A nationwide survey of 380 US internal medicine (IM) resident physicians suggests that those interested in specializing in infectious diseases (ID) are more likely to cite early exposure to the specialty, mentorship from an ID physician, and interests in public or global health, while uninterested respondents report concerns about compensation, training length, and limited procedural opportunities.

The study authors, led by a team from Baylor Scott & White Medical Center, said the findings, published today in Clinical Infectious Diseases, should prompt resident programs to use recruitment strategies targeting these barriers, as well as increase early engagement and mentorship opportunities.

“A 2020 study examining the distribution of ID specialists found that 89.4% of counties have below-average or no ID physicians present,” they noted. “This deficit is expected to worsen as recent ID fellowship match data have demonstrated a years-long decline in the percentage of ID positions filled.”

More early opportunities needed to explore public, global health

The team fielded the 19-question survey to IM resident physicians across the country, with 41 of 637 programs (6.4%), including 380 residents, responding.

Interest in ID was significantly associated with an interest in public and global health and service-oriented careers. Early ID exposures such as mentorship from an ID physician, an ID rotation during medical school, and shadowing an ID physician outside of required rotations were tied to increased interest. 

Since exposure to ID typically occurs at medical schools, academic medical centers, and hospitals in the United States, it is essential to integrate opportunities to explore public health, global health, and community engagement at these levels.

During residency, early exposure to ID in the first and second years, outpatient ID electives, and ID-related research were linked to increased interest. Common reasons given for lack of ID interest were low compensation, the need for more training, long work hours, and limited opportunities to perform procedures.

“Since exposure to ID typically occurs at medical schools, academic medical centers, and hospitals in the United States, it is essential to integrate opportunities to explore public health, global health, and community engagement at these levels,” the authors wrote.

New reporting from Politico says the US Department of Health and Human Services (HHS) under Secretary Robert F. Kennedy Jr. is holding up $600 million in funds that Congress has appropriated for the use of vaccines in low-income countries. The move is intended to put pressure on Gavi, the Vaccine Alliance, the report said.

Gavi said it has not received any funding for this year or last year, and the missing funds make up 15% of its operating budget. 

HHS told Politico, “Gavi has refused to provide the United States with the specific data, studies, or detailed accounting of how U.S. funds are used.” The funds will expire on September 30 if they are not used.

Kennedy wants thimerosal-containing vaccines gone

Gavi provides 20 vaccines, including measles, mumps, and rubella vaccine, to 30 low-income countries. The main issue likely is Gavi’s use of thimerosal-containing vaccines, which are commonly used in countries lacking adequate refrigeration for vaccines. 

In January, the Trump administration linked phasing out thimerosal-containing vaccines to future US funding. Last June, the Kennedy-reconstituted Advisory Committee on Immunization Practices recommended that US patients avoid flu shots that contain thimerosal. And just last week, during congressional testimony, Kennedy incongruously raised the Gavi-thimerosal link when discussing environmental mercury exposure, which involves a serious, neurotoxic form of mercury, not the much safer thimerosal found in some vaccine.

Last week, Kennedy also told a Senate committee that Gavi uses a diphtheria, tetanus and pertussis vaccine that had been discontinued in the United States because it was causing brain injury. That shot hasn’t been used in the United States since 1997, but the World Health Organization said there is no evidence the vaccine is linked to brain damage. 

Gavi said the vaccine is given to children in low-income countries because it offers long-lasting protection, and “is safe and effective and estimated to have saved 40 million lives in the past 50 years.”

A literature review suggests that increased resources for antimicrobial stewardship programs (ASPs) are associated with improved antimicrobial use and costs, researchers reported today in JAC-Antimicrobial Resistance.

In a scoping review, US and Canadian researchers evaluated 32 studies examining ASP resourcing and outcomes. Most of the studies were hospital-based, observational, and conducted in high-income countries (including 19 in the United States, three in Canada, and three in Japan). Antibiotic use was the most studied outcome. The researchers grouped the findings into three categories: studies comparing different staffing coverage models, studies comparing zero versus some staffing, and studies comparing more staffing with less staffing.

The study authors note that while there is evidence that antimicrobial stewardship strategies are associated with lower rates of antimicrobial resistance and Clostridioides difficile infections, ASP staffing levels range widely across hospitals, and lack of staffing and resources are often cited as barriers to advancing ASP goals. But the impact of ASP resources on patient outcomes, and the level of staffing to achieve those outcomes, has not been widely studied.

“Efforts to optimize and improve ASP resourcing may require a more fulsome understanding of the association between ASP resourcing and programme outcomes,” they wrote.

More evidence needed

Among the 21 studies that assessed antimicrobial use after increasing ASP resources, 17 (81%) reported a reduction in at least one antimicrobial use metric. Increased ASP resourcing was also associated with improved process outcomes in eight of nine (89%) studies, reduced costs in four of four (100%) studies, and improved clinical or microbiologic outcomes in three of seven (43%) studies.

“Our findings echo the importance of adequately resourced ASPs and suggest increased resourcing can support ongoing efforts to reduce antibiotic overuse,” the authors wrote. But they add that “rigorous, prospective studies and evidence-based recommendations” are needed to guide optimal ASP staffing.