REPORT Volume VI, Number 1 Sabin Vaccine Spring 2003 The newsletter of the Albert B. Sabin Vaccine Institute — dedicated to disease prevention www.sabin.org Accelerating Cancer Vaccine Development is Rallying Cry at 2003 Colloquium Sabin Vaccine Institute Convenes Fifth Annual Meeting at Walker’s Cay Cancer vaccines present an elusive lant that has found a place in the treat- cancer, is it possible to use vaccines to goal, yet one that is increasingly within ment of bladder cancer. Colloquium par- prevent disease? The underlying tenets reach for biomedical researchers. Their ticipants were challenged by Dr. of immunoprevention maintain that can- hope is to offer physicians and cancer Shepherd’s refrain, “Why are there so cer formation occurs slowly, thus pro- patients more and better therapy options few vaccines, and why does it take so viding a window of opportunity during than radiation and chemotherapy. The long to develop them?” which a meaningful response could be advancement of cancer vaccine re- Forty of the world’s leading scientists, induced. The capacity to induce a re- search, from the bench to clinical trials, medical researchers, and thought lead- sponse lessens as cancer progresses, was the focus of the Sabin Vaccine ers convened for the think-tank sessions due to increased suppression of immune Institute’s 5th Annual Colloquium on on the island where former President cells that correlates with tumor stage. Cancer Vaccines and Immunotherapy Richard Nixon first declared the War Data Dr. Forni presented showed that held this past March 5-8 at Walker’s on Cancer in 1973. Their discussion survival was “barely improved” in vac- Cay in the Bahamas. topics ranged from underlying mecha- cinated mice bearing tumors only 24-72 According to H.R. Shepherd, chair- nisms of immunity, to clinical results, in- weeks old, as compared with pretreat- man of the Sabin Vaccine Institute, this cluding such concepts as immunocom- ment of normal mice. year’s colloquium generated immense petence and immunosuppression. “Fun- In rounds of presentations, encourag- energy toward progress on cancer vac- damental to the presentations was the ing signs pointed to tangible progress to- cine research and immunotherapy ad- idea that academia, industry, and the gov- wards a prescribable treatment therapy. vances. Dr. Shepherd is a proponent of ernment can work better when working Participants provided evidence that in vaccines as therapeutic agents against together to circulate information and pro- vitro and animal models can be used to many forms of cancer, having been duce more potent and effective cancer design treatment regimens and remove treated successfully with BCG vaccine treatments,” said Dr. Shepherd. less promising vaccines from further de- (traditionally a tuberculosis vaccine), The plenary lecture provided by velopment. The timing of administra- which is a non-specific immuno-stimu- Dr. Guido Forni from the University tion and immune status of a patient are of Turin ad- as important to achieving therapeutic dressed pro- Continued on page 3 phylactic can- cer vaccines. His proposal I nside was both simple ViewPoint .................................................... 2 and fascinating: Looking Back, Moving Forward ........... 3, 8-9 Since the stimu- Ciro de Quadros Joins SVI ........................... 4 lation of anti-tu- Rotavirus, Search for a Next Generation mor immune re- Vaccine ................................................... 5 sponses follow- Samuel Katz to Receive Sabin Gold Medal ... 6 Immunization on Capitol Hill ..................... 7 ing vaccination BioShield ................................................. 10 seems most PAHO and WHO Select Leaders .................. 11 Gathered are the 40 participants at the Fifth Sabin Vaccine Institute Colloquium on successful in the Double Helix Turns 50 .............................. 12 Cancer Vaccines and Immunotherapy at Walker’s Cay, Bahamas. initial stages of Lance Gordon Elected to Sabin Board ....... 14 2 SPRING 2003 SABIN VACCINE REPORT The Sabin Vaccine Report VIEW is published by the POINT Albert B. Sabin Vaccine Institute Subscriptions are free Weight of Science Shows No Link Between Vaccines & Autism Please direct inquiries to: —by Peter J. Hotez, MD, PHD, FAAP SABIN VACCINE REPORT THIS COMMENTARY APPEARED ON MARCH 30, 2003 IN THE AKRON BEACON JOURNAL AND 58 Pine Street ON APRIL 6, 2003 IN THE ROANOKE TIMES AND TULSA SUNDAY WORLD. New Canaan, CT 06840-5408 phone: 203.972.7907 As a pediatrician, vaccine researcher and The second vaccine/autism theory is based fax: 203.966.4763 the father of an autistic child, I have great on the idea that autism is the result of mer- www.sabin.org concerns regarding an ongoing debate about cury poisoning from the thimerosal in vac- email: firstname.lastname@example.org the safety of our infant and childhood vac- cines. In 1999, public health officials de- EDITOR cines. The unfounded association that has cided that thimerosal should be removed from Raymond MacDougall been proposed by some between vaccines vaccines as a precautionary measure. ASSOCIATE EDITOR C OPY EDITOR Veronica Korn David Bedell and autism is at best misleading and at worst A study on thimerosal conducted by the O FFICERS OF THE SVI BOARD OF TRUSTEES a serious undermining of children’s health. University of Rochester was published last fall H. R. Shepherd, Chairman The vaccine/autism question stems in The Lancet. The study showed that ethyl William R. Berkley, Co-Chairman from two separate theories that are both mercury—which is what thimerosal becomes Michael E. Whitham, Esq., Secretary/ Treasurer equally unscientific and have been de- as it is metabolized—is excreted from the SVI STAFF termined as invalid by the qualified ex- body within seven days and does not appear Fran G. Sonkin, Executive Vice President perts in vaccine science. to build up from one vaccination to the next. Paul J. Vilk, RPh, RAC, Vice President, The first claims autism is the result of Even when it is still in the body following Program Management and Regulatory the combination measles, mumps, rubella immunization, the levels of this mercury do Affairs, Hookworm Vaccine Initiative Ciro de Quadros, MD, MPH, Director, (MMR) vaccine. The second claims thime- not exceed the government standard, International Programs rosal is the autism culprit. Thimerosal is which is based on a more potentially harm- Raymond MacDougall, Director of a mercury-based compound that was used ful form of mercury known as methyl mer- Communications David Bedell, Executive Assistant to in many vaccines since the 1930s, but cury (the type found in some types of fish). the Chairman MMR vaccine does not, and has never, When the report was released, research- Michelle Diggs, Assistant to the Director, contained thimerosal. ers wrote that children would likely be ex- International Programs Let’s begin with the MMR question. Nu- posed to more mercury by eating a tuna Martha Fleischer, Information/Database Coordinator merous large-scale studies have shown no fish sandwich than by vaccines. Veronica Korn, Research Associate increase in autism for children who received More research into thimerosal is under- Christel Lane, Receptionist/Staff Assistant the MMR vaccine. The most recent study, way, though if thimerosal were the cause of Gboku Lumbila, Executive Assistant, published in the New England Journal of what some believe is a dramatic increase in Hookworm Vaccine Initiative Vanessa Santiago, Assistant to the Medicine and funded by the National Alliance the incidence of autism, one would expect Executive Vice President for Autism Research, examined more than the incidence to drop dramatically since the Jean-Serge Valcourt, Accounting 500,000 Danish children. The study found removal of thimerosal from vaccines in 1999. SVI ADVISORS there was no greater incidence of autism But it hasn’t. Philip K. Russell, MD, Senior Advisor to among children who received the MMR vac- As the father of a child with autism, I know the Chairman Peter J. Hotez, MD, PhD, Senior Fellow cine than those who did not. the need for parents to understand the root & Chair, Scientific Advisory Council Scientific organizations including the of this heartbreaking disorder and find some- William Muraskin, PhD, Sabin Fellow Centers for Disease Control, the Institute of thing to blame. However, as a medical doctor, Patricia Thomas, Sabin Fellow Medicine and the American Academy of I believe a more constructive focus is on ad- Nancy Gardner Hargrave, Development Counsel Pediatrics have all said that the scientific vancing treatment options, extending reim- evidence does not support a causal link bursement policies, and finding a cure. between MMR and autism. Ironically, the By focusing on unproven theories, we not only known cause of autism is rubella, only risk wasting our precious resources and which the MMR vaccine prevents. Continued on page 16 dedicated to disease prevention www.sabin.org 3 Looking Back, Moving Forward Sabin Vaccine Institute 10th Anniversary Evokes Reflection and Commitment to the Future them, the human immunodeficiency vi- Ten years ago, the Sabin Vaccine Institute was founded to pursue Dr. rus presents an urgent and compelling Albert B. Sabin’s vision of a world protected from disease by vaccines. The challenge for the world. Malaria, emerg- Institute’s anniversary theme—“Looking Back, Moving Forward”—takes ing forms of tuberculosis, rotavirus, and stock of these seasons of progress and captures the spirit of ongoing en- parasitic diseases like hookworm and deavors. The Institute’s projects have international scope. Their range in- dengue fever also have no effective cludes vaccine policy, immunization advocacy, basic vaccine re- vaccine. New delivery mechanisms for search, and recognition of achievements in vaccinology. Fol- vaccines require champions as lowing is a brief retrospective and pictorial timeline. well—aerosolized measles vaccine in fact provoked the initial discus- The Sabin Vaccine Institute is the ful- passion for public health, sion between Dr. Sabin and H.R. fillment of an idea that germinated in a and is the inspiration for Shepherd. The need for more at- series of conversations between busi- the Institute that carries tention on vaccines has been a clear nessman H.R. Shepherd and renowned on his legacy. Scientific mandate for the Institute and its on- scientist Dr. Albert B. Sabin. The two excellence, ingenuity, re- going efforts. met to discuss aerosol technology, in sourcefulness, and determina- During the first five years of the Sab- which H.R. Shepherd had become a tion are Dr. Sabin’s hallmark as both in Vaccine Institute’s existence, many successful innovator, having devised a vaccine developer and statesman. people lent their time, expertise, support, full range of products from pharmaceu- Vaccines have become the greatest and reputation to building a strong col- ticals to cosmetics to industrial lubri- defense against preventable infectious lection of programs. Mrs. Heloisa Sabin cants. Dr. Sabin’s quest was to devel- diseases, but there still is a long list of was a co-founder, along with Robert op an aerosolized measles vaccine. diseases yet to be defeated. Among Continued on page 8 The series of conversations pro- gressed through 1992 but were cut short Cancer Vaccines and Immunotherapy Colloquium by Dr. Sabin’s grave illness and death Progress on Vaccine Studies Reported at Walker’s Cay Meeting in March 1993. Recognizing the impor- from page 1 tance of Dr. Sabin’s work, H.R. Shep- benefit as are the components of a vac- ernment research laboratories, and in- herd and a group of colleagues conferred cine, according to some evidence. dependent researchers. with Mrs. Heloisa Sabin about establish- The colloquium targeted five themes This year’s colloquium was co- ing an organization to continue her hus- of investigation, focusing on why so chaired by W. Martin Kast, PhD, pro- band’s legacy. With the help of a num- many patients do not respond to treat- fessor of microbiology and immunology ber of seasoned scientists, resourceful ment as well as on data supporting why and pharmacology at Loyola University entrepreneurs, and trusted advisors, an some respond more successfully. The Chicago; and Malcolm S. Mitchell, MD, organization where the ideals of the sci- themes were: program leader, Biological Therapy, entist would be emulated and pursued • Models for Cancer Vaccines Karmanos Cancer Institute, Wayne came into being. The Institute emerged and Strategies to Enhance the State University, Detroit. in 1993 as a tribute to this noted scien- CD8+ T Cell Tumor Response More of this year’s speakers had clini- tist and public health hero. • Immune Response to Tumors cal trials underway or under concerted In his life, Albert Sabin (1906-1993) • Developing New Targets and development. A continuous pipeline of courageously pushed the boundaries of Constructs for Cancer Vaccines vaccines into clinical trials is essential, science with his development of the oral • Clinical Trials and Immune since proof-of-principle in cancer pa- polio vaccine (OPV), which became the Monitoring tients is essential if these biologics are primary tool in the fight against the • Escape from Immunological to be approved by regulatory agencies dreaded poliomyelitis pathogen and the Destruction and made available as alternatives to che- one used to rid the greater part of the The 40 colloquium participants in- motherapy and radiation. If the cancer globe from the paralyzing disease. “A cluded approximately 20 from biomedi- vaccine development described at scientist who is also a human being can- cal research departments at several of Walker’s Cay is even partially success- not rest while knowledge which might the nation’s leading universities as well ful, the day will come sooner when a be used to reduce suffering rests on the as from Italy and Canada; 10 pharma- doctor no longer need tell a cancer pa- shelf,” said Dr. Sabin. This philosophy ceutical industry researchers; members tient, “There is nothing more we can do.” conveys the pioneering vaccinologist’s of biological research institutes and gov- —by Michael Salgaller, PhD 4 SPRING 2003 SABIN VACCINE REPORT SVI Taps Ciro A. de Quadros, MD, MPH for International Programs Post Internationally Recognized Vaccines Advocate to Pursue Immunization Goals for Latin America and Elsewhere Around Globe The Sabin Vaccine Institute has vaccines to prevent human suffering due National School of Public Health, Rio named disease eradication champion to preventable diseases.” de Janeiro. He subsequently participated Ciro A. de Quadros, MD, MPH to lead At the outset of his activities as direc- in the organization of the first National its international programs. Dr. de tor of international programs, Dr. de Epidemiology Center in his native Bra- Quadros is a distinguished international Quadros will head up an advocacy ini- zil. There he was involved in the devel- public health diplomat, having this year tiative to call attention to the burden of opment of the surveillance and contain- completed an eight-year term as direc- two diseases with devastating health ment strategies for smallpox eradication tor of the Division of Vaccines and Im- impact—rotavirus and rubella. in Parana State, Brazil. In 1970, Dr. de munization for the Pan American Health Rotavirus is the most common cause Quadros was appointed chief epidemi- Organization (PAHO). Dr. de Quadros of diarrheal deaths among children in ologist for the Smallpox Eradication Pro- will pursue international immunization developing countries. Each year, it gram in Ethiopia by the World Health advocacy for the Sabin Vaccine Insti- claims the lives of 600,000 children, with Organization. Following the global tute, with a special emphasis on the at least 18,000 deaths occurring in Latin eradication of smallpox, Dr. de Quadros Latin American region. America and the Caribbean region. The joined the Pan American Health Orga- “Dr. de Quadros has devoted his en- Sabin Vaccine Institute anticipates the nization to initiate the Expanded Pro- tire career to disease prevention and day when a second-generation rotavirus gram on Immunization for the region public health and has achieved tremen- vaccine is available. Such a vaccine will of the Americas. He led the PAHO dous results in immunization coverage have a tremendous impact not only in team in the successful eradication of for the Americas,” said H.R. Shepherd, improving health, but also in furthering poliomyelitis from the Western Hemi- chairman of the the social development sphere, declared in 1991. Sabin Vaccine Insti- of the countries in which In addition to disease eradication lead- tute. “The Institute the disease has the ership, Dr. de Quadros has overseen will be energized by greatest hold. general immunization programs for Ciro’s role in current “Encouraging the PAHO. Regional vaccine campaigns programs and new search for a rotavirus save the lives of more than 200,000 chil- international initia- vaccine is a high priority dren in Latin America and the Caribbean tives because of his of both the World Health each year, according to Dr. de Quadros, expertise and the Organization and the and over 80 percent of children in the high esteem in Pan American Health Americas under one year old are vacci- which he is regarded Organization,” Dr. de nated against diphtheria, pertussis in the international Quadros said. “The (whooping cough), tetanus, poliomyeli- public health commu- Ciro de Quadros, MD, MPH availability of such a vac- tis, measles and tuberculosis. In his in- nity.” A staunch sup- cine will be a major con- ternational public health work Dr. de porter of the Institute’s efforts tributor to the survival of children around Quadros has highlighted the important through the years, Dr. de Quadros the world.” role played by immunization programs. was recognized in 2000 with the Rubella and congenital rubella syn- “I know from my experience with small- Albert B. Sabin Gold Medal for his drome (CRS) account for several thou- pox eradication in Brazil and the Horn achievements in vaccinology. sand cases of congenital disabilities each of Africa, with polio eradication and now “We have an opportunity to take the year such as blindness, deafness, and the measles eradication initiative in the international programs of the Sabin Vac- heart disease. Several countries in the Americas, that well-run immunization cine Institute to a new level, since vac- Americas, following their successful programs do help strengthen health in- cines for the developing world are a criti- efforts to eradicate measles, have now frastructures in the countries where they cal aspect of both public health and so- launched campaigns to eliminate rubella are properly implemented.” cial development,” said Dr. de Quadros. and CRS. “The interruption of transmis- Dr. de Quadros is associate adjunct “The Institute is in a unique position to sion of rubella will have an immediate professor, Department of International encourage countries to make their vac- impact in eliminating the burden of Health, School of Hygiene and Public cine programs a key priority, for all chil- CRS,” Dr. de Quadros said. Health at the Johns Hopkins University; dren and the entire society.” He added, Dr. de Quadros received his medical adjunct professor, Department of Epi- “The Institute has truly embraced the degree from the Catholic School of demiology and Biostatistics, School of legacy of Dr. Albert B. Sabin, whom I Medicine, Pôrto Alegre, Brazil and his Medicine, Case Western Reserve Uni- knew as a great believer in the ability of master in public health degree from the Continued on page 11 dedicated to disease prevention www.sabin.org 5 Rotavirus—The Search for a Next Generation Vaccine Interview with Ciro de Quadros, MD, MPH and another by Merck. The The following is the first of a series of interviews with Ciro de Quadros, MD, MPH, the GlaxoSmithKline vaccine is based on a Sabin Vaccine Institute’s new director, International Programs. This interview fo- single strain of rotavirus isolated from a cuses on rotavirus vaccine advocacy, one of several international activities in which human with diarrhea and attenuated by he will be engaged. The availability of a new rotavirus vaccine is much needed, repeated passaging in cell culture. It especially for the developing world’s children. would be given as a live, oral vaccine in two or three doses to children at the time SVR Dr. de Quadros, what are the development of severe disease that of their routine immunizations. The factors that make rotavirus such a could lead to hospitalization or a fatal Merck vaccine will be based on a bo- dangerous disease? outcome. vine strain of rotavirus that has been CdQ Rotavirus is the most severe of all reassorted and combined to provide pro- SVR Who needs the rotavirus vac- the diarrheal diseases of children. Un- tection against the four main serotypes cine? like many diseases that affect children of rotavirus in circulation, plus another CdQ Every child in the world will be only in developing countries, rotavirus is outer capsid protein that is the most com- infected with rotavirus in the first few a democratic virus and affects children mon target for virus neutralization. This years of life and every child could ben- worldwide—rich and poor, black and vaccine, a live, oral vaccine as well, efit from a vaccine. In developed coun- white—without distinction. Conse- would be given in three doses. tries, rotavirus leads to doctor visits, hos- quently, every child is affected in the first pitalization, lost parent workdays, and SVR How would the vaccine be few years of life. Why this first infec- economic expense. In developing coun- administered? tion is so severe is unknown, but while tries, the consequences of rotavirus can CdQ Both vaccines are live oral vac- most rotavirus diarrhea is mild, about ten be fatal. A vaccine will serve to prevent cines that would be administered orally percent of cases lead to dehydration severe disease in any setting—fatalities at the time of the other routine childhood requiring a doctor visit, and in develop- in developing countries, or hospitaliza- immunizations—to children 6, 10, and 14 ing countries one in 250 children will die tions and economic problems in devel- weeks of age. from this dehydration. oped countries. SVR We’ve heard about the small SVR What factors make it so SVR Your career in public health number of cases of bowel obstruc- prevalent? and disease eradication is impressive. tions, or intussusception, that CdQ The fact that rotavirus affects What has been your experience with prompted the withdrawal of the pre- children worldwide, in the United States implementing efforts to address the vious vaccine. Is this the main hurdle and Bangladesh, for example, indicates rotavirus disease burden? to be overcome in developing the sec- that improvements in water and sanita- CdQ We have been working to assess ond-generation vaccine? tion will not change the incidence of dis- the burden of rotavirus diarrhea in Latin CdQ Early studies with the rhesus vac- ease, but it is likely spread by other America. Many studies of the importance cine that was given to nearly one million routes, such as airborne droplets or con- of rotavirus have been conducted children demonstrated that the vaccine tact. It is highly infectious in low dose throughout Latin America over the past was highly effective and relatively safe. and spreads rapidly among children with- 20 years that indicate rotavirus is a ma- It was withdrawn because of the rare out prior exposure. jor problem. Efforts are being initiated adverse event of intussusception. In SVR Besides a vaccine, what pre- to set up sentinel hospital surveillance studying new vaccines, we would like cautions, if any, can be taken to pre- for rotavirus in many countries of Latin to know that their risk of intussuscep- vent rotavirus? America, so the full extent of the dis- tion is less than the risk posed by the CdQ We know of no way to prevent ease burden can be further ascertained. rhesus vaccine. This safety profile is the rotavirus infection but we do know that biggest hurdle to overcome in testing the SVR Can you describe the general the disease can be made less severe if next generation of vaccines. It requires formulation of the vaccines that could children are begun on treatment with oral that tests be conducted in more than potentially effectively prevent rehydration when the first signs of vom- 60,000 children to ensure that the rate rotavirus? How will it be a better vac- iting and diarrhea begin. This strategy of intussusception is less than one in cine than the one that was used from of early oral rehydration therapy will 11,000. It also requires that investiga- 1998 to 1999? work for all acute diarrheal illness re- tors conducting trials have in place a CdQ Two vaccines to prevent rotavirus gardless of etiology, so while we can’t diarrhea are currently under develop- prevent rotavirus, we can prevent the Continued on page 13 ment: one by GlaxoSmithKline (GSK) 6 SPRING 2003 SABIN VACCINE REPORT Samuel L. Katz, MD, to Receive 2003 Sabin Gold Medal Co-developer of Measles Vaccine to Be Honored at May Ceremony Samuel L. Katz, MD, the Wilburt teem in which I hold all the former Medal Vaccine Action Program and the Na- Cornell Davison Professor and chair- recipients.” tional Network for Immunization Infor- man emeritus of pediatrics at Duke According to Peter Hotez, MD, chair- mation, in addition to his consultancies University, will be this year’s recipi- man of the Institute’s Scientific Advi- with the National Institutes of Health, ent of the Sabin Gold Medal. The sory Council, “Since the measles vac- Centers for Disease Control, Food and award recognizes exemplary leader- cine was implemented widely through Drug Administration and World Health ship in the field of vaccinology. Dr. the Expanded Program Organization. Katz is contributor to numerous vac- on Immunization in Dr. Katz provided cine discoveries, including collabora- 1974, the number of professional lead- tion to develop the measles vaccine childhood deaths from ership as president in use today. measles decreased of the American “Samuel Katz exemplifies a rare from roughly 7 million Pediatric Society sort of commitment and perseverance deaths per year to now and of the Associa- that culminates in life-saving medical less than 800,000 tion of Medical discoveries,” said H.R. Shepherd, deaths per year.” Dr. School Pediatric chairman of the Sabin Vaccine Insti- Hotez noted that the six Department Chair- tute. “The global benefit of the million young lives con- men. His published measles vaccine alone is tremendous ceivably saved by the studies include nu- and can be realized even further with vaccine every year merous original sci- amplified immunization rates.” In ad- since 1974—150 mil- Samuel L. Katz, MD entific articles, dition to development of the measles lion total—is in number chapters in text- vaccine, Dr. Katz worked extensively greater than the estimated toll from all books, abstracts, commentaries, edito- on a range of other vaccines, in- wars during the 20th century. rials, and reviews. He is co-editor of cluding vaccinia (used as Dr. Katz’s early career included Infectious Diseases of Children, a text- smallpox vaccine), polio, an internship at Beth Israel Hos- book now in its 11th edition. rubella, influenza, per- pital, a residency in pediatrics tussis (whooping at the Massachusetts General Previous Recipients cough), Haemophilus Hospital and the Boston Albert B. Sabin Gold Medal influenzae b conju- Children’s Hospital, followed gates, and HIV. by a research fellowship in vi- 1994 His selection by the rology and infectious diseases. Donald A. Henderson, MD, MPH Sabin Gold Medal Advi- He became a staff member at 1995 sory Committee of the Albert Children’s Hospital, working with Nobel Robert M. Chanock, MD B. Sabin Vaccine Institute places Dr. Laureate John F. Enders to develop the 1996 Katz among a prestigious fraternity attenuated measles virus vaccine. Joseph L. Melnick, PhD (d. 2001) of 10 previous recipients. The award For 22 years, Dr. Katz was chairman 1997 will be presented at 7:30 pm on May of Duke University’s Department of Pe- Maurice R. Hilleman, PhD, DSc 6 at the Crystal City Marriott Hotel diatrics. In addition to mentoring two 1998 in Arlington, Virginia. The medal cer- decades of students and residents, he Myron M. Levine, MD, DTPH emony is planned during the 6th An- established an exchange program with 1998 nual Conference on Vaccine Re- Oxford University and provided train- Allen C. Steere, MD search, a meeting of several hundred ing for an annual succession of residents 1999 of Dr. Katz’s fellow scientists that is from the American University of Beirut. Major General Philip K. Russell, MD co-organized by the Sabin Vaccine In- Having relinquished the chairmanship in (USA Ret.) stitute and sponsored by the National 1990, his activities continue with vac- 2000 Foundation for Infectious Diseases. cines and pediatric AIDS. He partici- Ciro A. de Quadros, MD, MPH “This award is especially meaning- pates in the clinical research trials of the 2001 ful,” Dr. Katz said. “I am thrilled to NIH, serves on their Committee for John B. Robbins, MD be selected as the 2003 recipient of AIDS Vaccines and devotes time to the 2002 the Sabin Gold Medal and there are care of children with HIV infection. Dr. Stanley A. Plotkin, MD so many reasons, including the es- Katz currently co-chairs the India-U.S. dedicated to disease prevention www.sabin.org 7 Message on Importance of Immunization Brought to the Hill Peter Hotez, Paul Offit, and Walter Orenstein Present Congressional Education Session The National Partnership for Immu- through cases of varicella (chickenpox) entry; vaccines in the pipeline; and the nization and 27 other sponsoring organi- disease; the most recent information parameters and cost-benefit of develop- zations, including the Sabin Vaccine In- regarding thimerosal; parents’ noncom- ing new vaccines. stitute, hosted a briefing on vaccine pliance because of their misperception The initiative was intended to inform safety at the U.S. Capitol in Washing- that there is no disease risk; how cul- the policy making process. By encour- ton, DC on Thursday, January 23, 2003. tural barriers are being addressed when aging questions and dialogue, the brief- “Vaccines: Our Children Are Worth a dealing with minority populations to re- ing delivered the public health messages Shot” gave attendees the opportunity to duce disparities in immunization; delay familiar to the immunization community view the new video, Vaccines and Your of vaccination until mandated for school regarding vaccine safety. Baby, produced by the Vaccine Educa- tion Center at the Children’s Hospital of Philadelphia. The following congressional members were represented at the briefing, The video screening was followed by Vaccines: Our Children Are Worth A Shot: a question and answer period with Paul Offit, MD, director of the Vaccine Edu- Senator Jeff Bingaman, D-NM Senator Christopher Bond, R-MO cation Center, and Peter Hotez, MD, Senator Barbara Boxer, D-CA PhD, FAAP, chairman of The George Senator John B. Breaux, D-LA Washington University Department of Senator Hillary Rodham Clinton, D-NY Microbiology and Tropical Medicine and Senator Christopher J. Dodd, D-CT Senator Richard J. Durbin, D-IL Sabin senior fellow. Walter Orenstein, Senator John Edwards, D-NC MD, director of the CDC’s National Im- Senator James M. Inhofe, R-OK munization Program, was also available Senator Jack Reed, D-RI to field the questions posed by Hill staff Senator John D. “Jay” Rockefeller, D-WV members and others attending. Congressman Dan Burton, R-IN Congressman Jim Cooper, D-TN The issues raised during the meeting Congressman James C. Greenwood, R-PA included the efficacy of the Vaccine Ad- Congressman Ralph Regula, R-OH verse Events Reporting System Congressman Henry A. Waxman, D-CA (VAERS) for new vaccines; the appar- ent increase in the number of break- Sixth Annual Conference on Vaccines Research, May 5-7, 2003 The National Foundation for Infec- Biodefense; Vaccine Supply: Global Cri- cluding epidemiologists, microbiolo- tious Diseases (NFID), in collabora- sis; Regulatory/Suppressor T Cells: Im- gists, immunologists, molecular biolo- tion with the Sabin Vaccine Institute plications for Vaccinology; Vaccines gists, vaccine researchers, and public and a number of other organizations, Against Nosocomial Infections; Vaccines health officials. Attending physicians can will host the Sixth Annual Conference for Zoonotic Diseases; Malaria Vaccines; register for continuing medical education on Vaccine Research on May 5-7, at and Hot Topics in Immunology. credits. the Crystal Gateway Marriott in Ar- The 2003 conference will include a lington, Virginia. Expert faculty from keynote address on Effector and For registration information, various disciplines will present the lat- Memory T Cells featuring Antonio contact the National Foundation est vaccine-related scientific data, re- Lanzavecchia, MD, director of the In- for Infectious Diseases at (301) sults, and issues via symposia and stitute for Research in Biomedicine in 656-0003 x19, or by e-mail at panel discussions. The program in- Bellinzona, Switzerland. email@example.com, or you may cludes symposia on the Long-term Im- The 2002 conference was attended by visit the conference website at pact of Vaccination Strategies on Dis- more than 500 scientists, physicians, and www.nfid.org/conferences. ease Epidemiology; Vaccines and veterinarians from around the world, in- 8 SPRING 2003 SABIN VACCINE REPORT Looking Back, Moving Forward Today, with national and global rec- ognition, an $18 million Bill and Melinda The Sabin Vaccine Institute at 10 Years Gates Foundation grant to develop a from page 3 to get the Institute off the ground and into hookworm vaccine, and global and do- Chanock, MD, a close friend and con- a position of influence amidst the vac- mestic projects, the Sabin Vaccine In- temporary of Dr. Sabin. Maj. Gen. Phil- cine research, public health, and global stitute has established a strong record ip K. Russell, MD (USA Ret.), an ex- community. The entire cast of founding of successful initiatives. pert on infectious diseases and biological organizers kept the Institute on track de- The pictorial on these two pages warfare, stepped forward to serve as the spite its broad focus on the many aspects shows various highlights of a vital re- Institute’s founding president. Many oth- of vaccine advocacy that urgently pre- search and advocacy activities organized ers whose backgrounds exemplified the sented themselves from the start. by the Sabin Vaccine Institute in the crit- enormous potential of vaccines worked ically important vaccine field. 1993-1998 1999 H.R. Shepherd, Sabin The Cold Spring Har- Vaccine Institute Chairman, addresses Education bor Laboratory has be- come a favorite venue attendees at 1998 re- for Sabin Vaccine In- ception at George- stitute colloquia. The town University in Laboratory is research Washington, D.C. home to James Watson, PhD, co-dis- coverer of the structure of DNA, shown here with H.R. Shepherd, SVI chairman, in 1999. From 1999 to 2001, the Institute sponsored prizes in infectious disease research to high school stu- dents convened at the Intel International Science and Engineering Fair. Recognizing Achievement and Humanitarianism Participants discuss a presentation at the 1999 Vac- Sabin Vaccine Institute Trustees Carol Ruth Shepherd, cine Policy Colloquium at Cold Spring Harbor Labo- Since 1996, Steuben left, and Heloisa Sabin confer during a 1998 celebration ratory. glass eagles have in Washington, D.C. been presented an- nually by the Sabin Vaccine Institute to Lifetime Achieve- ment Award and Humanitarian Award recipients. Dr. Philip K. Russell (center) recipient of the 1999 Albert B. Sabin Gold Medal, is flanked by Sabin Vaccine Institute Chair- Scientific forums on vaccine topics quickly be- man H.R. Shepherd and Dr. Sue Bailey, Assistant Secretary of came the trademark of the Sabin Vaccine Insti- Defense for Health Affairs. Dr. Bailey praised Dr. Russell’s tute. At a 1997 forum, above, Robert Gallo, MD, contributions to disease research and vaccine development as co-discoverer of the HIV virus that causes AIDS, a major general and Commander of the U.S. Army Medical confers with H.R. Shepherd. Research and Development Command. dedicated to disease prevention www.sabin.org 9 2000 Science writer Pat Thomas, who received support from the Institute in 1996 for her investigation into AIDS vaccine research, had the book Big Shot: Research Passion, Politics and the Struggle for an AIDS Vaccine published in 2001. Below, Peter J. Hotez, MD, MPH, de- SVI Board Member Allan Goldstein, picted here with a Honduran PhD, introduces her at a SVI celebra- child, is principal investiga- tion of her accomplishment. tor for the Sabin Institute’s Hookworm Vaccine Initiative. The work is funded by an $18 million research grant awarded in 2000 from the Bill Allan L. Goldstein, PhD, SVI Trustee, and Melinda Gates Foundation and H.R. Shepherd, SVI chairman, pre- and is being conducted at The pare for scientific colloquium on can- George Washington University, where Dr. Hotez is chairman of the cer vaccines and immunotherapy at Department of Microbiology and Tropical Medicine. He also is Walker’s Cay, Bahamas, 2000. The meet- chairman of the Institute’s Scientific Advisory Council. ing has been held annually since 1999. 2002 SVI Board Members Lance Gordon, PhD, Edward S. Cold Spring Harbor was the site for the 2000 Collo- Neiss, MD, and Lewis A. Miller meet at the 2000 Sabin quium of the Sabin Vaccine Institute, attended by, Gold Medal ceremony. from left, Carol Nacy, PhD, Sequella; Karin Holm, IPPH Global Health Research; and Philip Russell, Guests revel at the 2002 Awards Dinner at The Pierre MD, SVI Founding President. Hotel in New York City. SABIN VACCINE INSTITUTE COLLOQUIA AT COLD SPRING HARBOR LABORATORY, 1994-2003 October 2002 Global Vaccine Shortage: The Threat to Children and What to Do About It October 2001 Making Vaccines for the Developing World: Access to and Deployment of New Technologies The 2000 colloquium team featured Gina Rabinovich, October 2000 Social Venture Capital MD, PATH/Malaria Vaccine Initiative (currently with Presenters at the 2002 scientific meeting Facing the for Neglected Vaccines: Creating the Bill and Melinda Gates Foundation) Phil Russell, Challenge: Disease Prevention in a Time of Crisis, Successful Alliances MD, Lance Gordon, PhD, VaxGen, and Melinda Moree, held at the New York Academy of Sciences. Front row, December 1999 Vaccines for PhD, PATH/Malaria Vaccine Initiative. from left, Margaret Hamburg, MD; Peter Hotez, MD, Developing Economies: Who Will Pay? PhD; Tee Guidotti, MD, MPH; Tom Zink, MD; Sam October 1998 From the Bench to Katz, MD; and Tom Frieden, MD. Back row, Philip Bedside: Colloquium on Translational Research 2001 Russell, MD; John Robbins, MD; John Woodall, PhD; Allan Goldstein, PhD; and Paul Offit, MD. November 1996 Case Studies in Vaccine Development March 1996 AIDS Vaccine Initiative: 2003 . . . The Sabin Foundation’s Role in H.R. Shepherd was rec- Ciro de Quadros, MD, heads up Developing an AIDS Vaccine ognized in 2001 with an International Programs for the October 1995 Vaccine Development honorary DSc degree from Institute, including projects ad- and Delivery in the Era of Managed The George Washington dressing rotavirus and rubella. Dr. Care University. de Quadros was a leader in both October 1994 Planning for the Next the smallpox and polio eradica- Generation of Vaccines tion programs. 10 SPRING 2003 SABIN VACCINE REPORT President Details Project BioShield SVI’s Philip Russell, MD Provides Expertise on Defense Against Bioterrorism In his State of the Union Address in According to the White House, the tory process is underway and they go late January, President Bush announced national stockpile of medical counter- through testing for effectiveness and Project BioShield, which the White measures is extensive and it can be ac- safety on their way to licensure.” House calls “a comprehensive effort to cessed more rapidly than ever before. New FDA “emergency use authori- develop and make available modern, Additional diagnostic tests, drugs, and zation” would also be implemented for effective drugs and vaccines to protect vaccines are under development. How- promising medical countermeasures un- against attack by biological and chemi- ever, the medical treatments for some der development. Some of the most cal weapons or other dangerous patho- types of bioterrorist attacks have seen promising treatments for a terrorist agent gens.” He included BioShield in the Fed- little recent improvement. BioShield will may still be under formal FDA review eral FY04 Budget request now being bring researchers, medical experts, and when an attack occurs. BioShield considered by Congress. the biomedical industry together in a new would permit the effective use of such Project BioShield was conceived to and focused way to develop treatment treatments in an emergency, if alterna- ensure that resources are available to breakthroughs for bioterrorism. tive treatments are not available. This pay for “next-generation” medical coun- “As we worked through the budget will improve access to a potentially ben- termeasures. The novel program will process we garnered the very strong sup- eficial treatment in an emergency situa- allow the government to buy improved port of the Office of the Vice President,” tion, when it is most likely to save lives, vaccines and drugs to treat such Dr. Russell said. “The vice president also even if it has not yet been proven to be bioterror agents as smallpox, anthrax, asked what other initiatives can help this suitable for routine general use or has and botulinum toxin. Use of this author- process along. So we included in the fi- not completed the formal process for full ity is currently estimated to be $6 billion nal legislation an initiative for streamlin- FDA licensure. over ten years. Funds would also be ing the current processes at NIH and a The extraordinary authorization is available to develop countermeasures to legislative initiative for FDA work.” carefully written not to undermine ex- protect against other dangerous patho- NIH’s usual methods for supporting isting FDA licensing processes. gens, such as Ebola and plague. research and development on conven- BioShield would supplement the tradi- “The president’s BioShield Initiative is tional diseases, while extremely effective tional FDA licensing process, ensuring basically a legislative initiative on the part in those areas, may not always be suited that the government could respond ef- of the administration freeing obstacles to to meet the urgent demands posed by the fectively in a crisis with a medical coun- very rapid development of biological risk of terrorism. Under the BioShield termeasure. These countermeasures products,” said Maj. Gen. Philip K. authority, technical experts could be rap- would be deemed by experts to be safe Russell, MD (USA Ret.), special advisor idly hired and NIH could more quickly and effective, even though they have not on vaccine development and production, execute research grants and contracts. completed the formal FDA review pro- Office of the Assistant Secretary for Pub- How would the special authority to cess. This authority is very narrowly lic Health Emergency Preparedness, U.S. engage BioShield be invoked? The Sec- focused and targeted only at drugs and Department of Health and Human Ser- retary of Homeland Security and the vaccines under the direct control of the vices. “In order to manufacture this large Secretary of Health and Human Ser- U.S. government. It would only be in- list of products in very large volume we vices will collaborate to identify critical voked after certain certifications had need special procurement authority.” medical countermeasures by evaluating been made, and civilian use of the treat- The new initiative would strengthen potential threats. New biomedical re- ments would be voluntary. development capabilities at the National search initiatives will be developed in The BioShield program provides a Institutes of Health (NIH) to acceler- view of public health requirements and stable funding source for the pharma- ate research and development on medi- appropriate NIH programs would be cre- ceutical industry to produce drugs and cal countermeasures based on the most ated to speed research and development vaccines for the national stockpile. “The promising recent scientific discoveries. for medical countermeasures. really exciting thing about this to me is It would also give the Food and Drug “The strategy we put in place is to that it produces a mechanism for the Administration (FDA) the authority to overlap several of the activities we usu- government to assure a financial incen- rapidly approve promising investigational ally do end to end,” Dr. Russell said. “For tive,” Dr. Russell said. “We need a solid treatments for emergency situations. instance, with the smallpox vaccine the manufacturing base to build the vaccines. FDA can judiciously use its new au- manufacturing will be completed prior For a long time there was a problem thority to make the newest treatments to completion of a Phase II trial. For all showing long-term support.” widely available to patients who need of these products, we expect to have (This article draws upon White House press state- them in a crisis. them in the stockpile while the regula- ments and Dr. Russell’s presentation at the National Vaccine Advisory Council meeting on February 5, 2003.) dedicated to disease prevention www.sabin.org 11 New Leaders Take the Helm at PAHO and WHO In the past few months, two international organizations that coordinate and conduct public health activity around the globe have chosen new leaders to govern their international programs. The Pan American Health Organization (PAHO) and the World Health Organization (WHO) both conduct vaccine purchase and immuniza- tion programs that reach millions around the world. Dr. Mirta Roses Sets Commitments as New Director of the Jong-Wook Lee, MD Begins New Pan American Health Organization Role as Director-General of the Renewing her commitment to work for continue serving health in the Americas,” World Health Organization public health in the Americas, Dr. Mirta she said. “The focus of my attention will The Execu- Roses Periago was sworn in January 31 be working in and with the countries. tive Board of as the new director of the Pan Ameri- Faithful to my profession as an epide- the World can Health Organization (PAHO), be- miologist, I will seek contact with the Health Organi- coming the first Argentine and first communities and observe the projects zation nomi- woman to lead the Organization. “We in the field.” nated Dr Jong- are committed to health “This Director and her team Wook Lee to for all, to the strategy will be defending your health,” become the of primary health care Dr. Roses declared in her first organization’s Jong-Wook Lee, MD strategy, to health pro- address as director. She said she director-gen- motion, and to the re- will give special importance to eral this coming duction of inequities the fight against the AIDS epi- July. The post is WHO’s chief technical and social exclusion,” demic, focusing on the countries and administrative office and Dr. Lee Dr. Roses said. PAHO of the Caribbean, and to im- will be charged with setting the policy works with all the provements in health conditions for the Organization’s international countries of the Mirta Roses Periago, MD in priority countries, particularly health work. Americas to improve Haiti, she said. Dr. Lee received his medical degree the health and living standards of all their After thanking outgoing Director Dr. from Seoul National University and a peoples. It also serves as the Regional George Alleyne and a host of well-wish- master of public health degree from the Office for the Americas of the World ing dignitaries, Dr. Roses said, “I reaf- University of Hawaii. During the past Health Organization. firm my commitment with emotion and 19 years with WHO, he held technical, In her inaugural speech, Dr. Roses pride as the first woman to assume the managerial and policy positions, notably recalled her first paid public health job direction of this centenary and presti- leading the fight against two of the as a door-to-door vaccinator in the gious Organization and to guide it at the greatest challenges to health and devel- smallpox eradication campaign of 1965. beginning of this new Millennium.” opment: tuberculosis and vaccine pre- “I feel very moved after 38 years to ventable diseases of children. After heading the WHO Global Programme for Vaccines and Immunization and serving as a senior policy advisor, in 2000 Ciro de Quadros to Direct International Programs for SVI he became director of the Stop TB from page 4 Needle, for his contribution to smallpox program, a coalition of more than 250 versity; and adjunct professor in the eradication; the International Child Sur- international partners including Department of Microbiology and Tropi- vival Award from UNICEF and the WHO member states, donors, non- cal Medicine at The George Washing- Carter Center, for personal contribu- governmental organizations, industry ton University. tion to polio eradication; the Prince and foundations. Dr. de Quadros is a member of the Mahidol Award of Thailand, for his Dr. Lee, a South Korean national, will American Public Health Association, contribution to polio eradication in the succeed Dr. Gro Harlem Brundtland, a American Association for the Advance- Americas; the Order of Rio Branco former Norwegian prime minister, who ment of Science, National Council for In- of Brazil, for contributing to improv- is stepping down following a single term. ternational Health, American Society of ing the health of the peoples of the Dr. Lee will begin a five-year term on Tropical Medicine and Hygiene, and the world; and this past February he re- 21 July 2003. His nomination is expected New York Academy of Sciences. Among ceived the Order of Public Health from to be approved at the 56th World Health his awards are the World Health the Government of Bolivia. He is the Assembly scheduled to meet in Geneva Organization’s Order of the Bifurcated recipient of numerous other honors. from May 19-28, 2003. 12 SPRING 2003 SABIN VACCINE REPORT Marking 50 Year Anniversary of Discovery of the Double Helix Cold Spring Harbor Laboratory Commemorates Landmark Event with Scientific Meeting Genetics and genomics are cutting- This year, the Cold Spring Harbor sequences can be calculated per day and edge research fields today, offering Laboratory on Long Island, New York, fed into “public” databases to be enormous medical potential and celebrates this landmark discovery along analyzed by all scientists. This opportunity for therapeutic innovations. with the role the Laboratory has played information has spawned a new field of Just 50 years ago, the structure of DNA as a research base for investigations in informatics, which scans large libraries was hardly understood and a new genetics. A featured scientific meeting of data to derive new discoveries. discovery offered a breakthrough of of the anniversary commemoration was Take for example, the comparison of immense proportions. Dr. James Watson the conference on Biology of DNA, held genome homology of gorillas, and Dr. Francis Crick determined how from February 26 to March 2, 2003. c h i m p a n z e e s , deoxyribose nucleic acid (DNA) is The conference featured noted Neanderthals and structured and governed and launched speakers, including Nobel laureates, humans—this analysis a sort of scientific revolution. who recounted their discoveries, can yield not only the At the time of their landmark including developments on the sequence of evolution discovery in 1953, the chemical structure enzymatic and structural processes but also determine the of DNA was known, as were its involved in DNA replication, millions of years bases—GCAT, their pairing—G=C and translocation and expression (see between each evolutional A=T, and that they were strung along list). The impact on subsequent deviation that occurred. polyphosphate chains. Still to be research illustrated the progression Similarly by comparing discovered was how they were arranged in science that has led up to modern genomic homology amongst into strands to make chromosomes, the sophisticated technologies and Africans, Europeans, and basic building blocks of life. Using x-ray techniques in the field. Those Asians, the tree of human life crystallography and chemical bonding scientists who came more can be established and the information, Dr. Watson and Dr. Crick recently to the field also spread of the human race were able to describe the double helical participated. Computer timed. Non-genetic DNA in the structure. Their discovery won for them graphics, fluorescence chromosome (80 percent of the the Nobel Prize and publication in such techniques, and molecular total) and in mitochondria also leading journals as Nature. This modeling created a may be very important in dictating discovery opened the window into the staggering depiction of the human variation. three-dimensional double helix structure, cellular and molecular events The events surrounding the 50th year therefore making it possible to associated with DNA and celebration showcased senior understand the function of genes and chromosomal synthesis and replication, researchers who were part of the early their mutations. and ultimately expression. discoveries in the genetics field as well The degree of sophistication among as the promise of new discoveries in the techniques in the field was on display at field assured by a new generation of Select Speakers and Talks Featured the meeting. Researchers can boast an investigators. at the Biology of DNA Meeting understanding of how three billion base For those anticipating an impact of Replication and Recombination of the pairs are linked to make life as we know genetics discoveries on the vaccine field, Double Helix, Frank Stahl it. With the accumulation of the base significant understanding has already The Enzymology of DNA and compositions of the 30,000 human genes been gleaned from the concepts Polyphosphates, Arthur Kornberg (Nobelist, 1959) elucidated by the Human Genome elucidated by Dr. Watson and Dr. Crick. Project, it has become possible to DNA defines “self.” It is this Chromosome Replication, Bruce Stillman envision an “encyclopedia” containing characteristic that enables the nervous Recombination with DNA Strands, the determination of how we are system and the immune system to Robin Holliday uniquely different from plants and other recognize what is “self” and what is the Deciphering the Genetic Code, forms of life. “other,” and to react appropriately. Marshal Nirenberg (Nobelist, 1968) The impact of the Human Genome Immunologic response is rooted in this Comparative Genetics, Eric Lander Project on molecular biology is concept, and the immune system, in outstanding. The technical achievement defense of self, conveys vaccine- Closing Remarks, James Watson to assess the base sequences of a induced protection from pathogen (Nobelist, 1962) number of species is itself challenge. remarkable…such that millions of base —by John W. Hadden, MD dedicated to disease prevention www.sabin.org 13 On Rotavirus: An Interview with Ciro de Quadros, MD, MPH continued from page 5 mechanism to identify children with ery, with many economic, political and SVR How would this differentia- symptoms that might represent intussus- cultural overtones. However, with the tion be addressed in a new vaccine? ception, which can be assessed and trials ongoing and new vaccines prepar- CdQ The only way to know if a new treated by a quality-care facility. ing for future tests, we can develop a vaccine will work against the main se- Since the new generation vaccines be- vaccine that is as effective as the first rotypes of rotavirus is to conduct large- ing tested are both live, oral vaccines, vaccine, but with a safer profile and scale field trials in a variety of settings. one might question whether it will be any fewer adverse events. These studies are planned and will be better than the rhesus vaccine that was ongoing shortly, and should give us an SVR I’ve heard that there can be licensed in 1998. In fact, we won’t know answer to these important questions in different strains or serotypes of the safety profile of these two vaccines a couple of years. rotavirus. Are these different serotypes until 60,000 children have been immu- distributed geographically so that SVR What about the clinical tri- nized and we can assess whether these different kinds of cases would appear als for a new vaccine? What will children develop intussusception. None- in say Latin America, than Africa or they entail? theless, for the GSK vaccine, we have North America? CdQ Trials need to be large, with ac- no evidence that natural human rotavirus CdQ There are four or five main sero- tive follow-up for intussusception, and is implicated as a cause of intussuscep- types of rotavirus found worldwide. The are relatively costly. It is unfortunate with tion, so we hope that this holds for the vaccine—to be effective—must cover rotavirus that we have no good proxy vaccine as well. For the Merck vaccine, these principal serotypes. At the same for protection from vaccine. Conse- the bovine strains replicate less than the time, the common serotypes in the quently, the only way to assess the effi- rhesus strains and cause less fever than United States are also common in Latin cacy of a new vaccine is through a the rhesus strains, meaning they are America and worldwide; however, in large-scale clinical trial. Large-scale more attenuated. We hope that these some countries like Brazil, unusual se- clinical trials of both the GSK and Merck milder infections will also be associated rotypes have emerged, perhaps from vaccines are ongoing, so it conceivable with fewer adverse events. contact with cows or pigs, which also that these vaccines could be licensed in SVR There has been some contro- have rotavirus. Some evidence exists two to four years. versy over the withdrawal of the 1998 that genes of rotavirus of animal origin SVR What is the global outlook for vaccine because intussusception can reassort and infect humans. These a vaccine once it is licensed? cases were few and the cases of chil- situations appear to be rare, but will re- CdQ Our hope for the global agenda is dren who die as a consequence of quire some monitoring of strains over that in 10 years, we would be able to rotavirus are tremendously greater in time. Trials of the new vaccines are immunize 80 percent of the world’s chil- number—between 600,000 and about to be conducted in many countries dren against rotavirus and decrease 800,000 per year. How does this di- of Latin America, Asia, and the United rotavirus mortality by 60 percent. lemma impact the urgency of making States and Europe. At the same time, a a rotavirus vaccine available? Is the vaccine has already been licensed in SVR Do you imagine rotavirus ul- rotavirus vaccine a good case study China and several other new vaccines timately will be on the recommended on rethinking the benefit versus risk could be licensed in India and Indonesia childhood immunization schedule? of vaccines, in general? in five to seven years. CdQ Absolutely, yes! CdQ The risk-benefit analysis of rotavirus is quite different in developed and developing countries. In the United The Sabin Vaccine Institute published SABIN States, few children die of rotavirus and a white paper following its October VACCINE INSTITUT the disease is generally mild. Conse- 2002 vaccine policy colloquium titled E 2003 quently, a vaccine with any adverse ortage: event poses an unacceptable risk. In Global Va The Threa ccine Sh t To Child ren and W hat To Do About It Global Vaccine Shortage: The Threat developing countries where one in 250 A White Paper Exploring Lessons from the e’s 9th Ann ual Vaccine Colloquiu m to Children and What to Do About It. cine Institut children die of rotavirus, even a vaccine Sabin Vac Readers can locate an electronic PDF with a small risk of an adverse event 2003 February could still be effective in preventing this file of the document on the Sabin most common cause of death in children. Vaccine Institute website, This is a true dilemma in vaccine deliv- www.sabin.org. 14 SPRING 2003 SABIN VACCINE REPORT Vaccine Developer Lance Gordon, PhD, Elected to Sabin Institute Board VaxGen CEO Named to the Board of Trustees at February Meeting The Sabin Vaccine Institute Board of Therapeutics Group. He was the found- tor of the Connaught Haemophilus Trustees elected Lance Gordon, PhD, ing president and chief executive officer influenzae type b conjugate vaccine, to its membership during its meeting this of OraVax from 1990 though 1999. ProHibit®. Dr. Gordon serves on the past February. Dr. Gordon is chief ex- In the late 1980s, Dr. Gordon led advisory board of BioSciences Contract ecutive officer of VaxGen, Inc., the Cali- Selcore Laboratories, Inc., as CEO, as Production, a private biopharmaceutical fornia-based biopharmaceutical com- well as its successors, American Vac- services company. He is a member of pany whose AIDS vaccine trials were cine Corporation and North American the Scientific Advisory Council of the so closely followed the world over this Vaccine, Inc. He was associate direc- Sabin Institute and is a Fellow of the past year. tor, Infectious & Inflammatory Diseases, U.S. Medicine Institute. He is a con- “Lance Gordon’s name is virtually Clinical Pharmacology— sultant on vaccine re- synonymous with cutting-edge vaccine Drug Medical Affairs, of lated issues to the Part- development and we’re entirely pleased E.R. Squibb & Sons, Inc., nership for Appropriate that he is now a member of the Institute’s pharmaceutical com- Technologies in Health, board of trustees,” said H.R. Shepherd, pany. He was research the United Nations chairman. “He’s been in the vaccine director with Connaught Children’s Fund, and business, making progress in an indus- Laboratories for six the World Bank . try that has struggled to stay alive. He years in the early and mid Dr. Gordon is a understands the critical importance of 1980s, before its merger graduate of the Univer- vaccines in modern health care and his with Pasteur Mérieux, sity of California at name is the first to come to mind re- which later emerged as Humboldt and from the garding the current state of the art in Aventis Pasteur. University of Connecti- vaccines.” During his seven years Lance Gordon, PhD cut, where he received Dr. Gordon is an expert vaccine sci- with Connaught, Dr. Gor- his PhD in biomedical entist and entrepreneur who has held a don was responsible for both bacterial science. Dr. Gordon completed his number of senior executive management and viral vaccine research and devel- postdoctoral fellowship with the roles in biopharmaceuticals. Prior to join- opment programs as well as for scien- Howard Hughes Medical Institute at ing VaxGen in 2001, he served two years tific support of licensed products. He Washington University Medical School as North American director for Peptide was also the inventor and project direc- in St. Louis, Missouri. The Iditarod—The Last Great Race Famous Sled Dog Race Reenacts Heroic Effort in 1925 to Arrest Diphtheria Outbreak An epidemic of the disease diph- The name “Iditarod” refers to an can cause a complete loss of visibil- theria loomed over the small town of Athabascan term for their inland hunt- ity, long hours of darkness, and treach- Nome, Alaska in 1925. A serum was ing ground—“the distant place.” A trail erous climbs. needed to inoculate the townspeople from Nome through Iditarod and on to The original Iditarod was a race but it was in short supply. Bad weather Seward, the major seaport in southern against time and the ravages of a in the area kept airplanes from Alaska, originally called the Seward Trail, deadly disease. One can only imagine Fairbanks on the ground. The serum later became known as the Iditarod Trail. the relief and satisfaction of the was instead rushed from Nenana to The Iditarod is also called the “Last mushers in 1925, whose efforts Nome—about 675 miles—by dog Great Race on Earth.” Today competi- averted the progress of the diphtheria teams. The medicine was relayed the tors navigate across 1049 miles of the epidemic by transporting the vital se- distance in just 127.5 hours. Alaska’s roughest terrain, including rum. This year’s winner, Robert Sorlie The Iditarod Trail Sled Dog Race is jagged mountain ranges, frozen rivers, of Norway, was the first European run to commemorate the historic se- dense forests, desolate tundra, and miles musher to continue the tradition and rum run. The race begins in Anchor- of windswept coast. Each team of 12 cross the Iditarod finish line. He fin- age during the first weekend in March to 18 dogs and their musher endures ished the race in 9 days, 15 hours, 47 and ends about 10 days later in Nome. temperatures far below zero, winds that minutes and 36 seconds. dedicated to disease prevention www.sabin.org 15 Sabin Vaccine Institute Salutes Deborah Wexler, MD Immunization Action Coalition Founder Turns Community Outreach into National Forum Deborah Wexler, MD believes in be- resident in the University of Wisconsin hepatitis B vaccination for all children ing well informed. Her work, her pas- Madison’s Department of Family Medi- up to 18 years of age, screening for all sion, and her life is seeing to it that cine and Practice, she trained at the pregnant women, testing and vaccina- healthcare providers—along with an community-based program in Eau Claire, tion for high-risk groups, and education often misinformed public—are well in- Wisconsin. There she became interested and treatment for people who are chroni- formed about immunizations and the ca- in hepatitis B preven- cally infected with hepati- tastrophes that can result when compla- tion as she treated tis B. In 1994, the Hepati- cency sets in on this health topic. refugees from South- tis B Coalition became an Dr. Wexler is the founder and execu- east Asia, where there official program of IAC tive director of the Immunization Action is a high rate of hepati- when IAC was granted tax Coalition (IAC), a nonprofit organization tis B infection. She de- exempt status. she started from grassroot efforts to veloped a clinic-wide IAC has grown from hav- boost immunization rates and thus pre- tracking system to en- ing just one staff member vent disease. Today it is an information sure that these refu- to an operation of eight full- clearinghouse helping healthcare provid- gees received vaccina- time and two part-time em- ers to stay abreast of immunization re- tions against hepatitis B ployees, with several con- quirements, benefits, and breakthroughs. or were followed for sultants who assist in pro- The information published by IAC is liver disease. gram development, grant available on the organization’s website In 1988, while work- Deborah Wexler, MD writing, and web site devel- www.immunize.org and includes pedi- ing at a community opment. Today the IAC has atric and adult immunization schedules health center in St. Paul, Minnesota, she a $1 million budget. and practical vaccine information and again treated refugees regularly and A major focus of the IAC is its publi- guidelines not only for physicians but for discovered that most of the refugees cation of three newsletters twice a year the public as well. In fact, some of the and their children citywide were not which provide helpful, practical immu- information has been translated into 29 getting screened for or vaccinated nization information for health profes- languages! against hepatitis B. sionals and the public. NEEDLE TIPS Dr. Wexler graduated from the Uni- Because of this, Dr. Wexler and other (illustrated by Dr. Wexler’s children) is versity of Minnesota with an under- public health and healthcare profession- a 28-page newsletter mailed to 200,000 graduate degree in biology in 1975 and als formed the Hepatitis B Coalition. health professionals; VACCINATE a medical degree in 1982. As a medical The Hepatitis B Coalition promotes ADULTS! is mailed to 180,000 adult medicine specialists; and VACCINATE WOMEN is mailed to 35,000 obstetri- cian/gynecologists and others who are SAVE THE DATE concerned with women’s health issues. All IAC’s information is available on the main web site, www.immunize.org, which provides links to the other websites maintained by the IAC, w w w. v a c c i n e i n f o r m a t i o n . o r g , www.izcoalitions.org, as well as Wednesday, May 14, 2003 www.hepprograms.org. Sabin Vaccine Institute Would you like to read Annual Awards Dinner Vaccine the Sabin Vaccine Report online? Our newsletter is available The Pierre Hotel in a PDF format at New York City www.sabin.org. www.sabin.org. 16 SPRING 2003 SABIN VACCINE REPORT VIEWPOINT: SABIN Science Confirms CALENDAR Vaccine Safety APRIL 2003 14 New York, New York from page 2 23-25 Boston, Massachusetts Sabin 2003 Awards Celebration 2nd Annual Conference on Advances The Pierre Hotel not finding the real cause of autism, but in Designing Cancer Vaccines firstname.lastname@example.org we also risk parents losing confidence in Hilton Boston Back Bay 19-22 Amsterdam, Netherlands www.knowledgepress.com/events/ vaccines, resulting in fewer children be- Phacilitate Vaccine Forum Spring 10311228.htm ing immunized. 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Sabin Gold Medal Award www.infocastinc.com/Biodefhome.htm to Samuel L. Katz, MD have led to a significant drop in the immuni- 3-5 Alexandria, Virginia Crystal Gateway Marriott zation rate, resulting in a dramatic increase Chlamydia Vaccine Development firstname.lastname@example.org Hilton Alexandria Mark Center in the number of measles and mumps cases. 7-11 New York, New York email@example.com We often forget that measles is still the single 8th Conference of the International 4-6 Dublin, Ireland leading killer of children in the world. Society of Travel Medicine (CISTM8) Modern Vaccine Adjuvants With today’s ease of travel, these diseases Marriott Marquis Hotel & Delivery Systems firstname.lastname@example.org can quickly be imported into the United The Alexander Hotel www.talley.com/ISTM/istm.html States, putting children who are unprotected www.meetingsmanagement.com/ mvads_2003 at great risk of contracting the disease. Every parent has to decide: is it worth pro- tecting my child from a real, deadly threat or protecting him from a hypothetical, sci- entifically unproven leap of logic? I chose NON-PROFIT ORG. the former and I am confident I made the U.S. POSTAGE right decision. PAID MONTROSE, PA Peter J. Hotez, MD, PhD is professor and PERMIT NO. 2 chair of the Department of Microbiology and 58 Pine Street RETURN SERVICE REQUESTED New Canaan, CT 06840 Tropical Medicine, The George Washington U.S.A. University, and senior fellow of the Albert Sabin Vaccine Institute. He is also visiting professor of the Institute of Parasitic Dis- eases of the Chinese Academy of Preventive Medicine in Shanghai.