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Nina Martin, PhD and Mary Carol Jennings, MD

 

Listen to the full episode: Public Health United Episode 57: Mary Carol Jennings on Accelerating Vaccine Access

 

IVAC continues to collaborate with Public Health United, Inc. on another vaccine podcast. This week, PHU host Dr. Nina Martin speaks with Mary Carol Jennings, MD, Assistant Scientist at IVAC. Listen to the podcast here, or read below to learn more.

Who is Dr. Mary Carol Jennings?

Dr. Jennings is a physician-scientist who has seamlessly paired her training in obstetrics and gynecology, and preventive medicine, with her desire to affect positive change in the global health field. Before she became a physician, she worked as a community organizer internationally and here in the US. At IVAC, she directs the RAVIN project, a vaccine access accelerator program, and is the Center’s lead on developing new projects for the primary prevention of cervical cancer – i.e. through HPV vaccines.

What does it mean to accelerate vaccine access?

Dr. Jennings works to “understand the communities that are not getting access to really powerful prevention tools: vaccines.”

In this episode, Dr. Jennings speaks about her work on the Rotavirus Accelerated Vaccine Introduction Network (RAVIN) project, which aims to shrink the gaps in vaccine access between richer and poorer countries. RAVIN has a specific focus on rotavirus vaccine, which prevents a common yet severe infection that hospitalizes millions of children and kills over 200,000 every year.

Dr. Jennings also speaks about the new projects she is leading at IVAC. Cervical cancer is one of the most common cancers in the world, yet it is vaccine preventable. Dr. Jennings explains how she hopes to expand vaccine access to hard-to-reach communities, such as out-of-school girls in selected communities in India, who are not typically targeted populations to receive these vaccines.

"Where are the communities that lack access to vaccines? Why are they not experiencing equal levels of access and what can be done about it?” Learn more in the Public Health United podcast interview with Dr. Jennings.

What is Public Health United?

Public Health United, Inc. (PHU) is a non-profit organization that improves science communication through podcasts, outreach, and public engagement training for scientists. Dr. Nina Martin is PHU’s Chief Executive and host of their weekly podcast, with each episode featuring a different public health science expert with stories and insights on science communication.  At IVAC, Nina does research on adult vaccines on the Policy and Advocacy Communications Team.

Click here to listen or download the episode

 

Related Episode Links:

·       Dr. Mary Carol Jennings Bloomberg Faculty Page

·       Learn more about HPV at Gavi

·       Learn about Alliance for a Healthier World, which supports Dr. Jennings’s cervical cancer awareness project

·       Connect with Dr. Jennings on LinkedIn

·       Follow Dr. Jennings on Twitter

Nina Kate Swati selfie

Nina Martin, Kate O'Brien, and Swati Sudarsan, IVAC

 

Listen to the full episode: Public Health United Episode 52: Kate O’Brien on Vaccines and Social Justice

 

What is PHU?

Public Health United, Inc. (PHU) is a non-profit organization that improves science communication through podcasts, outreach, and public engagement training for scientists. Dr. Nina Martin is PHU’s Chief Executive and host of their weekly podcast, with each episode featuring a different public health science expert with stories and insights on science communication.  At IVAC, Nina does research on adult vaccines on the Policy and Advocacy Communications Team.

Why did PHU team with IVAC?

Can you guess our favorite topic here at IVAC? If you guessed vaccines, you are correct! That’s why we decided to team up with Public Health United, Inc, (PHU) to release a vaccine-related podcast series, featuring some of our in-house experts. Join us for our first episode in the series featuring Executive Director of IVAC, Kate O’Brien and Swati Sudarsan, who works on pneumonia advocacy and global coordination on IVAC’s Policy and Advocacy Communications Team.

Who is Dr. Kate O’Brien?

Kate is a sitting member of the Strategic Advisory Group of Experts (SAGE), which advises the World Health Organization on global vaccine policy, and serves on the Gavi Board representing the Technical and Research constituency. She is a senior advisor at the Center for American Indian Health, and of course, a beloved professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

Can't listen, but want the info?

During this episode, Kate tells us a little about who she is and why we should care about vaccines. A pediatrician by training, she explains that her passion for health equity was fostered during her time in Haiti, where she saw first-hand the consequences of vaccine-preventable disease on children. Here she developed “a deep desire to contribute to the vaccine world.” Because of this experience, Kate believes that vaccines are fundamentally a social justice issue. The current reality that a poorer person is less likely to be vaccinated than someone from a higher income setting is what she calls “a moral failing” of our society.

Part of the reason this happens is because there needs to be greater financing for vaccines. Kate is working to advance scientific discussions by helping quantify the “full public health value of vaccines.” For example, vaccines not only prevent disease in an immunized child, but they can protect the people around them, can help families avert the costs of hospitalization from disease, and can even help mitigate an emerging crisis – antibiotic resistance.  Kate is also working to make vaccines more accessible to families in novel ways. For example, new evidence has demonstrated that fewer doses of pneumococcal conjugate vaccine (PCV) may be effective in areas where pneumonia transmission is virtually eliminated and thus be able to save government’s billions of dollars, an important benefit to global vaccine policy and implementation.

Kate’s passion for vaccines extends beyond the office and to her family dining table. This holiday season, take Kate’s advice and talk to your family about their vaccination status. For more on Kate’s take, click here to listen or download the episode.

 

Related Episode Links:

·       Full list of PHU podcasts

·       Join the online discussion on Twitter with IVAC and PHU.

·       Kate’s profile at JHSPH

·       SAGE at WHO (expert panel on immunization)

·       Kate’s World Health Organization (WHO) Profile

·       Kate is quoted in this November 2017 National Geographic feature, “Here’s Why Vaccines Are So Crucial”

·       Journal article in Vaccine (Oct 2017): ‘Estimating full public health value of vaccines”

·       Gavi: The Vaccine Alliance

 

 

WHO HQ

Your companion on the red-eye from Dulles airport to Geneva is a two inch-thick Yellow Book—478 pages of previous meeting notes, disease eradication plans, reviews of evidence, references, and more related to the meeting of WHO’s Strategic Advisory Group of Experts (SAGE)—including at least seven global policy questions you will need to make a decision about. All this in 30 hours of meetings over three days.

Feeling fuzzy getting off your flight? Grab a double expresso as you are head over to WHO HQ on Avenue Appia. Outcomes of these meetings will inform WHO’s Director-General and lead to new recommendations from WHO for all countries on the best ways to ensure vaccines improve health and save lives for as many people as possible.

Welcome to SAGE!

IVAC's Delegation at SAGE 2017 

WHO Meeting Room

 

From October 17-19, three faculty members from the International Vaccine Access Center (IVAC), of the Johns Hopkins Bloomberg School of Public Health (JHSPH), provided technical expertise and leadership at the annual SAGE meeting, an advisory body formed in 1999 to provide guidance on immunizations to the WHO.

IVAC’s delegation included Director of Epidemiology Bill Moss, Director of Science Maria Deloria Knoll, and IVAC Executive Director Kate O’Brien. The meeting, held in the August Room where WHO’s 34-member Executive Board meets, was attended by about 200 people and included presentations from nine Working Groups. SAGE Working Groups delve in to key immunization-related questions of interest to policymakers around the world.  

Maria and Kate at SAGE

The Executive Board’s elevated screen helps viewers sitting on multiple tiers follow presentations. Maria’s purple sweater helped people locate her in the immense room.

 

How did IVAC members at SAGE support policy-making for WHO?

Measles and Rubella

Dr. Moss, who also serves as a Professor in the Departments of Epidemiology, International Health, and Molecular Microbiology and Immunology (MMI) at JHSPH, has been a member of SAGE’s Measles and Rubella Working Group since 2011. Dr. Moss presented evidence supporting a recommendation that people living with HIV do not need to be re-vaccinated against measles if they were not infected with HIV at the time of their measles vaccination in young childhood. This policy has implications on the estimated 34.5 million adults living with HIV infection and on the achievement of measles elimination goals.

Rabies

Dr. O’Brien, who is a Professor in both Departments of International Health and Epidemiology at JHSPH, has served as a SAGE member since 2012 and has participated in multiple Working Groups over the past four years. This year Dr. O’Brien chaired the SAGE Working Group on rabies vaccines and rabies immunoglobulins, which are antibodies that recognize and bind to the rabies virus to destroy it. Sidebar Dr. O’Brien’s analysis of rabies vaccine policy became personally relevant during a holiday in Mexico: a bat flew into her son Jack’s face and sent them on a complicated journey to locate rabies immune globulin and vaccine (fortunately, they found them both and Jack remains healthy!).  

Pneumococcal conjugate vaccine

Dr. O’Brien also co-led the Pneumococcal Conjugate Vaccines Working Group (more about this below). During this meeting, Dr. Knoll, who serves as an Associate Scientist in the JHSPH Department of International Health, presented on a review IVAC authored of over 200 studies assessing the effect of both of WHO’s recommended dosing schedules on vaccine-type disease, or the strains of pneumococcus included in the 10- and 13-valent conjugate vaccines.

Recommendations to WHO Director-General

Dr. O’Brien and the other 14 members of SAGE—each representing a different institution and country—considered the evidence and made formal recommendations to WHO. For example, based on the evidence presented, SAGE concluded that both WHO-recommended PCV schedules have a substantial impact on reducing vaccine-type disease. All evidence presented during the meeting is available in the Yellow Book.

WHOHQ Room

How SAGE gathered evidence to optimize the impact of pneumococcal conjugate vaccines

Starting in January, the pneumococcal conjugate vaccines (PCV) working group, led by SAGE members Dr. O’Brien and Dr. Andrew Pollard of the University of Oxford, reviewed extensive evidence on PCV impact. One of the main sources of evidence was the PCV Review of Impact Evidence (PRIME) Systematic Review, an effort co-led by IVAC with partners including the US CDC, WHO, the University College of London, and Agence de Médecine Préventive. Over the past two years, the PRIME group reviewed studies to assess differences in disease, immunogenicity, and carriage impact by PCV schedule and product, as well as evidence of immunogenicity of catch up immunization. This systematic review served as an update to a previous review conducted by IVAC, which compared impact of different schedules in the context of PCV7 use and served as an important evidence base for previous SAGE WHO PCV recommendations. 

Among the PRIME review’s findings on PCV schedules:

Immunogenicity: A 3-dose primary series induces a greater immune response compared to a 2-dose primary series. However, in a 3-dose schedule, the third dose is more immunogenic when given as a booster (2+1) for most serotypes. It is important to note that greater immunogenicity may not necessarily mean better protection from disease.

Nasopharyngeal Carriage: Both schedules showed an impact on overall vaccine serotype carriage (product specific vaccine-type).

Invasive Pneumococcal Disease: Both schedules showed impact on overall vaccine-type invasive disease.  For serotype 1, the 2+1 schedule showed clear evidence of impact from a substantial body of evidence; for the 3+0 schedule although some impact was seen the data were more limited.  

WHO’s recommendations related to dosing schedule, catch up vaccination, and product usage will be published in a PCV Position Paper in 2018. If there are opportunities to improve impact, countries using pneumococcal vaccines may consider update their schedule and product choices.

In the meantime, we’re clearing off our bookshelf space for the next onslaught of documents… SAGE will re-convene April 17-19, 2018 – see you there!

 

For more information, see the resources below:

By: Dignamartha Kakkanattu, Social Media & Communications Assistant, International Vaccine Access Center

During Thanksgiving in the U.S., much well-deserved gratitude goes to the obvious all-stars in our lives: family, friends, teachers. But one group that doesn’t seem to get enough thanks are child health advocates. During World Pneumonia Day on November 12, they broke the silence on pneumonia, the leading infectious killer of children under 5.

As an aspiring health advocate, I’ve had the opportunity to work with the Stop Pneumonia team at the International Vaccine Access Center to help turn up the volume. How? We created the Pneumonia Fumbler Challenge, which asked people to say the following tongue twister five times fast for the under-fives: Pretty please prevent pneumonia to protect precious lives.

 

 

Advocates, and children, who accepted the challenge lent their voices to the scores of children who have a high likelihood of catching and dying from pneumonia: the poorest of the poor in developing countries. In 2015, approximately 920,000 children died from pneumonia—ending more young lives than Zika, Ebola, malaria, tuberculosis, and HIV combined.

Among participants around the world were future public health professionals—my classmates—at the Johns Hopkins Bloomberg School of Public Health. They took on the Pneumonia Fumbler Challenge while attending a World Pneumonia Day reception co-hosted by the Child Health Society. Through a little confusion and lots of laughter, the students shed light on the need to stop pneumonia in order to improve child health globally.

 

 

 

 

We need more voices to bring attention to pneumonia, a disease so common that its deadly nature is overlooked by country leaders and policy makers. We need voices to ensure that protective and preventive interventions—such as breastfeeding, adequate nutrition, and vaccines—are available to children in developing countries. We need voices to educate health professionals and caregivers about identifying pneumonia in its early stages. We need voices to secure treatment measures, such as amoxicillin and oxygen therapy, in low-resource settings.

 

 

 

 

The Pneumonia Fumbler was just one fun way to remind the world that all children should have resources to achieve good health and avoid preventable diseases, such as pneumonia. This Thanksgiving, I’m grateful to everyone who participated, and for the countless other campaigns and events advocates organized. Thank you for your voice—and the opportunity to amplify it worldwide.

 


Dignamartha Kakkanattu is an MSPH student at Johns Hopkins Bloomberg School of Public Health working on pneumonia advocacy at the International Vaccine Access Center.  

This is the first in a series of profiles to help IVAC partners and friends get to know our team. We thought we’d start with Lois Privor-Dumm, a long-time IVAC team member and Director of our Alliances and Information team. We caught up with Lois in between her busy travel schedule to chat about her background, her work at IVAC and what she likes to do in her spare time.

Tell us a bit about your background, what inspired you to work in global health, and how you ended up at IVAC.

Lois_PrivorDumm

Lois Privor-Dumm

I didn’t set out to work in global health, but I’ve always wanted to work internationally. I spent most of my career in the private sector and was fortunate enough to have the opportunity to launch Prevnar®, the first pneumococcal conjugate vaccine (PCV), in the U.S. and then help other countries around the world introduce the vaccine. I had worked with other vaccines and pharmaceuticals, but this experience, coming in direct contact with families impacted by pneumococcal disease, particularly meningitis, made a major impression. I saw the value that the vaccine had for countries that had introduced, but also recognized the severe disparities that existed in vaccine access around the world. I decided I could play a role in helping reduce those disparities. Although I was able to influence some change while working in pharma, I thought I could make a bigger impact by bringing my understanding of the industry and my marketing and operations experience to public health. I was fortunate to be working with experts on PCV, including Orin Levine, Mathu Santosham and Kate O’Brien, who recognized how my perspective – despite my non-traditional background for a public health career – could be beneficial. We shared the vision that new vaccine introductions did not need to see delays of 20 years or more between licensure and introduction in low-income countries, and helping devise and implement a plan to achieve this goal was very intriguing to me. 

So, I first joined Hopkins in 2005 as Director of Communications and Strategy on the Hib Initiative and soon after took on the role of Director of Access and Implementation, and later Communications, for the PneumoADIP. Our approach of addressing the needs of all stakeholders – countries, donors and suppliers – proved to be an effective way to achieve our vision, and we’ve been fortunate that we’ve been able to continue our mission through what is now IVAC. I consider myself very lucky to work with such a diverse, creative and talented team. I think it is the team and the way we work that has enabled us to work on some really tough challenges that have a big impact and achieve success.

I’m also a strong believer that there are always solutions and, at Hopkins, I value the opportunity to help facilitate those solutions, bringing both a manufacturer perspective and that of someone working with global health colleagues and country leaders. There’s been significant progress in vaccine access in the past decade or so, and I hope our work will continue to accelerate greater access and equity for vaccines and other interventions that make such a difference in peoples’ lives and contribute to healthier and more productive societies.

What projects do you work on at IVAC?

PrivorDumm_Nigeria_Vaccine_Summit

Lois Privor-Dumm and a group of children at the 1st National Vaccine Summit in Abuja, Nigeria in April 2012.

I lead the Alliances and Information team at IVAC, which includes projects covering advocacy and communications – both globally and in-country – as well as policy research and supply and access issues. I spend a great deal of time on our country-focused work, namely India, where we have been working to synthesize the evidence base and advocate for interventions for pneumonia and diarrhea at both the national and state level, and Nigeria, where we have helped analyze barriers and solutions to improve routine immunization and continue to provide technical support and encourage government accountability. I’m also excited that we’ve recently added country work with Pakistan.

Our work is varied, and there is never a dull moment. Our efforts have helped others become advocates and add their voice to important issues in child health. For instance, we’ve run advocacy workshops and collaborated with a network of trained experts to address child pneumonia and diarrhea in their countries. We support the efforts of experts including the ROTA Council, a dedicated council of scientific experts working to accelerate the introduction of rotavirus vaccines, and the Global Coalition Against Child Pneumonia. With the help of key partners, we established World Pneumonia Day to call for action on protection, prevention and treatment of the leading global killer of children. Our team also coordinates closely with IVAC’s Epidemiology and Economics & Finance teams to help communicate the results of their work and highlight the work of other researchers that relates to vaccines and child health.

Last but not least, I spend much of my time on our supply and access work, which is also very important. One of our more recent projects centers around primary container decision making and building awareness of how these seemingly straightforward decisions have significant impact on not only cold-chain space and procurement cost, but also wastage and other costs, vaccine coverage, and safety. We’ve developed a framework and have been working with various experts to help advocate for a more robust approach to considering all the implications of these decisions.

I’d be remiss not to mention, that none of this, of course, could be done without the great team of hard working and very capable individuals and students on the A&I team.

What have been some of your most rewarding or memorable experiences at IVAC?

One of my most memorable experiences was my first week at Johns Hopkins. I was working with the Hib Initiative and went to the Gambia and Bangladesh to film the BBC World Kill or Cure: Hib documentary, which highlighted the impact of the disease and efforts needed to bring a vaccine to developing countries. I remember meeting people at the labs and families that had been affected by meningitis and seeing how dedicated they were to finding the solution. I have great memories from that trip, for example touring the lab at MRC and then having tea with a family in the Gambia with little kids around very curious about all of our cameras. Bangladesh was no different, although it was tough seeing a child and her mother who did not know whether her daughter would survive the night or succumb to a severe case of pneumonia.

Another big moment was the first World Pneumonia Day in 2009 and seeing that kick off not only in the U.S. but probably more importantly around the world. That sense of pride continues when I see how many other people have taken up the cause. As we move into World Pneumonia Day’s fifth year, I am increasingly impressed by the level and volume of activities that take place – creating a global community of sorts. The fact that people are talking about antibiotic access, bringing new vaccines into countries, improving breastfeeding rates – it is very gratifying.

What is the most interesting place you’ve traveled to? Anyone who has seen your passport will know this will be a tough question to answer.

Yes, it is. Everywhere I’ve gone has been interesting. Large countries hold a lot of interest for me simply because of the level of contrast you see within the same country. I’m always struck by the disparities within the countries, but at the same time, the level of hope and generosity of those that don’t have much. I am fascinated by the diverse modes of transportation like the trucks that are brightly painted with “honk please” signs in India and Bangladesh, navigating the same roads as people walking with bundles of firewood on their heads or families piled three or four onto a small motorbike seat. In Nigeria I’ve been captivated by the people and the diversity of just about every aspect from dress to food, language and density of the population. And in some countries you’ve got such a long history that can’t help but impact you – Angkor Watt in Cambodia, Petra in Jordan, and slave quarters in Africa – it reminds me of how far the countries have come, yet how much more is still to be achieved.

Since you spend a lot of time in India and Nigeria, what similarities and differences do you see between the two?

India_National_Course

Lois Privor-Dumm and fellow participants at a national course on pneumonia and diarrhea prevention in Delhi in December 2012.

That’s a great question. I’d love to hear the perspective from those who live in one of the two countries. From my perspective though, they are similar in that they both have some wonderful, high caliber people. Both have large bureaucracies and complex environments, and I’m always impressed by

individuals who’ve been great champions of children who’ve successfully been able to navigate the environment and overcome some real barriers to getting things done. The real heroes are the ones who’ve been able to not just talk about change, but have been able to see things through, and there have been examples in both places. Another similarity is that health is very much a state subject, and implementation and sustainable change is highly dependent on the individual states. As different as priorities and ways of life are between these countries, the same can be said of individual states, and it is important to understand the priorities and players in each.

Both countries obviously have had to tackle an ongoing challenge of polio, and the related challenges and opportunities of an enormous vaccine effort. India has now gotten ahead of the curve with no cases of wild-type polio for the past two years. Nigeria still faces many challenges with polio, but has moved ahead to strengthen routine immunization and add new vaccines. 

One major difference may be in the way vaccines are portrayed in the press in each country. Although the dialogue is changing and more and more positive stories emerge surrounding vaccines, media in both countries still often like to report on sensationalist stories that do not hold scientific muster, and controversy reigns. Politicians and bureaucrats often do not recognize how political capital can be built by improving routine immunization. In Nigeria, although there are anti-vaccine sentiments, particularly surrounding polio in certain areas, health is an important issue, and leaders will take advantage of reporting on the steps they’ve taken to combat disease.

On a related note, what progress have you seen in vaccine access in India and Nigeria recently, and what do you expect to see in the next few years?

I think there is much more recognition in both countries that the systems must be strengthened, infrastructure for delivering polio immunization can be leveraged, and that a focus on bringing up routine immunization coverage will benefit new vaccines and vice versa. There has been a greater level of engagement at the state level, and I expect that this will become increasingly important moving forward. As states are implementers and must ultimately ensure that there is both adequate demand and supply, their engagement in the planning and decision-making process is key. Another area that should see improvement over the next few years is surveillance, not only to be able to measure the impact of the vaccines but also to be able to monitor any adverse events that may happen and to quickly determine if they are related to the vaccine. This has especially been a challenge in India, where activists and media have questioned whether adverse events are due to vaccine and have treated government assurances with suspicion. Good surveillance with baseline measures of child health statistics prior to introduction will make it easier to assess claims and address concerns that may be unfounded, as well as provide a basis for measuring the trends and impact that are so important to communicate to sustain public and policy maker support for vaccines.

On a personal note, when not traveling internationally, you split your time between Baltimore and West Chester. What do you like about each?

Yes, both places are great. West Chester is where I’ve lived for a long time, and where I spend a part of the week with my husband and dog. It is a historic city with brick sidewalks, and a small town where I’ve gotten to know a lot of people over the years. I consider it home, although I am originally from upstate NY. Baltimore is a great city. I love where I live in Fells Point, right by the water. I’ve got great colleagues and friends in the city, and the ability to walk to work is a huge bonus!

Do you have any interesting hobbies?

I like doing things outside, including spending time gardening, hiking and exploring different places old and new. But, there is no place I’d rather be than under the water diving (although on safari is a close second). I’ve been diving since 1992 and try to go every year. One of my favorite places is the South Pacific where you have just an amazing range of color and variety of marine life – sharks and eels and all sorts of different things. I think I like it because I’m an explorer at heart, and you never know what you’re going to find down there, and it’s a way to really relax.

What is the most recent book you’ve read?

I just read Cutting for Stone about a doctor from Ethiopia and am now reading Behind the Beautiful Forevers – Life, Death and Hope in a Mumbai Undercity. I like reading about places I’ve been or would like to go. I also have been reading some of the excerpts from an international thriller novel a friend of mine is working on publishing – can’t wait to see that in print.

Ok, just one last question. If you could have dinner with anyone, alive or dead, who would you pick and why?

That is a really tough question. Can I just throw a party?! I’d love to meet famous women who have made a difference – like Aung San Suu Kyi or, closer to home, Hillary Clinton. They are role models for how you can help change the world. And then there are people who I’m just starting to hear about who are doing some cool things with social innovation – not as well known of course, but just as inspirational. Coming from a business background, I’m interested in hearing about new ways to solve the world’s problems.