The Immunization Partnership asked some of the leading voices championing immunizations — the heroes in the fight against vaccine-preventable disease — what set you down the path of immunization advocacy? What made you passionate? In short, what is your origin story? Throughout the next few months, we hope to showcase the responses.
by Peter Hotez, MD, PhD
My entry into the world of vaccines began as a student in the 1980s enrolled in a unique MD PhD program at Weil Cornell Medical College and Rockefeller University (originally known as the Rockefeller Institute for Medical Research) in New York. I began testing whether the molecules I was analyzing from parasitic hookworms might one day be developed into a human hookworm vaccine. Some thirty years later a human hookworm vaccine developed by our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development is undergoing clinical testing, with vaccines for several other neglected tropical diseases — such as schistosomiasis, ascariasis, trichuriasis, Chagas disease, leishmaniasis, SARS, and West Nile virus infection — hopefully entering the clinic soon!
An unexpected second and parallel career path was my becoming a global health and vaccine advocate. With respect to vaccines, this interest first began as a medical student when I saw my first case of congenital rubella infection during a rotation on the pediatric wards of the New York Hospital. I was horrified not only by the devastating nature of this syndrome but also the fact that it was totally avoidable had the child’s mother been vaccinated.
The need to advocate for vaccines was reinforced when I later became a pediatric house officer in Boston. Something I will never forget was admitting young patients to the Children’s Service of Massachusetts General Hospital with Haemophilus influenzae B (Hib) meningitis and explaining to the parents about the likelihood that their child might die or become neurologically devastated. At that time during the late 1980s several new conjugate Hib vaccines were being introduced and starting to be made available. Within just a few years through widespread immunization of children in the United States, Hib meningitis disappeared. By 1993 as a new attending pediatrician at Yale, I was teaching the pediatric house staff there about Hib meningitis, but mostly for its historical interest! Through expanded use of a vaccine, for all practical purposes Hib meningitis had been eradicated from the US. Indeed, I taught about Hib much in the same way that my medical school professors previously taught me about diphtheria and measles. Such was the power of immunizations!
Starting in the 1990s I began to make visits to Central America and elsewhere in Latin America in order to further my tropical disease interests. I will always remember reaching Guatemala City after a short flight, getting off the plane, and making clinical rounds at Hospital Roosevelt – their big public general hospital. It was though I had gone back in time 100 years seeing children with measles, pertussis, and neonatal tetanus, i.e., diseases that had disappeared long ago from the US. The major difference between American children and Guatemalan children was that we vaccinated our children whereas the Guatemalans did not have access to vaccines.
Witnessing first-hand the effects of not vaccinating children was a strong motivator for me to advocate for childhood immunization, especially as a very shrill and increasingly powerful anti-vaccine movement began to take shape in US during the 1990s and into the 21st century.
It seemed to me that the “anti-vaxers” (as they are now sometimes labeled) had no scientifically sound arguments when it came to linking vaccines with autism. Yet they had a strong voice. I still remember flying back from Brazil where local public officials campaigned on their track record of vaccinating children living in poverty, and then landing in the US where ignorant politicians campaigned on making vaccines optional!
The disassociation between vaccines and autism became especially clear to me when my youngest daughter Rachel was diagnosed with pervasive developmental disorder – autism – at the Yale Child Study Center. I could not envision a single plausible mechanism by which a vaccine could cause the complex neurodevelopmental changes that go with Autistic Spectrum Disorder. Numerous published scientific findings have confirmed the genetic and epigenetic basis of autism and the fact that vaccines do not and cannot cause autism. And yet the anti-vaccine movement remains strong.
Moreover new reports of nascent anti-vaccine sentiments emerging in several large middle income countries such as Brazil and India – where the great childhood killers have not yet been eradicated – has convinced me that our vaccine advocacy work is only now just beginning!
In the coming years we must remain vigilant on the importance of ensuring that all of the world’s children receive their childhood vaccines. A new Global Vaccine Action Plan (GVAP) has now been launched as part of the Decade of Vaccine (DoV) Collaboration through the efforts of a group of international partners that includes WHO, GAVI Alliance, UNICEF, the Bill & Melinda Gates Foundation, and NIAID, NIH. It is more important than ever that the global health and vaccine community rally around GVAP to ensure that my sad and tragic scenes I first saw during visits to Central America will not be repeated!
Peter Hotez, MD, PhD, is on the Board of Directors of TIP. He is also Founding Dean at the National School of Tropical Medicine at Baylor College of Medicine; President of the Sabin Vaccine Institute and Director of the Texas Children’s Hospital Center for Vaccine Development; Texas Children’s Hospital Endowed Chair in Tropical Pediatrics; and a Baker Institute Fellow in Disease and Poverty.