Former NIAID Chief Warns of ‘Shameful’ Federal Response to Measles

With federal vaccine policy and infectious disease research undergoing major changes, professional medical societies are stepping in to fill gaps once occupied by federal health agencies.

In a conversation with MedPage Today Editor-in-Chief Jeremy Faust, MD, Infectious Diseases Society of America (IDSA) leader and former National Institute of Allergy and Infectious Diseases (NIAID) Director Jeanne Marrazzo, MD, MPH, discusses IDSA’s role in vaccine guidance, what she calls a “shameful” federal response to measles outbreaks, shifts in research priorities at NIAID, and her concerns about the future ID workforce.

The following is a transcript of their remarks:

Faust: Hi, it’s Jeremy Faust, editor-in-chief of MedPage Today. Today, I’m joined by Dr. Jeanne Marrazzo. Dr. Marrazzo was previously the head of the NIH’s National Institute for Allergy and Infectious Diseases, and now leads the Infectious Diseases Society of America. Dr. Marrazzo, great to see you. Thanks for joining us here.

Marrazzo: It’s great to be here, Jeremy. Thanks for having me.

Faust: The IDSA is busier than ever, and in a way, has a higher profile than ever. And I wanted to start, as we come into respiratory virus season, with a question about vaccine policy, and that is in the absence of a functioning ACIP, the Advisory Committee for Immunization Practices at CDC, groups like the IDSA are now coming out with their own vaccine recommendations, and this appears to be maybe something that’ll be on an ongoing basis. Can you tell us about that?

Marrazzo: Yeah. So, in the absence of trusted sources of information, people have to step up, right? So, people have to step up and provide the information that people need. What the idea was behind the respiratory season vaccine guidance is that it would be a coordinated effort between several societies. And it was done quickly and very, I think, nicely, collegially, and resulted in those JAMA articles you saw last week.

Is this going to be a perpetual thing? I really hope not. I hope all of this craziness is temporary and that we are just doing our best to plug the leaks in the system. I mean, I feel like we are sophisticated plumbers at this point. Will it change things going forward? I don’t know. Maybe this is a good system to look towards.

We’ve been pretty homogeneous in what we’ve relied on, and if we’ve learned anything in this past year and a half, we’ve learned that reliance on a single portfolio, whether it’s a funding portfolio like the NIH or single information portal like the CDC, comes with some risks.

Faust: Many people watching this will know, but some will not, the ACIP recommendations in the traditional ACIP where it was functional, came after a long process behind closed doors. And basically by the time the public meeting was happening, yeah, sure, the votes were almost always unanimous. That’s because the decisions were really made in meetings. And I’m wondering how it would play out in a time when, “Hey, we have some new data. Do we really need RSV [respiratory syncytial virus] every year for certain people?”

And so two questions. One, how would that be vetted? And two, just, not to be pejorative, but essentially it’s a journal club, but ACIP is not because it had proprietary information through industry and other partners that made it more than just let’s all look, see what’s out there in the medical literature. It had proprietary stuff that no one else had access to that really did drive these decisions.

Marrazzo: That’s right. So are they really two separate things? You’re right. I mean, the “journal club” you’re referring to is sort of the systematic review that VIP [Vaccine Integrity Project] has now sort of staked their claim on and is doing for several things. And the guidance for this fall is pretty baked in with the data that is publicly available and that we have. The review of original data and how that fits in and how it feeds into recommendations is a completely separate beast.

And right now there are conversations ongoing about where people should go to have this done, particularly industry, because they don’t really have anywhere to go right now, as far as I can tell. I mean, the working groups are disrupted. They’ve all been disassembled or completely discontinued. So I think there are a couple of options, but how are you going to make it work the same way?

You alluded to the fact that this work behind closed doors was intense. Experts who can review it who are unconflicted, which is a very important thing, and who have enough stature in the field to essentially “take the place” of what would ideally be the ACIP. There are ACIP members who were let go for unclear reasons who are extremely qualified.

So again, this gets to this whole question of, to what extent should we set up parallel systems to replicate what we had, and are these going to be temporary and stopgap measures or are we going to set up something that may ultimately be an alternative or a better model than what we have?

So, it’s a really dynamic space and it’s crazily exciting and crazy making at the same time because you don’t really want to be doing it because the system worked, I think, pretty well before. On the other hand, we had no choice and I think we have an obligation to figure this out.

Faust: Just on the news cycle a little bit, tell me your reaction, just as an infectious disease expert, but also as the leader of IDSA, with how HHS is handling their measles outbreaks where they are occurring.

Marrazzo: You mean how they’re not handling the measles outbreaks?

Faust: Well, I mean there’s a response. You could say they’re not handling it, but tell me about it.

Marrazzo: The CDC director has not made one statement about the fact that there have been at least five deaths in Pennsylvania right now. There are at least six cases of congenital measles that I’m aware of. There are almost certainly going to be in the coming years cases of subacute sclerosing panencephalitis, which if you get measles before the age of 1, you have a one in 600 chance of getting.

With the numbers we’re seeing and the likelihood of underestimation, this is going to be a real mess in the future. We also know that measles kind of trashes your immune system for a significant period of time. That’s a very unsophisticated immunologic summary of what it does to the immune system. But we do know that there clearly is an immune suppression associated with acute measles, especially in younger children.

So, the fact that HHS has not really sounded the alarm and unequivocally said we need to have all hands on deck to get people vaccinated to make sure pregnant women know that they can’t get the vaccine, but there is immunoglobulin they can get so that their babies don’t get congenital measles, that’s a travesty.

So, I am totally fine going on the record that the response has been extremely underwhelming and frankly shameful.

Faust: In an environment where you’re trying to keep things afloat, your organization has talked about the transparency around these kinds of issues. Can you just, for people who haven’t necessarily followed this for years, say what it was like before in terms of understanding transparency around say, you have a press release with HIV funding, the kind of transparency that was there in the past and what is the current situation?

Marrazzo: Yeah, so it’s a great example. So you probably are aware of the HIV clinical trials networks, right? They’re funded by NIH, so billions of dollars. Billions of dollars have gone into these networks over the last 30-some years.

So, there’s the HIV vaccine trial network, there’s the prevention trial network, there’s the treatment network, and there’s the adolescent and pregnant women network. These were supposed to be renewed; they’re on a 7-year cycle. Last spring, the announcement was supposed to come out last spring for the renewal applications.

Those still haven’t come out. No one knows what the status of those applications are. And these are entities that run clinical trials. So places that run these trials are having to lay off workers. But put your money where your mouth is. If you’re going to build on decades of successful, spectacular HIV research, then tell us what you’re going to do with the clinical trials networks. And there’s really been no messaging about that. So that’s a really big one, I think.

The other thing is emerging infectious diseases. When all these grants were sort of selected for review and unfunding, if you look at the areas that were targeted, it wasn’t just the DEIA [diversity, equity, inclusion, and accessibility] kind of things or the gender and minority sort of stuff. A lot of it was around coronaviruses and pandemic preparedness.

So, there’s kind of this contradiction about what we expect NIAID in particular to be doing to prepare us for the next whatever it might be or to work on what’s going on now like Ebola. It’s a travesty really. I mean, another really, really horrible situation there. So I think we would like to know what is the roadmap here and why are we not hearing and jumping in.

Faust: And thank you for leading us right to the National Institute for Allergy and Infectious Diseases, which of course is the institute that you led prior to your current position at IDSA.

What is your sense of the direction of research intramurally, in-house, there right now? And my sense — tell me if this is wrong — is that there is a major shift that has occurred since you left. And I’d like you to describe to people what’s at stake.

Marrazzo: I don’t see that being emphasized because instead what you’re seeing is building the agenda around these politically correct buckets, whether it is avoiding emerging infectious diseases or avoiding coronaviruses or avoiding pandemic or avoiding biodefense.

You probably have heard that there’s this $2-plus billion dollars going to DoD — the Department of Defense — that was about a third of NIAID’s budget that was for preparedness writ large, which meant you use a lot of that money for things like universal flu vaccine because of course military recruits are exquisitely at risk for the consequences of flu outbreaks.

So, you see all this stuff not only kind of missing in what you would like to see in a comprehensive outward-facing plan that you really got a lot of input in, and instead you’ve got this thing that reflects, I think, the administration’s priorities and omits what the administration has declared in this concept that I call “otherness.”

So, if you’re in this other category, you don’t matter, whether it’s transgender, whether you’re an immigrant, whatever you are. So, I think that’s what’s at stake. And that’s not even talking about the science that’s at stake — mRNA vaccine platforms. That was one of the things that there was a data call for in the early days of the administration, we had to flag any grant that involved mRNA.

And of course there was half a billion dollars taken from BARDA [Biomedical Advanced Research and Development Authority] that was earmarked for mRNA research for vaccines and brought back into the intramural program to be applied to the intramural flu vaccine program under Jeff Taubenberger.

Faust: Which if I’m correct, is sort of an old platform, nothing really novel there.

Marrazzo: It’s a whole-cell vaccine platform. Exactly. And a lot of people are skeptical that it’s going to be the way forward. I think most people think that platforms where you can plug and play the genetic sequence of the viruses as they evolve from the Southern Hemisphere, you can predict it, that’s the mRNA vaccine. That’s probably what’s going to be the future. So, who knows? So, there’s a lot, a lot at stake.

Faust: Do you think that what’s driving this obsession is somewhat political? In other words, this is the former agency led by Anthony Fauci?

Marrazzo: I do.

Faust: I ask because you did succeed him. What do you think the effect of these attacks on Dr. Fauci is just in terms of actually people deciding whether or not they should go into this field at all?

Marrazzo: Yeah. I just spent 2 days at the University of Maryland at their Center for Vaccine Development, and I can tell you that it’s a fantastic place. Postdocs are really not in a good place. So, postdocs for your audience, for those who don’t know, are people who generally have their PhD. Sometimes they have their MD, sometimes they have both degrees.

And they are really feeling, I would say, besieged because the funding is being threatened right now, but also the value of their work. I think they’re feeling that it’s not being perceived the way that it used to be. Scientists, I would say it used to be a wonderful thing to say you were a scientist and you had a lab and you worked with viruses because you wanted to conquer the viruses and protect people from the viruses. It’s not so much like that anymore, given all the rhetoric that we’ve heard.

We know there is a recent poll that came out last week talking about healthcare workers, specifically in public health, people feeling incredibly attacked and stressed as a result of their involvement in the pandemic. And we know that happened, people were targeted.

So, I’m afraid that all of this coupled with the deferred gratification that it takes to have a career in science, as you know, you work in a lab, you don’t make much money as a postdoc, you usually have to have a partner who works to support your kids. It’s not looking good. It’s not looking good for the field.

So, I really, really worry, and I hope we can stoke people’s excitement, not just about science, but about doing really important work that we need to do to keep people safe.

Faust: IDWeek is coming up. It’s good branding for the Infectious Diseases Society of America’s annual scientific assembly meeting research policy. And tell me what’s on your radar for what are we going to hear this year at IDWeek that reflects where you see things headed?

Marrazzo: Yeah, it’s going to be great. We’re opening the plenary on the first day with a talk from Atul Gawande and we’ll be showing his film later in the meeting, “Rovina’s Choice.” And I really wanted people to see what the effects of this last year have been graphically. And I think, remember a lot of people in ID don’t do HIV. A lot of people are very hospital-based.

And so, I think it’s important for this audience to really understand how devastating this has been, not just at a personal level, but also in terms of global health and in our reputation as a global citizen. But I think it’s going to be a really good dialogue because what we have not been good at is getting these people in the same room. We’re great at our little silos. I mean, our ID meetings are all about antimicrobial resistance and maybe optimizing HIV management, blah, blah, blah.

But boy, have we found out that if you don’t talk about the global impact of what we’re doing and saying, how we communicate what you’re doing and saying, and how intimately we have to work with our public health colleagues, and some of us are public health people, then we are not going to be able to do our job successfully.

So, I would say that’s the theme of the meeting. It’s sort of like all of us rising together because … and I’ve been trying to work on that with other societies too, really doing more because again, one thing IDSA does well is advocate. We do have a good budget for advocacy and policy. We have lobbying status, so we can do that. Not every organization can do that. And I’ve been really wanting to work with people to help get their footprint out there more using some of our resources.

We also have a very exciting medical student/resident/fellow contingent. So, we’re really trying to bring that up because our workforce challenges are pretty serious. We want more people in the field.

Faust: We need them. And thank you for encouraging that work and for pushing the ball forward on all of these issues. And Dr. Marrazzo, thank you for joining us on MedPage Today. Thanks so much.

Marrazzo: Thanks, Jeremy. Thanks for your work. Really appreciate it. Bye.

Produced by Greg Laub, Senior Director, Video, MedPage Today.