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Dr. Orin Levine Headshot

The Adrenaline Rush Of Public Health Research

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PUBLIC HEALTH RESEARCH
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If you're an adrenaline junkie and you want to pursue a health career, you're probably better served by becoming an emergency room doctor than an epidemiologist or researcher. In these careers, you may work a long time for uncommon rewards and infrequent milestones of success.

Yet in spite of these stereotypes, careers in public health and research can also have their exciting times. The #1 movie in America this week, "Contagion" -- a thriller starring Lawrence Fishburne, Kate Winslet, Gwyneth Paltrow and Matt Damon, and based on the outbreak of a deadly disease and the CDC's efforts to stop it -- is one such example.

Being an epidemiologist or researcher responsible for cracking the puzzle of how to stop an outbreak -- especially when the cause is new or unknown -- is one of the most exciting jobs you can ever hope to have. You survive on adrenaline and work around the clock to piece together the story in hopes of generating a solution that can save countless human lives.

Another, more common chance to get an "adrenaline rush" in a public health research career is when you "break the code" on an experiment, like a vaccine trial. Breaking the code goes something like this:

You begin a trial that like many is double-blind, meaning that neither you nor the participants know whether the subject is receiving the actual drug or a placebo (this helps ensure accuracy of the research findings). You work for months or years to administer the treatments and follow the patients to see what happens. All this time you collect the data that will determine whether the vaccine or drug works but without knowing who got what. Now comes the moment of truth: Your statistician runs the analysis by applying the deciphering code, and the outcomes fall into place, revealing the promise, safety and efficacy of a new cure or preventive measure.

Ironically, last week, while "Contagion" was hitting the screens in movie theaters amidst a lot of fanfare, the code on a vitally important vaccine trial was quietly being broken in a computer center in Belgium. After a rigorous study conducted in 11 sites in seven countries, immunizing thousands of young children, the first read-out on the effectiveness of a new malaria vaccine called RTSS is becoming available this fall. After working for nearly five years to set up the study, enroll the children and monitor their health, the results of how well the vaccine prevents moderate and severe forms of malaria will be known shortly. Among the researchers responsible, the adrenaline is sure to be at an all-time high.

When the results are made available, it will be time to start discussing what to do with the vaccine. If the vaccine is safe and effective, one of the most important questions will be how to pay for it. Malaria is a huge problem in the world's poorest countries, and even though Andrew Witty, the CEO of the vaccine's manufacturer, GSK, has promised to price the vaccine at a point just above its production cost, this price may still end up being to high for many malaria-affected countries to pay for it.

While we can't yet predict the vaccine's effectiveness, we can reliably predict that access to this vaccine for children in need will be heavily influenced by the decisions made by global donors in relation to financing. To date, the donors have not yet faced the single biggest decision on this front: Does this fall under the Global Fund to Fight AIDS, TB and Malaria or under the GAVI Alliance? Until that decision is made, the ambiguity around financing will be a major, predictable and avoidable barrier to access.

The main donors to both agencies are virtually the same and include the usual suspects: the governments of the USA, UK, France, Norway, Italy, Germany and, of course, the Bill & Melinda Gates Foundation. They will all be in New York next week for the UN General Assembly. Maybe they can find the time to get together, take this simple decision and do their part to be prepared for whatever news comes from breaking the code in the malaria trial.

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