ProMED issues ultimatum to striking moderators, as questions about site’s future persist

Striking moderators of the infectious diseases surveillance website ProMED have been given an ultimatum: Signal their interest in remaining with the program by Wednesday and return to work on Friday, or they will be considered to have “moved on” from the organization.

The moderators, subject matter experts who are paid a nominal stipend for curating and contextualizing the numerous infectious diseases reports ProMED posts to its website and pumps out to its mailing list daily, have been on strike since early August.

The decision to stop work was in protest of plans announced in mid-July by the International Society of Infectious Diseases to convert ProMED into a subscription service, putting its valuable archive behind a paywall. The move is part of an effort to shore up the site financially, and the ISID said, to stop others from scraping ProMED data, which they then monetize.

The moderators, whose stipends are in arrears, were not consulted about the plan to move to a subscription model and most object to the idea. Furthermore, they have signaled they have lost confidence in the administration of the ISID, which has struggled to raise the money to operate ProMED, and believe it is time for the venerable public health program to find a new home. (Their posting announcing the strike was quickly removed from the ProMED website, but can be read here.)

In an email on Friday, Julia Maxwell, director of disease surveillance for the ISID, told the moderators that those who wish to stay with ProMED needed to inform ISID staff of their intent by 5 p.m. EDT Wednesday.

“For anyone we do not hear from by Wednesday, August 30th by 5PM ET., we will assume you have elected to move on from ProMED and we wish you the very best. For those who choose to recommit to ProMED, we plan to have September 1st be our first day back at ‘full’ capacity with those members of the team who remain,” Maxwell wrote in the email, which was seen by STAT.

STAT sent an email to Maxwell, asking what would happen if moderators indicated they intended to remain with ProMED, but were not willing to resume work on Friday. Maxwell did not reply.

ISID CEO Linda MacKinnon, who was cc’d on the email, did, however, though she did not answer the question.

Instead, MacKinnon acknowledged the striking moderators and the ISID differ on some plans for modernizing ProMED, but she said the changes were “necessary for the continued viability of the program.”

“We have deep respect for them and are fortunate that many are experts in their fields. We hope that they will continue to consult with us as we modernize the model, and we are committed to entering September with a strong program in order to provide continued leadership in the international disease outbreak surveillance space,” she wrote.

Paul Tambyah, chair of the ISID’s executive committee — its equivalent of a board — would not comment on whether the executive committee supported the ultimatum, saying the committee “does not interfere in the management of the major programs of the society such as the Journals or ProMED.”

The ISID publishes three open access journals: the International Journal of Infectious Diseases, IJID Regions, and IJID One Health.

Strike organizers held two open sessions on Saturday for all moderators — those who are striking and those who remain at work — to discuss the ISID’s ultimatum. Some questioned whether the society was on the necessary footing to make this type of demand.

“It’s absurd and unconscionable for ISID to give this kind of ultimatum to its subject matter experts and content creators when it hasn’t even paid them yet,” Leo Liu, associate editor, told STAT.

Liu said it isn’t clear yet what the striking moderators will do, and in fact it is unlikely all the strikers will make the same decision about whether or not to return to work on Friday.

But Liu said he thinks that regardless, the strike will have the desired effect, leading eventually to ProMED finding another home.

“I think the wheels have been set in motion already and there’s enough momentum here that I think it would be pretty hard to stop,” he said. “Whether it’s now, or whether it’s in six months or whether it’s in 12 months, I think there’s a recognition that the best future for ProMED would be in an … academic consortium rather than a single medical society.”

ProMED — short for the Program for Monitoring Emerging Diseases — was started in 1994 by several academics as a network through which scientists could interact. But the network grew with the expanding use of the Internet and in 1999, it entered an agreement with the ISID, which has been its home ever since.

One of the key features of the program is that it does not rely solely on information provided by governments, which often have vested interests in playing down emerging disease outbreaks. In addition to monitoring news from official sources and the media, it accepts and vets tips from scientists and others around the globe whose identity can remain hidden from ProMED readers.

ProMED alerted the world to disease activity in Guangdong, China, that became the 2003 SARS outbreak. The first report of MERS, a disease caused by a camel coronavirus that pops up sporadically on the Arabian Peninsula, was published in 2012 by ProMED. And it was one of the first outlets to pick up on the outbreak in Wuhan, China, that went on to trigger the Covid-19 pandemic.

Despite its track record, ISID has struggled to raise the funding needed to maintain ProMED. John Brownstein, who leads a team that developed and runs a complementary disease surveillance program, HealthMap, understands the challenge well.

“It is very hard to get core operational support for public health systems,” said Brownstein, who is chief innovation officer at Boston Children’s Hospital.

“Funding is very transient. It’s obviously so dependent on what is happening in the world. In times of crises, public health crises, there’s a lot of funding. It gets unlocked. … You sort of live and die by public health emergencies. It’s a really tough way to exist.”

But Brownstein doesn’t see a subscription service as the answer. “At the individual level, it’s a very hard thing to navigate,” he said.

Tambyah and others have said a number of possible suitors have come forward to try to find a way to salvage the program. “We have received more serious offers of help in the last month than in the last two years as far as I know. Some of these are advancing significantly and we hope to be able to share positive news with the wider ProMED community soon,” wrote Tambyah, a professor of medicine at the National University of Singapore.

The suitors are also in discussions with the striking moderators, who are the core of the program. News aggregators are not rare. But programs that contextualize events in the way that ProMED does are.

Brownstein said that it would be easy work to recreate a platform that aggregates the type of news ProMED disseminates. But what is not replaceable is the moderators’ expertise.

“The value that ProMED will continue to have even with the rise of automation and AI is the contextualization,” he said. “You need the knowledge, the deep knowledge, the long history of knowledge…. And then be able to go to colleagues you have around the world and check that.”

“There’s limited value in just repurposing news. You need that expertise.”