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A lifetime journey through clinical care, research and public health

Focusing on making global vaccine recommendations and navigating the intersection between science and public health policy is where I find myself these days, but it is neither where I started out nor where I thought I would end up. Upon starting college at Boston University in 1968, I found an environment that stimulated critical thinking and the pursuit of research questions. This experience led me to consider a career in medicine where I could pursue my interest in research in a way that could be practically applied to helping people. Starting in 1972, I attended Wake Forest School of Medicine (WFSM). During the third year clinical rotations I decided to pursue a pediatric residency at the same institution. I found caring for children with infectious diseases to be particularly rewarding and in 1979 did a pediatric infectious disease fellowship at the University of Minnesota under the mentorship of Dr. Paul Quie, an internationally renowned pediatric scholar whose research interest involved neutrophil function. Caring for children raised many interesting research questions one of which related to the pathogenesis of influenza virus-induced secondary bacterial pneumonias which is the major cause of death due to influenza infections in children and adults. Studies ongoing in the laboratory were examining the impact of dual infection with influenza virus and pneumococcus on the incidence of otitis media in an animal model. I began in-vivo and in-vitro studies looking at the effect of influenza virus on neutrophil function. These studies showed that influenza viruses decreased the ability of neutrophils to kill bacteria, but the mechanism remained to be determined. Upon completion of my fellowship in 1981, I returned to WFSM as a faculty member in the Department of Pediatrics. WFSM had a very strong research group focusing on neutrophil function and I was fortunate that several senior faculty (Drs. Charles McCall and David Bass in Internal Medicine, and Douglas Lyles inMicrobiology) providedmentorship for me. Additionally, Dr. Jimmy Simon, Chair of the Department of Pediatrics, provided startup funds for my laboratory, allowing me to spend comparable time doing research and clinical care/teaching. Early on our studies led to a novel finding. The dogma at that time was that neutrophils were important for bacteria killing, but did not interact with viruses. However, our in-vitro studies demonstrated that influenza viruses were able to enter into neutrophils. Furthermore, when Staphylococcus aureus organisms were added to solutions containing neutrophils and virus, inhibition of the fusion of lysosomal vacuoles with phagosomes containing S. aureus was observed. This finding suggested a mechanism by which the virus caused decreased bacterial killing by neutrophils and led to an increased incidence of secondary infections. The study was published in the Journal of Clinical Investigation in 1982 and was a key to obtaining NIH funding supporting my work in this area over the next 15 y. Later studies demonstrated that neutrophils had the capacity to produce some components of the virus, but not whole infectious virions. In total we published 14 manuscripts describing the interaction between influenza viruses and neutrophils. However, the molecular mechanism by which the virus causes neutrophil dysfunction remains to be elucidated. I also was involved in clinical research looking at various questions that arose during my time on the clinical service. One question was whether premature infants should receive vaccines at the recommended chronological age or whether vaccination should be delayed to an older age to compensate for the possibility that the immune system of premature infants would be unable to respond to a vaccine at the recommended chronological age. In several studies, the response of preterm infants to oral polio, inactivated polio and Hemophilus influenzae type b vaccines was examined. While the antibody response was somewhat lower in preterm infants, the data suggested that the antibody levels achieved would be protective when given at the recommended chronological age. Looking back, these clinical immunization studies were the beginning of my long journey in the area of vaccines. Several other events important to my career occurred during the 1990s. I was elected to the council of the Society for Pediatric Research (SPR) in 1991 and in 1996 became SPR President. In this position, I advocated for increased funding specifically designated for pediatric research and training of more pediatric investigators. This advocacy included testifying before the House Appropriations Labor/HHS subcommittee on this issue. Unfortunately, the numbers of basic/translational pediatric investigators has continued to decline over the past 2 decades. While serving as the SPR President, I was asked by the WFSM leadership to assume the role of Chair of the Department of Pediatrics following the retirement of Dr. Simon. The additional responsibilities meant that the time I was able to devote to research and clinical care would decrease. In addition, maintaining a reasonable balance between my career and