ChairmanH.R.ShepherdHonoredatGWUniversityCommencement HonoraryDegreeRecognizesH.R.Shepherd’sAchievementsinScienceandIndustry Continuedonpage4. Cardinal Theodore E. McCarrick was installed at the beginning of this year as the Archbishop of Washington, serving the more than half million Catholics in the area of the nation’s capital; he was subsequently named cardinal. During a visit this past summer at the archbishop’s residence, Sabin Vaccine Institute (SVI) Chairman H.R. Shepherd and Peter J. Hotez, MD, PhD, SVI senior fellow and scientific advisory council chair and chair of The George Wash- ington University’s Department of Microbiology and Tropical Medi- cine, had the opportunity to intro- duce Cardinal McCarrick to the work of the Institute, especially the VaccineDiplomacyExploredwithWashington’sCardinalMcCarrick PeterJ.Hotez,MD,PhD,andH.R.ShepherdPayVaccineDiplomaticVisittoProminentCatholicCleric Hookworm Vaccine Initiative that stands to benefit millions worldwide. Cardinal McCarrick has over the years maintained a particular interest in the poorest of the SabinVaccine ThenewsletteroftheAlbertB.SabinVaccineInstitute —dedicatedtodiseaseprevention www.sabin.org R EPORT Continuedonpage4. VolumeIV,Number2 Fall2001 poor living in the developing nations of the tropics. Amid his pastoral duties, Cardinal McCarrick has served as a human rights advocate and has surveyed the humanitarian needs in China, Viet- nam, the Philippines, Korea, Rwanda, and Burundi. He was previously president of the Catho- lic University of Puerto Rico in Ponce and served on numerous committees that addressed refu- gee and peace issues in the Trop- ics. As such, the Cardinal’s work and that of the Sabin Vaccine In- stitute share a common goal. “Hookworm infection is a major Fromleft,SabinVaccineInstituteChairmanH.R.Shepherd, CardinalTheodoreMcCarrick,andPeterHotez,MD,PhD. H. R. Shepherd, Sabin Vaccine Insti- tute chairman, celebrated his 80th birth- day on May 20 in a most unusual way. From the commencement platform set up on the Ellipse adjacent to the White House, Stephen Joel Trachtenberg, presi- dent of The George Washington Univer- sity (GW), presented him with an hon- orary doctorate of science degree. Shepherd is an adjunct professor in the Department of Microbiology and Tropi- cal Medicine at GW’s School of Medi- cine and Health Sciences. Sabin senior fellow and scientific advisory council chair, Peter Hotez, chairs the GW de- partment, where he heads the research team for the Institute’s Hookworm Vac- cine Initiative. At the commencement ceremony, the university honored Shep- herd for his many contributions to sci- ence and industry. He has 50 years of experience in the pharmaceutical indus- try and is a renowned expert on aerosol medications. He holds several patents on aerosol products and spearheaded the development of the metered-dose inhaler for asthmatics. Before becoming chairman of the In- stitute, Shepherd was chairman and chief executive officer of Armstrong Pharmaceuticals. Shepherd is a member of the National Academy of Sciences Presidents’ Circle, heading its library out- reach program. He received his Bach- elor of Science degree from Cornell Uni- versity in 1943 and an Honorary Doc- torate of Letters from Villanova Univer- Inside Viewpoint .................. 2 SIVVaccineAsHIVVaccineModel .... 5 VaccinesforPeaceProposal ....... 6 HealthasGlobalSecurityChallenge ... 7 SVIAwardsatIntel2001ScienceFair .. 8 BookReview ................ 10 Days of Tranquility ............. 11 ColloquiaProceedingsPublished ..... 12 SVI Salutes ................. 13 SVIFellowPublishes BigShot ...... 14 SabinInstituteNews ............ 15 Calendar .................. 16 T HEME OF T HIS I SSUE : V ACCINE D IPLOMACY
Transcript
Chairman H.R. Shepherd Honored at GW University CommencementHonorary Degree Recognizes H.R. Shepherd’s Achievements in Science and Industry
Continued on page 4.
Cardinal Theodore E. McCarrick wasinstalled at the beginning of this year asthe Archbishop of Washington, servingthe more than half million Catholics inthe area of the nation’s capital; hewas subsequently named cardinal.During a visit this past summer atthe archbishop’s residence, SabinVaccine Institute (SVI) ChairmanH.R. Shepherd and Peter J. Hotez,MD, PhD, SVI senior fellow andscientific advisory council chairand chair of The George Wash-ington University’s Department ofMicrobiology and Tropical Medi-cine, had the opportunity to intro-duce Cardinal McCarrick to thework of the Institute, especially the
Vaccine Diplomacy Explored with Washington’s Cardinal McCarrickPeter J. Hotez, MD, PhD, and H.R. Shepherd Pay Vaccine Diplomatic Visit to Prominent Catholic Cleric
Hookworm Vaccine Initiative that standsto benefit millions worldwide. CardinalMcCarrick has over the years maintaineda particular interest in the poorest of the
Sabin Vaccine
The newsletter of the Albert B. Sabin Vaccine Institute —dedicated to disease prevention www.sabin.org
REPORT
Continued on page 4.
Volume IV, Number 2Fall 2001
poor living in the developing nations ofthe tropics.
Amid his pastoral duties, CardinalMcCarrick has served as a human rights
advocate and has surveyed thehumanitarian needs in China, Viet-nam, the Philippines, Korea,Rwanda, and Burundi. He waspreviously president of the Catho-lic University of Puerto Rico inPonce and served on numerouscommittees that addressed refu-gee and peace issues in the Trop-ics. As such, the Cardinal’s workand that of the Sabin Vaccine In-stitute share a common goal.“Hookworm infection is a major
From left, Sabin Vaccine Institute Chairman H.R. Shepherd,Cardinal Theodore McCarrick, and Peter Hotez, MD, PhD.
H. R. Shepherd, Sabin Vaccine Insti-tute chairman, celebrated his 80th birth-day on May 20 in a most unusual way.From the commencement platform setup on the Ellipse adjacent to the WhiteHouse, Stephen Joel Trachtenberg, presi-dent of The George Washington Univer-sity (GW), presented him with an hon-orary doctorate of science degree.
Shepherd is an adjunct professor in theDepartment of Microbiology and Tropi-cal Medicine at GW’s School of Medi-cine and Health Sciences. Sabin seniorfellow and scientific advisory councilchair, Peter Hotez, chairs the GW de-partment, where he heads the researchteam for the Institute’s Hookworm Vac-
cine Initiative. At the commencementceremony, the university honored Shep-herd for his many contributions to sci-ence and industry. He has 50 years ofexperience in the pharmaceutical indus-try and is a renowned expert on aerosolmedications. He holds several patents onaerosol products and spearheaded thedevelopment of the metered-dose inhalerfor asthmatics.
Before becoming chairman of the In-stitute, Shepherd was chairman andchief executive officer of ArmstrongPharmaceuticals. Shepherd is a memberof the National Academy of SciencesPresidents’ Circle, heading its library out-reach program. He received his Bach-
elor of Science degree from Cornell Uni-versity in 1943 and an Honorary Doc-torate of Letters from Villanova Univer-
I nsideViewpoint .................. 2SIV Vaccine As HIV Vaccine Model .... 5Vaccines for Peace Proposal ....... 6Health as Global Security Challenge ... 7SVI Awards at Intel 2001 Science Fair .. 8Book Review ................ 10Days of Tranquility ............. 11Colloquia Proceedings Published..... 12SVI Salutes ................. 13SVI Fellow Publishes Big Shot ...... 14Sabin Institute News ............ 15Calendar .................. 16
Hookworm in the Catholic WorldPredominance of Catholics Live in the Developing World, Amid the Greatest Threat
Most of the world’s one billion cases ofhuman hookworm infection occur whererural poverty intersects with the warm andmoist climates of the tropics. While hook-worms, like other infectious pathogens thatplague humans, do not respect national, eth-nic, or religious boundaries, it is of interestto consider the vulnerability of certaingroups of people to these blood-feeding hel-minth parasites. Our recent visit to Arch-bishop of Washington, D.C., CardinalTheodore McCarrick, gave me pause toreflect on the predominance of Catho-lic populations who live in the devel-oping nations of the tropics and theirrisk for acquiring hookworm infection.
Large numbers of Catholics comprise thepopulations of Sub-Saharan Africa. Inci-dence of hookworm infection occurs in analarming percentage of the 24 millionCatholics living in Congo; 13 millionCatholics living in Nigeria; 10 millionCatholics in Uganda; seven million Catho-lics in Angola; two to three million Catho-lics living in Cameroon, Cote d’Ivoire,Ghana, Madagascar, Mozambique,Malawi, Rwanda, Sudan, and Zambia; andthe estimated one million Catholics livingin Benin, Burkina Faso, Zimbabwe, andTogo (demographics are from the 2001Catholic Almanac). Similarly, many of theestimated 61 million Catholics who live inthe Philippines and the five million livingin Vietnam are at risk for hookworm infec-tion, where the species Necator americanusis highly endemic. In the Western Hemi-sphere, hookworm is ubiquitous in the ru-ral tropical regions of South America, in-cluding Venezuela, Guyana, Suriname,Brazil, Colombia, Peru, Bolivia, and north-ern Paraguay and Argentina. Catholicsmake up 80 percent or more of the popula-tions who inhabit these regions.
For the last year, we have been workingto establish a field site in Central Americaas part of our Human Hookworm VaccineInitiative (HHVI). Hookworm is endemicthroughout Central America, but particu-larly in regions where there are high levelsof rural poverty. As a nation, Hondurasstands out, not only for its hookworm prob-
lem, but also other endemic tropical infec-tious diseases such as leishmaniasis, den-gue, and Chagas disease. Hookworm is acommon problem among the 6.2 millionpeople living in Honduras, 5.7 millionCatholics among them.
Adding to the mix of poverty and dis-ease was the misery created in 1998 byHurricane Mitch, in which more than 6,000Hondurans perished and more than 2 mil-lion evacuated their homes. Workingclosely with the Catholic Church, the FirstLady of Honduras, Mary Flores, has madeheroic efforts to improve the health infra-structure of her country. For the past year,she has championed a state-of-the-artChildren’s Pediatric Specialty Hospital lo-cated in Tegucigalpa. From the Universityof Pennsylvania, we recently recruitedMaria Elena Bottazzi, PhD, to the HHVI,who will conduct enzymology research ona new class of hookworm antigens discov-ered in our laboratories. Dr. Bottazzi is anative Honduran who aspires to somedaydirect a research program in the Children’sHospital. In August, I visited Honduras withDr. Bottazzi in order to establish an epi-demiologic field site in that country. Ournascent efforts were funded by a gener-ous grant from the Central AmericanBank for Economic Incentives (CABEI),and could serve as a basis for beginninghookworm vaccine clinical trials in Hon-duras. Along with Allan Goldstein, PhD,of SVI’s board of trustees, we also areexploring similar efforts in Panama.
The Archbishop of Washington, D.C.,shares our deep concern for the plight ofall of the poorest of the poor, both Catholicand non-Catholic, living in the world’s“hookworm belt.” We share with Cardi-nal McCarrick a commitment to workon this important public health problem.
—by Peter J. Hotez, MD, PhD, FAAP
Peter J. Hotez, MD, PhD, is professor and chairof microbiology and tropical medicine at TheGeorge Washington University, and senior fel-low of the Sabin Vaccine Institute. He also is visit-ing professor, Institute of Parasitic Diseases, ofthe Chinese Academy of Preventive Medicine.
VIEWPOINT
ASSOCIATE EDITORVeronica Korn
COPY EDITORDavid Bedell
OFFICERS OF THE SVI BOARD OF TRUSTEESH. R. Shepherd, ChairmanWilliam R. Berkley, Co-ChairmanMichael E. Whitham, Esq., Treasurer
SVI STAFFDon L. Douglas, President & CEOFran G. Sonkin, Executive Vice PresidentRaymond MacDougall, Director of
CommunicationsRobert Milanchus, Director of
DevelopmentPaul J. Vilk, RPh, RAC, Director of
Program Management and RegulatoryAffairs, Hookworm Vaccine Initiative
David Bedell, Executive Assistant tothe Chairman
Veronica Korn, Research AssociateChristel Lane, Receptionist/Staff AssistantGboku Lumbila, Executive Assistant,
Hookworm Vaccine InitiativeEdward Smith, Information Coordinator
and LibrarianSerge Valcourt, AccountingVanessa Santiago, Research Assistant
SVI ASSOCIATES
Philip K. Russell, MD, Senior Advisor tothe Chairman
Peter J. Hotez, MD, PhD, Senior Fellow& Chair, Scientific Advisory Council
The events of Septem-ber 11 changed our worldin ways we cannot evenyet fully comprehend. Aswe try to recover from thetragic loss of life andproperty, we also face therealization that the worldis suddenly a far more dangerous placethan it seemed to be just a few weeksago. In the process of getting back towork on vaccines, our effort to savelives take on greater importance be-cause it gives us the opportunity todemonstrate to the world how sciencecan be used in a positive way to alle-viate suffering and, in particular, howvaccines contribute to making theworld a safer, more stable place to live.
This is precisely the point we are try-ing to make with this issue of the SabinVaccine Report, which is devoted tothe subject of vaccine diplomacy—an issue of even greater relevance now,given the terrorist attacks on the WorldTrade Center and the Pentagon. SabinSenior Fellow Peter Hotez, MD, PhD,and other scholars have been studying
A Letter fromthe President
the underlying causes ofconflict and they are ableto establish a link betweena lack of healthcare and agiven country’s proclivityto enter into conflict. In hisstudy entitled “Contagionand Conflict,” MichaelMoodie, president of theChemical and BiologicalArms Control Institute,supports this thesis. Our
own Sabin Trustee Michael Osterholmwrites about the potential threat of bio-logical terror in his book, Living Terrors.We begin exploring these frighteningand important issues in this fall editionof the Sabin Vaccine Report.
While the topic of vaccine diplomacyhas been an interest of the Institute forsome time, we are also now taking upthe question of how the Institute can helpfind solutions to the threat of biologicalterrorism. We are working toward hold-ing a meeting on this topic early in 2002if we determine that it will help advancethe policy dialogue on this crucial issue.
There are several new sections in thisedition of the newsletter to which Iwould like to draw your attention. Weare initiating a primary theme for the is-sue, and want to encourage you to share
your thoughts in a feedback column thatwill appear henceforth on these pages.We are also recognizing excellence invaccine-related work in the profile ofDr. Bruce Gellin, director of the Na-tional Network for Immunization Infor-mation (see page 13), and in laudingthose organizations, such as Wal-Martand its use of its parking lots for immu-nization sessions (see page 13), whohave made special or unique contribu-tions to the field of immunization.
We look forward to seeing some ofyou at next month’s Sabin VaccineColloquium at Cold Spring Harbor (9-11 October) on “Making Vaccines forthe Developing World: Access to andDeployment of New Technologies”.The winter issue of the Sabin VaccineReport will cover these important dis-cussions.
Your feedback is truly welcome; doprovide us with your thoughts on howwe can better serve the needs of theimmunization and vaccine community.
During 35 years aschairman of a publiccompany (ArmstrongPharmaceuticals, laterMedeva) devoted tosaving lives through
the development of a metered-doseinhaler for asthma, it was a chal-lenge for me not only to achievethe mission of producing inhalers,but also to make a profit for thestockholders who believed in whatwe were doing. That company stillexists, and the chief operating of-ficer is my son Ben Shepherd. It isproducing more inhalers than everbefore, carrying on the work westarted over 40 years ago.
loquia at Cold Spring Harbor havemade a real impression on deci-sion makers in the public sector,private sector, and academia andhave resulted in a number of influ-ential publications. Our cancer col-loquia at Walker’s Cay has beenimportant to cancer researchersand we hope to continue this se-ries. We have become the recipi-ent of an $18-million grant fromthe Gates Foundation for the de-velopment of a hookworm vac-cine, and that initiative has justcompleted a very successful firstyear. We have awarded nine SabinGold Medals to recognize great vac-cine scientists, and we are on the
verge of forming a Sabin ScholarsProgram with these scientists as itsguiding vision. The creation andcontinuation of each of these en-deavors has been an extraordinarychallenge for the Institute, and wehave met these challenges with adegree of success that still aston-ishes me.We are now at a critical point in
our development, institutionalizingthe administration of all these pro-grams under a professional staff. InApril we hired a full-time presidentand CEO, Don Douglas, who cameto us after 15 years as country di-rector and Asia regional advisor
Advancing the Mission of the Sabin Vaccine Institute—A Message from the Chairman
I took on a second challengeabout eight years ago when HeloisaSabin and I decided to create theAlbert B. Sabin Vaccine Founda-tion, now the Sabin Vaccine Insti-tute. Most of our readers are wellaware of our success to date, firstmade possible by the wisdom ofHeloisa in allowing us to use theSabin name and by the efforts ofour co-founders, namely Dr. BobChanock and Dr. Phil Russell, andour early board members, Dr. EdNeiss, Lew Miller, Nancy Hargrave,and Fenmore Seton. All these indi-viduals made it possible to get towhere we are now.And where are we now? Our col- Continued on page 13.
FALL 2001 SABIN VACCINE REPORT4
H.R. Shepherd Honored with GW DegreeSabin Chairman Encourages GW Graduates to Dedicate Energy Towards Resolution of a Moral Outrage
sity in 1973 for his contributions in ex-ploring the frontiers of aerosol technol-ogy. Since founding the Sabin VaccineInstitute in 1993, he has been a tirelessadvocate for the advancement of vac-cine science and public health policy.
Also receiving GWhonorary degreeswere Pulitzer Prize-winner Herman Wouk,entertainer TonyBennett, National Sym-phony Orchestra di-rector Leonard Slatkin,and National ScienceFoundation DirectorRita Colwell, amongothers.
Trachtenberg ac-knowledged Shepherdand the other honorees,saying, “As our gradu-ates look to the future,they would do well totake their cues fromthese masters of theirprofessions. All of ourhonorees have left in-delible imprints on land-scapes ranging fromour local community tothe world stage.”
In Shepherd’s remarks to the students,he said, “Coming and being involved withGeorge Washington University was anextraordinary experience for me. It’s astory that should be told in a very dra-matic document, which some day I hopeyou will hear about.
“It’s because ofThe GeorgeWashington Uni-versity, it’s be-cause of SteveTrachtenberg, SkipWilliams, and theother members ofthis university thatmade it possiblefor the Sabin Insti-tute to get an $18million grant to de-velop a hookwormvaccine and madeit possible for us tomove an extraor-dinary group ofscientists from avery prestigiousuniversity, Yale,that didn’t knowany better and letus bring it toGeorge Washing-ton University, and
they are already making extraordinaryprogress. For this I am thankful, youshould be thankful, and I am very, verypleased to be here. I just want to saytwo things to you: Pick a moral outrageand work on it.”
Continued from page 1
scourge among the poorest Catholicpopulations in Asia, Africa, and LatinAmerica,” Hotez said. “It robs both chil-dren and adults of their health and vigor.Our efforts to make a hookworm vac-cine, as well as the efforts of some ofthe other vaccine initiatives would havetheir most immediate and significant im-pact on these populations.”
“Cardinal McCarrick is clearly a manof extraordinary compassion and gentle-ness and our meeting was certainlymemorable and informative,” Shepherdsaid. “We had the opportunity to intro-duce Cardinal McCarrick to our impor-tant vaccine initiatives, which have apotential for making a critical humani-tarian impact in the world and may someday change the course of human his-tory.”See the ViewPoint column on page 2 for
“Businessman, inventor, chemist,philanthropist, citizen: you set anambitious course for your life andsucceeded in ways that enhanced thelives of millions. You founded theAlbert B. Sabin Institute to honor thememory of your friend, encourageresearch and advocacy for newvaccines to prevent deadly diseases,and improve the worldwidedistribution of these medications.Your longstanding effort to be ofmaximum service to your fellow man isan inspiration and your dedication to‘real world’ problems is uplifting. Foryour leadership for over 50 years in thepharmaceutical industry and yourpioneering work in vaccine research,The George Washington Universityhereby awards you the degree of Doctorof Science honoris causa on your 80th
birthday.”—Excerpt of statement by GW
President Stephen Joel Trachtenbergrecognizing H.R. Shepherd with
Honorary GW Degree
Albert B. Sabin Vaccine Institute proudly sponsored its first sports team, The Bears, of Stamford,Connecticut, a t-ball team comprised of 4 to 6 year olds (Aaron Santiago is seated with hat reversed)!
Sabin Vaccine Institute Sponsors T-Ball Bears
H.R. Shepherd addresses 2001 graduates ofThe George Washington University.
5
Sabin Poliovirus Vectors Engineered to Vaccinate Against Simian Immunodeficiency VirusBreakthrough Could Serve as Model for a Human AIDS Vaccine
The Sabin live poliovirus vaccine is oneof the most effective human vaccinesever developed. Over one billion vacci-nations have proven it safe, inexpensiveto produce, and it has been distributed glo-bally. The Sabin vaccine elicits long-last-ing immunity in individuals and collec-tive immunity in communities. To add toits success, exciting results reported inthe August 2001 Journal of Virologysuggest that an anti-Simian Immunodefi-ciency Virus (SIV)vaccine based on theSabin poliovirus vector promises an ap-proach for developing a vaccine for theprevention of HIV.
Why the Sabin Vaccine?A research team at the University of
California at San Francisco, led by RaulAndino, PhD, focused on the Sabin vac-cine because it produces a potent mu-cosal immune response. Human immu-nodeficiency virus (HIV) infection,which causes AIDS, is transmitted bysexual intercourse in more than 80% ofinfections worldwide, thus a strong mu-cosal immune response is desirable foran anti-AIDS vaccine. Most currentanti-AIDS vaccine candidates targetonly the cellular-based immune response.
Monkeys were chosen as the experi-mental test system because they are theonly nonhuman primates, other thanchimpanzees, infected by SIV via themucosal route. The oral poliovirus (OPV)vector was chosen because of its safety,
eters. They all produced substantial anti-SIV antiserum and mucosal antibody re-sponses. SIV-specific cytotoxic T-lympho-cyte responses were also detected in threeof the seven. Two of the seven were com-pletely protected from SIV. The othersshowed a pronounced reduction in vire-mia, indicating that the vaccine elicited aneffective cellular immune response.
According to Dr Andino, this study high-lights the “proof of concept to approach.”No other AIDS vaccine concept elicitsprotective mucosal immunity, and at thistime no arm of the adaptive immune sys-tem can be ruled out as a critical compo-nent of an AIDS vaccine.
The Sabin recombinant vaccine(SabRV) doses used in this study arecomparable to normal Sabin oral polio-virus vaccine doses used for infants,children, and adults. Andino believes aSabRV would be substantially more effi-cacious in humans, because Sabin virusesare several orders of magnitude more in-fectious in people than in monkeys, andalso replicate more effectively in people.This would generate a significantly stron-ger immune response to SabRV-ex-pressed antigens in humans than in theexperimental monkeys. Andino believesthat SabRVs have exciting potential as hu-man vaccine vectors, and that vaccina-tion with an array of defined antigenic se-quences—a cocktail of multiple HIV an-tigens—could be used to protect againstdiverse HIV strains.
Andino foresees engineering SabRVto carry HIV antigens. These experi-mental vaccines will then need to betested in human phase 1 and phase 2clinical trials. There are major produc-tion, legal, and regulatory issues involvedin the design and execution of clinicaldrug trials, but the world has 50 years ofexperience with the Sabin oral polio vac-cine as safe for the individual and forthe environment, affordable, efficacious,and stable for transport and distribution.
—by Phyllis B. Moses, PhD
Phyllis B. Moses, PhD is senior fellow atSVI’s New Canaan office.
The live poliovirus vaccine, legacy of Albert B. Sabin (shownabove) continues to have utility and innovative applications.
affordability, stability, and ease of trans-port and administration. Oral administra-tion is particularly important to obtaingood mucosal immunity in order to con-trol SIV (or HIV) infection, and to pre-vent chronic infection.
Experimental StrategyBecause the OPV vector is too small
to clone an entire SIV (or HIV) virus,and researchers do not yet know which
SIV (or HIV) genesor antigens are es-sential to vaccinesuccess, Sabin 1 and
Sabin 2 strain vectors were used tomake a vaccine library consisting of 20viruses, each with a little piece of theSIV genome. A mixed cocktail of all 20Sabin recombinant vaccines (SabRV)was given to the experimental set. Firstthe Sabin 1 vaccine cocktail was admin-istered. It was followed 20 to 22 weekslater with the Sabin 2 vaccine cocktaildesigned to boost immunity.
The monkeys produced secretory im-munoglobulins IgG & IgA for mucosalimmunity. The researchers next waited10 weeks for this immunity to peak andthen decline, mimicking the real worldsituation where protection from infectionwould rely on vaccine “memory immu-nity” or “baseline immunity.”
The subjects were then infected withSIV via the vaginal (mucosal) route. Sevenexperimental monkeys were challengedtwice each, with high doses of a virulentSIV strain. The doses were 100 times
higher than a normal infection,because the researchers neededto ensure that all experimentalmonkeys became infected.Twelve who had not been giventhe anti-SIV vaccine cocktailswere similarly challenged withthe virulent strain of SIV.
Striking ResultsAll 12 control animals devel-
oped SIV infections; three de-veloped clinical AIDS within 48weeks. In contrast, the sevenvaccinated subjects remainedhealthy by all clinical param-
dedicated to disease prevention www.sabin.org
NEWS FROMTHE BENCH
FALL 2001 SABIN VACCINE REPORT6
The 1990s saw significant develop-ments in the area of vaccine supply.Many Western vaccine producers wereabsorbed by pharmaceutical companies.Focus was on the bottom line, rather thanthe provision of vaccines at prices withinthe reach of poor countries, and still lessthe development of new vaccines againstdiseases prevalent in those poor countries.
Even in the United States recently,there have been shortages of meningitisvaccine and tetanus toxoid that are linkedto price increases. There also are short-ages of yellow fever vaccine. The ad-enovirus vaccine used by the U.S. mili-tary is no longer produced in the coun-try, resulting in a predictable increase inmorbidity and mortality among recruits.
With the collapse of the Soviet Union,many of its vaccine-producing institutesfound themselves in newly independentrepublics with no staff or funds to con-tinue production, while its biowarfare re-search scientists found themselves outof jobs. Coincidentally, in Geneva, techni-cal experts were looking for ways tostrengthen the Biological Weapons Con-vention (BWC), demilitarize the ex-Sovietcountries, and use the skills of those re-search scientists for peaceful purposes.
In that context, the concept of “dual-threat” agents—pathogenicmicroorganisms that occurnaturally and cause diseasein humans, animals or plants,but which, at the same time,have the potential for use inbiowarfare or bioterror (BW/BT)—was introduced.
Out of concerns aboutdual-threat agents came theidea of Vaccines for Peace(VfP). The mission of VfPwould be to produce dual-threat-agent vaccines not
The Vaccines for Peace ProposalMotivating the Production of Vaccines Against Dual-Threat Agents
being produced by other programs, un-der conditions of full transparency, foruse by both military and civilian popula-tions. Transparency would be achievedby having scientists from developingcountries participate fully in the programinside converted ex-Soviet military andcivilian institutes. Those institutes alreadywere equipped to produce large quanti-ties of microorganisms under safe con-ditions, and could easily be converted toproduce vaccines.
VfP was welcomed by both the Thirdand Fourth Review Conferences of theBWC as an incentive for developingcountries to join and support the Con-vention. It would give them access tomodern vaccine technology, in addition toproviding transparency into the researchprograms of former biowarfare institutes.Current funding for military vaccine re-search would be diverted to supportthese transparent institutes.
An objection to VfP was that defenseappropriations for vaccine research anddevelopment were not to be used for vac-cines that also would be used by civil-ians. A countervailing argument is thatmilitary, including peacekeepers, on ac-tive duty in developing countries are of-ten called upon to live in conditions ap-
proximating those ofthe local people, soit obviously is in themilitary’s interest todevelop protectionagainst locally en-demic diseases. Ad-ditionally, currentU.S. BW/BT con-cerns are increas-ingly focused on ci-vilian protection. Un-der current projec-tions, there is a need
to produce and stockpile, for both civilianand military use internationally, much moreanthrax, smallpox and yellow fever vac-cine.
Another objection is that the nationalright of states to self-defense allegedlywould be compromised by VfP, since allmilitary vaccine development would beconducted under conditions of transpar-ency. For instance, a particular state maywish to improve its self-defense by vac-cinating its military against an agent thatis not in the VfP program. It also hasbeen argued that the vaccines given to acountry’s military should be a state se-cret, since a potential adversary wouldotherwise know in advance againstwhich agents the opposing forces wereprotected. But these arguments can beturned on their heads. A state claimingthe right to develop its own vaccine inconditions of secrecy will inevitably besuspected of doing so in order to protectits own troops against an offensiveweapon it is clandestinely developing.Furthermore, the knowledge by a poten-tial aggressor of the immune status ofopposing troops would complicate, ratherthan simplify, the aggressor’s plans be-cause the immunizations would logicallybe against the most common, easy toweaponize, BW agents. Trying to cir-cumvent such protection would involveresearch and development of muchmore difficult organisms.
Vaccines for Peace would not only pro-tect the military and civilians against pos-sible BW/BT, but also provide protec-tion for large populations suffering fromendemic diseases for which no vaccinesare currently being produced, and which,given the accelerating globalization of in-fectious diseases, may soon be importedand start to spread in non-endemic coun-tries (e.g. West Nile virus in the UnitedStates). VfP is thus a worthy object ofsupport by both defense and foreign aidfunds—all it needs is a sponsor.
—by Jack Woodall, PhD
Jack Woodall, Federal University of Rio de Janeiro,was leader of the World Health Organization’s del-egation to the Third Review Conference of the Bio-logical Weapons Convention in Geneva. He is founderof ProMED-mail. [email protected]
Since the collapse of the Soviet Union,changes in the international system havegiven rise to novel national securitythreats, the implications of which are notfully appreciated. The national securitydimensions of health issues are a goodexample of such a threat.
Former United Nations Secretary Gen-eral Boutros Boutros-Ghali, in his1992report, Agenda for Peace, makes thepoint that, “Drought and disease candecimate no less mercilessly than theweapons of war.” Research since thattime suggests a relationship between de-clining health indicators and a reducedcapacity to govern. A deteriorating na-tional health profile could• reduce the healthy labor pool;• undermine agricultural output, diminishfood supplies, and increase vulnerabilitiesto infectious diseases created by poor nu-trition;
• reduce industrial productivity through in-creased absenteeism and higher workerturnover, ultimately impeding economicdevelopment;
• reduce family income and drain savings asfamilies provide for ill members;
• further strain fragile government institutionsas they try to provide care and sustenanceto a growing number of the afflicted;
• reduce the pool of political leaders, as wellas military and police recruits, diminishingthe ability of the state to maintain order;and
• add to a feeling of hopelessness and despair.Ultimately, declining health is one fac-
tor that exacerbates tensions and con-tributes to an environment conducive tothe eruption of violent conflict.
Countries of particular concern includeRussia, China, and India, whose size,strategic importance, nuclear capabilities,and worrisome health trends give themspecial international importance. Healthindicators in Russia—maternal and in-fant mortality, life expectancy, fertility—
dedicated to disease prevention www.sabin.org
have declined precipitously over the lastdecade, while risky social behaviors suchas intravenous drug use, alcoholism, andprostitution exacerbate this negativehealth spiral. China’s and India’s HIV/AIDS epidemics are only just being dis-covered. In China where until recentlythe government denied anHIV/AIDS problem existed,600,000 people are nowknown to be infected, and astesting and reporting becomemore common this number islikely to grow several fold.Likewise, 3.7 million (a con-servative estimate) are in-fected in India. Given that cul-tural taboos discourage test-ing, reporting, or educationabout HIV-related illnesses in both coun-tries, and since neither country can af-ford expensive treatments used to con-trol the disease in the West, their HIVtransmission curves are likely to continueto climb steadily for some time before theyflatten or begin to decline. Combined withother infectious disease threats, non-com-municable health problems, immense so-cial burdens, and the pressures that thesefactors will place on social and politicalcohesiveness, these countries could be-come sources of regional instability.
Health issues are now an integral partof many of the ethnic and other civil con-flicts confronting the international com-munity. In some instances, the negativesynergy of infectious diseases, disrup-tive population movements, environmen-tal degradation, weak government struc-tures, and long-standing grievancesmanifests itself in “complex humanitar-ian emergencies.” Complex humanitar-ian emergencies highlight the inability ofa government to maintain civil order orprovide basic human needs to its people.In these cases, where the intense inter-action of starvation, sickness and disease,and violence takes place, the outcome is
usually extremely lethal.Unlike traditional security challenges,
the solutions to problems at the nexus ofhealth and security will not be found instraightforward applications of militarypower; rather, they will require cross-sector partnerships involving nationalgovernments and industry, the nationalsecurity, medical and public health, sci-entific, developmental, relief, and aca-demic communities, among others.Health crises, like so many novel secu-rity threats, are enormous challenges that
require nontraditional part-nerships, a wide variety ofexpertise, and creativestrategies to respond effec-tively.
Truly leveraging health topromote stability requiresbalancing altruism and self-interest, charity and strat-egy. The newly establishedGlobal AIDS Fund repre-sents a unique opportunity
to use health to enhance stability. As theinternational community moves aheadwith the fund, establishing sound criteriafor administering the fund requires lead-ers and their governments to not only bol-ster public health practice, but also dem-onstrate their commitment to, andprogress towards:• general absence of civil conflict;• stable governance;• control and accounting of fund resourcesto ensure they are not used to supply mili-taries or diverted to the black market; and
• nondiscrimination against women or popu-lation groups in the application of fund re-sources.Given the level of resources potentially
at stake, the Global AIDS Fund couldtruly become an effective lever for shap-ing political, as well as social behavior.
Another promising strategy is using“health as a bridge to peace.” The WorldHealth Organization (WHO) has appliedthe concept through programs inMozambique, Croatia, Bosnia, Sri Lanka,Angola, and others. These efforts aimto employ peace-building and conflictmanagement strategies in conjunction
Health as a Global Security ChallengeSecurity Issues Invoke Partnerships Among Government, Industry, and Science
COMMENTARY:VACCINE DIPLOMACY
“Drought anddisease can deci-mate no less mer-cilessly than theweapons of war.”
—BoutrosBoutros-Ghali
FALL 2001 SABIN VACCINE REPORT8
The Albert B. Sabin Vaccine Instituteproudly sponsored four young scientistsat the 52nd Annual Intel InternationalScience and Engineering Fair in SanJose, California in May. For the thirdconsecutive year, the Institute awardedfour prizes of $500 each to studentswhose projects included work on infec-tious disease, immunology, andvaccinology.
The Intel ISEF was formerly knownas the Westinghouse Fair and is widelyregarded as the “Olympics,” or highestachievement, in high school sciencecompetitions. This year over 1,200 stu-dents—half of them female and 95%from the public school system—camefrom over 30 nations to compete for over$2 million in cash and scholarship
prizes. Judges at the competion includedPhDs, MDs, Nobel Laureates, and mem-bers of the scientific and engineeringprofessional communities. With theevent location in California’s SiliconValley, the Sabin Vaccine Institute ben-efited from a strong panel of judges,inlcuding Lisa Danzig, MD, and AllenIzu, MS, of Chiron Corporation; JamesMatriano, PhD, of Alza Corporation;
and Vaishali Kerekatte,PhD, and BridgetO’Keefe, of Universityof California–Berkeley.
Chiron Corporation isheadquartered inEmeryville, Californiaand is a global biotech-nology company with anestablished vaccine de-partment. It is the manu-facturer of a rabies vac-cine, Rabavert. Chironis partnered with theSwiss pharmaceutical
company Novartis.Alza Corporation, inMountain View,California, is a re-search based phar-maceutical companywith a strong focuson drug delivery.Their best-knownproduct is theg roundb reak ingNicoderm®CQ®patch for smokingcessation.
Judges chose thefour winners on thebasis of the stu-
2001 Intel International Science and Engineering FairSabin Vaccine Institute Presents High School Science Student Awards
Albert B. Sabin Vaccine Institute awarded $500 prizes to these high schoolstudents, from left , Salvatore Mottillo, Karen Beckman, Stephanie Killian,and Yen Lung-Lin.
Judges for the Intel ISEF came from Silicon Valley-area companies and orga-nizations: Seated, from left, Allen Izu, Lisa Danzig, James Matriano. Standing,Sabin Vaccine Institute’s Veronica Korn, Bridget O’Keefe, and VaishaliKerekatte. Photos of the Intel event are courtesy of James Matriano.
Sabin Vaccine Institute AwardeesIntel 2001 International Science
and Engineering Fair
Karen Leanne Beckman, 17Jamestown High SchoolJamestown, North Dakota
New Fermentation Apparatus andMethod for the Production of DNA-Vaccines and Other Gene Therapy
Products
Stephanie Killian, 17Great Neck South High School,
Great Neck, New York
Analysis of HIV-1 Dynamics UsingMathematical Modeling that Incorpo-rates Latently Infected CD4+ T Cells,Immune Response, Apoptosis, Muta-tion, and Drug Therapy Including
Integrase Inhibitors
Yen-Lung Lin, 17Taipei Municipal First Girls’ Senior High
Taipei, Taiwan
Expression of Recombinant EV71Capsid Protein (VP1) and Production
of Antibodies Directed to It
Salvatore Mottillo, 14Laurier Macdonald High School St. Leonard, Quebec, Canada
Phages: The Ultimate Cure!
The San Jose, California Convention Center served as the venue for 2001 Intel ISEF.
dents’ independent research, its rel-evance to the mission of the Sabin Vac-cine Institute, and the students’ abilityto clearly explain their work.
Congratulations to the four winners!
dedicated to disease prevention www.sabin.org 9
THE INFINITE ALLURE OF
SCIENCE—by Karen Beckman
My name is Karen Beckman and I am an incomingchemistry major at North Dakota State University.Throughout the past three years, science has played amajor role in my life. I have worked for an innovativebiotechnology company, have participated in extra-curricular summer science programs and have com-peted in scientific research contests across the na-tion. My experiences have allowed me to meet someof the world’s top researchers and compete with theworld’s top students in the scientific field. The manychallenges I faced and the rewards I received haveinspired me to pursue a career in scientific research.The International Science and Engineering Fair has
provided some of my more memorable awards andscientific experiences. I have competed in three ISEFfairs and have placed both 2nd and 4th respectively, inthe category of Biochemistry. This past fair I also re-ceived a special award from the Albert B. Sabin Vac-cine Institute. I am very honored to have been chosenas a recipient of this award because I truly admire thework of the scientists at the Albert B. Sabin Institute.
NEVER TOO YOUNG FOR
SCIENCE—by Salvatore Mottillo
I am a secondary IV student attending LaurierMacdonald High School in Montreal, Quebec. I am veryinterested in science and I plan to pursue a career as adoctor and medical researcher. I’ve been presenting sci-ence projects for nine years, most of which have dealtwith biotechnology and infectious diseases.This year, I was privileged to present my science project
on bacteriophages, Phages, the Ultimate Cure!, at theIntel International Science and Engineering Fair in SanJose, California. Here, I was honoured to receive theAlbert B. Sabin Vaccine Institute Award. It was a greatpleasure to explain my project to Albert B. Sabin VaccineInstitute judges as well as other evaluators, the press,scientists, and the public at large. Meeting and convers-
ing with individuals from around the world made theIntel experience truly remarkable.In my project, I attempted to test an alternative for
antibiotics: bacteriophages. When my grandfather got veryill from a ruptured appendix, doctors treated him withvarious antibiotics, which all failed. I decided to researchand soon found that antibiotic resistance is becoming anincreasingly dangerous problem. I chanced to find a sci-entific show talking about antibiotic-resistance, and tomy surprise, they were proposing sewage water as thecure for harmful bacteria! They explained that certainviruses, bacteriophages, each used a specific type of bac-teria as factories for the production of their offspring,ultimately lysing them! My curiosity was peaked; I wantedto find a phage of my own and wanted to confirm if these“phages” really worked. I managed to find a mentor. Dr.Murthy, at the company Biophage Inc. in Montreal, Que-
bec. I then collected water fromsewers in the Montreal area andfrom the St. Lawrence River in hopeto extract a phage of my own. Un-fortunately, I did not find any, but Istill decided to test the Coliphageagainst E. coli K12 bacteria that rep-resented harmful bacteria. I iso-lated, amplified and concentratedphages against this bacterium withsuccess. These viruses really didwork! I also tested their efficacyagainst antibiotic-resistant bacteriain beef. This helped prove that theseviruses could be the new alterna-tives for ineffective antibiotics. I wasprivileged to see the photos of theColiphage magnified over 200 000times by an electron microscope! It
was amazing to see the awkward shape of the virus.The hexagonal head, the tail, the lunar module-liketail fibres were like science fiction to me. My experi-ments helped prove that phages are more advantageousthan antibiotics. They attack only one or two bacterialstrains. Antibiotics kill many types of bacteria simulta-neously, often killing helpful bacteria in our body, whichprovokes further resistance. Phages are viruses, there-fore adapting with bacteria and preventing resistance.Phages don’t cause side effects like antibiotics (aller-gies, cramps, etc.) and a single dose is sufficient tocure an infection. Phages aren’t perfect, mind you; theyare specific to only one bacteria, which means thatwhen you visit the doctor with a bacterial infection, hemust determine the bacteria causing it, which can taketime. It is important to note that finding a phage forevery bacterium in nature is quite an arduous andlengthy task. However, when phages were comparedto “miracle drugs” in my project and appeared to bemore efficient and more effective, I could only think,what more could we ask for when something is betterthan a miracle?No, I didn’t find a phage to save my grandfather
from his Staph infection; fortunately his immune sys-tem picked up and managed to eradicate the bacteriawith some of the help of antibiotics. What if all patho-genic bacteria resisted antibiotics? The consequencesare too serious to write on paper. For this reason it isimportant that scientists continue to research alterna-tive treatments such as vaccines and bacteriophagesagainst pathogenic bacteria. Nobel laureate JoshuaLederberg once said, “The single biggest threat to man’scontinued dominance on the planet is the virus.” I thinkthis is true, however simultaneously I say, “One pos-sible solution to sustain man’s continued dominanceon the planet is the virus.”
The work that these scientists perform can and hasgreatly altered the way that we discover new vaccinesand fight diseases.A relatively new form of vaccine I am particularly in-
terested in is called a “DNA-Vaccine” or genetic vaccine.As sophisticated as our culture has become in terms ofpharmaceuticals, up until the last couple of decades treat-ments for diseases and disorders have been built rathercrudely upon treating symptoms rather than treatingcauses. Genetic research and the potential of genetic vac-cines has opened a new frontier in immunization op-tions by allowing diagnosis and treatments of diseases ata genetic level. People who suffer from afflictions suchas influenza, malaria, herpes, hepatitis C and genetic dis-orders such as hemophilia and MS will see incrediblechanges in their lives because of genetic vaccines. I canrelate to these people because I am one of them. I sufferfrom an extremely rare form of hemophilia. This mayhave a lot to do with why I am so interested in the poten-tial and promise genetic vaccines have to offer.Before these genetic vaccines can be produced, in-
credible amounts of time and money have to be investedinto the discovery process. A very necessary componentof genetic vaccine research is plasmid DNA. Plasmid DNA
is essentially a small ring of DNA that also acts as adelivery device to introduce genes from one organismto another. Production of the necessary amounts ofplasmid DNA for research is currently a tedious andexpensive process. The ultimate focus of my ISEF re-search was to explore cheaper and faster methods ofmass-producing plasmid-DNA. For my science project,I developed a miniaturized fermentor and fermenta-tion procedure that produced three times the amountof plasmid-DNA in less than half the amount of culturethan conventional methods. This new method will hope-fully revolutionize the way that biomass is produced.In addition to the obvious potential of my
research results, I hope my example demonstrates toother students and anyone else interested in science,the impact that one person can have with determina-tion and hard work. From my experience, it does nottake a whole lot to spark an interest in science. Oncean interest is started, fostering it will only make itgrow. Although I am proud of my accomplishmentsthus far, I know that with science there is no limit asto what is waiting to be discovered. It is because ofthis I know science will continue to be a major partof my life.
Salvatore Mottillo, a high school freshman from Canada, answersquestions during the judging rounds at the science fair.
Students Offer Insights from Science Fair ExperienceYouthful and Bright Perspective Underscores the Promise of Budding Scientists
BOOKREVIEW
Richard Coker’s From Chaos to Coer-cion: Detention and the Control of Tu-berculosis, published in 2000 by St.Mark’s Press, New York, is a fascinatingand provocative study of New York City’smulti-drug resistant tuberculosis epidemic ofthe early 1990s.
The explicit goal of the book is to use“the lens of tuberculosis...to examine theAmerican response to those who pose athreat to others through their failure toconform.” His specific interest is the will-ingness of Americans to use coercion toenforce public health regulations. Thechief question he poses is whether the useof state power to force individual compli-ance is morally or even rationally justified.While he concentrates on the problemof tuberculosis, his discussion is also di-rectly relevant to the question of child-hood immunization that in the UnitedStates relies upon mandatory compliance.
Simply raising the question of why theUnited States, a country that prides itself onmaximizing individual liberty, would so eas-ily turn to mandatory compliance in mat-ters of protecting the public’s health, whenother nations (e.g., Coker’s homeland, GreatBritain) facing similar situations choose vol-untary compliance, is intellectually challeng-ing. For instance, most of us have grown soaccustomed to mandatory vaccination forour children entering public school that wedon’t give a moment’s thought about its co-ercive implications. Since many Americansaren’t aware that countries such as theUnited Kingdom have rejected mandatorycompliance, we don’t ask if our methodmay have some relationship to why our vac-cination rates are much lower than theirs.
In the case of tuberculosis, Coker is con-cerned about the interplay between anindividual’s responsibility to the communityand the community’s reciprocal responsi-bility. He raises the question “whether soci-ety should be held at least in part respon-
sible for theantisocial andchaotic be-havior ofsome of itsmembers.If...this isthe case,then themoral is-sues re-g a r d i n gdetentionof thosewho arenot infec-
tious but persist in failing to com-ply with treatment are complex.” The ques-tion of society’s responsibility to the poor,mentally ill, addicted, and homeless—andthus society’s indirect causal relationship tothe spread of infectious disease— is a vitalone. In raising the issue Coker performs animportant service for us.
In constructing his argument, Cokertakes aim at one of the most widely praisedinnovations developed for dealing withmulti-resistant strains of tuberculosis: Di-rectly Observed Therapy (DOT). DOT hasbeen credited with ending the New YorkTB epidemic, and is seen as a humane andeffective method that can be employedwherever it is needed in the world. WhileDOT is far less restrictive than incarcera-tion, it nevertheless contains compulsionas an inherent part of its constitution. Coker,keenly aware of this aspect of DOT asks,“have alternative approaches to preventingrelapse and the subsequent development ofdrug resistance been considered adequately,and if not, why not? And is DOT morallyjustifiable and culturally acceptable?”
While Directly Observed Therapy has co-ercion hidden under its velvet glove of help-ful outreach workers, actual confinementof those who are not cooperative with DOTputs state power right up front. The authorasks, “Is detention of noninfectious,noncompliant individuals right from ethi-cal, legal, and public health perspectives?”
Coker supplies answers that are not al-ways convincing, but his positions are al-ways well argued and cogently presented.While he failed to persuade this reviewerthat New York City was unjustified in con-fining a relatively small number of recalci-trant people who refused to take their tu-berculosis medicine to prevent a relapse ofthe disease, most of his other points hithome. Most persuasive were his argumentsthat society is deeply implicated in the“uncooperativeness” of those at the mar-gin of society who are most at risk for tu-berculosis and most likely to refuse to taketheir medicine; that the lack of decent hous-ing, drug, alcohol and mental illness treat-ment facilities are communal failures thatdirectly feed the spread of tuberculosis andare not solvable by blaming the victims ofsociety’s neglect; that the lack of health in-surance for all Americans is directly linkedto the spread of disease among the poor;widespread contempt, hostility and self-righteousness of the majority of middleclass Americans to the poor and dependent,makes compulsion more attractive than vol-untary approaches regardless of their ac-tual effectiveness; that social neglect andlack of empathy toward socially marginalindividuals provokes the very type of un-cooperative behavior that then terrifiesmainstream Americans and seems to jus-tify resorting to compulsion.
Tuberculosis is an illustrative model ofa social disease. It thrives where people arebadly housed, clothed, fed, employed, andtreated. The image of socially irresponsibleindividuals who threaten society is a vis-cerally powerful one that has often galva-
From Chaos to Coercion: Detention and the Control of Tuberculosis—by Richard Coker
FALL 2001 SABIN VACCINE REPORT10
The Sabin Report seeks to enrich the currentdialog on vaccine research and policy witharticle and review contributions. Opinionsexpressed in the articles are those of theauthors and do not necessarily represent theposition of the Institute.
Continued on page 11.
dedicated to disease prevention www.sabin.org 11
nized Americans to take punitive action toprotect themselves. Coker forces the readerto realize how much of what society fearsreaping from its outcasts, it has carelesslysown itself. For this reason alone the bookshould be required reading.
The book is more than a series of well-argued discussions about ethics and moral-ity. It is filled with interesting and impor-tant factual information about the tubercu-losis epidemic in New York City. Much ofthe material to this reviewer was as surpris-ing as it is disheartening. For instance, itwas quite unexpected that triple-therapyinvolving the simultaneous use of three dif-ferent tuberculosis drugs was not standardtreatment in much of the United States atthe time of the epidemic. It had been knownsince the early 1950s that the TB bacteriumcould successfully mutate against any onedrug but not against a “cocktail” of mul-tiple drugs. It also came as a surprise thatduring the epidemic individuals could be,and were, confined in New York City be-fore less restrictive alternatives were tried.
As far as the question of mandatory im-munization goes, the book has major im-plications for it as well as for tuberculosis.It is common to assume that low vaccina-tion rates among the poor in the UnitedStates are the result of “irresponsibility” on
the part of parents. As a result, mandatoryimmunization seems like a reasonable wayto ensure that parents help protect both theirown children and society. However, inGreat Britain it is assumed that parents willvoluntarily comply if agents of society firstdo their part. Doctors are financially re-warded if they take every opportunity tovaccinate the children that they see; theyare financially penalized if they don’t. Incases where a doctor has not seen a child atall, public vaccinators are sent directly tothe child’s home, instead of blaming theparents for not bringing in their offspring.Our goal, like the British, should be to maxi-mize the number of protected children byfinding the most efficient way of achievingthat result. The British assumption thatpeople will cooperate if the health systemdoes its job, seems to work far better thanthe American supposition that some formof required immunization is necessary toforce parents to protect their children.
All in all, this is a book that everyone in-terested in public health should have in hisor her bookcase. It succeeds even when thereader disagrees with it by asking the rightquestions, and by showing there is a viablealternative way of doing things. As in somany cases, America seen through foreigneyes can be a very enlightening experience.
—by William Muraskin, PhD
William Muraskin, PhD, is a Sabin fellow and pro-fessor of urban studies, Queens College, New York.
BOOKREVIEW
Continued from page 10
Days of Tranquility occur when ar-rangements are made between opposingarmies to lay down their arms for a speci-fied period of time to ensure the deliv-ery of humanitarian relief and the pro-vision of health and education services,including the implementation of vacci-nation campaigns. Afghanistan, Angola,El Salvador, Lebanon and the Philip-pines all have experienced Days of Tran-quility that have interrupted either waror civil unrest and allowed immuniza-tion to proceed as a symbol of persis-tent and hopeful humanitarian effort.
The United Nations Children’s Fund(UNICEF), in collaboration with othermajor world organizations such as PanAmerican Health Organization (PAHO)and the World Health Organization(WHO) have on many occasions con-solidated their efforts to better structurerelief and immunization efforts.
Truces, or “humanitarian cease fires,”to immunize have been called since theearly 1990s when the race began to glo-bally eradicate polio by the year 2005or earlier. Most Days of Tranquility havebeen successful and warring factionshave respected the human right to healthcare. In 1999, for example, an estimated10 million children were vaccinatedagainst polio in the Democratic Repub-lic of the Congo, according to figuresfrom the United Nations. Nationsplagued by ongoing armed conflict havehad varying degrees of success. In Af-ghanistan, for instance, the effort failedto reach children in some of the moreaffected and isolated areas in the north-ern sections of the country.
Conflict itself is a major obstacle toproviding the children in these war-tornregions with preventive healthcare suchas immunizations. Without Days of Tran-quility and the cooperation of world gov-ernments, the children would be beyondreach. In a poignant and humanitarianway, the health of the world’s childrenhas been a bridge toward peace and un-derstanding, if only for a short time.
Vaccinations Create Causes for Ceasefires During Days of TranquilityCreating a Humanitarian Bridge Toward Peace Through Healthcare
In August 2000, UNICEF Executive Director Carol Bellamy immu-nizes a girl against polio during the National Immunization Days(NIDs) campaign in the south-central town of Kananga. She visitedthe Democratic Republic of Congo (DRC) to further global effortsto eradicate polio, especially in countries affected by conflict. Oneof 20 priority countries where wild poliovirus is still endemic, hervisit there coincided with a NIDs campaign targeting 11 millionchildren. Polio eradication efforts in the country are hampered byongoing armed conflict in six provinces affecting some 14 millionCongolese, as both the national economy and health system aredeteriorating. Each child must be immunized three times to befully protected from the polio virus. Photo provided courtesy ofUNICEF/HQ00-0673/ RADHIKA CHALASANI.
Sabin Vaccine Institute Publishes ProceedingsTwo Recent Colloquia Culminate in Lively Publication Series
FALL 2001 SABIN VACCINE REPORT12
SOCIAL VENTURE CAPITAL FOR NEGLECTED VACCINES:CREATING SUCCESSFUL ALLIANCES
VACCINES FOR DEVELOPING ECONOMIES: WHO WILL PAY?A scientist on the verge of a major labora-tory breakthrough in creating a vaccineagainst a parasite that has devastated popu-lations in India and China goes looking forfunding to continue his work—but finds“zero interest” from pharmaceutical com-panies, large and small.
The Sabin Vaccine Institute, foryears acutely aware of the difficultyin creating and introducing lifesavingvaccines in emerging economies, de-veloped directly from this researcher’sexperience the colloquium and book,Vaccines for Developing Economies:Who Will Pay?
This publication looks at some of thereasons for this “zero interest” and how,in the light of global security and con-tinued economic growth, it is essentialthat attitudes toward vaccines against
Review copies of both of these books are available from theSabin Vaccine Institute upon request.
Neglected vaccines mean neglectedchildren. A new publication of theSabin Vaccine Institute, Social VentureCapital for Neglected Vaccines:Creating Successful Alliances exploresthe economics of vaccine developmentand production in a unique andcompelling way.
Throughout the developing world,thousands of children suffer and diefrom malaria, tuberculosis, and HIV/AIDS each year. These diseasesdestroy untold potential and countlessyears of productive life. They preventeconomic development and leave largesections of the world impoverished.Although vaccines would save them,the value of the market in the develop-ing world is so limited that companies
that need to make a profit in order toexist invest their efforts and resourceselsewhere. If the market is left to itsown workings, these vaccines—andchildren in the poorest countries—willremain neglected.
The Albert B. Sabin Vaccine Insti-tute convened the 7th Annual VaccineColloquium at Cold Spring Harbor inthe fall of 2000 to bring together keyplayers to address this challenge.Colloquium participants—leaders inscience, public health, policy, andindustry—were asked to focus theircombined expertise on envisioningways to reduce barriers and stimulatecommitment to the development ofvaccines for developing countrymarkets.
Edited by Virginia Ross, PhD,Social Venture Capital for NeglectedVaccines is the latest in a series ofcolloquia proceedings that the SabinVaccine Institute has published inorder to generate discussion on criticaltopics related to vaccines.
diseases including HIV, malaria and tu-berculosis change.
Vaccines for Developing Econo-mies: Who Will Pay? reports from theleading edge of global public health plan-ning. Selectively invited leaders from sci-ence, industry, government and global or-ganizations gathered at the 6th AnnualAlbert B. Sabin Vaccine Institute Col-loquium at Cold Spring Harbor. Theirsolutions, while not conclusive, map outthe territory of international policy, sci-ence and economics that lies ahead.
Rather than simply publish a collec-tion of reports and papers from the col-loquium, editor William Muraskin craftsa compelling narrative out of the origi-nal points of debate and dissension atthe 1999 conference and adds recentinterviews for further insights. Voices
from the colloquium—and some that wentunheard there—pointedly and unspar-ingly hammer out the political, economic,and social challenges of saving humanlives in developing countries through vac-cines.
The resulting forward-looking reportis valuable to those in every field whoneed to keep up with new technology,the new economy, emerging policy is-sues and security threats, and new gov-ernment administrations.
dedicated to disease prevention www.sabin.org 13
in Southeast Asia for PATH (Program forAppropriate Technology in Health). His mis-sion is to carry on and improve the pro-grams we have initiated and to introducenew visionary approaches. He is undertak-ing what is again a major challenge, not onlyin managing our programs, but also in devel-oping a financial base to ensure their success.To this end, he has already engaged a
director of development, Bob Milanchus,who has many years of experience as adevelopment officer, and a director of com-munications, Ray MacDougall, who hasworked closely with us in his previous posi-tion at The George Washington University.We have opened another office in Washing-ton, DC, from which Don Douglas will carryout his activities along with his staff.As we have faced each of these chal-
lenges over the last eight years, we havebeen very fortunate in having all our con-stituents in one way or another provide uswith the financial sustenance necessary toreach this point. We want to acknowledgeeach and every one of you who made it pos-sible, in the space of a few short years, tohave raised a sum of $6 million—and thisis exclusive of the Gates hookworm grant.We hope you will continue to value and sup-port our growing number of programs.We thank every one of you very sincerely,
and I hope you will take our thanks seri-ously. We would not have been able toachieve all that we have without the com-mitment each of you has shown and thecontributions you have made, financially,professionally, and otherwise, to supportour work. I hope that, after reading ournewsletter, you will feel free to let us knowhow we can improve. If you have any ideascompatible with our mission, or if we haveneglected a critical issue of concern to you,please send us your suggestions.
H. R. Shepherd
Advancing The SVI MissionChairman’s Message
Continued from page 3.
Bruce Gellin, MD, MPH
become weakened. Gellin and the NNiiare working.
Supported by grants from the AnnieE. Casey Foundation, the JewishHealthcare Foundation and the Robert
Wood Johnson Founda-tion, NNii was created toimprove the understand-ing of vaccines and im-munization practices andpolicies by providing up-to-date, science-based in-formation about immuni-zations to healthcare pro-fessionals, the media,policy makers, and thepublic.
For more informationabout Bruce Gellin and the work ofNNii, visit the following website:www.immunizationinfo.org.
Bruce Gellin, MD,MPH, an internist andinfectious diseases phy-sician, is an assistantprofessor in the Depart-ment of PreventiveMedicine at VanderbiltUniversity School ofMedicine in Nashville,Tennessee. Dr. Gellindirects the National Net-work for ImmunizationInformation (NNii), aneducational initiative started threeyears ago by the Infectious DiseasesSociety of America and the PediatricInfectious Diseases Society. Since thattime NNii has grown and currently in-cludes the American Academy of Pe-diatrics, the American Academy ofFamily Physicians, the AmericanNurses Association, the National As-sociation of Pediatric Nurse Practitio-ners and the American College of Ob-stetricians and Gynecologists amongits partner organizations.
In mid-1999, Dr. Gellin and his col-leagues conducted a nationally repre-sentative telephone survey asking par-ents of young children about the im-portance of immunization. The survey,published in Pediatrics (November2000), found that while the large ma-jority of parents support the use of im-munization, many have serious mis-conceptions that could adversely influ-ence their decision-making about im-munizations: approximately one in fourparents in the United States are con-cerned that children receive more vac-cines than are good for them, and thatas a result, their immune systems could
Wal-Mart Introduces FreeChild Immunizations
Sabin Vaccine Institute Salutes
Selected nationwide Wal-MartStores, Inc. teamed up this past sum-mer with state health and human ser-vices organizations to provide freechild immunizations. The programpartnered selected local stores witharea clinics to give families a conve-nient and easy opportunity to get freeimmunization and protection fromdeadly infectious diseases. While Wal-Marts in Arkansas were the first stateto introduce this program last spring,as many as 31 additional states signedon. “Investing in the health of chil-dren is always important to Wal-Mart,”said Wal-Mart Senior Vice Presidentfor Pharmacy Jim Martin. “This pro-gram allows us to reach families andimmunize children that might other-wise go unprotected from these pre-ventable diseases.”
Bruce Gellin, MD, MPHDirector, National Networkfor Immunization Information
The Sabin Vaccine Report introduces this regular column in our newsletter to salute indi-viduals and organizations whose innovation and dedication in promoting public health throughimmunization are worthy of a special mention.
FALL 2001 SABIN VACCINE REPORT14
Big Shot: Passion, Politics, and the Struggle for an AIDS VaccineNew Book by Patricia Thomas, Sabin Fellow, Hits the Book Stores
A veteran journalist dramatizes thecontroversial search for an AIDS vac-cine—the players, the politics, themoney—in a vivid, suspenseful storythat reveals how science is done, andnot done, in America today
When the human immunodeficiencyvirus was identified in 1984, the com-petition to create an AIDS vaccine wasfierce. Now Patricia Thomas brings thecontenders to life in a fast-paced, dra-matic narrative: Two biologists rescueprecious virus culturesfrom destruction by amilitary biohazardteam. Other researchersdrive hundreds of milesduring a heat wave towork in a safe contain-ment lab. And a heroicfigure from RandyShilt’s And the BandPlayed On just mightwin the vaccine mara-thon.
Thomas shows how thescientists’ youthful optimismis honed into gritty determi-nation as they struggle withdifficult research challenges,public condemnation ofAIDS patients, cautious bu-reaucrats, conservative ex-ecutives, hostile activists,and a perennial shortage ofmoney. The lives and com-plex motivations of the char-
acters illustrate the triumphsand frustrations of the questfor a vaccine. Interwovenwith these gripping humanstories are lucid explana-tions of how vaccines aimto block the potentiallydeadly tango of the AIDSvirus and the human immunesystem.
Above all, Big Shot showshow the health of futuregenerations rests on the
shoulders of individualswho are as strong, andas weak, as the rest ofus. Just as A Civil Ac-tion ultimately told usmore about human na-ture the environmentallaw, Big Shot is about agreat deal more thanAIDS vaccines.
Patricia Thomas haswritten about medical
research for many years, and from1991 to 1997 she was editor of theHarvard Health Letter. She hasbeen a Knight Science JournalismFellow at MIT, and in 1998 wasawarded the Leonard Silk Journal-ism Fellowship. Thomas was one ofthe first healthy volunteers to be in-jected with an experimental DNAvaccine for AIDS, in a study at theNational Institutes of Health.ISBN: 1-891620-88-6528 pages, $27.50/41.50 CANADAPatricia Thomas
The National Immunization Program(NIP) of the Centers for Disease Con-trol and Prevention (CDC) is workinghard to communicate information relatedto the production, distribution and admin-istration of influenza vaccine for the2001-2002 influenza season. Vaccinemanufacturers project that 77.1 milliondoses of influenza vaccine will be dis-tributed this season. Some delays in dis-tribution are still anticipated.
Projected distribution of influenzavaccine for 2001 is greater than the num-ber of doses available in 2000 and com-parable with 1999. Compared to 1999and other previous years, when most ofthe total vaccine supply was distributedby the end of October, distribution of asignificant portion of this year’s totalsupply will extend into November andDecember. Manufacturers currently are
projecting that the final 27.3 million dosesof the total supply will be distributed inNovember and December 2001. Offi-cials at FDA and CDC stress that theseprojections from manufacturers are pre-liminary and could change as the seasonprogresses.
The optimal time to vaccinate personsin groups at high risk is in October andNovember. To avoid missed opportuni-ties, vaccine also should be offered ear-lier to high-risk persons when they areseen for routine care or are hospitalized,if vaccine is available.
High-risk patients should be remindedof the importance of their receiving in-fluenza immunization and encouragedto come into the office for a vaccina-tion-only visit. As more vaccine be-comes available in November and De-cember, providers also should offer vac-
cine to unvaccinated lower-risk patients,such as contacts of high-risk persons,healthy persons 50 - 64 years of age andany other persons wanting to reducetheir risk for influenza. Providers shouldcontinue to vaccinate their patients evenafter influenza activity is detected in thecommunity, as long as vaccine is avail-able. In recent years, peak influenza ac-tivity has not occurred until late Decem-ber through early March. Consequently,vaccine administered after November willbe beneficial in most influenza seasons.
Patients should be advised that it maytake as long as two weeks after vaccineadministration to develop sufficient an-tibody to be protected from the virus andthat other viruses can cause similarsymptoms as influenza. For more infor-mation on this year’s flu vaccine, visitwww.cdc.gov/nip/flu.
Bulletin on Influenza Vaccine for 2001-02The Centers for Disease Control Keep the Nation Posted as Flu Season Approaches
dedicated to disease prevention www.sabin.org 15
INSTITUTENEWS
Sabin Vaccine Institute Names Directorsof Development and of Communications
Phyllis B. Moses, PhD
Phyllis B. Moses, PhD,Named Sabin Fellow
Phyllis B. Moses, PhD, joined theSabin Vaccine Institute as senior fel-low, to conduct science policy schol-arship in support of the Institute’smission of vaccine advocacy and re-search. In addition to contributionsto the Institute’s website and news-letter, and representing the Institute at
scientificmeetings,she willd e v e l o pproceed-ings of theInstitute’stwo annualcolloquia.
M o s e shas exten-sive expe-rience in
commercial publishing, and also inpharmaceutical, nonprofit, and aca-demic environments. She most re-cently was manager of scientific pub-lications at Purdue Pharma LP. Sheworked for 10 years at AcademicPress and then with Macmillan Ref-erence Ltd., in the United Kingdom.She previously worked in sciencepolicy at the National Academy ofSciences/National Research Council.She held positions as a National Sci-ence Foundation plant biologypostdoctoral fellow, a RockefellerUniversity graduate fellow with con-centrations in virology, genetics, andbiochemistry (PhD, 1983), an under-graduate major in biology at theJohns Hopkins University (BA,1977), and an Undergraduate Re-search Program fellow in moleculargenetics at Cold Spring Harbor Labo-ratory (1976).
Dr. Moses is based at the Institute’soffices in New Canaan, Connecticut.
Joining SVI President Don Douglasat the program offices of the Institute inWashington, D.C. are two new staffmembers who will undertake, respec-tively, development activities and com-munications programs.
Robert J. Milanchus joined the SabinVaccine Institute in September as direc-tor of development. A 30-year veteranfundraiser, he has directed the develop-ment enterprise and held senior execu-tive posts at a number of national andregional non-profit organizations.
At the Aircraft Owners and Pilots As-sociation Air Safety Foundation,Milanchus served as vice president forfoundation development, coordinatinggrant development and corpo-rate, government, and indi-vidual major gifts. He servedfor five years as executive di-rector of development, pub-lic relations, and marketingfor the Washington CountyHealth System in WesternMaryland, where he coordi-nated a development programthat included major grants,capital projects, and specialevents, as well as marketingand media affairs. In the early‘90s, he was director of de-velopment and communityrelations for St. Joseph Ser-vices for Children and Families inBrooklyn, New York, and director of de-velopment for Sacred Heart Universityin Fairfield, Connecticut, and the StateUniversity of New York at Stony Brook,New York. He previously held execu-tive directorships of Girl Scout Coun-cils in New York and in Ohio.
Milanchus holds a degree in speecheducation and broadcasting arts and is amember of the National Society ofFundraising Executives, Council for theAdvancement and Support of Education,and the Association of Healthcare Pro-fessionals.
Raymond A. MacDougall joined theInstitute in August as director of com-
munications. He has worked for morethan 10 years in publications manage-ment, media relations, and marketing inthe Washington, D.C. area.
MacDougall was with The GeorgeWashington University for the past fiveyears, where he served most recently aspublications director for the MedicalCenter’s office of communications andmarketing. There he covered news ofGW’s partnership with the Sabin Vac-cine Institute and relocation of the re-search component of the Institute’sHookworm Vaccine Initiative to the Uni-versity. He was managing editor of themedical alumni magazine and of theMedical Center’s monthly periodical,
reporting on medical and public healtheducation programs, breakthroughs indisease diagnosis and treatment, and ini-tiatives in community health and diseaseprevention.
MacDougall has also held positionsat GW’s School of Engineering and atthe University of Maryland. He was apublic relations specialist at the UM’sInstitute for Systems Research and at theInternational Development ManagementCenter, and marketed University Collegegraduate management programs.
He is a graduate of the University ofMaryland with bachelor’s and master’sdegrees from the College of Journal-ism.
Robert J. Milanchus Raymond MacDougall
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58 Pine StreetNew Canaan, CT 06840U.S.A.
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FALL 2001 SABIN VACCINE REPORT
Health as aGlobal Security Challenge
Continued from page 7OCTOBER 2001
October 9-11, 20018TH ANNUAL SABIN VACCINE COLLOQUIUM
Making Vaccines for the Developing World:Access to & Deployment of New Technologies
Sponsored by Sabin Vaccine InstituteE-mail: [email protected] Spring Harbor, New York
October 17-19, 2001VACCINES OF THE FUTURE: FROM RATIONAL
with public health practice. On numer-ous occasions WHO has been success-ful at negotiating “days of tranquility”during which belligerents to conflictsagreed to adhere to a cease-fire whilepublic health and medical practitionerscarried out immunizations. Angola,Congo, and Sudan are only a few of theexamples where polio eradication effortshave been the impetus for temporarilyseparating warring parties. Prior to theDayton Accords, the health ministersfrom Bosnia-Herzegovina, Croatia, andSerbia came together to discuss publichealth practice that would address healthissues along functional rather than eth-nic lines. By putting ethnic divisions asideto discuss health issues of common con-cern they demonstrated the potential ofusing health as a conflict resolution tool.
The lessons from these examples andother similar experiences need to be moreclearly drawn out to evaluate their po-tential as a lever for ameliorating violentconflict. As WHO makes a final push toeradicate polio by 2005, the most chal-lenging areas remain those embroiled inviolent conflict. If the 2005 target is tobe met, it will be crucial that hostilitiescease, at least temporarily, for immuni-zation efforts to take place. When theseopportunities present themselves, wemust take advantage of the window topush for a lasting peace. Our successwill hinge on how well the internationalcommunity is prepared to do so.
The international security environmentis continuously evolving, creating bothnew challenges and new opportunities.The stakeholders must first recognize thenature of the challenges before us, andsecond, identify and exploit opportunitiesfor shaping this environment in ways that,ultimately, enhance security.
—by Jonathan Ban
Jonathan Ban is a research associate at theChemical and Bioligical Arms Control Institutein Washington, D.C. ([email protected])
