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Johns Hopkins Bloomberg School of Public Health


Date: Nov 2012

In October, Dr. Kate O’Brien took over as Acting Director of IVAC. One of IVAC’s founders, she reflects here on how far the organization has come and her vision for the future, while also sharing a bit about her diverse career in global health.

You have been at Johns Hopkins University for more than 20 years. Can you tell us a bit about your background and how you ended up at IVAC?

When asked about my background, I find myself saying first and foremost that I am a Canadian, which helps explain who I am and why I do what I do. As a pediatric infectious disease physician, as well as an epidemiologist and vaccinologist, I’ve had the great fortune to work on meaningful problems and with remarkable people. Much of my training and career has been spent at Johns Hopkins where I first came to work as a pediatric intern in 1988. I also did my infectious disease training, and my Masters of Public Health at Hopkins. Following those formal training programs I joined the Centers for Disease Control in Atlanta as an Epidemic Intelligence Service Officer where my career direction was really set in motion, working on pneumococcus, Hib, and other bacterial diseases of childhood. Although over the years I’ve worked on many different pathogens and vaccines, all of that work has been held together by the concept of preventing disease in children, and specifically preventing disease through vaccines. For me an important notion is that throughout the developed world we have the incredible good fortune to live in communities with abundant resources. When it comes to children, vaccines are a social justice issue. Every parent, everywhere in the world wants their child to have a life of opportunity – it doesn’t seem fair, or just, that some kids have the benefit of receiving vaccines and others don’t, by the quirk of where they happen to be born. My work is about assuring not only that we have the best vaccines possible for preventing as much disease as possible, but also that the benefit of those life-saving vaccines should be available to all kids around the world regardless of where they were born, or whether their families can pay.

Kate O'Brien, Acting Director, IVAC

Dr. Kate O'Brien, Acting Director, IVAC

This is the foundation of IVAC and before that the PneumoADIP project, whose provenance is an interesting story. I had returned to Hopkins from CDC to work for the Center for American Indian Health on vaccine trials [Editor’s note: Dr. O’Brien continues to serve as Associate Director of the CAIH]. Soon after I returned, Orin also came back to Hopkins to join our group after he had spent time at the CDC and NIH. Soon thereafter, the RFP for the PneumoADIP was issued by GAVI; I remember sitting in my office with Orin discussing if I wanted to go in on this, to which I naively committed but warned him that I didn’t know what an “ADIP” was! We submitted a proposal setting out our ideas of how a set of activities could accelerate pneumococcal vaccine decision-making and were awarded the PneumoADIP grant. That was a really stimulating period of time and one that was transformative within the School by bringing together domains of science, finance and communication in a way that was not typical for the kinds of projects Johns Hopkins was doing at the time. Through that project we envisioned a place within the School that worked on vaccines from a multi-dimensional perspective and brought together skills and domains that go beyond the traditional science or academic ways of working. When the PneumoADIP project came to an end we embedded those principles into the founding of IVAC – to use the skills that we have within academia, of unbiased, rigorous, data driven decisions, always being clear as scientists that we allow the data to speak for themselves, and to bring those into the world of policy development and advocacy for vaccines.

You have had quite a varied career within public health. What inspired you to work in global health specifically?

Working in global health for me is really a social justice issue. Growing up in Canada, where the values of contributing to society are very strong, I hold as a guiding principle that all people are precious regardless of their station in life; children especially should not only have the opportunity, but they should also have the right to good health and the right to protection from preventable diseases. So for me the global health sphere is one that really speaks to my values, one that informs what I want to spend my working days doing, and how I want to contribute to society. From a personal perspective, it is a remarkable opportunity to constantly learn from others. It is also a career that demands humility – there are very few concrete “right” ways of solving problems, because there are just so many different ways people make decisions and contribute to health, and so many ways that communities and societies interact to make decisions for the collective good. In all those ways there is always a learning curve, always a way to feel enriched and a great sense of contribution. 

The global health landscape has really expanded in the past several years, and some would say that the space is now crowded. What makes IVAC stand out?

That’s a great question. There are some really clear things that make IVAC special in the global health arena. One is that IVAC is fundamentally seated within a university. Being in an academic setting means the fundamental characteristic of our work and approach is being balanced, agnostic and neutral – the pursuit of new knowledge, the revelations of new learnings, will always lead us in the direction of benefit and good decision making. This philosophy, that the data will speak for themselves, draws people to IVAC as faculty and staff who are committed to letting the evidence drive our efforts. The second thing that makes IVAC unique is that within the university, IVAC is really an unusual center; sitting within a single center are people working in diverse domains of vaccines where interaction with each other on a daily basis doesn’t usually happen. I think this was the incredible lesson of PneumoADIP – when you take people who are experts in financing, strategic vaccine supply, advocacy and communications, and you put them in the same space, thinking about the same problems as the epidemiologists, the vaccine clinical trialists, and the people who are scientifically driven, you end up with a learning space and leveraging of those skills well beyond the sum of the parts. You end up being able to look at problems in the vaccine space with solutions that were otherwise not imagined by any one group of people working on the problem. It is this multi-dimensional characteristic that is unique, and the emphasis and demand for excellence in all we do, which I think is what comes out of the academic atmosphere.

Kate O'Brien with child in Bangladesh

Dr. Kate O'Brien with a child in Bangladesh.

Along those lines, what have been some of the proudest moments at IVAC over the years?

There are many, but what come to mind are several tangible things. Going back to PneumoADIP days, a really proud moment was the launch by GAVI of the Advance Market Commitment for pneumococcal conjugate vaccines. PneumoADIP’s mission for five years was to figure out – in collaboration with the many global partners and country partners who all had views on and interests in this – whether or not pneumococcal vaccine should and could become a reality for the poorest kids around the world. So, the launch of the Advance Market Commitment was really one way when it all came together and became tangible; we knew we had reached a goal. There were many steps, some of them small steps and some of them really big steps, that culminated in an expression that global health decision makers, viewed the evidence as sufficient, credible and conclusive that pneumococcal conjugate vaccine was a product worthwhile to deliver to kids in the developing world and that there was a way of making that happen. So that was an incredibly proud moment and really felt like a culmination. 

Since then, each time a country launches pneumococcal vaccine it is a proud moment because it is an on-going living expression of the value of the work that we have been doing. It becomes something real for me that there are infants and children whose lives have been saved by those vaccines; of course we don’t know which kids they are but we know they are there.

Other proud moments come from the spirit and enjoyment of the people at IVAC and those we work with in partner organizations; there is real motivation by the mission and by the creativity and innovative way that we work. Events like World Pneumonia Day that bring pneumonia fighters to the streets of Washington or events like Pneumonia’s Last Syrah in New York where we sold wine to promote the prevention of pneumonia are really amazing – those are just not activities that the average pediatric infectious disease physician gets to spend time working on!

So looking to the future, what are your top three priorities for IVAC as we move into 2013?

My top priority for 2013 is to continue delivering the highest quality work for every project we’re are engaged in. This is the guiding core value of IVAC and we will continue to deliver the quality of work that we have always delivered.

The second priority is for IVAC to contribute meaningfully to new areas of work---that could be new projects within areas that we’re already engaged in, or completely new areas. Whether it is pneumonia etiology studies, impact evaluations of vaccines, economic and advocacy projects that help decision makers understand the best use of vaccines, or work on prioritization and implementation of those vaccines – there are many areas where IVAC can contribute its expertise to really important decisions.

The final and foundational priority is to assure that the people within IVAC continue to have a supportive atmosphere where their effort is valued and where they know that the work they are doing is making a difference.

Building on that and taking it forward, what does success look like for IVAC in the next five years?

That’s an easy one; success for IVAC is when, five years from now, there is a healthy IVAC. And what I mean by that is IVAC continues its contributions in the global health sphere with people who are working on topics that they feel are important and that the global health community is deriving value from that work. It’s really important that we not be rigid in what that looks like, instead we need to be flexible to address the needs of the community. A successful IVAC in the next five years is responsive to the needs that emerge to actually get vaccines where they need to be and demonstrate the value of those vaccines so they can continue to be supported.

Tell us a little bit about your family.

My husband is an adult infectious disease physician who also works in the global health sphere, but mostly in the domain of HIV/AIDs. We met while working in Haiti. We have two kids, Emma who is 15 and Jack who is 13. My extended family still lives in Canada so we spend a good deal of time there.

As some readers may know, you moved from the Washington, DC-area to Geneva last year. What do you and your family like best about living in Geneva?

Beyond the work we do here what we appreciate most is the incredible access we have to the  outdoors and the stunning beauty of this land. Everyone in our family really loves being in the mountains, being on a bicycle, taking a walk in the woods or through farmland, or skiing or ice-skating. Switzerland is such a small country, it means all of these things are close by. We love having the ability to enjoy this remarkable part of world for however long we are here.

We also really appreciate the opportunity to live in more than one language. Just having that lovely experience of coming into other cultures and into other peoples’ ways of living means we all can learn a lot about better ways of living.

What is the most interesting place that you have traveled to?

I knew you were going to ask me that!

We thought it might be Haiti, since that is where you met your husband.

I should say that, shouldn’t I? In fact Haiti is probably the most interesting place I’ve ever lived. It has an incredible mixture of cultures and histories, the European influence, the African influence – it is really a remarkable and unique culture. The art and the music that comes out of Haiti is phenomenal. It has a deeply troubling and in many ways tragic political history, but in spite of that there is a resilience and love that people have for their culture, for their country and for each other. Another place that is a favorite of mine is Jerusalem. It’s hard not be overwhelmed by the presence of history there.

One last question. You’ve had an amazing career – what are some of the highlights you’d like to share?

The greatest highlight has been the privilege to care for my patients…there are many kids and their families who have touched me in ways that they will never realize. I know this is a common experience for every physician, for every nurse, but it is true. There is far more that our patients give back to us than we can ever give to them, much as we try. The communities I’ve been able to serve are undoubtedly a highlight, in particular the Navajo and White Mountain Apache tribes who I’ve worked with for over 14 years, trying to address health disparities from vaccine preventable diseases. Those communities have a beauty and a history that is deeply humbling, showing us how little we really understand about life and spirit in this contemporary, modern, western society we live in. The other highlight is one that underlies everything, and that is the people I’ve worked with over the years. Those who know me know that beyond all else is my belief that in the end our work, our success, our joy, is always all about the people. Over the years I’ve had the most amazing mentors, colleagues, collaborators and students at Hopkins, at CDC, and at many other organizations around the world. In the end, it is always, all about the people.   

By Dr. Kate O'Brien

Being a doctor doesn’t necessarily make being a mom to a sick baby any easier. Like every mother, I’ve spent my share of sleepless nights tending to my kids sick with a cold, or diarrhea, or an earache, but those episodes are just a distant blur for me. Not so the time my son had pneumonia.

It was his first Christmas and we were both really sick with a respiratory illness that I’m sure was the flu. I kept telling myself we would both feel better soon. But we didn’t. In fact, Jack got worse. By evening and into the night, with more rapid breathing and some tugging of his chest with each breath, there was no question we needed to get him medical care. These were signs that something was very wrong.
An x-ray confirmed that Jack had pneumonia. My heart sank. I was supposed to have gotten him vaccinated against the flu weeks earlier, but I put it off. As a pediatrician and vaccinologist, I knew that vaccine could have protected him from pneumonia. As a parent, I should have never have been “too busy” to get him vaccinated. Thankfully with proper treatment, Jack quickly recovered. I knew we were lucky but also knew there were hundreds of thousands of children each year who are not. Read the full blog at Million Moms Challenge.

Accurately diagnosing pneumonia can be very difficult in the resource-challenged settings of developing nations.  IVAC’s PERCH study allows the opportunity to explore a new technology that can help improve the accuracy and speed of pneumonia diagnoses. This type of innovation enables us to reach more children and save more lives, while also furthering our understanding of the epidemiology of this disease. In advance of World Pneumonia Day, marked each year on November 12, we’re excited to offer a look at the digital future of using state-of-the-art technology in diagnosing and treating respiratory illness in the world’s poorest settings.

By Eric D. McCollum, MD    

Digital auscultation in The Gambia

Digital auscultation to record and analyze the breath sounds of a patient, as seen in The Gambia. Photo by Eric D. McCollum.

The scene is familiar, an African healthcare worker with only several months of training but working as the community doctor, is setting up his temporary pediatric clinic in a remote village beneath the shade of a baobab tree. The queue is long, as mothers and their children from this small community and beyond have waited since the early morning for their child to be seen. Some children are sick and need medicine, and some are not and instead need only a weight check and their immunizations. The penetrating tropical sun begins to rise signaling the beginning of the clinic. Fortunately, the girth of the baobab tree provides the necessary relief. “Okay, let’s begin,” the healthcare worker states in the local dialect as his eyes meet with the mother of the first child, a toddling 17 month old girl with only a dirty brown shirt covering her body. “How can I help you?”

“She is sick with fever and cough for four days,” the mother answers, brow tense with concern.

The healthcare worker continues with his routine follow-up questions until this trite scenario takes an unexpected, most interesting turn. He reaches into his pocket and pulls out his mobile phone and attaches to it what looks to be almost a miniature suction cup with fine beads covering its face. Several mothers waiting in the line take notice and turn to each other talking quickly. The worker pushes several buttons on his phone and then presses the device onto the bare chest of the girl, who remains clinging to her mother’s breast. He then sits back, rests against the heavy trunk of the baobab tree, punches a button on his mobile phone, and waits. After several short moments the phone then beeps, and his eyebrows raise up in response. “Your child has pneumonia… and needs antibiotics.”

The continent that skipped over clunky technology like landline phones and large desktop computers in favor of slick mobile phones and the internet may also be leapfrogging what many consider to be the first medical device, the stethoscope.  Learning to interpret the sounds captured by the stethoscope can take years of practice.  Even then, opinions processed by the ears of vastly experienced physicians can still differ.  The stethoscope is quite simply “the art of medicine.” Given these inherent drawbacks of traditional stethoscopes, the World Health Organization’s (WHO) diagnostic criteria for childhood pneumonia intentionally ignores respiratory sounds altogether. This allows healthcare providers with minimal training who work in remote areas, often where childhood pneumonia mortality is greatest, to still diagnose and treat pneumonia. The drawback of the WHO not including respiratory sounds in its diagnostic criteria is that many children with pneumonia are incorrectly diagnosed and thus incorrectly treated, a potential danger to the health of the child and waste of scarce financial resources. 

Digital auscultation

Digital auscultation at work. Photo by Eric D. McCollum.

Art may soon be giving way to cutting edge clinical science and computer technology. Electronic devices exist that act similarly to traditional stethoscopes, except that they generate digital sound waves that can be fed into computer software programs. In fact, they are under active study and continued refinement, such that a small mobile device that contains sophisticated software may soon be able to accurately interpret chest sounds for use in clinical care of children. The Pneumonia Etiology Research for Child Health study, or PERCH, is a large collaborative project funded by The Bill and Melinda Gates Foundation currently ongoing in seven developing countries throughout Africa and Asia.  PERCH is utilizing digital stethoscopes to record chest sounds from children hospitalized with life-threatening pneumonia. These sounds are then uploaded onto local internet servers that can be accessed by co-investigators at The Johns Hopkins School of Public Health International Vaccine Access Center and the Johns Hopkins University Engineering Department. These investigators are in turn creating novel computer software algorithms that can interpret these sounds and therefore accurately diagnose childhood respiratory illness. This could mean more efficient use of childhood pneumonia resources and even better outcomes for children sick with pneumonia, the number one cause of childhood mortality globally.

While digital auscultation devices and computer software able to interpret chest sounds from children may still be in experimental phases, it is not unrealistic to envision a time where healthcare professionals located anyplace and anywhere, even beneath a Baobab tree in a remote African village, can utilize this technology to accurately diagnose and provide life-saving treatments to children with pneumonia. So listen up carefully on this World Pneumonia Day, a revolution is coming.

Dr. Eric D. McCollum is a Post-doctoral Fellow in the Division of Pediatric Pulmonology at the Johns Hopkins School of Medicine, and a member of the PERCH study team.