONNER: Of course.

Q: Yeah, with--I mean you mentioned it earlier, that loss of CDC culture in the early EIS officer training, so yeah.

BONNER: Of course.

Q: Yeah. All right. Is there anything we haven't covered that you'd want to share?

BONNER: No. No, that was great.

Q: Awesome, great. Well then, we'll end this interview, and thank you so much for participating, Dr. Bonner.

BONNER: Thank you so much Heather, pleasure to get to talk with you, and thank you for your great questions.

Q: Thank you.

[END OF INTERVIEW]