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[00:00:07] Angela: Hello and welcome back to Communicable, the podcast brought to you by CMI communications ESCMID's, open Access Journal, covering infectious diseases and clinical microbiology. My name is Angela Huttner. I'm an infectious disease doctor at the Geneva University Hospital in Switzerland, and editor in chief of CMI Comms.

[00:00:25] Angela: I'm joined by my esteemed fellow editor, Thomas Tangy, professor of Infectious Diseases at Upsala University in Sweden, and head of many AMR directed initiatives, both inside and outside of ESCMID, to name just a few. He is Science officer of ESCMID's AMR Action, subcommittee and Medical Advisor of the Global Resistance Network, react AMR, being antimicrobial resistance.

[00:00:51] Thomas: Good morning, Angela. It's good to be back in the podcast.

[00:00:54] Angela: Thanks Thomas. Somewhat like our last two episodes. Today's episode will take a macro view of our world of infectious diseases and clinical microbiology and the way that we as healthcare professionals and as organized societies of such are dealing with current dynamics, trends, and events for those who are used to our usual infection based episodes.

[00:01:17] Angela: No worries. We will return to that in our next episode with a fifth yes, fifth installment of the Nightmare Series. on how to deal with measles this time and in the lead up to our coming together at ESCMID Global , formerly known as ECCMID in Vienna. We are delighted to have with us ESCMID's current president, Robert Skov and ESCMID's immediate past president Annelies Zinkernagel.

[00:01:44] Thomas: Robert is a medical doctor and clinical microbiologist by training and is a senior physician at the Division of Infectious Disease Preparedness at Statin Serum Institute, the National Public Health Institute of Denmark.

[00:01:57] Thomas: He has worked on AMR in public health In most of his career. He served as the Danish antimicrobial resistance focal point at the European Centers for Disease Control and Prevention, ECDC. In several expert committees such as EMA committee for categorization of antimicrobials used in veterinary practice.

[00:02:17] Thomas: He has also been science director at ICARS, the International Center for Antimicrobial Resistance Solutions, tackling AMR in low and middle income countries. Robert became president of ESCMID last year and is halfway through his term.

Robert: hi

[00:02:33] Angela: and Annelies Zinkernagel is professor and chair of infectious Diseases at the University Hospital of Zurich here in Switzerland. She's also an experimental microbiologist leading the host bacterial interactions laboratory at USZ. She was president of ESCMID from 2022 to 2024 and continues to serve on the society's executive committee.

Annelies: Hello everybody.

[00:02:57] Thomas: As you'll know

[00:02:57] Thomas: by now, we start these episodes with a get to Know You question. Here it is. Everyone is an ESCMID Global veteran on today's podcast. What is one of your favorite ESCMID global traditions? I can start. at ESCMID global you have the opportunity to actually meet the experts. you can listen to their talks, but you also have the opportunity to go to them, approach them, and tell them, who you are, if you're interested in some kind of exchange for educational research. and especially I think the early sessions educational sessions is a very nice opportunity to actually interact and communicate with leading experts.

[00:03:36] Thomas: So that's, I think, a quite unique, opportunity that ESCMID Global provides that I really enjoyed.

[00:03:43] Thomas: How about you, Angela?

[00:03:44] Angela: I would say that probably my favorite ESCMID event is the clinical grand rounds. you learn a lot.

[00:03:50] Angela: You see people, you know, handling real cases in real time. And, it's hugely informative.

[00:03:58] Angela: And Robert, what about you?

[00:04:00] Robert: Yeah, well, for me it's clearly the opening and the following reception. this gives me an opportunity to meet colleagues, friends that I haven't seen for a long time, sometimes more than one to two years.

[00:04:15] Robert: And having this time of mingling and then afterwards, having the time to really concentrate on the science, that is for me really a have to go to, session at ESCMID Global.

[00:04:29] Thomas: Yeah, that's really nice. And finally, yours Annelies.

[00:04:32] Annelies: So for me it's really interacting with a bit like what Robert was saying, dedicated, compassionate healthcare workers, and really meeting people again in person.

[00:04:43] Annelies: That was important after Covid. And what I particularly like about ESCMID Global and the participants is they don't care about borders similar to our microbes. So it's really seeing everybody in the same spot talking about microbes which do not care about borders.

[00:05:02] Angela: Love it. So it is really an honor to have you both here and a great opportunity because of the backdrop in which we quite suddenly find ourselves.

[00:05:11] Angela: So I'm going to jump right into the difficult stuff Exactly. Because of that. This is what's on people's minds. It's a time of at least seemingly unprecedented uncertainty upheaval in our field of medicine and science. Both places and in some places, people and even organizations seem to be fearful and don't quite know how to react.

[00:05:33] Angela: It's interesting to watch how some medical societies are handling this. So first off, and this question is for both of you. What is your opinion on the role in general of an international non-governmental medical society when it comes to healthcare policy and even other policies, which we know will affect healthcare downstream?

[00:05:53] Angela: How much should a society do or not do?

[00:05:57] Robert: Well, I can start for me, scientific societies is really essential in providing space, for both the development and for exchange of science within the science communities. But as you know, science do not change anything unless it's acted upon. And I think here medical societies is getting part of the larger ecosystems of health policy.

[00:06:26] Robert: And we really need to communicate, science both to the public, to policymakers and to politicians, and especially in these times here, reiterating the importance of science for driving progress. And I think both international, but probably even more national societies has an important role in both informing and educating on the consequences of, changes in health policies.

[00:06:58] Angela: Thanks Robert, Annelies what do you think?

[00:07:01] Annelies: Yeah, picking up on Robert's statement, I think what we learned during the Covid Pandemic is how important it is to explain facts, communicate well, make it, understandable, that people can move forward also with their opinions. And so I think we as scientists, but also clinicians, really have to step up and explain the facts if we understand them, if we don't understand them, also voice the doubts we have and go outside of our hospitals and outside of our universities.

[00:07:35] Annelies: And this is something we've picked up at escmid and escmid global. Taking up these leadership responsibilities. How do we communicate amongst peers? How do we interact with the lay public and moving this forward? So I think this is an extremely important aspect and we've all learned the hard way. What Robert also mentioned is the differences between societies on different levels be that national, be that international, but in particular on the international level.

[00:08:06] Annelies: Also does a society encompas many different countries as the case for ESCMID. And again, we saw during COVID how difficult it is to give advice or recommendations for a single disease such as Covid because all the national guidelines were different. If the society is one country. It's much easier because then the society can also voice some political aspects of that single country.

I do think these are also points we should be considering when communicating outward. I think the national aspect, which Robert also mentioned, should be taken up in more detail.

[00:08:50] Annelies: And on the national, level, we should be focusing also on interacting more between clinical microbiologists and infectious disease specialists. In our case, because many, countries do not really have this marriage as we have at escmid between clinical microbiologists and infectious disease specialists. And so there also, the voices that come up are not always united.

[00:09:13] Angela: That's really interesting. So these are two juxtapositions that maybe people don't always think about. Clinical microbiology versus infectious diseases. National versus international. there's Really a lot to unload there, I think. policies, at a national level, especially in our field, go across borders immediately, and clinical microbiology obviously is at the heart of our infectious disease practices, our efforts at infection control prevention.

I think, you know, we all feel stronger, in partnerships, certainly in cross border partnerships. Does an international society then have a role, can it strengthen a national society?

I [00:10:00] think obviously these cases we're talking about policy and practical change. It has to take place on a national level and as an international society, I think the main function could be to, bring people together and, help them interact or learn from other countries. it's always a question of bottom up or top down.

[00:10:20] Thomas: so the question is how much can you actually, uh, lead, the process, or, how much should you rather work on sort of catalyzing exchange of information and, best practice. any thoughts about that? I mean, these are different roles, but could all be taken on by an international society.

[00:10:40] Annelies: I'm happy to chip in there.

Again, looking back, at Covid, I mean, being in Switzerland, we were on the border to Italy, so we were communicating on a daily basis with our colleagues from Italy, learning from them. and they were very generous with their time. They were telling us how they did certain things and, this interaction was tremendously valuable.

[00:11:02] Annelies: We also had many interactions amongst the university hospitals in Switzerland . We helped with patients if the ICU was full in one city. The patients were transported. So I do think, exactly what you were saying, Tomas profiting from each other. This is something we have become better at after covid, having been plunged into a crisis before, we all thought we know what we're doing and we just did our jobs.

[00:11:31] Annelies: And I think this, with all the negative aspects, we have learned to be more open in communicating. Scientists became better interacting, especially during the first wave . And also how the healthcare workers helped each another in this crisis. I think that was, for me, a very positive experience.

If we could take up some of that momentum. Into the societies and the way we interact, it would be tremendous. I think again, here, such a large society as ESCMID did facilitate the interactions because we know each other. Not only, From our day-to-day basis that we also knew of each another and then reached out even if we didn't know the person directly.

Yeah. Well, I can just continue here. And I think one of the things that is underestimated is the person to person interactions. That, an, international society as ESCMID is creating because with this interaction, it gets much easier to call.

[00:12:34] Robert: So I think this, if I can call it the social part of having such a community is really, underestimated. And this is why I think that, even really big conferences like ESCMID really do have a merit here because it actually gives people across different, specialties, different disciplines, but also within microbiology and infectious diseases.

[00:13:02] Robert: Today it's so complex that we are all sub-specialized in some way or another. And a crisis like Covid really showed us that we. Really are interdependent on each other, on all levels, and I really think that this creation of space is very important for scientists to feel comfort in, expressing their views at the more national level as we discussed before.

[00:13:32] Thomas: Yeah, if you know the person, and something happens, you know exactly who to, send an email to and ask for advice.

[00:13:39] Angela: Yeah. Thanks a lot. these are important, observations, indeed. We should not be underestimating simply the, importance, the usefulness of an international space for people to come together, be supported, be enriched, be shown how things can be done, and be strengthened.

[00:13:57] Thomas: Moving from the general to the specific, our society has indeed made an official statement on the global impact of the US policy changes. For our listeners, this has been published jointly online at CMI Comms and at CMI and can be found on our websites. Going from there, how should escmid fit into the current ecosystem? What are the risks of coming out with strong statements and actions, and what are the risks of not coming out with strong statements and actions? How do you thread this needle, Robert?

Robert: Well, that's a very difficult one, obviously, and this is bringing us back to the discussions about the international and the national, societies here. but we really need, as scientists to communicate within our own circles, but also outside of our own circles and speak to both public policy makers and politicians.

[00:14:54] Robert: And as you mentioned, we recently commented on the global implications of the policy changes happening at the moment in us and what we highlighted here is what we see as the global implications, and especially what can we do as ESCMID? And I think what we can do is to continue to work to actually provide this platform of exchange of science, but also exchange of ideas, including science, which disproportionately, affect minorities.

[00:15:29] Robert: So ESCMID will continue to provide this platform here and do that.

[00:15:35] Robert: Another example is that last year, ESCMID, together with the IDSA, made a call for, the UN General Assembly, for, setting up a scientific panel for AMR mitigation, just as has been done for climate change in the, , end declaration of the meeting. We also advocated for medical societies, including ESCMID that they should be part of the process of providing the scientific basis for the future policy interventions in all the key, uh, scientific areas of, climate change and AMR.

[00:16:13] Robert: So these are examples where I think that ESCMID is playing a role, , in, this, global health policy that we are seeing.

[00:16:24] Angela: Yeah,

[00:16:25] Angela: I was, pleased to be the editor on both of those statements and, they were both very strong and obviously in support of ESCMID and other international societies supporting policy. I think ultimately it is hard to separate science from policy because we want science, which essentially means knowledge.

[00:16:44] Angela: We want that enacted. it will protect us. Science is knowledge. Knowledge protects us. I encourage people to read the most recent statement by ESCMID, , on the US policy changes. It's a strong statement. It's a constructive statement above all. And it was very well received.

[00:17:05] Angela: I know it's emboldened it encouraged, it reassured a lot of people who are dealing with, abrupt changes.

So, moving away or trying to from the political sphere, let's have a look at ESCMID's, current mission and hear from you about your visions for the short and long term. Obviously there'll be some overlap with what we've just been discussing. The society's mission is beautifully summed up in this one sentence.

Our mission is to champion medical progress in infection for a healthier tomorrow. And indeed, from what I can see, ESCMID is doing a fantastic job supporting education research, international collaboration in our field. So what are for you, the most effective concrete weights to champion that progress?

[00:17:50] Angela: What are the current priorities for ESCMID

[00:17:53] Annelies: thanks Angela for asking this important question we've in ESCMID, sort of set a strategic plan for the next years and we've been focusing on emerging infections where we have set up a new task force, realizing how important it is to be timely and accurate once a new infection pops up.

[00:18:14] Annelies: And as we've seen with Covid, mpox, this is something that is occurring on a very regular basis. We have also seen how important it is to foster and push education. We set up. Various educational platforms, including a leadership platform where we're trying to expand these skills. And one very important focus of ESCMID is antimicrobial resistance.

[00:18:43] Annelies: And again, here we've set up a new committee platform where we're really pushing forward with these aspects. And we've also taken up, the ESCMID Global Leaders Group on AMR, which we will be hosting for the third time at ESCMID Global in Vienna.

[00:19:01] Robert: I can continue on that one there. I mentioned the UN General Assembly, before, and the AMR Action Committee has been working together with us at the ESCMID Board in order to, come up with that statement together with IDSA.

[00:19:19] Robert: We were also present in New York during, the meeting exactly to get these, uh, influences here. I could also mention that in education, we are now expanding, so we have two, two year courses, with a certificate and one of the courses we are now taking outside of Europe is establishing a full two year course in Latin America.

[00:19:45] Robert: So, so we really are focusing both on those three areas that Annelies was mentioning. But of course we at the same time keep working on, traditional core values of, [00:20:00] ESCMID. And given that we are growing in membership and also in diversity, we are setting up new study groups that is taking up new different entities of clinical micro and infectious diseases.

[00:20:15] Robert: So in this way I think that, we try really to build on the strategy that we set up. In 2023 and to really expand, given the times that we're facing, there's so much misinformation, being pedaled, that's permeating, across borders. The anti-vax misinformation that's out there and really being amplified, by lots of different media.

[00:20:45] Angela: Are we as experts, are we coming up short in terms of how we communicate? Is there a way to learn, to better, put out real. Inform rather than misinformation. Should we be trained better? Could ESCMID help us to partner with science journalists who have some experience in this? Could it have a role in training clinicians microbiologists to do better science communication? Is that something that's already being done?

I think it picks up a bit what I tried to say in the beginning, that we've learned how important it is to communicate with the lay press and try to explain getting out outside of our golden castles and how far we can push forward.

We've had discussions on communicating under different difficult circumstances or during the pandemic. We have been looking into this and I think we've had also podium discussion of how do we communicate.

I think we as infectious disease specialists and clinical microbiologists already learned how to communicate difficult topics when HIV came up and the AIDS pandemic. So I do think we have communicated, but I agree with you, Angela, we should become better. , .

[00:22:08] Thomas: Yeah. So I wanted to come back to some of the things you mentioned Annalise, you talked about the science policy meeting at ESCMID Global with escmid and GLG members. So, this is also communication in a way. it's, trying to, transform science findings to policies about first communicating what we actually found and then turning them into something that's actionable by politicians.

[00:22:34] Thomas: for example, our evidence says that we need to do exactly this intervention. It'll cost this much. I think, uh, also calculating the costs is a difficult but important task if you want politicians to act on it. so that's another way of communication that maybe we haven't been as active in, or what do you think?

[00:22:57] Angela: Yeah, and I'm thinking, communicating with politicians is a bit different than communicating with the lay public. I think , one feeds off the other, but there's so much misinformation now, and I think politicians can be somewhat agnostic to, actual facts.

They're by definition, politicians are not science experts. They are also listening to, , regular voices, you know, non-experts who are now leading major, , scientific bodies in certain countries, right. And people who are not trained at all in science.

[00:23:31] Robert: But I don't think we can save the world Angela. I I think what we can do is that we can stand for science, and I think this is where our most important task is, is really to make sure that the science coming out, from ESCMID is seen as trustworthy, as seen as, a stable source of, information.

[00:23:58] Robert: I think this is, the kind of a landmark of communication that, we can do.

[00:24:04] Angela: Fair enough. And I think saving the world is, relative. Yes. Everybody thinks that what they're doing is saving the world. and maybe it's just incremental. Yeah. Maybe it's just bit by bit.

[00:24:15] Thomas: I think you have a good point there, Robert.

[00:24:17] Thomas: You need to sort of find your place and prioritize where you think you have most to contribute . so we talked bit about the priorities of, ESCMID. And along these same lines, what do you think are the most urgent problems in infectious diseases or clinical microbiology today in Europe and elsewhere?

[00:24:36] Robert: I can start with that one and say that, . It's obviously very dependent on where you are situated, in which context are you living and or practicing. but I think regardless where you are, one of the big problems that we all are facing is budget cuts. And, at the same time we are looking at advances in medicine that really makes medical treatment more and more complex.

[00:25:06] Robert: And those things are kind of counteracting each other.

If we are talking AMR, and If you look a bit to the, , resource limited part of the world, which is really hit the hardest of AMR and the have the poorest resources, there is really a need for a general strengthening of the healthcare system in order to allow them to use antibiotics in a more prudent way.

[00:25:34] Robert: and this is a huge problem because antibiotic resistance is coming in, faster and faster. And due to the travel and the movement of goods we are really facing, just as we saw with covid, things may start one place, but it will disseminate over time. And the problem here is that we are all going to be affected if we don't take care of this.

[00:26:04] Robert: So I think all of us actually have have a role, as scientists to find the optimal way for, people in low resource settings to, to handle these things, but also to communicate that the spread of, resistance, but, also other infectious diseases is really respecting no borders, no sectors.

[00:26:29] Robert: So, so that this here is really a global challenge. but the, day-to-day is very different from when you're sitting in a country like Denmark or if you're sitting in Sub-Saharan Africa. something to add, Annaly,

[00:26:46] Annelies: Always. Yes. So I do think we have to consider changes in temperature over time, which do bring hazards such as flooding, drought, changes in mosquito populations, for example. , and this leads to changes in infectious diseases as well as, dealing with infectious diseases. So I think this is one extremely important topic that we look into the aspects of climate change and how we deal with that. Also, what Robert mentioned with antimicrobal resistance, a huge problem.

[00:27:23] Annelies: We also refer to it as a silent pandemic. Unfortunately, it's not that silent anymore. And since this is really spreading, one particular important aspect in infectious diseases is prevention. And we can prevent infections by vaccinating people, individuals, and vaccination is one of the largest success stories of modern medicine.

[00:27:49] Annelies: So I do think vaccinating people against viral as well as bacterial infections will prevent spread of bacterial infections. and The use of antibiotics, and this is extremely important also, the world population is. Becoming larger and larger. People are getting older and older. So we have more immunocompromised individuals, not only due to age, but also to the success of modern medicine, be that treatment of cancer, transplantation, immunosuppression for autoimmune diseases, et cetera.

By using , standard precautions also vaccinating these individuals, not less because they're immunocompromised, but these individuals should be even vaccinated better. So I think there's ways to go forward.

So coming to happier subjects, ESCMID Global Global. It's from April 11th to the 15th in Vienna this year.

[00:28:50] Angela: It has truly become a phenomenon. This conference, it has grown dramatically in recent years, and also it's increasingly attracting participants from outside Europe. So why do you two think that it has been so successful? A question from Thomas here, I think, it's getting so big.

[00:29:06] Angela: Is there a need also to organize more focus meetings on specific diseases or new antibiotics, for example? or do you envision a sort

[00:29:15] Angela: of ever expanding Congress.

thank you very much for the question. There's definitely a need for ESCMID Global, otherwise people would not be coming so enthusiastically. We heard about the beauty of networking, interacting, having the possibility. To talk directly to specialists, in the field.

Ask questions although we've learned to interact via the internet in various ways, having these person to person conversations is still extremely important. So definitely a need. The size is a question. what do you want to achieve from such a conference?

[00:29:55] Annelies: And there is definitely the need for very focused conferences, [00:30:00] which are going on. ESCMID, for example, is pushing a vaccine conference, which we will be having this autumn. We have different forms of smaller conferences, which allow, closer interaction on one particular topic. But I think ESCMID Global, one of the beauties is really seeing people from all over the world coming from different angles, and this allows to foster ideas thinking outside of the box and moving forward.

[00:30:30] Robert: I can only echo what Annelies is saying I think that, the growth of ECCMID, which is now transformed into ESCMID Global deliberately because we are seeing a more global attendance, throughout, this year is incremental.

and we really have to thank the scientist who is making the program, who is really all the time, thinking of innovating how we should present, but also acknowledging the ever more complex role that we are facing. And there you end up in the discussion, you know, do you stay in the traditional, really hardcore clinical micro.

[00:31:15] Robert: And infectious diseases, or do you acknowledge that you have actually behavioral science we need to take economy into practice here? , you can say, yes, you can go to a different conference for economic, issues or for behavioral, but we have chosen to say, no, this year is actually a key part of infectious disease management and therefore it belongs here. And if you believe that it belongs in ESCMID Global, well what do you cut away?

[00:31:50] Robert: this is where we have felt that no, we need to stay with our core as well. So. There is really merit, I think, for this big gathering. But as Annelies was saying, there's definitely a need for smaller meetings where you really have focused, topics. And on top of the vaccine conference that Annelies was mentioning, we actually do have the IMMEM, the Molecular Marker Conference this year.

[00:32:20] Robert: And we are also, starting a new conference of drug global innovation, what we call the GAMRIC conference, that we are starting together with a number of other partners and which will be held, for the first time in Washington from October 1st to October 3rd. And again, Talking about the globalization.

[00:32:45] Robert: One of the ideas here with the GAMRIC Conference is actually not to keep it only to US and to, Europe, but every third time take it around the world to really acknowledge that we are facing a global, community here.

we really need to send huge merit to our office who is doing an ever, greater job in accommodating all of these practical aspects. So we make escmid global, an enjoyable, way to come. And also there we are looking at new innovations like, uh, making tracks, or you can call it conferences in the conference so that people can, interact with like-minded scientist, but at the same time also open their mind for other topics.

[00:33:41] Angela: Yeah. it's quite incredible what the ESCMID office is able to do. And I love the new sort of digital support where you can find your own track. It is such a huge conference. You can get lost in, in all your spoil for choice. but with the digital tracks, I highly recommend people do it.

Use the app, find the track that suits you, and that way you get the best, the most out of your, conference. let's face it, it's like having five or, or seven or 10 conferences in one. It is so big and so rich.

[00:34:13] Thomas: but you're right. There's a reason people go there, and it is because everyone is there so you can really, Meet anyone you want in this field, and they'll be there. So that's, amazing. with an increasing number of non-European members in escmid, you might have to adopt some activities such as courses or webinars to make them accessible to everyone.

[00:34:33] Thomas: And I think you already mentioned Robert, there is now a Latin America edition of the AMS certificate starting in 2025. Are there other examples where escmid works in collaboration with organizations in other regions?

Yeah, , we actually have had a very long tradition for having contact with societies and individuals around the globe.

[00:34:55] Robert: one example is the partnership that we have had with WHO and the Dutch RVM, where, uh, we made a pong to the European, uh, network of, antimicrobial, resistance surveillance, the ears net. so W-H-O-R-V-M and ESCMID partnered and created the Csar program, which is doing surveillance, on AMR in Central Asia and in non, EU Europe countries.

[00:35:26] Robert: also together with other partners. We hold courses, we do webinars, we co organize sessions at, conferences around the world. so I think in that way we have done this for a long time, but given that the international membership is growing, we are definitely looking into see how can we, expand of this.

[00:35:52] Robert: And one of the new things that we are doing is that we are having now the ESCMID education fund, which really is meant to support education around the globe and to make more of these programs here because in many countries, The specialization, and especially subspecialization in infection control in AMR in, antimicrobial stewardship is not really a formal education, and I think escmid could really have a role in providing such courses.

[00:36:32] Annelies: In addition, I would like to point out that we live stream the talks from escmid Global, and so this really allows the global participation even without traveling. So we have the Go Green aspect there as well. And I think also the accessibility that people can listen to these talks without being present.

[00:36:54] Annelies: They lose the networking component, but it makes it accessible. We also have ESCMID Library, the E-library, allowing people to access many of the talks that were held. And I would like to also point out that the webinars Robert mentioned are always in collaboration with local specialists upfront, knowing about the local difficulties and discussing these.

[00:37:20] Annelies: So it really encompasses many different angles as well.

on a somewhat positive note, I have a question, which I think was written by Tomas because this is a sneaky question, it's got like five questions in it.

[00:37:33] Angela: What do you think are the most important achievements and opportunities for improvements in infectious diseases and clinical microbiology today and in the coming decade? Can we expect groundbreaking innovations in antibiotic research and development diagnostics, or AI supported management of infections?

[00:37:54] Angela: It's a Trojan horse of question to must.

[00:37:58] Angela: That's for either of you.

[00:37:59] Annelies: So I'll take just one slice, out of that huge question. And I think, I mean, again, going back to the Covid pandemic, the introduction of mRNA vaccines has been a tremendous plus. It has helped deal with the pandemic per se, but also move science forward. So I do think we've had tremendous output on the, prevention.

[00:38:25] Annelies: Front. Also, just the simple education of the basic precautions, measures such as the standard precautions that every school child has known has helped really deal with infectious diseases problems in the everyday life. And so I think we can even start with the very basic precautions, which people have known to use over many decades already, but it has been introduced into the society in a more broad way.

[00:38:59] Annelies: So that's for standard precautions. Vaccines are extremely important and moving forward with various forms of diagnostics, for example, also sequencing, allowing a more in-depth understanding of microorganisms per se.

[00:39:16] Robert: Yeah, I think, that ai, maybe we never know, but maybe actually the game changer that in many aspects, can really, change, both science and healthcare.

[00:39:31] Robert: I see so much advancement there also in what we call machine learning the technology can give us this long awaited, groundbreaking innovation. You know, people are always waiting for the next game changer where everything will happen. And most things are actually tedious hard work in the laboratories, in the different places and making small, [00:40:00] incremental, advances.

[00:40:01] Robert: But I think AI really will change our world and for most of us, I actually think to a small extent, at least for me, But for the younger generation, I think that AI will really change and. we will start to use ai, or it is already used for development of new, molecules, new designs.

[00:40:25] Robert: But otherwise, I truly believe that the hard work every day, the small incremental scientific advances is what in, the end will lead us to new innovations rather than this one technology maybe apart from ai.

[00:40:45] Thomas: Yes. So we need to keep working on all these aspects and see what's going to happen.

[00:40:51] Thomas: Diagnostics. Robert, do you have an interest in this? I think from the AMR perspective and, to me it's always amazing to think about resistance in the sort of opposite way. So if you, let's say you have 80% resistance to a specific antibiotic, you still have 20% treatable patients. So if you would know that immediately once you make decision on, treatment, you could still use this antibiotic.

[00:41:14] Thomas: Do you think we are wasting old antibiotics that we could potentially use if we have better diagnostics? how can we deal with this?

[00:41:21] Robert: I definitely think that there is too much attention on developing new antibiotics. I think this is a very important thing, but we have seen very clearly over. The last years that the resistance raise is ever faster.

[00:41:37] Robert: So a new drug can be lost within one to two years if it is not used correctly. So we really need to get diagnostics back into the space and that is not trivial, so that really requires quite a bit of change also In the way that diagnostic companies are working the way that we need to see healthcare much more, in a, holistic, perspective, I would say.

[00:42:08] Robert: So we seldom do really proper calculations of what is the health benefit of a diagnostic. We just say quicker diagnostics is better, but in a world where money can only be used once, we really need to change our attitude in doing those things here. But if we just look 10 years back.

[00:42:31] Robert: Things in diagnostic has been tremendously advancing. Think about how we do ID today, where we today use either MALDI-TOF or the new four year transforming, spectrometry which will, give you diagnostics in minutes and also for antimicrobial susceptibility testing.

[00:42:53] Robert: I'm sure that we will see a lot of new , inventions during the upcoming years. So definitely I think that there is possibilities here and. We are missing out at the moment because we need to put in more emphasis on diagnostic and more holistic treatment. , nobody, and I mean, nobody would even think of having a cancer treatment without a proper diagnostic before.

[00:43:24] Robert: so we need to couple diagnostic and, treatment of infectious diseases much, much closer together.

[00:43:31] Annelies: I would like to pick up on the holistic aspect because I think it's not only diagnosing a genetic resistance, but also being able to understand how long we should be treating a patient. We probably are overtreating many patients because we don't know is this a more chronic, potentially recurring infection or is this an infection we could treat with just a couple of days of antibiotics?

[00:43:57] Annelies: And so I think the holistic approach Robert mentioned is extremely important that we understand also these more tolerant, phenotypes and, can define better. What is the correct treatment option. At the moment we're using, uh, one size fits all.

[00:44:16] Angela: Oh, I couldn't agree more.

yeah, I agree.

[00:44:18] Thomas: So this is a al approach, but it is also very individualized approach. It's, it's about tailoring treatment to pathogen patients, biomarkers and ai. So, in a way, Angela, I think this tricky question comes together. So to say you, to save the new antibiotics, we get to save them and to prevent rapid emergence of resistance, we need to take care

And also use of the old antibiotics we have. And to do that, we need the diagnostics. We need maybe AI supportive management of infections to determine how should the new diagnostics be used, how long should we treat patients, stuff like that.

[00:44:52] Angela: So you can tie it all together. Thomas Ha.

[00:44:56] Thomas: Based on the responses we got, I think it comes together in a way. Fair

[00:45:00] Angela: enough. and I have to say, yeah, speaking of holistic, I would love to, come back to one thing that Robert mentioned, because we have a beautiful, opinion piece that was published in CMI comms on the fact, a very simple statement, and so obvious you sort of like, why didn't I think of that myself and write it down.

Dan Morgan a few months ago published a nice piece in CMI comms about. When we put a diagnostic test out on the market, we shouldn't just be testing it for accuracy, for performance. It should be tested for its clinical impact. What does it mean in terms of, the patient's outcomes, , what will it lead to clinically for the patient?

[00:45:41] Angela: and we really don't culturally do that yet. we need to integrate clinical impact into any diagnostic test, into the testing of any diagnostic test. had to plug that because it's really, it's, really not something we've been thinking about enough, I think.

[00:45:57] Thomas: Finally, is there something else either of you wants listeners to know,

So I would like to wrap up this session just stating infectious diseases have impacted society. from the beginning. I mean, our life has been dominated by infections. It's not only the recent infections, but really everything we've been doing has been impacted.

[00:46:20] Annelies: And so I do think this is something we are living with on a daily basis and thus, understanding infectious diseases is extremely important in order to find solutions to prevent them in the future, but also to diagnose them and treat them if they occur. So stay tuned. It will remain interesting and infectious diseases will be ongoing.

[00:46:46] Robert: Yeah, I can only echo what Annaly is just saying, and I know from both Anise and me, we really hope to meet a lot of you at ESCMID Global in Vienna .

Oh, I can't wait. I think it's really a special, occasion, best time of the year for infectious diseases and clinical microbiology.

So thank you so much to our guests, ESCMID president Robert Skov joining us from Copenhagen, Denmark and Annelies Zinkernagel joining us from Zurich, Switzerland. Thanks to my co-host Thomas Tangen in Upsala, Sweden. Thank you for listening to Communicable the CMI Comms podcast. This episode was edited by katie Hostetler, oy, and for the second time ever, it was not peer reviewed.

[00:47:30] Angela: Theme music was composed and conducted by Joseph McDade. This episode will be citable with a written summary referenced by A DOI in the next eight weeks. You can subscribe to Communicable on Spotify, apple, wherever you get your podcasts, or you can find it on ESCMID's website for the CMI COMMS Journal.

[00:47:47] Angela: Thanks for listening and helping CMI, comms and ESCMID move the conversation in ID and clinical microbiology further along.