An Afternoon with Vaccine Pioneers

Since the beginning of time we have gone over hurdles and hurdles of different diseases. Today, many of those hurdles have already been jumped. Two of these hurdles were Measles and HIV/AIDS.

Today I interviewed Dr. Katz and his wife Dr. Wilfert. Dr. Katz was part of the four Doctor team who developed the Measles vaccine while Dr. Wilfert spent her career trying to eradicate the spread of the HIV virus from mothers to their unborn children in the US and around the world (especially in Africa).

I interviewed Dr. Katz and Dr. Wilfert, who were in Culver City this week to visit their daughter Dr. Penelope Katz Facher as well as their grandsons Miles and Leo Facher.

Dr. Samuel L. Katz, M.D. – Wilburt C. Davison Professor- Chairman Emeritus of Pediatrics at Duke University. Dr. Katz is a Pediatrician and Virologist. Honors graduate of Dartmouth College and Harvard Medical School (1952). Member of the Duke Human Vaccine Institute. Following his pediatrics residency training at Massachusetts General Hospital and Boston Children's Hospital and a research fellowship in virology and infectious diseases Dr. Katz became a staff member at Children's Hospital working with Nobel Laureate Dr. John F. Enders.

He worked with Enders for 12 years during which time they developed the attenuated Measles virus vaccine now used throughout the world. Dr. Katz was the 2003 winner of the Albert B. Sabin Gold Medal awarded by the Sabin Vaccine Institute for his contributions to vaccine discoveries during his career. He recently retired.

Dr. Cathy Wilfert, M.D. – Division Chief of Pediatric Infectious Diseases in the Department of Pediatrics at Duke University (1976-1994) as well as Professor in the Department of Microbiology and Immunology. In 1996 she left Duke to become Scientific Director of the Elizabeth Glaser Pediatric AIDS Foundation. Honors graduate of Stanford College and Harvard Medical School (1962). Dr. Wilfert's work since the onset of AIDS has been focused on the eradication of pediatric AIDS. She has worked primarily to reduce the incidence of mother-to-child transmission of HIV. Due to the application of this knowledge pediatric AIDS in the US has been reduced by 75 percent.

She has worked very hard to reduce the transmission of AIDS in developing countries around the world, including Africa and India. Dr. Wilfert was inducted into the Institute of Medicine in 1999 and has many prestigious awards for her efforts. She recently retired.

Q:- "At what age did you both know you wanted to be a Doctor?"

Dr. Katz- "For me it came very easily at age 17 because I joined the Navy and the Navy sent me off to Hospital Core Training School and that was really my first contact with medicine and I loved it so that that was the beginning."

Dr. Wilfert- "7th Grade. I always wanted to be a Doctor and I don't know why?"

Q:- "Dr. Wilfert, how many women were in your medical school class?"

Dr. Katz- "She was six or seven out of a class of 120."

Q:- "How did it feel to be in a group that was mostly men?"

Dr. Wilfert- "It was fine, I just had to do my work and then it was fine. Until I got to the hospitals and they were not used to accommodating women. The on-call rooms were just for men."

Dr. Katz- "They were used to women nurses. That was the way they classified you, the same way as the nurses".

Q:- "Dr. Katz, how were you chosen to be on the team with Dr. Enders?"

Dr. Katz- "As part of my training I was what they call a resident, which is part of your post M.D. training. The last year I was a resident was the last year of Polio in this country and I was very impressed with the whole business. I went to the Chief of my division and said, "I would like to get involved in that". He said he would send me to see his friend John Enders who had just won the Nobel Prize for having isolated the viruses that caused Polio so that what was how I got involved. I went over to his laboratory and he was very cordial and very accommodating. "

Q:- "For both of you, how did it feel to be in labs with diseases like AIDS and Measles? Were you scared?"

Dr. Wilfert- "No, I wasn't scared, but it collected a number of people who were disadvantaged and it was my responsibility to take care of them."

Dr. Facher- "Mailee I don't know if it was in the material but when my dad and Cathy were running the Pediatric AIDS clinic at Duke it was one of the first and only ones around that treated children who were HIV positive.

" It was a clinic in North Carolina so there were a lot of people there who would not have gotten services otherwise. When they started the amount of time when a child would be diagnosed with HIV and death was pretty short. After their research and their work in the clinic the time extended longer and longer to the point where people were living with HIV. Children would die very quickly because they were so vulnerable"

Dr. Katz- "Well I think the other thing was Cathy was really one of the first, if not the first, to recognize that you have got infants infected with HIV because their mothers were infected."

Q:- "How did you figure out how to prevent AIDS from going to the children when their mothers were pregnant?"

Dr. WIlfert- "I did not figure it out but a clinical trial showed that if you gave the mothers anti-viral meds they did not transmit this to their babies."

Q:- "How long did it take to develop the vaccine for Measles?"

Dr. Katz- "That is a very interesting question when you compare it to what goes on today. It took us from 1956 to 1963 so that was even years. That seems a long time but that is a miniscule amount of time compared to the vaccines that are licensed today.

Q: "Why did it take such a little time to regulate?"

Dr. Katz- "There were many fewer regulations, FDA was not involved to that extent, things were accepted as they came through and not repeated with thousands and tens of thousands of people, rather with dozens and hundreds of people. It was a lot easier to do that a lot more rapidly. We tested it on one another, but of course as adults we had all had measles. It was merely a matter of testing of the material was so called "innocuous" and it was not until we began the studies in children who haven't had the Measles that we began to see what was really the result of the vaccine".

Q: "What was Measles like, how could you explain it?"

Dr. Katz- "Measles is one of the most contagious of all the infections. It is a virus that is spread from the nose and throat to those who have not had it. It is almost 100% if you are exposed and you haven't had measles you will get the infection. It lasts from the time you are first exposed to the virus to when you develop the symptoms of Measles is about 10 days. You develop a cough and a cold, a runny nose, and then you begin to develop the spots that indicate to people that it's Measles.

"It is interesting, why, I have no idea, but it always begins around the head and the neck and then the rash spreads down the body onto the trunk and eventually onto the extremities. The rash lasts for 3-5 days and then it begins to fade. Then if you are fortunate and you have no complications you get over it and you are immune to Measles thereafter.

"That is pretty much the situation in a country like ours with well nourished, healthy children. On the other hand, and we discovered this later of course, if you live in Africa or Southeast Asia where the children are vitamin depleted, where they are poorly nourished, where they have Malaria, where they have all these other complications, Measles with them is a very, very much more serious disease. As many as 10 to 20 percent of them may die of Measles.

Q: "Is it a one dose vaccine?"

Dr. Katz- "Yes. We have been very fortunate in contrast to many other vaccines and obviously we were not that scientifically sophisticated in that era. As I said, the vaccine was licensed in March of 1963 and the same vaccine 50 plus years later works effectively."

Dr. Wilfert- "You have not explained about the second dose."

Dr. Katz- "For those rare individuals who do not respond to the first dose the second dose fills it in."

Q: "Did the medical community know that you were developing the vaccine or was it top secret?"

Dr. Katz- "In contrast to many of the things that go on today our attitude was the more people who knew about what was going on the more people who would work in their laboratories and the sooner you would get things done. There was none of this secretive work I think in part because there was not the big monetary aspect to it.

"You were not going to come up with something that was then going to make millions of dollars for Glaxo Smith Kline or some other pharmaceutical company. It was something you wanted to do for "humanity" and not for a profit. We never licensed it so that we were not the sole manufacturers once it was done and we never gained any money from it. "

Dr. Facher- "Contrary to what Robert Kennedy Junior wrote in his article in Rolling Stone, an anti-vaccine article from about 15 years ago. I was incensed. He wrote an article about how vaccines cause autism and how evil my father and other people are. How my father made millions from the vaccine and I remember reading it and being enraged because Dr. Enders and my father specifically did not make any money on purpose, they could have.

They painted them as these sinister people who were doing something evil for money when they did exactly the opposite. I remember I was so mad and I wanted to write Rolling Stone and you told me I shouldn't, I was enraged.

Dr. Katz- "We were in some ways, fairly naïve, but also but very openly actively seeking to help mankind and not to benefit ourselves. It wasn't until after we had shown how to make vaccine and how effective it was that Merck was the first company to license vaccine and Merck became very successful because of that."

Q:- "What would you say to people who are skeptical about giving shots and vaccines to their children now?"

Dr. Katz- "Well today it is a very different world, in a country like ours where Measles has been pretty much gone for more than a decade. Parents are not familiar with the disease and how difficult it can be for their children and many of the young physicians have never seen a case of Measles unless they have worked in countries like Africa and Southeast Asia where there is lots of Measles.

"So that even they are a little less aggressive about trying to convince parents to have their children receive, but it is not just Measles vaccines, it is vaccines in general. Cathy mentioned that there was a physician in England who wrote a paper and said that Measles vaccine caused Autism in children.

'It wasn't until about 10 years later that people showed that the paper was totally fallacious. He had made up the whole story with the children. The paper was not only withdrawn from the journal but his medical license was taken away from him in England.

Dr. Facher- "It was Andrew Wakefield. He lost his license in England and he came here funded through a lot of wealthy families who were anti-vaccine and he has his own institute here. The reason his license was revoked because they found out he had fraudulently made up the research, it wasn't even that he got it wrong by mistake, he had fraudulently and purposefully misled people."

Q:- "My Uncle has Autism. My Grandmother believes that it was because of vaccinations when he was two. My parents decided to give me vaccinations when I was a baby so that is why I asked."

Dr. Wilfert- "I think that vaccines are damned because they occur in the youthful time frame of infancy and they are in proximity to events which also occur in infancy, but are not related."

Dr. Katz- "There have been dozens and dozens of studies now that have shown no relationship between vaccines and Autism. There is still that core group of individuals with Wakefield who pursue this."

Q:-"How has the medical industry changed from the 1950's to today?

Dr. Katz- "It has changed in so many ways. In particular, with regards to vaccines, physicians and pediatricians who care for infants and children accept as a normal part of the care of infants and children to make sure that they get vaccines. Polio was the first, then Measles and since Measles and Polio a lot of them have come along, Rubella, Mumps, Whooping Cough, Diphtheria, Tetanus, etc. These are a lot of diseases that were common among young infants and children which now are almost never seen in this country."

Dr. Wilfert- "It took laws to generally have the acceptance and the uniform application of pediatric practice."

Dr. Katz- "One of the things that is some ways difficult in this country is that vaccine recommendations and requirements are by state and not national."

Dr. Wilfert- "I think that money has become more important and in everybody's lives, physician's lives, pharmaceutical industry."

Q:- Dr. Facher asked Dr. Wilfert to talk about her experience in Africa and trying to eradicate the transmission of AIDS from mother to unborn child.

Dr. Wilfert- "You first had to impact the public health system, declare universal testing for women during their pregnancies, then have available drugs to administer and all of that took major changes in the public health system."

Q:- "People in Africa, how did they feel about all of this going on during your visits?"

Dr. Wilfert- "They were very open and conversant with HIV. They welcomed any relief."

Dr. Facher- "Cathy and her team would go and train the public health care workers to teach the villages. They would do a skit or a dance, really creative ways to communicate with people. It wasn't like going to Culver City and talking to people who have the same knowledge base. Some of these people lived out in farms or out in the country where this was not common knowledge for them so they would come up with these accessible and creative ways to do that public health education about safe sex and HIV".

Dr. Wilfert- "They made up lyrics of songs repeatedly to music that everyone knew."

Dr. Katz- "The other thing that you did that sometimes people don't appreciate is that the young pregnant women may be seen only one time in their home in the latter part of their pregnancy before their time of delivery and you were able to give them the medicine they needed."

Dr. Wilfert- "They would take the pills home with them whenever they went to the clinic and then when they went in to labor they took the medication."

Q:- "Were you scared about HIV when it first came out?"

Dr. Wilfert- "I was not personally frightened, I knew how it was transmitted. I didn't think I was at risk. The lady who worked with me at Duke decided not to process any unknown bloods in her laboratory. The nurses raised the biggest objections on the wards. They would not allow the HIV infected children to be with the other children. They drew a line in the sand so to speak. They got over that. HIV was transmitted by blood and sex, unlike Measles which is airborne. In Africa, it was well established that in Africa, people were eating monkey meat that was infected with HIV related virus".

Q:- "With Ryan White, was he the first child diagnosed with AIDS or was it because he was the first one to come out publicly?"

Dr. Wilfert- "He was the first one to make it public."

Dr. Facher- "So taboo that no one wanted him to be in school."

Dr. Katz- "You would be ex-communicated".

Q- "Has there been an impact on third world countries with the Measles and HIV vaccinations?"

Dr. Katz- "Absolutely- we estimate that before the Measles vaccine there were several million children a year who died of Measles in Africa. The last year for which we have any data we have less than 100,000, still too many. This is a lot different than several million."

Dr. Wilfert- "Yes and no. The distribution of drugs is a huge problem. Many more thousands are getting it today than used to get it, but we will never make it go away with drugs alone."

Q:- "If you could choose to work on a vaccine for a disease right now, which would you pick?"

Dr. Katz "That is a hard question. There are so many for which there are opening clues such as Rotavirus with the overwhelming problems of diarrhea in developing countries, things like Zika, new infections that have been coming along and people are just beginning to learn about like Ebola, lots of opportunities.

Dr. Wilfert- "I would pick HIV. I don't think without a vaccine it will ever go away".

Having a chance to sit down with Dr. Katz and Dr. Wilfert was truly amazing. Getting to peak back when this vaccine was created through his words was truly inspiring for my generation and the future. Dr. Wilfert spent a lot of time going to Africa to try to help moms with the hope that their babies would be born without HIV.

They were both very successful and passionate about helping people. To have sacrificed over 60 years of their lives to save millions of lives is something all of us should appreciate.