Outbreaks and Superbugs

Storytelling on the Frontlines with Journalist Maryn McKenna

Contagious Conversations  /  Episode 1: Outbreaks and Superbugs

A closer look at global disease threats, chickens and more

Acclaimed journalist Maryn McKenna talks to the CDC Foundation's Claire Stinson about what it's like to report on the frontlines of emergency responses, the impact of antibiotics on the food we eat, and what actions we can all take on behalf of the world's health and safety.



(View full transcript)





Below: Journalist Maryn McKenna makes the link between the routine use of antibiotics in modern agriculture and the deadly rise of drug-resistant infections around the world in her new book Big Chicken. (Photo courtesy of David Tulis)





Claire Stinson: Hello, and welcome to Contagious Conversations. I'm your host, Claire Stinson. Every episode, we'll hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives. Joining me today is Maryn McKenna, an independent journalist who specializes in public health, global health, and food policy. Maryn is a columnist for WIRED, a senior fellow at the Emory Center for the Study of Human Health, and the author of the 2017 bestseller BIG CHICKEN, as well as the award-winning books Superbug and Beating Back the Devil. In this episode, Maryn shares her unique career journey, describes why storytelling matters, and tells us what it's like to be on the front lines of public health responses. Welcome, Maryn.

Maryn McKenna: Thanks for having me.

Claire Stinson: We're so excited you're here today. For starters, Maryn, how did you decide to become a journalist?

Maryn McKenna: I was an unsuccessful dramaturge, seriously. So I have an undergraduate degree in 16th Century Theater and 20th Century Poetry, which was mostly Shakespeare and Elliot. I thought I was going to be an English professor. This is the point at which everyone who's acquainted with me, as a public health person, starts to feel their eyebrows climb up their foreheads. I thought I was going to be the owner of a theater company, and I would work in theater. It took a couple of years out of being undergrad to realize that that was not actually going to be sustainable. I thought I'd revert to being a writer. Where I was living at the time in Washington, DC, was a highly competitive writing environment as it is now. It seemed to make sense that if I went and got some kind of writing degree, I would be a more competitive freelancer. I went off to journalism school. I wasn't expecting to actually fall in love with journalism, but I exited journalism school, not as a writer about the arts headed back to Washington, DC, but as a journalist trained in investigative reporting and heading to my first newspaper job.

Claire Stinson: Fascinating. That's not an answer you get from many that you ask about their journalism path. Would you say you were drawn to public health pretty immediately when you went to journalism school?

Maryn McKenna: At the time, it felt completely random and accidental. Though, when I look back, it actually all makes sense. As I said, I got out of journalism school with a specialty of investigative reporting. My first job in upstate Illinois actually didn't have anything to do with public health. I was tasked with helping figure out why savings and loans, in the town where I lived, were going broke unexpectedly. That involved a lot of document-based digging into profit and loss statements as always happens in newspapers, or at least as used to happen when you do a particular kind of story. Well, your reward is to do another one of that kind of story. The next sets of stories I were asked to do, the next investigations, all turned out to hinge on epidemiology.

One was a cancer cluster close to a closed nuclear weapons plant that dated back to the Manhattan Project. Another was the first signals of illness among reservists returning from the first Gulf War, which turned out to be the first cases of Gulf War syndrome. Then there were others involving emergency medical funding, and communications, and so forth. All of those turned out to be public health stories, but I didn't actually go to them, at least at the start, because they were public health stories, but rather because they were investigations that could use my skills. Then, at a certain point, I turned around and thought, "Oh, I've become a public health reporter. That was not actually part of the plan."

Claire Stinson: That's amazing. Did you fall in love with investigative journalism pretty quickly?

Maryn McKenna: I did. Absolutely. There was something about being able to dig very deeply into a story and understand the nuances. The trick in journalism then and now is to internalize enough of the nuances that you can sum them up for your readers. Because if you spend six months or a year and thousands and thousands of pages digging into something, your audience is not going to have an appetite for all of that. So understanding how to translate and sum up things in a manner that made sense to people who know nothing about the topic turned out to be a really key skill. It's probably the thing that I most have carried with me from my earliest days as an investigative reporter to the work that I do now.

Claire Stinson: That's amazing. You are a really truly talented storyteller.

Maryn McKenna: Thank you.

Claire Stinson: How would you say your storytelling talent came about? Did you know immediately that you needed to become a storyteller through investigative journalism?

Maryn McKenna: This is the part of journalism that I think makes public health people nuts! The strongest stories are essentially "n of 1." They find a single thread of narrative, whether it's the story of one person, or the story of one group, and use that as the spine for an explanation of a problem, a phenomenon, a thing that has to be addressed. I think we all actually understand that intuitively from children. When our parents, or whoever is taking care of us, or our preschool teachers read us a story, the story is about a character or a small group of characters. If you think of something like Lord of the Rings, for instance, there are archetypes of story that we naturally gravitate to. I think both one of the pleasures and also one of the challenges of public health storytelling is finding those perfect narratives that are not only moving personal or small group stories, but also serve to illuminate whatever that larger question is that you're trying to tackle.

Claire Stinson: Building on that, based on your experience, what role do you think journalists play in increasing awareness about public health?

Maryn McKenna: I think it's really critical, partly because journalists are storytellers and because public health is a discipline of populations and groups. The point of intersection between public health scientists and practitioners and journalists telling stories about public health is finding that moment or that spot where the big data sets or the big experiences and populations can be translated into a narrative that makes sense for the mass audience. The journalist's challenge and job and joy, if it goes well, is finding that exact right story or set of stories that are rich enough and accurate enough and complex enough that they can make these complicated encounters with data real for the mass audience in a way that doesn't require them to know some complicated software program somewhere.

Claire Stinson: Exactly. What you were talking about earlier resonates with me. Storytelling resonates. Stories resonate with people, maybe more so than some data and statistics. I think that you're really truly talented at that. I appreciate that about what you do in your writing. You've covered emergencies from a tsunami to Hurricane Katrina, to all different kinds of outbreaks. What did you learn about the difficulty in conducting basic health activities following crises like these?

Maryn McKenna: In 2005, I had a particularly keyhole, close-up view of this because in the same year I went to the Indian Ocean tsunami and also to Hurricane Katrina. I think the thing that people who don't have any reason to be up close with epidemics and disasters don't understand is how messy and chaotic things are on the ground. Also, how much of what goes on the ground is something that looks from the outside really boring, right? It's figuring out the logistics. It's finding drivers. It's figuring out if the roads are open. It's trying to sort out how if the cell networks are down. You're going to communicate with people who are 50 miles up the road from you. I think you really have to be in that situation to appreciate how much upfront work there is before you can actually get to the tasks that people would think of as public health tasks. Here's one example. In the early 2000s, I embedded with a polio eradication team in Uttar Pradesh.

I think I was there for a couple of weeks. I was going to accompany the members of that team, especially those two leaders, as they tried to figure out how immunization was being conducted in a particular essentially, slum area, in a very poor village, in a village that had a lot of vaccine hesitancy and resistance. It turned out that there were no maps for the slum, so there was no way to know where the households were. Now, this was more than 10 years ago, the mapping has proceeded at a very rapid pace now so this might not be a situation that would exist today in the same way that it did more than a decade ago. I have this vivid memory of sitting with this female German physician with the leaders of this village, all older men; not particularly interested in encountering a woman in a position of influence of manpower. As she stared at these giant handwritten maps of the slum and saying to them, "This is not going to work. This is not adequate. We need to know wherever every family is."

No one had ever needed to put that down on paper before in the village, because everyone had a sort of intuitive sense of where people were. It would never have occurred to me that one of the challenges, one of the logistical challenges, before you could do a big public health activity like an immunization campaign, would be that you literally had to draw a map of where you're going because the map didn't exist.

Claire Stinson: That's a good segue into my next question. You have covered antibiotics and antibiotic resistance extensively in your career. What has drawn you to this topic in particular?

Maryn McKenna: My first encounter with the problem of antibiotic resistance actually is because of the CDC disease detectives. In 2002 and 2003, I had wrangled an agreement to embed, as we say now, with the 2002 incoming class of the Epidemic Intelligence Service. This is an experience that is the basis of my first book, Beating Back the Devil, which is a history of the EIS. I went through their initial training with them in the summer. I identified some people in the class, who I thought were particularly interesting, or who were least resistant to having a journalist hang out with them, which was by no means a guaranteed thing. I just kept in touch with them over the year and would visit them periodically when some interesting things were going on. One of them, a doctor, Nolan Lee, had been sent to Los Angeles where he was in the Infectious Disease Division of the Public Health Department. He ended up involved in this really interesting outbreak of drug resistant staph, MRSA.

Maryn McKenna: This is 2003. It's a little bit before the crest of the epidemic of community-associated MRSA in the United States. He stumbled across, thanks to some reports from some alert clinicians, a group of men in Los Angeles who had very serious skin and soft tissue infections from drug resistant staph that were requiring surgical help and were putting them in the hospital. It was really a very unpleasant outbreak. These men all were gay. They all went to sex clubs. This was an investigation that was politically fragile and touchy because had it gone badly, it had the potential to ignite a "sex panic" that might have been similar to the sex panics around sex clubs in the early days of HIV. Fortunately, thanks to this perspicacious disease detective, he figured out that the problem was benches in the sex clubs that were no different than benches in any gym.

They were basically just benches that people sat on that the organism from their skin was persisting on. It was just able to survive for a while, and they hadn't been disinfected well. An outbreak that was relatively uncomplicated, or at least it looked that way once it was solved, and yet could have had such profound social and political impact if it went badly, gave me a kind of pathway to follow into the whole problem of MRSA. How it started out as a hospital organism, became a community organism, became a livestock organism. How, at no point in that story, did we look far enough ahead to anticipate what was coming next? That was so interesting and complicated, and in a way, really encapsulates the entire international epidemic of antibiotic resistance from the earliest days of the antibiotic era, up until today. It was a story big enough that only a book could contain it. That led to my second book, Superbug, which is essentially the biography of MRSA.

In the experience of reporting that, I stumbled across some statistics about how we use antibiotics in livestock compared to how we use them in medicine, that again, was the story so big that it needed a book to tell it properly. That's this book that came out in 2017, BIG CHICKEN, which is the history of how we came to give antibiotics to most of the meat animals on the planet and how we discovered that was a terrible idea.

Claire Stinson: Let's talk chicken, shall we? Why chickens?

Maryn McKenna: It was a surprise to me to discover that story of chicken, in a way really, brackets the story of antibiotic discovery and antibiotic misuse. For anyone who hears this, who has any relation to Georgia or to Atlanta, they will hear the title BIG CHICKEN and want to know if it's about the Big Chicken in Marietta.

Claire Stinson: Of course.

Maryn McKenna: The answer is no. The Big Chicken, for people who are not familiar with Georgia, is a Kentucky Fried Chicken outpost that dates from, I think, the 1950s or 60s that is in fact a multi-story tall chicken. People use it as a landmark. They say, "You drive down to the big chicken and turn left." KFC actually is not part of the book really. They were kind of late to doing better on antibiotics and so I didn't tell their story. Chickens were the first animals to get antibiotics experimentally; the tiny doses of antibiotics that we came to call growth promoters, which were given to most livestock in most countries up until very recently. That means that chicken essentially prefigured the industrialization of livestock agriculture that occurs at the beginning of the antibiotic era, which is also at the end of World War II. Chicken effectively teaches the producers of other species, cattle and hogs, how to misuse antibiotics in a way that leans into industrialization and industrialization.

Then, here in the United States, chicken turns out to be the sector of the protein economy that just, in the past couple of years, has turned away from routine antibiotic use and turned away not really so much because of government regulation, though that has occurred, but because really of consumer pressure, because market tastes have changed, and buyers have convinced poultry companies at least to move away from routine antibiotic use. Chicken is teaching the rest of livestock agriculture how to reverse that historic mistake, that it led livestock agriculture into decades ago.

Claire Stinson: In your book, at the beginning, you talk about being on the streets of Paris and having some roast chicken from I believe a street vendor...

Maryn McKenna: True.

Claire Stinson: ...that changed your life.

Maryn McKenna: It was delicious!

Claire Stinson: Can you talk a little bit more about that?

Maryn McKenna: Sure. For anyone who's ever been to France, this is a very normal thing. Part of the reason why I wanted to tell the story was not just my personal sensory experience of this amazing chicken, but also to try to describe, or hint at, how common it is in the rest of the world for chicken to be delicious. When we say in the United States, "tastes like chicken," what we're really saying is that it doesn't taste like anything much at all, right? In most parts of the world, chicken actually tastes like something. I mean it tastes like itself. It doesn't taste like nothing. I went to Paris and I just happened to go to one of the street markets where Parisians very routinely buy their food. It's not a tourist thing. It's a thing where you go a couple of times a week and you meet the producers who brought things in, the most recent produce. There's always one or two vendors that have these vertical cabinets that looks like freestanding wardrobes or closets. They're metal, they're on wheels.

They plug into a generator or street power, and they have in them racks and racks and racks of chickens that have been split down the back. The cooking term for that is "spatchcock," but the French word is "crapaudine," which indicates that when you flatten the chicken, it looks like the outline of a frog. They turn on these racks for hours. When you buy one, they open up the cabinet. They slide the chicken off the rack, they put it into a bag that's foil-lined, but not super tightly closed up. Then you just carry home with it. Usually, you eat it for Sunday lunch. It is so delicious because, first, the chickens tastes like something. And second, they're very herby. Third, the skin is very crisp. Fourth, of course, it's Paris, so that probably enhances the whole experience!

Claire Stinson: Of course.

Maryn McKenna: I had just randomly walked past one of these and thought, "Oh, that looks tasty. I have to have one of those." I bought one, and I took it down the street to my apartment. I bit into it. My head exploded, and it changed my life.

Claire Stinson: It really does sound like it changed your life. We'll be right back with Maryn McKenna.

Since this is a show about Contagious Conversations, we want to hear from you. Each episode, we'll ask you a question. This episode's question is simple. Have you ever had chicken or any food in another country that changed your life? Just go to cdcfoundation.org/conversations and click on the email icon to answer. That's cdcfoundation.org/conversations. If you share your thoughts with us, you'll have the chance to win a signed copy of Maryn's book, BIG CHICKEN.

Now, back to our conversation with Maryn. A follow-up question that I think many of our listeners may have, "Do you still eat chicken?"

Maryn McKenna: I do. In fact, the scene we're talking about is the first scene in the book, but the last thing in the book is me also stuffing my face with chicken at a restaurant in Brooklyn that serves a bird that comes from a small farm in upstate New York. A very similar chicken to my French market chicken, but the underlying point of all of this for me was that I have thought about this very, very carefully through my life. I have concluded that I am in fact a meat eater. Being a meat eater, I feel like I am entitled to ask questions about how the meat I eat is raised and to advocate, if I can, for it being raised better. I don't think the only appropriate response to asking questions about meat eating is to turn away from livestock agriculture altogether and to no longer eat meat.

I think those of us who still want to eat meat are equally entitled to ask those questions. This book is sort of my book-length exploration of those questions and the answers I came up with and where I think meet agriculture made mistakes and where it's been pushed to be better and where, in the end, it can go.

Claire Stinson: That's quite an evolution. For our listeners that want to read this book, it is titled BIG CHICKEN by Maryn McKenna, 2017.

Maryn McKenna: Correct.

Claire Stinson: I believe published by Nat Geo Books.

Maryn McKenna: Right. National Geographic Penguin Random House. It will be out in paperback in the summer of 2019.

Claire Stinson: Oh, that's amazing. Well, congratulations on that.

Maryn McKenna: Thank you.

Claire Stinson: So going back to your investigative journalism, you wrote a piece in WIRED this past December about Disease X. It has a cryptic and scary sound to it. Could you tell us a little bit about that?

Maryn McKenna: It does have a cryptic and scary sound, and I want to just make it clear that I am not responsible for that. Disease X is actually a concept that was put out by the World Health Organization when, in the beginning of 2018, they were trying to set priorities for what nations and public health infrastructures should be aware of in terms of threats coming toward them. Disease X is not a particular disease. Disease X is really a concept and behind that concept is the sense that we don't know what's coming next. That whatever the next big thing is, or some big future thing, it is going to surprise us in some fundamental way. Whether it's a known disease that has new symptoms in a new place, like West Nile virus in the 2000s, or a disease that is in one area, and explodes in another like Zika just in the past couple of years, or a completely new disease that we've never seen before, we have to have the sensitivity and the structures, surveillance and the infrastructure, to be able to counter a threat of any type regardless of what that threat turns out to be.

That is my interpretation of what lies behind the Disease X concept. In the column that you're talking about, I was making the point that we have one of these diseases going on in the United States right now, which is these randomly-distributed cases of acute flaccid myelitis occurring in children, paralytic syndromes occurring in children that we have not yet; we, the public health infrastructure, has not yet been able to identify one single causative factor for this. This is an example contained to the United States and to a couple of hundred, less than 1,000 cases so far of what we might be dealing with, with a new disease that we see the symptoms, we see the cases, before we can identify the pathways by which it's come to us, the causative factors, the things that are making it more or less likely to occur, the host factors that make one person more vulnerable to it than another.

I was not, in particular, launching a criticism of how public health is responded to AFM, acute flaccid myelitis, as much as using AFM as a window to look at what the challenges are going to be when we potentially have a much larger epidemic, which everyone assumes we will have of something at some point someday.

Claire Stinson: That is a perfect segue into my next question. I was actually just about to ask you. It sounds like pretty much you are a disease detective. I'm going to go ahead and say it. Maryn McKenna is a disease detective.

Maryn McKenna: Thank you so much.

Claire Stinson: What concerns you on the horizon for public health? What do you think we, as Americans, need to be concerned about in terms of the next big outbreak or epidemic?

Maryn McKenna: There are so many things to be concerned about and each of them are most prominent in a different realm. I think, overall, the monster that lurks at the back of the mind of anyone who has any acquaintance with public health is some international pandemic. The one that we all think about is influenza because we're at the 101 year anniversary of the influenza of 1918, the largest known pandemic in history, possibly 100 million dead. Flu is a very unpredictable virus. We have moderately good surveillance for it, but it's still moves much faster than most of our surveillance can report. We have really profound challenges in getting countermeasures to it, getting vaccines out fast enough. Some of those problems are scientific problems, but many more of them are problems of the infrastructure of how we have consigned vaccine manufacture to the private sector and have asked the private sector to produce things that are not particularly lucrative for them to do.

As companies answering to shareholders into a market, they have good reasons not to do the things that public health would ideally like them to do. That mismatch between what public health needs and what the market can deliver is the thing that I think we are going to have to solve in some manner because it's also true for antibiotic resistance, that we have in the world very few companies now making antibiotics because they have decided with very defensible logic that making antibiotics is not in their financial interest. Antibiotics take as long to make as any other new compound, but you take them for a much shorter period of time. Making back your R&D, if you are a company, is very, very challenging. While you're making back that R&D or some portion of it, the bugs are gaining on your drug. The market structure that delivers antibiotics is not adequate to countering antibiotic resistance to getting new drugs out in front of resistance mutations in the same way that, or in a parallel way, to the structure of making vaccines not being adequate to the advance of a novel virus.

Claire Stinson: Maryn, here at the CDC Foundation, we are focused on public-private partnerships. I have to ask you, what role do public-private partnerships have in public health?

Maryn McKenna: I think they're very important. Let me answer out of the antibiotics world, which is the one that I know best at this point. An excellent example of a public- private partnership that's really accomplishing something is the organization CARB-X, which is an accelerator for very early-stage research into antibiotics that combines public funding from several governments and private funding from several large philanthropic organizations. The pool of money that that created is allowing that organization, which has a vast and very expert scientific advisory board, has very rigorous examination of projects, to pick researchers, organizations that are researching new antibiotic compounds, and crucially-needed things for antibiotic resistance such as new diagnostics.

Giving them enough money to get through their very, very early stage research, such that, when they get into the clinical trial part, that they will be able to move on from there on their own. This is a response in part to the backing away of the traditional, very big pharma companies, the legacy pharma companies, from antibiotics research. There might previously have been a small biotech working on something, trusting that, when they got to a particular point, they would be snapped up by the big fish, but the big fish have swarmed away somewhere else. This organization is now using this public-private money as leverage to get these very small biotechs over the gap to the point at which they're viable. There really are no other sources of funds to do that. Something like that might help us have another generation of antibiotics at a point when they're crucially needed.

We already know, as we talked about, that federal money, by itself, is not enough, because federal money is diminishing for reasons that exist outside of the public health sphere. Therefore, it's the combination of federal money and the extra boost from private philanthropy that might actually get us over the gap to having new antibiotics when we need them.

Claire Stinson: Thank you for saying that so eloquently. Thank you for sharing all of your stories today. This is really fascinating. I have one more question for you. As an experienced journalist, what advice do you have for young people today who want to pursue journalism?

Maryn McKenna: Oh, this is a complicated question. Partly because, of course, as someone who's as much of a peak of my career as I'm going to get, I think I'm supposed to say, "Oh, I want a younger generation to follow along behind me." But there is no denying that journalism is a difficult profession now. In some ways, I think more difficult than it's ever been, because the bottom of the pyramid, the small news organizations that acquainted people at a local level with all of the issues wherever they lived, whether that was outbreaks or the funding of their public health department or the funding of their school system, or whether their police chief was on the take. Those are vanishing. People no longer live in a context of local news. That makes it harder for them to understand why it is they should be invested in national news.

Of course, never before, at least not in the 20th century up to now in the 21st, has there been this atmosphere of distrust of news so profound that we're being told that we are not real. That we're fake news. You might be able to find that back in the 19th century, but that was not part of the 20th century compact that built the news media that I know today. On the one hand, it's hard for me to say to someone who's trying to figure out their path in the world, "Yeah, you should come into this profession, because this profession is fragile right now. But precisely, for that reason, I think this profession is needed more than ever. The one thing I would say to people who have an affection for public health, but also are interested in the watchdog and oversight and storytelling potential of journalism is that I think journalism is more open than it ever has been to people coming in from other career paths.

My career path shows that people who were becoming journalists in the 80s and 90s, you were supposed to train as a journalist. After that, you were supposed to learn your topic on the job, or to go off and do some extra schooling on your own that taught you to be a politics reporter, a public health reporter, a sports reporter, anything like that. Maybe you didn't have to learn to be a sports' reporter; maybe people just grew up knowing that. Now, I think it's much more common that people actually pursue a scientific career or public health care or at least the schooling for that; go through an MPH, go through a PhD. In some cases, go through an MD and residency and then decide no, they feel better suited for communicating science and public health than for practicing it as a clinician or as a researcher.

I think that journalism is much more open to people making a lateral move like that. I think it enriches journalism that people come in with subject matter expertise that they previously had to gain on the job. Summing up, I would say, I certainly hope that people continue to come into journalism. In some ways, I feel like the doors of journalism are wider to people with other interests than they ever have been. We just hope that the funding follows.

Claire Stinson: That's good advice. Thank you so much. Thank you so much for your time today.

Maryn McKenna: Thank you for having me.

Claire Stinson: To explore bonus content from today's episode, including a photo of Maryn on a poultry farm, links to her award-winning books and her TED Talk, which has been viewed over 1.6 million times, go to cdcfoundation.org/conversations. Thanks for listening to Contagious Conversations produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes and bonus content. If you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review, and tell others. It helps us get the word out. Thanks again for tuning in, and join us next time for another episode of Contagious Conversations.





Photo Credits: Billy Howard (portrait), David Tulis (poultry farm)