Next-gen leaders in diarrheal disease: Q&A with Dr. Elizabeth McQuade

This month, we celebrate International Women’s Day, a chance to shine the spotlight on the incredible women across the globe who are working to end diarrheal disease. At DefeatDD, we’re especially inspired by the next generation of women who are accelerating action on child health.

One of our next-gen champions is Dr. Elizabeth Rogawski McQuade, an associate professor of epidemiology at Emory University’s Rollins School of Public Health. Her research focuses on pediatric enteric disease in low-resource settings, examining the interactions between early childhood diarrhea, enteric infections, antibiotic use, and their effects on child health and development.

We sat down with Dr. McQuade to learn more about her work, how mentorship has shaped her career, and her advice for other women in global health.

This interview has been edited for length and clarity.

Could you tell us a bit about your background and your areas of study?

In college, I was really interested in science. I majored in biology and chemistry, but I knew I didn’t want to go to medical school or work in basic laboratory science. I sought out public health and discovered epidemiology was a great fit: it channeled my interest in science, medicine, and math into an opportunity to make an impact on a bigger scale.

I did a joint master’s and PhD at the University of North Carolina. I wanted to do infectious disease work based on my interest in immunology. This led me to global health, because the largest burden, particularly for infectious diseases, is international.

How did you become interested in enteric diseases in particular?

I did a few different research projects abroad and ended up living in India between my master’s and PhD. It was there I got a lot of on-the-ground public health experience, including working with the Public Health Foundation of India on several zoonotic disease projects. While I was there, I got sick with a lot of infectious diseases myself and gained an appreciation for the huge need to address childhood diarrheal disease.

I reached out to Dr. [Gagandeep] Cherry Kang, who was then at the Christian Medical College in Vellore, and we set up a collaboration that formed my dissertation, which was to evaluate the impact of antibiotic treatment for diarrhea on child health outcomes. I’ve been given a lot of opportunities to continue a deep dive into diarrheal disease research, and I’ve just expanded from there.

You recently published a study on how vaccines for diarrhea affect antibiotic use. Why is that an important question to look at?

Because children in low-resource settings are frequently ill, they receive a ton of antibiotics very early in life—half before they are six months old. The simultaneous exposure to enteric pathogens and to antibiotics increases risks for development of antibiotic resistance. There are often asymptomatic co-infections as well, which could result in antibiotic resistance developing for pathogens that aren’t the target of treatment. This is an important population in which to intervene.

When a child shows up to care and is sick, it’s difficult to implement antibiotic stewardship interventions, and it’s even more difficult in settings where antibiotics are widely available without prescriptions. So one way of preventing antibiotic use would be to prevent the disease from occurring at all, and vaccines are a prime candidate for that.

What did the study find?

We found that prevention of antibiotic use would be an important ancillary benefit of vaccines in terms of absolute number of courses prevented. But because the burden of antibiotic use is so high in these settings, on a relative scale, we would only prevent 1 to 2% of all antibiotic uses with a Shigella vaccine, for example. The absolute impact is large, and the relative impact is quite modest—and it’s still unclear how much of an impact that would have on development of resistance. As new enteric vaccines enter large clinical trials, it will be important to measure vaccine impact on antibiotic use and resistance as secondary outcomes.

What kind of role has mentorship played in your career?

Mentorship has been incredibly important for me. I would make the distinction between mentorship and sponsorship, and I’ve really benefited from both. Some of my biggest mentors have been at the University of Virginia: titans in the field of diarrheal disease research who have been critical in both providing career development advice and in sponsoring me.

I’ve benefited from folks who have stuck their neck out for me and made sure I could get involved in opportunities, and I’m really grateful to my many mentors and sponsors, both at the University of Virginia and my international collaborators. Dr. Kang, who I worked with on my dissertation, really took a chance on me—I was living in Delhi and I sent her a cold email to ask if we could work together. She said, “Great, come down and visit,” and invited me to come to Vellore and meet her team. It was incredibly generous. Without her, I would not be working on enteric disease work.

What advice do you have for other young women and students who want to work in global health?

We as women deserve to be in this space, and in a lot of ways we’re uniquely equipped to connect with and understand the lived experiences of mothers, who are largely the caregivers of children with diarrhea and often the main target audience for our work. We should feel confident and know that we have a lot to contribute to this space.

For folks who are new and getting into the field, I really encourage putting your feet on the ground for an extended period of time. That was really important and transformative for me, and it’s easier earlier on when you don’t have the same commitments as you might later in life. Being able to learn from our international partners is just invaluable.