Dr. Robert Edelman has long had to field questions
- from his own parents - about why he's not a
"real" doctor, seeing patients, prescribing
medicines and curing their ills.
His response: "I'm a real doc, except you don't
see what I do every day."
Edelman's lifework is vaccine research - long one
of medicine's most undervalued pursuits, even
though vaccines have helped conquer some of the
world's worst diseases.
But now, with bioterror a household word and
infectious diseases such as SARS scaring millions
around the globe, the discipline is getting more
respect - from the scientific community, the
federal government and even Edelman's parents, who
keep seeing their son quoted on television.
"All you need is one vaccine," said Edelman, 66,
associate director of clinical research at the
University of Maryland's Center for Vaccine
Development. "You've made an impact on potentially
tens of millions of people. Take that to bed with
you at night."
With increased funding and new technology, vaccine
research is thriving, scientists say.
"I think it's a very exciting time for
vaccinology," said Dr. Regina Rabinovich, director
of the infectious diseases program at the Bill &
Melinda Gates Foundation. The Seattle-based
foundation has committed more than $1 billion
since 1999 to developing new vaccines and
expanding access to existing ones worldwide.
"It's definitely more robust," said Dr. Myron M.
Levine, a prominent vaccine researcher who heads
UM's Center for Vaccine Development.
Since Edward Jenner developed the first vaccine,
for smallpox, in 1796, vaccines have been some of
the most successful public health interventions
ever, wiping out smallpox and protecting people
from scourges including polio, mumps and measles.
Children in this country now receive about two
dozen shots by age 6.
But vaccine research practically became a victim
of its own success. Over the years, it came to be
viewed as something of a scientific backwater as
the epidemics that afflicted earlier generations
faded into memory. Some ambitious scientists began
to look elsewhere.
Yichen Lu, principal research scientist for the
Harvard AIDS Institute and the Harvard School of
Public Health's immunology and infectious diseases
department, has heard the field degraded by
prominent scientists. "They think that doing
vaccine research doesn't require a lot of brain
power," he said. "My point of view is that, 20
years after AIDS, we haven't been able to come up
with a vaccine."
Tedious and expensive
Because vaccine-making is based in large part on
trial and error, and there is no universal
blueprint for how to do it, the process can be
tedious and expensive. Scientists have had
difficulty getting funding - most drug makers
considered vaccines for Third World diseases such
as malaria or cholera unprofitable. The work also
requires a multidisciplinary team of researchers
who might spend half a career or more on a single
vaccine, with no guarantee of success and a high
risk of failure.
The emergence of AIDS in the early 1980s was a
sobering reminder that infectious disease was not
a distant threat. Since then, outbreaks of Ebola,
West Nile virus, severe acute respiratory syndrome
and other illnesses have driven the point home.
"It's become clear over the last decade or so, or
even longer, that infectious diseases are not
going away," said Emilio A. Emini, head of vaccine
development at Merck Research Laboratories, which
recently began work on a SARS vaccine.
In the post-Sept. 11 world, the federal government
has emphasized the need to develop, produce and
stockpile the safest and most effective vaccines
against deadly bioterror agents such as smallpox
and anthrax.
Officials have earmarked more than $1 billion to
that end at the National Institutes of Health
alone. The Bush administration has proposed, in
Project BioShield, to create a guaranteed market
for those who make the vaccines.
"There's a great influx of resources, and that
means there are a lot of people who are going to
be working on problems related to these agents
that wouldn't otherwise have been involved," said
Dr. Francis A. Ennis, director of the Center for
Infectious Disease and Vaccine Research at the
University of Massachusetts Medical School.
Maryland institutions have benefited from the
largess. In February, the Johns Hopkins Bloomberg
School of Public Health received a $30 million
grant from the Global Alliance for Vaccines and
Immunizations to speed development of several new
childhood vaccines. Last summer, UM's Center for
Vaccine Development got a $22 million federal
grant for new vaccines against anthrax, malaria
and other diseases.
That's welcome news for researchers such as Dr.
Wilbur Chen, who even before going to medical
school became intrigued by the field while he was
a lab technician at the Food and Drug
Administration, working on vaccines against
meningitis and influenza.
"For me, it's a great thing, because you're
preventing disease from even happening in the
first place," said Chen, 33, who is an infectious
disease fellow at the
University of Maryland
Medical Center. He is applying to the
vaccinology training program at UM's Center for
Vaccine Development.
Chen likes the potential of being able to have an
impact in the Third World, where infectious
diseases are still a major killer. And he thinks
the growing understanding of the importance of
vaccine work - beyond the research bench - will
only help his cause.
"Now I can talk about my desire to do vaccine
research and people can identify with it," he
said. "Before they were like, 'Gee, vaccines are
just what you get from your pediatrician.'"
'Inelegant' science
Leaps in technology have helped dissolve the
long-held impression that vaccine research is
based on "inelegant" or unsophisticated science.
For example, Dr. Jonas Salk was hailed as a hero
in the 1950s for developing the first polio
vaccine, using "killed" poliomyelitis virus. But
even then, scientific rival Dr. Albert Sabin
derided Salk's work as "pure kitchen chemistry."
Dr. Gary J. Nabel, director of the Vaccine
Research Center in the National Institute of
Allergy and Infectious Diseases, said some
scientists still rely on traditional methods of
vaccine development.
"But, by and large, particularly within the last
five years, the sophistication of our science has
really reframed the whole field," he said.
Researchers have devised novel ways of delivering
vaccines, including an edible vaccine. With
advances in microbiology and genetics, scientists
are working on DNA-based vaccines as well as
therapeutic vaccines against cancer and other
diseases.
"I think it's advancement in science that
validates the field more today than ever before,"
said Garo H. Armen, chief executive officer at
Antigenics, a Massachusetts biotechnology company
working on a personalized cancer vaccine using
individual patients' cancerous cells.
But challenges remain. Harvard's Lu said more
resources and outside interest in the field have
helped - but only to a point.
"Morally speaking, it makes us feel like we're
doing the right thing," he said. "It makes us
realize our experience is badly needed. It's not
redundant. It's not nobody's interested."
He said his last three grant applications have
been turned down because the work he has proposed
on an AIDS vaccine doesn't have an innovative
scientific hypothesis. And private industry, he
said, is still primarily interested in making a
profit.
But Ennis, of the University of Massachusetts
Medical School, urges his colleagues to remember
why they got into vaccine research in the first
place.
"One of the things that the scientists have to
bear in mind is to try to do the best work they
can and not lose their perspective," he said,
"because the resources will come and the resources
will go."