August 25, 2021. Our Communications Manager, Katie M. Kanagawa, interviewed Dr. Jade Benjamin-Chung, Assistant Professor of Epidemiology & Population Health, about her work on infectious disease interventions, particularly the spillover effects of malaria elimination intervention, and school-located influenza vaccination. She also offers sage advice to students and scientists interested in pursuing work in similar fields, and shares how she likes to spend her "free time."
Can you start by telling us a bit about yourself? How did you get here (to Stanford Epidemiology & Population Health)? Was there something in particular that attracted you to the fields of science, health and your area(s) of focus?
As a teenager, I was fairly certain a veterinarian’s life was the one for me. I love animals, and I thrived in my high school job at a local animal hospital. My focus on human health took a turn, however, thanks to a biology teacher I had in 10th grade. He assigned The Hot Zone for an extra credit assignment and introduced us to the concept of population health. I was immediately drawn to the field because it married scientific discovery with a commitment to improving others’ lives.
At UC Berkeley, I was inspired to pursue an undergraduate degree in Public Health, and then an MPH. I gravitated towards epidemiology and biostatistics because I enjoyed collecting and analyzing data to answer questions about how best to improve population health. Over the next four years, I lived in Haiti, Thailand, and Bangladesh and gained experience working closely with local healthcare workers and research institutions. After that, I obtained my PhD in Epidemiology at UC Berkeley and then worked for several years on studies of diarrhea, soil-transmitted helminth infection, and child growth, among other topics. I was attracted to Stanford for its culture of collaboration across disciplines and its many innovators in global and environmental health.
Let’s turn to your research. I understand you are currently working on spillover effects of malaria elimination intervention. Can you please give us an overview of this research? What is the important problem you are working to solve and how have you approached solving it?
About half of the world’s population is at risk of malaria, with the largest burden in low- and middle-income countries and the most severe outcomes in young children. There is a renewed goal to globally eradicate malaria by 2050, with many countries in areas with lower transmission setting an earlier goal to have zero local cases by 2030. There are effective public health strategies to reduce malaria, including antimalarial drugs, insecticides, and bed nets. But in places that are approaching elimination, transmission largely occurs in “hot spots”, and the key question becomes how to target these strategies – which interventions to deliver to whom, where, and when.
My current research aims to determine whether targeted malaria interventions delivered in the neighborhoods around malaria cases can effectively reduce disease, not only in those neighborhoods but in the surrounding areas. In other words, do these interventions produce “spillover effects” or “indirect effects” in the areas around where they are implemented? Many people are familiar with the idea of herd immunity – when many but not all people are vaccinated in a given region, and the entire population benefits from interrupted transmission. This research is asking a similar question – by delivering health interventions to the neighborhoods where we detect malaria cases, can we reduce the incidence of malaria community-wide? I am working with scientists in Namibia, Eswatini, Zambia and at UC San Francisco to conduct this research using novel statistical methods.
You are also researching school-located influenza vaccination. Can you tell us about the disparities you have encountered in this work, and how we might begin to address them, as researchers and perhaps as individuals?
I have collaborated with local health departments and school districts in the San Francisco Bay Area to evaluate the impact of offering free flu shots at elementary schools. We hoped that easing access to flu shots would not only reduce school absences but also community-wide influenza hospitalization. We found that a city-wide school flu vaccination program led to lower illness-related school absences and lower influenza hospitalization, particularly among older adults.
However, the benefits of the program weren’t evenly distributed across all race/ethnicity groups. To give an example, even though the program led to up to 11% higher vaccination coverage overall, coverage remained lower in Black and African American students. In addition, the program was associated with lower hospitalization among Black and African Americans, but they continued to have a higher incidence of hospitalization compared to other groups and were more likely to express vaccine hesitance. Our findings suggest that offering vaccines at schools is a promising strategy to improve public health, and future programs need to address beliefs, concerns, and structural factors that contribute to lower vaccine coverage in different race/ethnicity groups.
Our findings suggest that offering vaccines at schools is a promising strategy to improve public health, and future programs need to address beliefs, concerns, and structural factors that contribute to lower vaccine coverage in different race/ethnicity groups.
What has driven you to pursue this work at this point in time? What have you loved most, or found the most rewarding, about it?
I find it highly motivating to study interventions that may result in rapid and impactful policy changes that keep everyone as healthy as possible. Recently, I have found it rewarding to make linkages between my research and potential applications to the COVID-19 pandemic. For example, when I originally started my research on influenza, the idea of having vaccination clinics at school was not widely discussed outside public health circles. Now, we are seeing school vaccination clinics pop up all around the country, and school-based vaccination is entering the national conversation.
I am excited about the opportunity to expand our prior work on influenza to identify strategies to increase COVID-19 vaccination and reduce disparities in vaccination. Similarly, my malaria work is focused on when and where to target interventions when transmission is clustered in space and time. As the COVID-19 pandemic evolves, we may see a very similar pattern of clustering of infection in “hot spots”. I anticipate that there might be useful applications of the methods I am using in my malaria research to future studies of COVID-19 interventions in later stages of the pandemic.
What do you hope to accomplish with this work? What larger impacts do you hope to make, scientifically and perhaps societally speaking, and who do you hope will benefit from this work?
I hope that my research creates evidence that can directly inform public health program design, implementation, and policy, particularly for vulnerable, low-income populations.
Is there advice you would like to offer to students or other scientists interested in learning more about, and perhaps researching infectious disease interventions?
This is advice I would give generally to anyone interested in epidemiologic research:
- Work with people who have different but complementary skills and expertise from your own.
- Find mentors you respect, who support and challenge you.
- Collaborate with the communities where you conduct your research.
- Make time to read old and new studies, even when it seems like there is no time.
- Do not be afraid to tackle big questions or approach your research in a novel way.