At IDWeek 2026, Céline Gounder's Smadel Lecture, "Crossing Lines: Infectious Diseases Careers When the Protections Fail," named two fears. The first is the fear of speaking up. The second gets less attention: the fear of standing next to someone who did.
She described scientists who lost federal jobs for objecting to political interference and then applied for positions elsewhere. Some were told they were "too hot to handle." No department chair wanted that association while salaries rode on federal grants. A virologist facing a stream of threats was called in by her university and asked whether she wanted to say something to the colleagues who had received hate mail because of her.
Few people will ever be the first voice. Anyone can be the second.
I know what it is like when the second voice doesn't come. In the fall of 2014, as a newly named IDSA spokesperson during Ebola, parts of the academic medical center that employed me wanted my media work to stop. In 2020, another academic medical center I was affiliated with asked me to remove its name from a Washington Post op-ed arguing that people would weigh COVID risk against their own values. During the COVID vaccine rollout, a third facility chastised me for being too pro-vaccine. It then had an anti-vaccine doctor on its staff speak with me.
No institution will silence me, though some may withdraw their name. I had advantages: more than one affiliation, and an IDSA role no single employer controlled. It was still a calculated risk, and I took it knowingly. I was once told that "most people fall in line." My answer was that so long as no one took my skateboard or erased my iPod, I was prepared for the consequences of not falling in line.
These episodes teach everyone watching, especially trainees. The lesson is that the institution may tolerate this person but will not stand behind them. Stay in line.
Dr. Gounder is fair to those who stay quiet. Some clinicians keep their heads down because they run clinics for patients who can't afford the attention. That is a real reason, and a trainee on a visa has real things to weigh. Weighing the cost is judgment. Never weighing it is the problem, because then fear decides before thought does.
Silence when a colleague is punished for being right is not neutral. It tells the punisher the price was worth paying, and it tells everyone else the price is real. Silence can be taken as sanction.
I have recently been told of pediatric infectious disease physicians being steered away from championing vaccine efficacy. This is happening in the middle of the largest U.S. measles outbreak in more than three decades. The reason given is that RFK Jr.'s HHS might take offense and punish the entire medical center. This is cowardice dressed as prudence. No one would accept that standard in their personal life, yet the same people enforce it in their institutional life.
During training, I was told the purpose of my fellowship was to make leaders in infectious disease. Leaders, like all individuals, should act with integrity, stand on principle, and think long-range. That holds even when betraying those commitments seems expedient, collegial, or pragmatic. It is why I have turned down prominent positions where integrity would have been treated as a character flaw.
In her introduction to the twenty-fifth anniversary edition of The Fountainhead, Rand wrote that in every generation only a few grasp the full stature of what it means to be human, while most betray it. The betrayal is not ignorance. It is knowing what one is capable of and surrendering it anyway. The same holds for our field. To be an infectious disease physician is to be a descendant of Jenner, Pasteur, Koch, Fleming, Enders, Hilleman, D.A. Henderson, and many more. I will not betray that inheritance. A physician who knows vaccines work and goes quiet to avoid offending RFK Jr.'s HHS is not confused about the evidence. He has surrendered it. That is the betrayal. One stands with Pasteur or with RFK Jr. There is no middle ground.
The second voice is powerful. The week Susan Monarez was fired as CDC director, Deb Houry, Demetre Daskalakis, and Dan Jernigan resigned. During the 2014 Ebola controversies, Pittsburgh's then-mayor posted his support for me on social media. The Pittsburgh Tribune-Review, which knew what I was facing, named me one of the Pennsylvanians to watch. Neither had to. Both mattered.
Dr. Gounder asked our field to cross lines. Not everyone will be the first to cross. But when a colleague does, stand next to them, publicly and by name. The first voice takes courage. The second takes only the refusal to stay silent.