[Indepth interview]The world’s top ‘vaccine diplomat’

Giving a vaccine shot to a child crying out in fear may not be a pleasant experience, but that small act goes a long way in preventing infectious diseases. It can even help foster peace, according to John Clemens, the director general of the International Vaccine Institute, an organization headquartered in Seoul, which works to develop and introduce new and improved vaccines to protect the health of the world’s most vulnerable people. The agency has been developing vaccines for Shigella dysentery, cholera, pneumonia and other infectious diseases that kill millions of children in developing countries. Established by a treaty signed by 40 countries and the World Health Organization, IVI is supported by major donors including the South Korean government, the Bill and Melinda Gates Foundation and the Swedish government.
The institute, which conducts research in 22 countries in Asia, Africa and Latin America, is soon to begin a landmark collaboration with North Korea to improve its capacity to diagnose and introduce new vaccines to prevent bacterial meningitis and Japanese encephalitis in North Korean children. This month, five scientists from the IVI are expected to visit the reclusive country for a pilot vaccination campaign on 6,000 children. The institute first set foot in North Korea last May and took a team from the North on a study tour in China and Vietnam.
Clemens, who has led the IVI for the past nine years, is a vaccine expert on diseases prevalent in developing countries. In 1983 he gave up a faculty position at Yale Medical School, his alma mater, to take part in a cholera vaccine trial in Bangladesh. Since what he called a “life-changing decision,” Clemens has held an array of positions in international public health organizations including the World Health Organization’s Collaborating Center for Vaccine Evaluation in Developing Countries. He spoke to JoongAng Daily recently in an exclusive interview.

Q. Tell us how IVI’s project with North Korea came about.
A. We initiated a project there last year to prevent central nervous system infections in children, specifically preventing bacterial meningitis and Japanese encephalitis, two very important problems in kids throughout Asia. There are very good new-generation vaccines for both of those diseases but the experience has been that generally kids in wealthier countries have greater access to those vaccines. Kids in North Korea have very limited access to these vaccines despite the fact that the diseases are public health problems. We are working in collaboration with the organization called the Academy of Medical Sciences in North Korea to provide training to local professionals on laboratory diagnosis, to improve clinical care for those children who are unlucky enough to come down with these diseases, and work with the Ministry of Health to conduct a demonstration project in which the kids will actually receive internationally licensed vaccines on a pilot scale. Early this month, we will begin vaccinating 3,000 kids each in the cities of Sariwon and Nampo. I should hasten to express our gratitude to the Ministry of Unification, which is generally funding this work, and our budget permitting, we hope to expand the project next year

As a public health official, how serious in your view is the public health situation in North Korea?
There are several major public health challenges in North Korea. Tuberculosis is a very significant public health problem in the North. I just attended a seminar hosted by the Ministry of Unification in which non-governmental organizations working in the North presented their programs and their findings about the North. It was pointed out now that diarrheal diseases are also major problems among kids in the North. It is also well known that malnutrition of children is a problem. One thing that people commonly do not recognize is that malnutrition is not just a problem of not enough food. One of the major exacerbators of malnutrition and nutritional decline in children are infectious diseases, especially diarrheal disease. These infections set up a spiral in which the child’s nutritional status goes down because of the infection and because the child’s nutritional status is down, the child is at an increased risk for a second infection. So vaccines are potentially a very important tool not only for preventing infectious diseases but also for addressing the problem of malnutrition.

What was the biggest challenge in doing the project with North Korea?
The project has been running incredibly smoothly. We have hit all of our timeline goals, so it has been very gratifying. And South Korea’s Unification Ministry has been incredibly supportive of our project in many ways, not only financially but also in providing us with guidance.
Plus the groups we’ve been working with in North Korea have been very collaborative, interested and keen to do this joint work, so it has been an absolutely great experience on a professional and personal level. We visited several clinics where the kids will be vaccinated, which I found to be extremely well organized and to have very good record-keeping systems. Probably the greatest challenge in the program was actually establishing a connection in the first place. It took us more than two or three years to finally establish a connection to develop the project with North Korea.

Is the project in North Korea more than just providing vaccines?
Vaccines are wonderful in that they’re not controversial and not political. Everybody in the world believes that every child, regardless of what country that child lives in, has a right to be vaccinated against the major childhood diseases, for which we have vaccines. And there have been many examples in which countries or segments of countries that are at odds with one another have come together to create space for vaccination of kids.
One of the first examples was a collaboration effort between an American vaccine developer, Albert Sabin, who developed the oral polio vaccine. Some of the first trials of that vaccine were done in the old Soviet Union during the height of the Cold War. There was a general recognition on both sides that kids needed to be vaccinated against polio and there was genuine collaboration between American and Soviet public health officials on that program. More recently, the world is now attempting to eradicate polio so that it will never infect another child in the future. One of the vehicles for doing that is called National Immunization Day, in which children of entire countries are vaccinated against polio using the oral polio vaccine. And there have been many incidents in which segments in warring countries declare days of truce so that the kids can be vaccinated against polio.
Another example is cholera vaccine. There was a very important demonstration project done by the WHO of killed oral cholera vaccines in refugee camps in Darfur, Sudan. Darfur is a place where a lot of violence has occurred, yet people there created space to allow for that vaccination. We feel in a very small way that our work with North Korea is an example of “vaccine diplomacy,” and indeed we’ve forged very good and very trusting relationships with our North Korean colleagues in this combined effort to vaccinate North Korean kids....
Also, our laboratory scientists are developing very important new vaccine delivery approaches, whereby injections are not required ... such as IVI’s work on sublingual immunization, in which the vaccine is simply placed under the tongue.

By Jung Ha-won Staff Reporter [hawon@joongang.co.kr]