Five questions for … Dr. Debbie Malden

Debbie Malden, DPhil, MSc, is an epidemiologist with research experience in large-scale prospective cohort studies. Before joining Kaiser Permanente, Dr. Malden completed her DPhil at the University of Oxford, assessing risk factors for cardiovascular disease among a half million U.K. adults using both observational and genetic epidemiological techniques.

In addition to her research on chronic disease, Dr. Malden also has field experience in communicable disease and outbreak response management with international nonprofit organizations. She has broad interests in disease prevention through the social determinants of health, particularly in underserved and vulnerable populations.

Through her role as an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention, Dr. Malden is expanding her training and expertise in applied epidemiology at Kaiser Permanente. In this capacity, she receives on-the-job training and mentoring from scientists within both the Department of Research & Evaluation and the Centers for Disease Control and Prevention.

Before you joined the Department of Research & Evaluation, you worked with international nonprofit organizations to manage disease outbreaks. How did those experiences help you prepare for addressing the COVID-19 pandemic?

My international experiences working in Papua New Guinea and China were very different, but each instilled within me a mission-driven, community approach to public health which has prepared me for COVID-19 work. In 2019, I pursued an internship with a World Health Organization country office because I envisioned being tasked with high-impact and rewarding community-level projects.

Papua New Guinea truly surpassed these expectations. I was responsible for real-time monitoring of polio vaccinations during a nationwide immunization campaign. We altered data collection tools to capture reasons for unvaccinated children, enabling us to immediately contact provincial health officials to address refusals; this project revolutionized the way this was monitored nationally. I led a project to design a rapid assessment tool of pre-campaign preparation by province. We identified major weaknesses in mapping components which appeared to adversely affect the proportion of children found unvaccinated. This produced actionable insight for improved coverage during subsequent rounds.

Additionally, working in China during my MSc, I developed an appreciation for cultural awareness in epidemiology beyond data and numbers. From questionnaire design to incorporating novel analytics into study design, I assisted local researchers on a project to account for socioeconomic status in epidemiological analysis.

In summary, my prior field experiences have allowed me to take the initiative to develop studies that address important public health questions and to approach epidemiological questions with tactful creativity and a bold application of novel analytical techniques. In many ways, the COVID-19 pandemic has provided similar opportunities, but with far-reaching implications for public health at large. One example is our smartphone safety project, which involves working in partnership with CDC to develop a smartphone-based vaccine safety reporting system for all members receiving their vaccines in Southern California.

Why did you choose the Department of Research & Evaluation as part of your experience as an Epidemic Intelligence Service officer?

I was cognizant of the fact that I require additional skills to achieve large-scale impact in applied public health, which the EIS program provides opportunities to develop. However, I was looking for a position that would both offer opportunities to expand my knowledge of outbreak response whilst maintaining my skills in data analysis and epidemiology. I also wanted a position that offered opportunities to improve patient care for everyone’s benefit.

With the availability of patient medical records on a large and representative insured population, together with the wealth of available networks both through its partnerships with public health professionals and clinical partnerships with practicing physicians, Research & Evaluation is uniquely positioned to be informed of the most impactful public health questions, to address these research questions with robust science, and to provide ample opportunities to put scientific learnings into practice. For me, it was a no-brainer.

In one of your current studies, you are looking at the distribution of variants causing COVID-19 among Kaiser Permanente Southern California members. What have you learned so far?

This study is just one example of the unique opportunities available to Kaiser Permanente Southern California researchers to gain timely and actionable public health insights from patient data. In this study, we used whole genome sequencing data to investigate the distribution of variants of the SARS-CoV-2 virus (the virus that causes COVID-19) among all positive samples collected from Kaiser Permanente Southern California members during this time.

We found that infections with the delta variant increased rapidly among members from March 4 to July 21, 2021. Infections with the delta variant were more common among persons of younger age and of non-Hispanic Black ethnicity compared to other variants. Also, among unvaccinated patients, delta had an apparent increased risk of hospitalization compared with unvaccinated patients infected with other variants.

Together, these findings highlight the importance of monitoring SARS-CoV-2 variants and the need for continued preventive measures to control the COVID-19 pandemic. We recently published the results of this study in the CDC’s Morbidity and Mortality Weekly Report journal.

You worked with a regional team to develop a digital voluntary symptom reporting tool that proactively prompts members regarding COVID-19 symptoms and triages them for appropriate care via text or email. How has the tool benefited members who have used it?

This was a very exciting project that involved working with Kaiser Permanente’s IT team to evaluate the usefulness of a digital outreach system to monitor the trends in COVID-19 symptoms in Kaiser Permanente members in Washington state. The system used text- or email-based surveys to record COVID-19 symptoms remotely and to direct members experiencing symptoms towards care services.

From August 27 to September 14, 2020, 18,460 randomly selected members had been invited and 953 (5%) consented to take part. Among these members, the frequency of tests ordered almost doubled among participants over the study period. By recording symptoms in real-time and facilitating the triage of members through care services, digital health tools could directly benefit patients whilst also providing timely, flexible, and scalable methods to supplement COVID-19 surveillance.

When you are not at work, how do you enjoy spending your free time?

I enjoy many outdoorsy activities that allow me to contemplate the awesome power of nature. I especially enjoy traveling to obscure places, mountain running, and playing beach volleyball. My partner Will and I have a particular passion for running up mountains at sunrise. Also, growing up in Edinburgh, the home of the Edinburgh Fringe Festival, I had no choice but to become a keen live music and comedy enthusiast.


Photo caption:

Dr. Malden visited Yosemite National Park with her partner Will in 2021.