Communicable

In this episode of Communicable, Emily McDonald and Josh Davis are joined by Roger Lewis (USA) and Ian Marschner (Australia) to compare and contrast Bayesian and frequentist statistical approaches. The panel discusses the fundamental principles of both methods, common misconceptions, and the extent to which they are often more similar than many realise. Together, they explore their use in clinical trial design, analysis, and reporting, including adaptive trials and sequential learning. Additional topics include sample size misconceptions, regulatory versus clinical thresholds, and the challenges of interpreting post hoc reanalyses of negative trials.This episode was edited by Kathryn Hostettler and the executive producer of Communicable is Angela Huttner. Further reading:Berry SM, et al. Bayesian Adaptive Methods for Clinical Trials (Chapman & Hall/CRC Biostatistics Series). Boca Raton (FL): CRC Press; 2010. FDA Guidance Document: Use of Bayesian Methodology in Clinical Trials of Drug and Biological Products FDA, 2026, https://www.fda.gov/regulatory-information/search-fda-guidance-documents/use-bayesian-methodology-clinical-trials-drug-and-biological-productsLee TC, et al. Contextualizing the use of corticosteroids in severe Pneumocystis jirovecii pneumonia through a Bayesian lens. CMI Comms 2025, https://www.cmi-comms.org/article/S2950-5909(25)00082-4/fulltextLivingston EH and Lewis RJ. JAMA Guide to Statistics and Methods, https://jamaevidence.mhmedical.com/Book.aspx?bookId=2742Marschner I. Confidence distributions for treatment effects in clinical trials: Posteriors without priors. Stat Med 2024, doi: 10.1002/sim.10000.Whitehead J. The design and analysis of sequential clinical trials. Revised 2nd ed. Chichester: John Wiley & Sons; 1997.

Our editors – Marc Bonten, Erin McCreary, Anne-Grete Märtson, Angela Huttner, and Josh Davis – are back for part two of the ESCMID Global Late Breakers series, summarising five more late-breaking trials presented at ESCMID Global 2026. They discuss the trials' strengths and weaknesses, and whether their results should change practice. The five trials presented in this half of the series are listed below, and links to their respective sessions can be watched and rewatched on the ESCMID Global Virtual Platform. Links to corresponding abstracts and publications where available are provided as well.Conflict of interest/involvement in the trials:Marc Bonten was the chair of the E.mbrace trial's steering committeeJosh Davis is global co-lead of the SNAP trialJosh Davis was a site investigator on the E.mbrace trialAngela Huttner was an independent/unpaid member of the E.mbrace trial's steering committee and an investigator on the precursor phase 1 trial testing the E. coli vaccinePROCALBAN trial (Late-breaking clinical trials in sepsis management)Chowdhury F, et al. Use of Procalcitonin Point-Of-Care Testing to Guide De-Escalation of Antibiotic Therapy in Adult Sepsis Patients in a Tertiary Hospital in Bangladesh: A Randomised Controlled Open-Label Trial, Preprints with The Lancet, doi: 10.2139/ssrn.6541698BENEFICIAL trial (Late-breaking clinical trials in sepsis management) De Cock PA, et al. Bedside model-informed precision dosing of vancomycin in severely ill neonates and children in Belgium (the BENEFICIAL trial): a multicentre, randomised controlled trial. Lancet Child Adolesc Health, doi: 10.1016/S2352-4642(25)00385-2 SNAP trial (Late-breaking clinical trials in sepsis management) Bowen A. Adjunctive clindamycin for treatment of Staphylococcus aureus bacteraemia: a randomised controlled trial within the S. aureus Network Adaptive Platform (SNAP), abstractAdjunctive betamethasone treatment of hypoxemic adults hospitalised with Mycoplasma pneumoniae community-acquired pneumonia: an open-label, multicentre, randomised, controlled trial (Late-breaking research from The Lancet)Hagman K, et al. Adjunctive betamethasone treatment of hypoxaemic adults hospitalised with Mycoplasma pneumoniae community-acquired pneumonia: an open-label, multicentre, randomised, controlled trial. Lancet 2026, doi: 10.1016/j.lanepe.2026.101610E.mbrace trial (Vaccines: landmark trials and preventive immunisation)Cohen CA, et al. Randomised phase III trial of a 9-valent vaccine (ExPEC9V) for prevention of invasive Escherichia coli disease (IED) in older adults (E.mbrace), abstractThe Swiss multicentre phase 1, first-in-human trial testing the conjugate E. coli vaccine:Huttner A et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis 2017: May;17(5):528-537

In this collaborative episode of Breakpoints and Communicable, the hosts revisit the “trial run” session from ESCMID Global, a format designed to facilitate critical discussion of major infectious diseases trials. This episode focuses on two studies addressing bloodstream infections caused by third‑generation cephalosporin-resistant Enterobacterales [1].Mical Paul (Rambam Health Care Campus, Israel) joins the podcast to discuss the PETER PEN trial [1,2], comparing piperacillin/tazobactam with meropenem, including its design, interim analyses, and interpretation alongside prior data such as MERINO. The episode also features Jesús Rodríguez‑Baño (University of Seville, Spain), who presents a post hoc analysis of the ASTARTE trial [1,3], comparing temocillin and carbapenems.This episode was edited by Lacy Worden and was peer reviewed by Jeanette Bouchard (Duke Antimicrobial Stewardship Outreach Network (DASON) Durham, NC, USA). ReferencesPaul, M., & Rodríguez-Baño, J. (2026, April 20). The trial run: treatment of ESBL bacteraemia - off to never-never land. [Presentation]. ESCMID Global 2026, Munich, Germany. ESCMID Global Virtual Platform.Bitterman R, Koppel F, Mussini C, et al. Piperacillin-tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen). BMJ Open. 2021;11(2):e040210. Published 2021 Feb 8. doi: 10.1136/bmjopen-2020-040210 Marín-Candón A, Rosso-Fernández CM, Bustos de Godoy N, et al. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): protocol for a randomised, pragmatic trial [Internet]. BMJ Open. 2021 Sep 27;11(9):e049481. doi: 10.1136/bmjopen-2021-049481 Further readingHarris PNA, et al. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial. JAMA. 2018;320(10):984–994. doi: 10.1001/jama.2018.12163.

Communicable is launching a new series on everything related to pharmacokinetics (PK) and pharmacodynamics (PD). Kicking off this series are hosts Thomas Tängdén, Erin McCreary and Angela Huttner, and invited guests Amy Legg and Rekha Pai Mangalore. They walk us through key parameters and terms of PK/PD, such as volume of distribution, minimum inhibitory concentration (MIC), epidemiological cut-off value (ECOFF), and PK/PD indices, laying the foundation to better comprehend clinical applications such as setting a clinical breakpoint and how it guides therapeutic drug monitoring (TDM). This first episode encompasses a broad scope across PK/PD theory, preparing the listener for subsequent episodes that will explore these topics with greater depth and make you love PK/PD. This episode was peer-reviewed by Ummu Afeera Zainulabid of the International Islamic University, Kuantan, Malaysia. Terms and definitions ADME, a drug’s journey through the body: absorption, distribution, metabolism, excretionVolume of distribution, a parameter describing the theoretical volume that would be necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasmaClearance, the volume of blood cleared of drug per unit timeHalf-life, the time required for the concentration of a drug to decrease to half of its initial amount in the bodyLoading dose, a larger initial dose designed to rapidly bring drug levels into the therapeutic rangeSteady state, an equilibrial condition in which the rate of input of a drug is equal to the rate of its outputMIC, minimum inhibitory concentrationECOFF, epidemiological cut-off value: the highest MIC value of isolates that are not known to have resistance and are therefore considered representative of wild-type bacterial isolatesClinical breakpoint setting, takes into account drug dosing, PK/PD, site of infection, clinical data; what we think is the breakpoint for the lab to call a bacterial organism susceptible to a drugPK/PD index, a parameter that describes the observed antimicrobial activity of an antimicrobial; there are three different indices: T>MIC (bacterial killing depends on the drug concentration’s remaining higher than the MIC over time)Cmax/MIC (bacterial killing depends on the drug’s peak concentration)AUC/MIC (bacterial killing depends on the area under the curve over the MIC)TDM, therapeutic drug monitoringFurther readingMouton JW, et al. MIC-based dose adjustment: facts and fables. J Antimicrob Chemother 2018. doi:10.1093/jac/dkx427Märtson A, et al. The pharmacokinetics of antibiotics in patients with obesity: a systematic review and consensus guidelines for dose adjustments. Lancet Infect Dis 2025. doi: 10.1016/S1473-3099(25)00155-0Eagle H and Musselman AD. The rate of bactericidal action of penicillin in vitro as a function of its concentration, and its paradoxically reduced activity at high concentrations against certain organisms. J Exp Med 1948. doi: 10.1084/jem.88.1.99

In this episode of Communicable, hosts Angela Huttner and Marc Bonten invite two members of the ESCMID Emerging Infections Subcommittee, Martin Grobusch (Amsterdam, Netherlands) and Pikka Jokelainen (Copenhagen, Denmark), to discuss infectious disease outbreaks. Sparked by the Subcommittee's beloved 'Epi Alert', which identifies and tracks outbreaks around the world, the episode covers common missteps and underestimated challenges in handling new outbreaks, the effects of climate change, and what 'One Health' really means. This episode was peer reviewed by Ummu Afeera Zainulabid of the International Islamic University Malaysia, Kuantan, Malaysia.Further readingEpi Alert. https://www.escmid.org/science-research/emerging-infections-subcommittee/eis-activities/Pellejero-Sagastizábal G, et al. Delayed correct diagnoses in emerging disease outbreaks: historical patterns and lessons for contemporary responses. CMI 2025. https://www.clinicalmicrobiologyandinfection.org/article/S1198-743X(25)00169-7/fulltext One Health High-Level Expert Panel (OHHLEP), et al. One Health: A new definition for a sustainable and healthy future. PLoS Pathogens 2022. https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1010537 Swiss Tropical and Public Health Institute News. https://www.swisstph.ch/en/news

In this third collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite two veteran authors of guidelines and guidances, Pranita Tamma (Philadelphia, USA) and Benedikt Huttner (WHO, Geneva, Switzerland) [1-3]. Together, they deconstruct the complex landscape of developing and implementing guidelines into digestible components: they discuss why different organizations develop guidelines and what need they hope to fulfil, the framework including the GRADE methodology under which guidelines are written, and major barriers in the uptake of guidelines. The conversation also details the distinction between guideline and guidance as well as the art and science behind formulating recommendations or suggestions, with a few anecdotal cases sprinkled in from the panel. This episode was edited by Kathryn Hostettler and Lacy Worden. It was peer reviewed for Breakpoints by Lacy Worden and for Communicable by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. References WHO handbook for guideline development, 2nd Edition The WHO AWaRe (Access, Watch, Reserve) antibiotic book IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative InfectionsFurther readingESCMID AMR Guidelines, https://clinicalmicrobiologyandinfection.com/retrieve/pii/S1198743X21006790 GRADE working group, https://www.gradeworkinggroup.org/GRADE Book, https://book.gradepro.org/ IDSA's intraabdominal guidelines, https://www.idsociety.org/practice-guideline/intra-abdominal-infections/ ESCMID Manual for Clinical Practice Guidelines and Other Guidance Documents, https://www.escmid.org/guidelines-journals/guidelines/ International Consensus Guidelines for the Optimal Use of the Polymyxins https://accpjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/phar.2209 American Thoracic Society guidelines on community-acquired pneumonia, https://www.atsjournals.org/doi/abs/10.1164/rccm.202507-1692ST

In this episode of Communicable, Josh Davis (Newcastle, Australia) and Emily McDonald (Montreal, Canada), plus invited guest, Steven Tong (Melbourne, Australia)—all practicing physicians and clinical trialists—assemble to discuss some of their ‘top infectious diseases papers published in 2025’. Bassam Ghanem (Jeddah, Saudi Arabia), whom one might know better as Antibiotic Steward on social media, was also invited to share his favourite publications of 2025.Six papers that were most consistently picked by the panel are presented, explaining why they were picked and how they have shifted paradigms or changed their practice. This episode complements the previous episode, which presented ‘top clinical microbiology papers in 2025’, and was peer reviewed by Akshatha Ravindra of Kasturba Medical College, Manipal, India. ResourcesCLARITY initiative websitePapers presented (in order of presentation) Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMAMeya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJMVodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJMKreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJMGuglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJMRoss JDC et al, Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1). Lancet ‘One liners’ (in order of presentation)Burdet C et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa). LancetLemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir MedLuetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf DisEyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. NatureXie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. CellPomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMADurbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJMHook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJMOpdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect DisArundel C et al, Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2). LancetHonourable mentionsChaccour C, et al. Ivermectin to Control Malaria. NEJMLucinde RK, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. NEJMMorel J, et al. Effect of a 1-month methotrexate delay on pneumococcal vaccine immunogenicity and disease control in patients with early rheumatoid arthritis (VACIMRA). Lancet RheumatolHaukoos J, et al. Hepatitis C Screening in Emergency Departments. JAMAMajor Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial, JAMA SurgAnderson CS, et al. Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II). LancetSt Peter SD, et al. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children. LancetPan CQ, et al. Tenofovir and Hepatitis B Virus Transmission During Pregnancy. JAMAGohil SK, et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection. JAMA SurgRelated podcast episodesCommunicable E44: Top clinical microbiology papers in 2025 https://share.transistor.fm/s/6e5c26aeCommunicable E29: Bacterial vaginosis & male partners, https://share.transistor.fm/s/3de4f5c3 Communicable E28: Late-breaker trials at ESCMID Global: Should they change your practice? - part 2, https://share.transistor.fm/s/4f044e8c Communicable E20: Tuberculosis today https://share.transistor.fm/s/9858900e

In this final episode of 2025, hosts Annie Joseph (Nottingham, UK) and Angela Huttner (Geneva, Switzerland), interview Communicable's producer, Katie Hostettler-Oi (Zurich, Switzerland), to learn which episodes she liked best this year. Their discussion provides a behind-the-scenes look at some of the episodes--including the strange surprises that sometimes came with them. Finally, the CMI Comms editors and editorial fellows send in their perspectives on 2025 and their wishes for 2026.

In the last ten years, 'diagnostic stewardship' has emerged as a core principle of good clinical practice whose implementation impacts both the individual patient and public health at large. In this episode of Communicable, hosts Angela Huttner and Annie Joseph invite two experts in the field, Daniel Morgan (Maryland, USA) and Valerie Vaughn (Utah, USA), to discuss diagnostic stewardship in the context of infectious diseases, hospital medicine, and healthcare in general. Other topics covered include practical interventions for better testing practices and the role of artificial intelligence in the future of diagnostics. The episode highlights how thoughtful, intentional diagnostic practices can enhance clinician workflows and improve patient outcomes.This episode is a follow-up from Morgan’s recently published commentary in CMI Communications on diagnostic testing, and the need for evaluating its clinical impact [1]. The episode was peer reviewed by Özlem Türkmen Recen of Çınarcık State Hospital, Yalova, Türkiye. ReferencesBaghdadi JD & Morgan DJ. Diagnostic tests should be assessed for clinical impact. CMI Comms 2024. DOI: 10.1016/j.cmicom.2024.105010Further readingAdvani S and Vaughn VM. Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges. Curr Infect Dis Rep 2021. DOI: 10.1007/s11908-021-00760-3 Core Elements of Hospital Antibiotic Stewardship Programs, https://www.cdc.gov/antibiotic-use/hcp/core-elements/hospital.html Core Elements of Hospital Diagnostic Excellence (DxEx), https://www.cdc.gov/patient-safety/hcp/hospital-dx-excellence/index.htmlCosgrove SE & Srinivasan A. Antibiotic Stewardship: A Decade of Progress. Infect Dis Clin North Am 2023. DOI: 10.1016/j.idc.2023.06.003 Dik JH, et al. Integrated Stewardship Model Comprising Antimicrobial, Infection Prevention, and Diagnostic Stewardship (AID Stewardship). J Clin Microbiol 2017. DOI: 10.1128/jcm.01283-17Fabre V, et al. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol 2023. DOI: 10.1017/ice.2023.5 Huttner A, et al. Re: ‘ESR and CRP: it's time to stop the zombie tests’ by Spellberg et al. CMI 2025. DOI: 10.1016/j.cmi.2024.09.016 Morgan DJ, et al. Diagnostic Stewardship—Leveraging the Laboratory to Improve Antimicrobial Use. JAMA 2017. DOI: 10.1001/jama.2017.8531 Messacar K, et al. Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship. J Clin Microbiol 2017. DOI: 10.1128/jcm.02264-16Messacar K, et al. Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection. J Pediatr. 2022. DOI: 10.1016/j.jpeds.2022.02.002 Qian ET, et al. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA 2023. DOI: 10.1001/jama.2023.20583 Siontis KC et al. Diagnostic tests often fail to lead to changes in patient outcomes. J Clin Epidemiol 2014. DOI: 10.1016/j.jclinepi.2013.12.008Vaughn VM, et al. Antibiotic Stewardship Strategies and Their Association With Antibiotic Overuse After Hospital Discharge. Clin Infect Dis 2022. DOI: 10.1093/cid/ciac104Vaughn VM, et al. A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria. JAMA Intern Med 2023. DOI: 10.1001/jamainternmed.2023.2749

Once confined to the tropics, dengue is spreading via its vector, the Aedes mosquito, to more temperate regions, causing increases in global morbidity, mortality and cost. In 2019, the WHO recognised dengue as one of the top ten global health threats alongside climate change and antimicrobial resistance [1]. In this episode of Communicable, Annie Joseph and Nav Narayanan welcome two dengue experts, André Siqueira of the non-profit Drugs for Neglected Diseases Initiative based in Geneva, Switzerland (Rio de Janeiro, Brazil), and Steven Lim of the Raja Permaisuri Bainun Hospital (Ipoh, Malaysia). Together, they discuss the epidemiology, clinical presentation and management of dengue including comparisons to other arboviral infections like zika and chikungunya, and the heightened risk of disease for vulnerable populations such as pregnant women and those with comorbidities. The conversation also highlights innovative vector-control strategies and candidate therapeutics currently under investigation. This episode was edited by Kathryn Hostettler and peer reviewed by Loora Grünvald of the University of Tartu, Estonia. Resources:Drug for Neglected Diseases (DNDi), https://dndi.org/ Dengue Alliance, https://dndi.org/global-networks/dengue-alliance/ Qdenga vaccine information: https://travelhealthpro.org.uk/news/763/qdenga-dengue-vaccine-guidanceDengavaxia vaccine information: https://www.cdc.gov/dengue/hcp/vaccine/index.html References: World Health Organization, Ten threats to global health in 2019.Further reading: Treating a feverish planet: The Dengue Alliance, a video

Contrary to popular belief, peer review has only recently become an integral step in scientific publishing. Currently seen by many as a badge of honour ensuring valid, innovative and honest research, peer review seems in reality to be increasingly thankless, exploitative, and sometimes invisible. How did we get here? In this episode of Communicable, Annie Joseph and Angela Huttner are joined by two experts, Melinda Baldwin (University of Maryland, USA) and Serge Horbach (Radboud University, Netherlands), to unpack and examine the role of peer review, why it is still essential, and how it fits within the greater editorial process. The conversation covers the history of peer review, contemporary formats including open review and the use of artificial intelligence, and thoughtful discussion on how to fix and rethink peer review. This episode was edited by Kathryn Hostettler and peer reviewed by Barbora Píšová from the Czech Republic.Related podcast episodes Communicable episode 13: The Wild West of publishing today—predatory journals and how to deal with them https://share.transistor.fm/s/e3abe9af ResourcesEASE, the European Association of Science Editors https://ease.org.uk/ Peer review week https://peerreviewweek.net/ Further readingCsiszar, A. The Scientific Journal: Authorship and the Politics of Knowledge in the Nineteenth Century. The University of Chicago Press, 2018. DOI: 10.7208/chicago/9780226553375.001.0001 Entradas, Sousa, Yan, et al. (2023) Public Deliberative Workshops – Findings. POIESIS project deliverable D2.2. https://poiesis-project.eu/deliverables/.Ross-Hellauer T and Horbach SPJM. Additional experiments required: A scoping review of recent evidence on key aspects of Open Peer Review, Research Evaluation, 2024. DOI: 10.1093/reseval/rvae004Horbach SPJM and Halffman W. The changing forms and expectation of peer review. Res Integr Peer Rev 2018. DOI: 10.1186/s41073-018-0051-5Danziger S, et al. Extraneous factors in judicial decisions. Proc Natl Acad Sci USA, 2011. DOI: 10.1073/pnas.1018033108Fyfe, A., Moxham, N., McDougall-Waters, J., & Røstvik, C. M. (2022). A History of Scientific Journals: Royal Society publishing, 1665-2015. London: UCL Press.“Misconduct in Science,” 9 February 1983, NN3-443-UD-12D-1 box 78, file “RES 12 Misconduct in Science, 1983-1987,” Papers of the NIH Director, National Archives and Records Administration, College Park, MD.Baldwin M. In Referees We Trust? How Peer Review Became a Mark of Scientific Legitimacy. MIT Press (Open Access). Work in Progress.

In this episode of Communicable, Angela Huttner and Erin McCreary invite two titans of vaccinology, Barney Graham (Atlanta, USA), former deputy director of the NIH NIAID Vaccine Research Center and architect of the mRNA vaccines against COVID-19, and Gary Kobinger (Galveston, USA), leading virologist in the development of the first effective Ebola vaccine, rVSV-ZEBOV, for a candid conversation about their direct experience building two of the most well known vaccines to date, and deploying them to the public. The episode also reviews the different vaccine platforms and addresses vaccine hesitancy, equitable access to vaccines, and global health equity. This episode was edited by Kathryn Hostettler and peer reviewed by Eren Ozturk of Ankara University, Ankara, Türkiye. Terms and sourcesVSV, vesicular stomatitis virusZEBOV, Zaire Ebolavirus rVSV-ZEBOV, recombinant vesicular stomatitis virus expressing the (Zaire) Ebolavirus glycoprotein (vaccine)VRC, the NIH Vaccine Research Center of NIAID Morehouse School of Medicine Satcher Global Health Equity InstituteGuardRX, https://www.guardrx.org/en/who-we-are/ ReferencesMarzi A, et al. VSV-EBOV rapidly protects macaques against infection with the 2014/15 Ebola virus outbreak strain. Science 2015. DOI: 10.1126/science.aab3920 Agnandji S, Huttner A, Zinser M, et al. Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe. New Engl J Med 2015. DOI: 10.1056/NEJMoa1502924Graham BS and Corbett KS. Prototype pathogen approach for pandemic preparedness: world on fire. J Clin Invest 2020. DOI: 10.1172/JCI139601Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. New Engl J Med 2020. DOI: 10.1056/NEJMoa2022483

Ethics in the field of infectious disease can be a delicate interplay between treating the individual patient and protecting the collective health of a society. Sometimes these two mandates go hand in hand; at other times they can appear to be in conflict. In this episode of Communicable, Dr. Angela Huttner invites Drs. Zeb Jamrozik (Melbourne, Australia) and Beenish Syed (Karachi, Pakistan), two members of ESCMID’s Ethics Advisory Committee, to unpack different scenarios encountered in the field of infectious disease from an ethics standpoint: how one ethically allocates scarce resources like antimicrobials; whether there is ethical justification for coercive public-health measures like lockdowns; and whether the need to collect evidence to advance patient care could include other models besides opt-in informed consent. This episode was edited by Dr. Kathryn Hostettler and peer reviewed by Dr. Goulia Ohan of Yerevan State Medical University, Yerevan, Armenia.Further reading:Barosa M, et al. The Ethical Obligation for Research During Public Health Emergencies: Insights From the COVID-19 Pandemic. Med Health Care Philos 2024. DOI: 10.1007/s11019-023-10184-6Symons X, et al. Why should HCWs receive priority access to vaccines in a pandemic? BMC Med Ethics 2021. DOI: 10.1186/s12910-021-00650-2Thorsteinsdottir B and Madsen BE. Prioritizing health care workers and first responders for access to the COVID19 vaccine is not unethical, but both fair and effective – an ethical analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2021. DOI: 10.1186/s13049-021-00886-2Huttner A, Leibovici L, Theuretzbacher U, Huttner B, Paul M. Closing the evidence gap in infectious disease: point-of-care randomization and informed consent. Clin Microbiol Infect 2017;23(2):73-77. DOI: 10.1016/j.cmi.2016.07.029