InsideSurgery recently had a chance to have an email conversation with Dr. James Campbell, a noted avian flu vaccine researcher at the University of Maryland Center for Vaccine Development. He is an investigator in a current NIH study testing an avian influenza vaccine with adjuvant.
You are currently working at the University of Maryland doing vaccine trials, but you originally trained as a pediatrician. Why pediatrics?
The impact that any doctor makes on a patient is great, but the impact a pediatrician makes on a child may be the greatest. I love the interactions with the children and their families. I also intellectually like the medical problems that are specific to children more than those of adults.
Why have you specialized in pediatric infectious disease?
I first practiced general pediatrics (which I loved). Each day I felt I had a small impact on individual children and their families. But, I thought that a career in vaccines and public health could possibly allow me to make a difference for more people. I trained when Hib was just going away due to vaccines. I thought it would be great to train in ID and vaccines and to play a role in elimination of other infections.
Some of your work in vaccines is supported by the Bill and Melinda Gates foundation. Do you think that one foundation can make a difference in pediatric diseases in the developing world?
Yes. The foundation has an extraordinary amount of money and it has vision. It hires people who really understand global health problems and then provides adequate funding to get things done. It has set an example for other foundations and governments to follow.
You have already spent some time as a physician working in a less developed part of the world when you were a naval officer in Guam. What was Guam like?
Guam was beautiful and hot. I very much enjoyed my time there. The Navy gives you responsibility for things that most people in such junior positions would not have the chance to do. Within 2 years of completing residency, I had been chair of the department, had run the infection control for the entire healthcare facility, and had run the immunization clinic.
Do you think that childhood immunizations play a role in the development of autism?
No, they do not. There is no credible evidence to support this claim and numerous reports to refute it.
The quality of military medicine has been questioned lately. Do you feel that the quality of care in Guam was lacking in any way?
The medicine practiced there was superb, in my opinion. Many people have the opinion that military medicine is not as good as civilian medicine. Most of them, though, have never been cared for at a military facility. The pediatric care at Guam Naval Hospital and at Bethesda Naval Hospital was excellent.
Are you still a naval officer?
I left the Navy as a Commander in 2006. I began when I was in medical school. I served 7 years on active duty and the others in the Reserves.
If you could take care of just one disease for the rest of your career, what would it be?
Hmmm. If I had to do just one thing, it would be caring for well children: health maintenance, prevention, counseling. If it had to be just one actual disease, I suppose I would choose an immune deficiency, since that may allow me to diagnose and treat a variety of infections.
You have worked on several different avian flu vaccine studies, an anthrax vaccine study, a phase I streptococcal vaccine study, a phase I malaria vaccine study, and a Shigella vaccine study under a large grant awarded to Myron Levine. Who is Myron Levine and how did you develop your relationship with him?
Myron (Mike) Levine, is the director of the Center for Vaccine Development (CVD). He is one of the true global leaders in the field of vaccinology. I came to the University of Maryland specifically to study and research vaccines. Mikeâ€™s leadership is one of the primary reasons for the CVD to have become so successful over the last 30 years.
Which of the above diseases that you have worked on will be most impacted by a reliable, safe, and inexpensive vaccine?
Studies of vaccines directed against influenza strains with pandemic potential.
Which bird flu strain does the vaccine you are working with protect against?
It is directed against the H5N1 strain. To date, these vaccines have been made from a seed virus that is what we call clade 1. Clade 2 vaccines are going to be tested soon
What is the current status of the bird flu vaccine trials? Does it look like the adjuvanted bird flu vaccine will provide protection?
Adjuvanted and whole virion vaccines directed against H5N1 (bird flu) are currently leading the pack in the race for an optimal pandemic influenza vaccine. At this point, we can only point to safety and immune responses. Studies of efficacy have not been done.
Have you been vaccinated against bird flu?
No, unfortunately, I cannot participate in my own trials.
If it was available to you, would you accept the bird flu vaccine?
How worried should the population be in the United States about a bird flu pandemic hitting this upcoming flu season?
There is no reason to believe that we are any more or less likely to have a pandemic this year than in other years. Researchers who work on the genetics of the virus and the attachment of the virus to receptors are getting closer to being able to predict the sequence and necessary mutations to confer transmissibility.
When would the bird flu vaccine you are working on be available to the public? Would you have any say in who receives it?
The first one we worked on was recently licensed, but it is not commercially available. The government is currently the one who has the say as to whether the vaccine will be made publically available. I potentially would be asked my opinion on which subsets of people should be offered vaccine in the event that there is not enough supply to meet the demand, but I will not have private access to the vaccine.
What is your opinion on how a bird flu pandemic would affect the United States?
It depends on which virus emerges to cause it. If it resembles the virus of 1918, it will cause enormous problems.
Have you personally made any preparations for a bird flu pandemic?
What recommendations would you make for preparations for a bird flu pandemic â€“ if any?
I am not of the opinion that extensive personal preparations are necessary. For those who would like advice on ways to prepare, one source is the Centers for Disease Control and Prevention website at www.cdc.gov
What do you think about the University of Iowa futures market on a bird flu pandemic? Are you participating and why or why not?
I know nothing about it.
What are your upcoming professional plans? Do you plan on continuing your bird flu work?
I will be moving, with my wife and children, to Kampala, Uganda this summer. I will be working for the Centers of Disease Control and Prevention (CDC) in their Global AIDS Program. Most of my work will involve supervising the CDCâ€™s work under PEPFAR, the Presidentâ€™s Emergency Plan For AIDS Relief and performing programmatic researchâ€”determining the best means to prevent and treat HIV infection. I expect to return to Baltimore in 2009.
Disclosure: the author of this interview has been a trial participant at the Center for Vaccine Development at the University of Maryland