Lifesaving Public Health

“SIX MONTHS AGO, A LOT OF PEOPLE may not have known what an epidemiologist does,” admits Dr. Liz Temkin ’83, pointing out that the coronavirus pandemic has brought increased attention to her field. An epidemiologist with Israel’s National Center for Infection Control and Antibiotic Resistance since 2011, Temkin focuses on how to control the spread of antibiotic-resistant bacteria, how to limit unnecessary antibiotic use, and how to respond to the fact that few new antibiotics are in development. “It’s incredibly rewarding,” she says. “Because of the work of my unit, we have saved countless lives.”

Long before joining the Israeli Ministry of Health, Temkin was drawn to a career in health care. “In college, I became interested in women’s health, and I met midwives who really impressed me,” she says. “I went to Yale for a master’s in nursing and then began my first career as a nurse-midwife.” But after a decade of this dedicated work, Temkin was looking to broaden the scope of her impact.

“I was working at Planned Parenthood in Bridgeport, Connecticut,” she continues. “I decided that I wanted to try to change things on the structural level rather than on the individual patient level, which led me to earn a doctorate in public health from Johns Hopkins, where my research focused on sexually transmitted diseases. And now in Israel, I am able to continue working in infectious diseases, albeit in a slightly different context.”

Every day, Temkin and her team stay vigilant, hoping to detect warning signs of a possible outbreak before it occurs. “My unit was formed in 2007 to respond to an epidemic of an antibiotic-resistant bacteria, carbapenem-resistant Klebsiella pneumoniae, in hospitals across Israel. The situation got out of control very quickly because there was no one in charge of infection disease surveillance at the country level. We don’t ever want to be surprised again.

“I helped set up two nationwide surveillance systems—one for antibiotic resistance and one for antibiotic use,” she says. “Each month, every general hospital in Israel sends us a report of all the bloodstream infections caused by seven major bacteria, including whether they are resistant or susceptible to certain antibiotics. We also monitor the rates of antibiotic-resistant infections, and if we see that rates are rising, we can intervene.

“With increased use of antibiotics, bacteria develop resistance to antibiotics that makes it harder and harder to treat infection,” Temkin notes. “This problem has existed since the 1940s, but the danger has increased in recent years as fewer new antibiotics are being released by drug manufacturers.

“From 1983 to 1987, there were 16 new antibiotics approved by the FDA. Between 2008 and 2012, just two new antibiotics were approved by the FDA,” she explains, “and since 2017, only eight new antibiotics have been approved, but most are variations on already existing drugs and do not target antibiotic-resistant bacteria.”

For these reasons, Temkin closely monitors the prescription of antibiotics throughout Israel. “In 2012, I helped write national guidelines for antibiotic stewardship to promote smart use of antibiotics,” she says. “Each year, every general hospital, post-acute care hospital, and health maintenance organization in the country sends us data about the antibiotics they’ve dispensed. We then compare each hospital to itself over time and to other similarly sized hospitals. If one hospital is using noticeably more antibiotics than the others, it is probably overusing. If another hospital is using much less than the average and we know that more patients are not dying of infection there, that tells us that the other hospitals could safely reduce their antibiotic use.”

Temkin’s work has helped to curb the overuse of antibiotics in the Israeli healthcare system, with the amount of antibiotics dispensed having decreased by 14 percent in intensive care units, 16 percent in internal medicine and surgical wards, and 44 percent in post-acute care hospitals since 2012. She stresses that each of us can also contribute to the reduction of antibiotic overuse. “Antibiotics are different from every other medication because taking them has an impact not only on you. Every time you take an antibiotic, you increase the risk that the antibiotic will not work for someone else in the future,” she cautions. “It’s up to us not to demand antibiotics when they are not needed, such as for viral illnesses like the common cold.”

More than anything, though, Temkin emphasizes one vital skill: thorough handwashing. “The best way for us to not need antibiotics is not to get sick, and the absolute most important way to do that is to wash your hands often. I really can’t stress that enough.”

—Christopher Browner ’12