Dr Julie Gerberding: “People don’t know that mothers die giving birth in Ireland or other Western European countries”.

Dr Julie Gerberding is a world-renowned infectious disease and public health expert. She served as Director for the US Centres for Disease Control and Prevention (CDC) from 2002-2009, the first woman ever to direct the organisation. As director, she led the CDC through more than 40 emergency responses to public health crises, including anthrax bioterrorism, SARS and natural disasters. She has also advised governments around the world on urgent issues such as pandemic preparedness, AIDS, antimicrobial resistance, tobacco and cancer. She now holds the position of Executive Vice President and Chief Patient Officer at MSD and is a central force in the Merck for Mothers campaign.

DB: Dr Gerberding, you have an impressive biography, and you’ve worked for years and years on all aspects of infectious diseases. Can you tell us what were the biggest challenges you faced during your time working?

JG: I began my medical training at the same time HIV emerged in San Francisco so the biggest initial crisis was the AIDS epidemic and how it affected us trainees before it was even known to be an infectious disease, but also how hard it was to learn medicine at a time when your patients all died. It’s had two lasting impacts: one is that I’ve learned about patient centricity in that environment, because the patients I took care of, in our public hospital were very empowered and they knew more about their disease than I did, they were activists and very much in charge of the decisions about their own care, and that really taught me the concept of patient centricity and that you have to co-create health and health decisions with patients.So it’s kind of ironic that today I’m the patient officer for Merck but that has been embedded in my psychology since I was an intern.

DB: Your title is chief patient officer – what does that title mean to you, in your everyday work?

JG: Patient centricity is really more of an attitude than an initiative and I think it’s just more conscious articulation of the fact that we try to always remember that medicine is for the patient not for the profits. It’s the idea that at the end of the day, as long as we keep the patient in the front of our mind we will invent medicines that bring value to patients and we’ll do things in an ethical way and we will really strive for access and equitable opportunity for people to benefit from that.

DB: The thrust of Safe Motherhood Week is that we aspire to create equality in maternal healthcare for everyone. What inspires you to work on Merck for Mothers?

JG: The big framework for Merck for Mothers is that Merck makes conscious choices about engaging in corporate social responsibility programmes that have a big impact. We wanted to go out and do something that really matters, rather than just starting a new project, so we thought why don’t we just ask the UN what areas of global health do they need the most help with and where a pharma company could be uniquely qualified to be relevant? And after talking to various UN agencies and health ministries around the world we realised that the maternal health Millennium Development Goals were not going to be met and they needed help, so we took that on as the opportunity to leverage unique capabilities that a pharma company has specifically. Merck for Mothers is primarily focused on the mother, and our involvement in projects is with a view to helping build a more sustainable health system, provide training, drugs that are fit for purpose, scalable services and can hopefully help certain Governments understand ways that they can convert what is really a very donor dependent system into something that’s a sustainable model for a health system. That’s why we partner with Safe Motherhood Week because it has the right message.

DB: In Europe we see vulnerable populations whether they are migrants or refugees or women in areas that don’t have access to maternal care services. You work in the US and we have also seen that in higher income countries, the maternal mortality rate is climbing. What do you see as the major issues facing maternal healthcare?

JG: In no country are there really adequate records of maternal death, so first and foremost one of the things we are doing in the US is working with the CDC and various entities like insurance companies to understand what is the true nature of pregnancy-related mortality. We have seen, huge health disparities. For example, one of our projects in NYC looked at mortality rates in women in different racial, ethnic and age groups, and if you were an African American college graduate in NYC your chance of dying in childbirth was greater than if you were a poor white unmarried mother. There is a systemic bias in the system that we don’t understand and we need to get to the root cause of it all, why is it going up?

I think the most tangible thing we can achieve is access to early pre-natal care, and that so many women are not aware they are pregnant and don’t seek medical help because of financial pressure or they don’t want their mother to know. but I think another area is the ability to have equitable access to family planning and resources. In the UK, almost 50% of births are unplanned, and they don’t take advantage of the technologies we have that allow them to space their babies according to their choice and we know that multiple birth and frequent birth is a risk factor for maternal mortalities. In Europe the data is lacking, so we need more data and ways of measuring maternal healthcare.

DB: Your career has seen you work on all these major public health crises, e.g. Sars, anthrax, but maternal mortality is something of a “silent crisis”. What do you think of the attitude towards it?

JG: I think this is a tangent across a lot of different domains of public health that because things happen one at a time it doesn’t seem like a crisis but if they all happened on one day we would be completely panicked, so how do you create that kind of awareness with a slow crisis, and part of it is just getting visible people talking about it. I think Safe Motherhood Week is so important, it’s the stories, you have to tell the stories. We need to make those stories from a humanitarian perspective much more visible to people. It’s very compelling when you know it.

DB: In terms of Safe Motherhood Week’s mission, what would your call to action be?

JG: I think that people need to know that it’s not just a problem “over there” – it’s a problem in their own community. People don’t know that people die giving birth in Ireland or other Western European countries. They believe that problem has been solved and so we need to tell the stories of women who have died or had close calls. During the UN general assembly week, I remember having a very wealthy woman from an affluent neighbourhood and a political figure from Nigeria both exchanging their birthing stories; the environment of the births were so different but they had almost identical experiences. We need to realise that we are all one woman, we all are connected in very profound ways and the miracle of giving life can also take a life.