Vaccine Development Tells a Story of Perseverance and Sacrifice
August 27, 2021
The topic of immunizations seems to open a Pandora’s box of emotions these days. Regardless of which side you stand on in the immunization debate, the development of vaccines has a truly fascinating history. In honor of National Immunization Awareness Month, I spent a little time learning about the history of vaccines and thought I’d share some of my findings.
Although Dr. Edward Jenner is credited with performing the first smallpox vaccination in 1796, the antecedent to vaccination was variolation, a process that involved injecting a small amount of infectious material from smallpox postules under the skin. Those injected with smallpox material had a much lower mortality rate (1 in 50) compared to those who were not (3 in 10). The subcutaneous method of variolation dates back to around 1000 CE and was introduced in India. This practice became commonplace in Europe throughout the 1700s. However, in the late 1700s, Jenner and his colleagues noticed that people who had been infected with cowpox (usually people who worked on farms) didn’t get smallpox. This discovery ultimately led to the smallpox vaccine. Smallpox was eradicated in 1977 and now only exists in two heavily secured laboratories in the US and Russia. The word “vaccine” comes from the Latin word “vacca” – meaning cow.
Another important chapter in vaccination history occurred in the 1950s when Henrietta Lacks, a black tobacco farmer, died at the age of 31 from an aggressive cervical cancer. At the time, it was common practice for physicians to collect human cells for research, without consent. Lacks’ cells had the ability to replicate indefinitely, while normal human cells are able to replicate on average around 50 times. This indefinite replication of cells allowed researchers to grow and study the cells in laboratory settings. Researchers from all over the world have used this cell line (now knowns as HeLa cells) to further their research. The cells have contributed to many important scientific breakthroughs, including the development of the polio vaccine and the study of the human papillomavirus, leading to today’s widely available HPV vaccine.
While the scientific breakthroughs attributed to the HeLa cells are remarkable and many greatly profited from new discoveries, Lacks and her family never benefited from these contributions. Her family was not aware that her cells had been in wide use in research until the 1970s (nearly two decades after her death). This injustice has led to a reckoning of sorts in research and healthcare communities. Informed consent is now required for those who donate tissue and cellular materials for research. Additionally, Institutional Review Boards (IRBs) examine every research study involving human participants before it is approved. As for Henrietta Lacks, her legacy lives on and is being honored by Johns Hopkins, the institution where she received treatment. Several scholarships and symposia have been named in her honor and a new building on the Johns Hopkins campus will bear her name. A book and movie also were developed, “The Immortal Life of Henrietta Lacks,” and share details of her legacy.
Immunization history tells a fascinating story of adaptation, innovation, and ethical considerations. Undoubtedly, the development of the COVID vaccines will offer another milestone chapter in the history of immunizations. How fortunate we are today that humans had the fortitude to continue developing a vaccine that was most effective for smallpox eradication. And we owe a debt of gratitude to Henrietta Lacks and her family for their many contributions to science, as well as understanding ethical considerations associated with medical care and research. As someone who desperately wants to protect my loved ones and community and for my children to be able to safely return to school, I am grateful for the perseverance and sacrifices of those who have contributed to vaccine development.
July 28, 2021
Like many people across the world right now, I am captivated by the Olympic games. What is it about this event that is so compelling, that seems to suck people in, and dominate our collective psyche for two weeks every few years? For me, it’s connecting to the human stories of the games and recognizing that people make so many sacrifices to achieve the highest pinnacle of competition by participating in the Olympics. Many of the competitors are people you’ve never heard of, and may never hear of again, but they continue to work tirelessly to achieve their Olympic dreams every day. Sometimes there is heartbreak, such as Simone Biles’ withdrawal from the competition, and sometimes there is incredible victory, such as Katie Ledecky’s amazing swimming performance.
As I thought about this month’s column, it occurred to me that HCIF and our partners face our own Olympics of sorts on a much more immediate basis. There are the everyday heroes who we may never be able to name who rise above day in and day out to meet the needs of our patients. There are the community partners who work to provide resources for their vulnerable clients and communities. There are the hospitals and healthcare stakeholders who band together to address public health crises, such as COVID. While medals may not be doled out for this work, we are driven by our own Olympic goal of supporting the well-being of all Americans through the provision of high-quality, equitable, and transformative healthcare.
HCIF is currently re-visiting goals we formulated during our last fiscal year and determining our goals for this fiscal year. In collaboration with our partners and colleagues, we achieved many programmatic victories during FY21. These include authentic engagement of community members in listening sessions to understand needs related to blood pressure management; reducing the biopsy complication rate for men with prostate cancer; and identifying individuals at high-risk for colorectal cancer. We also achieved organizational victories, such as developing partnerships with new stakeholders important to our mission, bringing on new Board members, addressing racism and health equity, and achieving wider exposure to our work. However, this work doesn’t come without heartbreak and there were goals we were not able to achieve, primarily due to COVID-related factors and unanticipated challenges. But this is all a part of our own Olympic story and recognizing that we’ll be back next year trying to overcome challenges to achieve metaphorical medals.
As we look towards Olympic gold in fiscal year 2022, our goals will be to continue providing high quality programming and support, while developing plans to expand our organizational focus, priorities, and impact. We will fully launch our exciting new health equity data strategy program, complete the next regional community health needs assessment, and celebrate the 15th anniversary of the Partnership for Patient Care program. We will also continue to strive for equitable care for all and develop new organizational strategies to achieve this goal.
Thank you to our staff, Board members, partners, funders and other stakeholders for continuing to support our Olympic dreams.
by Wendy Nickel, MPH
June 24, 2021
Over the past few weeks, I have begun to notice a palpable change in perspective within HCIF, among our staff, and in conversations with partners and stakeholders. It’s a hopeful perspective, and although unspoken, seems to ask the question, “what can be?” This change is undoubtedly related to increasing vaccination, a feeling that we are coming out the other side of COVID, and a timid willingness to begin thinking about the future. It’s the “what can be” that is the noticeable change, and not the “what will be” which has been streaked with trepidation and fear over the past 16 months.
It’s exciting to think about what can be in healthcare and the work we do at HCIF. If the past year has taught us anything, it’s that intention is critical in our work. If we want to provide equitable care and achieve the best possible health outcomes, we must be intentional in setting up systems to produce these results. That means calling attention to the issues and conditions that create disparities and poor outcomes. If I took a moment to think about “what can be,” it would be that we are intentional about the routine collection of racial, ethnicity, and language (REaL) data that allows us to evaluate the care we provide to different patient populations. With the launch of our Health Equity Data Strategy (HEDS) program this month, I believe we are on our way to supporting hospitals and healthcare organizations in developing intentional systems for this data collection and evaluation and that gives me great hope for making progress towards health equity.
I also believe what can be is a fervent commitment to collaboration among various stakeholders to create communities of health. These stakeholders include not only traditional healthcare providers, but employers, housing authorities, parks and recreation, and faith-based organizations. This type of collaboration is evident in the Cities Changing Diabetes program, where numerous stakeholders have joined together to develop creative and innovative initiatives to support community-based prevention and management of diabetes. Stakeholders include: organizations representing recently incarcerated individuals, food-based philanthropies, pharmaceutical companies, universities, and houses of faith, to name a few. Colorectal cancer screening disparities among Philadelphia African Americans provides another opportunity for collaboration among non-traditional stakeholders in order to intentionally remove barriers to screening. The “Go to Know” program is a unique initiative led by WURD radio station, in partnership with Colorectal Cancer Alliance, Penn Medicine, Independence Blue Cross Foundation, and LabCorp to offer free screening kits and any required follow up care.
HCIF embarked on a strategic planning process this past month and what can be is very much at the core of this initiative. Although we are at the very beginning, our staff, Board members, and external stakeholders have identified several issues that will help shape our vision of what can be in the future. This includes equitable application of technology to support care, authentic engagement of patients and families to support achievement of health outcomes most meaningful to them, and developing a bridge between care provided in healthcare organizations and care provided in the community.
In a year plagued with unease and apprehension, it is refreshing to begin thinking of what can be. This is our time to shape the future of healthcare – we’ve been given this gift of opportunity – let’s take advantage of it!
PS – If you have a vision for “what can be” in the future for healthcare and want to share your thoughts or ideas, please email me (email@example.com)!
by Wendy Nickel
May 26, 2021
It’s been a year since George Floyd was murdered. Not unlike many organizations, we at HCIF have expended many resources over the past year thinking about racism, talking about our goals as an organization, and planning ongoing educational activities. Admittedly, we have grappled with the amount of time our staff has dedicated to this work, given that our primary work is typically grant-funded and staff have limited time to work on anything besides their projects. We have also grappled with what HCIF’s role should be in speaking out against racism in contexts unrelated to healthcare.
Let me share a bit about this difficult and challenging journey and where we are going.
Six months ago, we gathered the leaders of our staff Anti-Racism Council to discuss how HCIF should respond to Walter Wallace, Jr.’s killing at the hands of police while experiencing a mental health crisis. We felt our best path was to continue educating our internal team about structural racism and re-double our efforts to dismantling racism within our own organization. We also offered resources for staff to learn about how they could volunteer, donate to or otherwise support organizations aligned with our anti-racist agenda.
And then six Asian-American women were murdered in Atlanta. And 13-year old Mexican American boy, Adam Toledo, was killed by police. And another African-American man, Daunte Wright, was killed by police not far from where Derek Chauvin was standing trial for the murder of George Floyd. And each time, I gathered the leaders of our Anti-Racism Council to discuss the HCIF response. Should we develop another statement condemning racism? Or develop a social media campaign? Or hold another educational session for our staff? Or provide listening sessions so our team can vent their concerns, sadness, and frustration?
And each time, we asked the same question, what is HCIF’s role in advocating against racism and promoting equity? The answer has actually become clearer each time a new racist incident or event gains media attention. The roots of racism are deep and intertangled not only in our criminal justice system, but in all facets of our society, including our public health system. If our vision as an organization is to “create a responsive, coordinated health care community that fulfills the needs of patients and consumers, and achieves better health,” we can’t possibly achieve our vision without improving the issues that lead to poor health, including addressing equity. To build an equitable healthcare system for all, we must fight against the injustices that lead to healthcare disparities including various social determinants of health: violence, poverty, food insecurity, and polluted air and water.
We know we can’t solve every issue and in some cases, our expertise and focus should be on how we can address racism specifically within the healthcare system. However, there are other ways we can and will not only show our support, but do our own work to dismantle racism. This includes having a long-standing commitment to becoming an anti-racist organization. Our Anti-Racism Council recently conducted an organizational assessment and we recognize that while we have a long way to go, we are committed to running the marathon, not just the sprint. We will be developing a roadmap for how we intend to address bias and privilege in our own programs. We hope to engage an external expert to advise on the development of this roadmap and other ways we can ensure equity in all we do. We commit to aligning ourselves with housing, criminal justice, mental health, and other stakeholders who have missions that contribute to the health of communities.
And when racist incidents or events occur in the future, as they almost undoubtedly will, we will continue to formulate authentic responses based on the needs of our staff members, our partners, and our community. These responses will be based on the premise that racism is a threat to the public health and just as we would fight against a virus, we will engage all of the tools and resources at our disposal to fight racism.