Next month, Dr. Orin Levine will leave his post as Executive Director of IVAC at Johns Hopkins Bloomberg School of Public Health to join the Bill & Melinda Gates Foundation as Director for Vaccine Delivery in the Global Development Program. Before he leaves, we asked him to reflect on the last 10 years and the changes he has seen in vaccine access and in the organization he helped build.

You started at Johns Hopkins with a single vaccine access project, GAVI’s PneumoADIP. Today, IVAC is a leader in vaccine access research and practice, with projects tackling a wide range of vaccine-preventable diseases across a mix of disciplines. What were your goals for the organization, and did you imagine it becoming anything like what it is today?

When we started PneumoADIP (Pneumococcal Vaccine Accelerated Development and Introduction Plan) we had no idea it would grow so quickly and evolve into what is now IVAC. And I know that because, when I took the job my wife and I had just had our first daughter and I told her, ‘don’t worry it’s just a three year grant, $30 million, a small team of about seven or eight people.’ Now, almost 10 years later, with a team of more than 30 people and the scope and breadth of what we are doing – it was almost unimaginable when we got started.

PneumoADIP was a really remarkable opportunity. One of the things the PneumoADIP team was really focused on was that this was the best chance we had ever had at making a really big difference on accelerating vaccine access. We were very focused on moving the needle, on getting pneumococcal vaccines out faster and more widely than ever before. So that team, that purpose, that mission, really came together all at once in a very special way.

Tell us about the evolution from PneumoADIP to IVAC.

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Dr. Orin Levine speaking at the launch of the UK All-Party Parliamentary Group on pneumococcal disease prevention in 2007. (Photo Credit: Amit Lennon)

In retrospect, PneumoADIP occurred at a really exciting time in global health and global vaccine access. GAVI was new, the Bill & Melinda Gates Foundation was new, and people were asking questions about what is possible and raising their ambitions. At the same time all the architecture was also new and small. There was an incredible space for a team based at Johns Hopkins Bloomberg School of Public Health (JHSPH) to play a leading role in the effort to get new vaccines out in collaboration with GAVI and a lot of other players.

The team really embraced that. We were very focused on a handful of core strategic goals. We designed everything to be rigorous and collaborative. Those are qualities that have carried forward into IVAC. We saw a compelling injustice, that pneumococcal vaccines were being used here in the United States and not where they were needed the most. That injustice is what drove people here at IVAC – and still does – to get up and come into work and do what they do.

You often refer to the ‘summer that wasn’t’ in 2008. Can you tell us about that?

The summer of 2008 was pivotal for us at IVAC and one busy summer. At that time, it was apparent that pneumococcal vaccines were going to roll out in GAVI countries and we were ahead of any historical precedent with a new vaccine. They were poised to take off, but they weren’t yet in the countries. There was a feeling here at PneumoADIP, soon to be IVAC, that while we could take some legitimate credit for having built things to the point where the table was set for rollout, it hadn’t quite rolled out, and we were anxious that if we left the scene, for whatever reason, it wouldn't continue the way we had envisioned. So, we were in this moment where the success, the thing we had worked so hard for, was almost there but not quite. We wanted to be part of that next step - the sometimes messy process of getting to implementation.

The PnuemoADIP contract was coming to an end so we knew that to be part of the next phase we had to write a proposal. At the same time, we wanted to keep the team together not knowing what was going to happen. We were pretty busy writing proposals in the summer of 2008. We wrote two really big proposals, one for the follow on from PneumoADIP - AVI - and one for PERCH, the world’s largest pneumonia etiology case-control study in a generation.

We had this attitude that we would be happy working as a team on either grant and then we won both. That was a really big step for us. It helped us feel like we could continue on the pathway that we had started with PneumoADIP, but it also really said to us that people recognize what our team can do. From that time forward, we just continued to diversify our portfolio, building off that same core of teamwork and innovation in solving difficult problems.

So were you able to rest at all that summer? Was sleep on the agenda?

It was, but not much. As with everything at IVAC, it was a team effort pulling those proposals together but, as I always tell people, when you pack a printer for your vacation, it's a pretty bad sign the vacation won’t go how you planned. That was certainly true that summer. I remember it so well. We were packing up the car with towels and boogie boards and there was a box with a laptop and a printer in it.

What are some of the other highlights over the past 10 years?

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Dr. Orin Levine in South Africa filming a documentary about pneumococcal disease for BBC in 2004. (Photo Credit: IVAC)

I'll give you a few because there were many, obviously with a team as talented as this one. One of the highlights was the very first strategic retreat of the PneumoADIP team. We got the PneumoADIP award in January of 2003 and by June, had identified, recruited and brought on campus everybody on the team. Together, with Thomas Cherian from WHO, we sat down for two days in Baltimore and built the strategic plan. Basically we mapped out the next few years of PneumoADIP on big sticky notes on the wall. It was really great to see everybody come together around this common vision and suspend disbelief for a couple days. You know it was pretty outrageous to believe in 2003 that we were going to accelerate access to the world’s most expensive vaccine for the world’s poorest countries, and yet they bought it and it has made a big impact.

The first IVAC video documentary we did was another highlight. We really put a face on pneumococcal disease, the problem and what could be done in a way that hadn’t happened before. I remember a few days after it aired on BBC World I got a phone call from a senior executive at a major vaccine manufacturer who said ‘That documentary was incredible. I watched it with my teenage kids and at the end they said to me, dad you need to get that vaccine for those kids in developing countries.’ With that I really came to appreciate the power of making the case with video and other multimedia. The case always starts with evidence, but using that kind of tool was really important.

We had a number of other highlights on the evidence side. It was a major accomplishment when our team built up pneumococcal surveillance in collaboration with WHO in more than 50 countries, then leveraged that data to generate disease burden estimates for the whole world, and then, in order to meet the needs of the $1.5 billion Advance Market Commitment, did the most incredible work on this project called the global serotype project. That's memorable because we had an incredibly tight turnaround. We got the final analysis and then had to summarize and submit back to GAVI and the AMC committee the night before it was due. I remember it was in August because it was Kate O’Brien’s birthday, and we spent her birthday as a team in her kitchen up until 3 a.m. writing that report.

So birthdays and vacations were often spent writing reports?

Definitely not, but I can see how it looks that way. [laughs] We have a team that knows how to celebrate as well as work hard and we shared many great times together. But when the team saw a $1.5 billion opportunity for pneumococcal vaccines, they made the sacrifices too.

Was there an especially memorable achievement for you over the years?

A really memorable moment was being in Rwanda for the launch of the first GAVI-supported pneumococcal vaccine program in 2009. I was there with the CEO of GAVI at the time, Julian Lob-Levyt, and seeing the expression of our work as kids getting vaccinated for the first time was a tremendously

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Dr. Orin Levine speaking with a nurse in Rwanda at the launch of the first GAVI-supported pneumococcal vaccine program in 2009. (Photo Credit: Thomas Rippe)

memorable experience. We had an event in Rwanda where kids got vaccinated and then we arranged a conference call back to Baltimore with the whole PneumoADIP team. The GAVI CEO joined me for that call and thanked the team for their work over the years to make this launch possible. Even though I wasn’t in Baltimore, you could feel, even over the phone, the pride that was coming from the team at having made a really big contribution to that achievement.

Wow, it must have been amazing to hear people say we need to fix this problem and then just a few years later see children being vaccinated.

Yes, it was, for the whole team. I think the thing that pulls people to work at IVAC more than anything is the mission. It's a mission-driven group, they are committed to the notion that we can do something about vaccine access. And when we do, it makes a difference in peoples lives and communities. There are lots of organizations that talk about that, and here we have the privilege and benefit to actually deliver on it. That’s one of the things that make IVAC special.

While we are talking about the mission, what do you envision in the future for IVAC?

IVAC is in a terrific position. The number one strength of IVAC is its team. We have incredibly talented people here who are going to carry the mission forward for years to come. You know, I see many opportunities for IVAC in the future. Really the question that IVAC probably will face is, out of so many opportunities, which do they choose to focus on? It’s a good problem to have.

What are the things you value most about the team here at IVAC?

One of the things that make it hardest to leave is the team. There are a few people who have been with me shoulder-to-shoulder from the beginning, like Kate O’Brien, Mathu Santosham and Maria Knoll, and others like Dagna Constenla, Danny Feikin and Lois Privor-Dumm, who have come on board later. What is really remarkable in many ways is that as we grew we retained a core set of ambitions: a sense that we didn't want incremental change, we wanted that big change, and that it was possible; a willingness to question things, not in an arbitrary or personal way, but in a very results-focused way;

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Dr. Orin Levine and members of the PERCH Expert Committe at a meeting in Baltimore in 2012. (Photo Credit: IVAC)

and an innovation-centered approach, that idea that if it was easy it would have been done already, so let’s try something a little bit different. Those are some of the things that IVAC is going to carry forward, especially this sense of bringing innovation to difficult problems and the willingness to experiment and fail, which is integral to making a difference.

What’s your vision for vaccine access in general? What changes do you think we will see in the next 5-to-10 years?

It’s an exciting time to be working on vaccine access. There are some really important trends that are going to impact vaccine access in the years to come. From my perspective, one trend is going to be an emphasis on more and more country-driven immunization programs. Countries are going to be less reliant on donors and international agencies and more self-reliant. That's a great opportunity and it requires shifting towards a policy dialogue model. I also think we are moving to a more integrated approach to delivering interventions within health and even between health and other sectors. So you are seeing things like financial services and health connecting. And then the last area that I think is going to be really exciting is improving service delivery. We have improved our vaccine introduction and accelerated that more in the last decade than we have improved coverage or service delivery. We made big gains by narrowing the time-lag in access to new products, but the next big step is going to have to be boosting us to universal coverage in every community.

So what excites you the most about your new position?

I think working at the Bill & Melinda Gates Foundation will be exciting because of their results-based approach to tackling problems. The foundation brings to bear great minds, substantial resources, and a prolonged focus.

And you are moving to Seattle. What are you looking forward to about that? Aside from the rain...

Well, the well-known weather patterns of Seattle are certainly a draw. The city itself is really beautiful and, for me and my family, who really enjoy the outdoors, there is just tremendous opportunity to enjoy the Seattle environment. I think we – me professionally and hopefully my family too – both literally and figuratively, will have new hills to climb that will make us stronger and bring us new rewards.