IDC talks with new NIP leader: Meet Anne Schuchat

April 2006

Q and A

What qualities and skills do you possess to help you in your new position as director of the National Immunization Program (NIP)?

My training is in internal medicine and epidemiology, but I’ve been working in public health for 18 years now. The focus has been on prevention of infectious diseases with an emphasis on infectious diseases in children. I think that my skills are around strategic thinking, analysis, partnerships and consensus processes. One of the big challenges that we have is strengthening partnerships within the CDC, outside of the CDC – internationally – to have health impact.

Can you tell us about one of your proudest public health accomplishments to date?

Group B streptococcal [disease] had been the leading cause of serious newborn infection in the United States since the 1970s. My role was leading the CDC’s part of a really great partnership with the AAP, the American College of Obstetricians and Gynecologists (ACOG) and the AAFP to try to change the standard of care for prevention, so that prevention would be put first instead of optional. So the work that I did involved epidemiologic studies and surveillance, and facilitating guidelines that were issued by the CDC as well as the AAP and ACOG to have a standard approach to preventing group B strep. There were families of studies after that that showed the impact, which at this point is an 80% drop in infections in newborns, and major narrowing of the black and white gap in disease.

[It’s] a real success story if you think about many of the breakthroughs in public health and medicine; there’s always been a new technologic advance that has let us open the door, and I think one of the things that I’m very proud of with the group B strep story is that it wasn’t actually a technologic advance; it was making the case for prevention. There were many others that were a very strong part of it, but I think the CDC played a key role and I was proud to be part of that story.

The NIP, as well as the CDC as a whole, is going through many changes right now. What are the biggest changes facing the NIP?

Well, the National Immunization Program is part of the Coordinating Center for Infectious Diseases, which has brought together all of the infectious diseases–related activities at the CDC and we are reorganizing our activities. So over the next few months, we’ll be transitioning to four new centers within this coordinating center and the NIP will be transitioning to something we’re going to call the National Center for Immunization and Respiratory Diseases. The idea is that nearly all the vaccine-preventable disease activities would be in one place. Hopefully for our partners, for pediatrics, for other health programs, they’ll have just one place to look to for vaccine-related information.

We’ll also be pulling together the acute respiratory infectious diseases. The ones that are vaccine preventable, like pneumococcal and Haemophilus influenzae type b (Hib), and some of the other ones that aren’t yet vaccine preventable like respiratory syncytial virus (RSV).

Another area that I think is of great interest to pediatricians, and a very big program that we’ll be pulling together, is influenza. Our influenza scientists, epidemiologists, communicators and vaccine programs will all be within one center where we hope we can serve our partners better.

What is your role during this period of transition?

My role is to lead the process of transitions and to help the groups within – and outside – feel that they are part of the transition, that we are meeting the needs of the public, of children, adults and our global partners. So my role is really to set the tone and provide leadership to the process.

I’m really excited about where we’re going, and part of my role is to help people see where they’re going and get excited about that place because it’s going to be great.

There’s a lot of talk about building an adult and adolescent vaccine infrastructure, especially with the recently approved and upcoming vaccines geared toward teenagers. What are the challenges in accomplishing this?

You know, I think that we have a really great childhood immunization program. But I think we have a long way to go with adolescent immunization programs, as well as adult programs. I feel like [over] the next few years, adolescents are a critical population. There are so many opportunities for health impact in this group, and the new vaccines really offer us this whole new chance to revitalize health care for adolescents and prevention as an adolescent health issue.

The CDC, in general, is trying to focus on health impact in different life stages and adolescents are an important part of that process. We’ll be trying to make sure we have good tracking of immunization coverage in adolescents, good outreach to the providers who care for adolescents and strong linkage to the schools and other programs that serve adolescents.

I would like to have immunization lead the way in improving adolescent health and prevention issues. There are many other issues that are important to parents and to teenagers that aren’t immunizations, but I think we have huge potential to offer there, and if we can open the door for other health issues to be addressed, that would be great.

Vaccine financing is another hot topic in immunization. In your opinion, what needs to be done to entice manufacturers, to stimulate growth and to keep vaccines affordable?

This is a huge area. Vaccine financing is one part of a huge health care finance issue. But prevention is so important. It is really one of the few aspects of health care that’s cost-effective and is often even cost-saving in terms of some of the interventions. And, there’s a lot going on to stimulate industry to make vaccines. This was a real crisis a few years ago and I think the recent efforts in influenza are a start to sort of say, we do need manufacturing capacity in the United States, we do need to deal with the supply shortages we’ve had. So I think there’s a need for a very active dialogue between the stakeholders, industry, providers, insurers [and] public health and I would like to be a strong advocate for us addressing this question and getting to a point where we can find common ground for solutions.

Manufacturing and distribution problems are linked to the influenza vaccine shortages and supply problems of the past few years. What do you think can be done to rectify this problem, and how do you think we can balance supply and demand of influenza vaccine?

With the emergency supplemental funding for pandemic influenza, quite a bit of that will be directed to invest in vaccine manufacturing capacity and new technologies that will potentially give us more flexible vaccine supply for influenza. I think we have short-term challenges because we have had problems with supply and demand mismatches over the past few years. Nobody’s really happy at this point with the way it’s been going. On the other hand, I think the value of vaccines for prevention of influenza is more in people’s minds than it had been. We have an opportunity to work over the next few years at increasing demand for vaccine, to use some additional vaccine that we expect to be produced little by little over the next few years and to work carefully with the different parts of the system that deal with distribution and delivery, so that we have good information available and we can react quickly and flexibly to the uncertainties of supply.

It would be great if more and more people can get used to an annual influenza vaccine, and if our systems can adapt to the challenge of not knowing what the supply will be until very close to when we start giving out vaccinations. But there are lots of opportunities to deliver vaccine throughout the season. Vaccine clinics don’t have to end in November or December. We can give vaccine in January and February and sometimes influenza lasts into April or May. I think there’s quite a lot of opportunity to change the expectations of influenza vaccine use, and because of the pandemic influenza preparedness activities, I do think we’re going to get a better, more stable vaccine supply.

Can you tell me a little bit about your emergency response experience with severe acute respiratory syndrome (SARS) and how it might help you in the event you have to spearhead the NIP during pandemic flu?

With SARS, I had an incredible opportunity to be sent to Beijing to work with WHO’s China office on the emergency response there, and use my epidemiologic skills and my respiratory disease skills to help the leaders of the city health department with the largest SARS epidemic in the world.

I learned a lot from that experience: how important communication is, how important critical data analysis is, how important it is to be able to rapidly look into questions that need answers immediately. I also learned a lot from the Beijing authorities about harnessing an incredible, complex response activity. Every home in Beijing got health information about where to go with fever, about how to deal with washing and respiratory protection and what were the signs and symptoms of concern. They built a hospital in a week for 1,000 people.

So the effective mass mobilization they carried out was a great example to me of the kind of efficient response [needed] in various emergency circumstances. I think that the spirit of the CDC work force and the public health work force that we have here in the United States is really exceptional. I’m confident we will rise to the challenges of a pandemic.

How long were you in Beijing?

The first trip I was there five weeks, and I was able to go back a couple of times. Its city health department has made me a visiting professor, so I go back periodically and prepare workshops for them.

We are so lucky to have vaccines that work and the ability to deliver them to the people that need them. We have room to grow there, but I think with SARS, we didn’t have a treatment; we didn’t have a vaccine. We had to use very traditional public health in terms of communication and education: isolation, very careful infection control in a health care setting, social distancing, which they did quite a bit of in Beijing, and the strategic use of quarantine. So we went back to the historical approaches of public health but they worked. I think that’s really reassuring — that even when it’s something quite fatal and unknown and new, some of the tried and true methods can be helpful.

What are some of the short-term goals that you’re working on at the NIP?

Incorporating new vaccines into routine practice is a big priority. The past year or two and the next year or two really have an unprecedented amount of change for providers, specifically changes in the pediatric and adolescent schedule on new vaccines. There’s a lot to absorb whether you’re a parent, or you’re a provider or a public health program. I think these new tools give you incredible opportunities for prevention, for health impact and to make things better for people. They also have a transition time, so the more we can do within our program to support the states and to incorporate these changes effectively, the better. So that’s clearly a priority.

I think it’s also important that our new center will have major responsibilities around influenza and the NIP has huge responsibilities around seasonal flu vaccine supply, distribution, delivery and facilitating that process. It’s very important that we put time into working with partners on this challenge. I would like to make sure we have a strategic approach. We need to help address some of the short-term challenges, but we really need to keep our eye on the longer-term goal of having a very ample supply and a very high uptake every year.

In addition, there are very important goals on the global front. We are at a very critical time in polio eradication. We’ve made huge progress with measles mortality reduction in Africa, transitioning to build that partnership in Asia as well, and there are new vaccines issues in developing countries as well. I think that the CDC’s role in some of these global vaccine-related activities is very important and something that I do intend to support and advocate.

How about long-term goals?

I would love to see secure prevention financing, so that vaccines are the right of everyone, that the economic barriers to vaccination are removed and that we value these products as the incredible resources they are for our populations.

I also would like to have an excellent evaluation capacity. We have very good tools right now in terms of tracking immunization coverage in certain populations and tracking certain disease conditions in certain populations. But to really monitor, revise and update national policy, we need excellent information about where we are. Are we seeing a resurgence of infectious diseases in some places because of our policies? Are we using our tools as strategically as we could?

I would like to get us to the point where we understand the best way to use the influenza vaccine in various age groups to control influenza and its complications. Similarly with the new vaccines, to make sure that the policies we are following are the best ones and that we update them as appropriate. I think a commitment to very good, strong, evidence-based policy and evaluation is a priority I’d like to promote.

Then I think short- and long-term goals are to make sure that we have a work environment that’s conducive to professional growth and impact. I feel so fortunate that my career has let me see so much positive change. … I really want everyone in the center to feel that way — that what they do matters, that the partnerships they have are strong and that we are working in an effective and coordinated way, but in a way where we get tremendous satisfaction. … I think we have lots of expectations from partners to meet, and I really want to be able to meet those expectations.

Pediatricians are one of many CDC partners. What message do you have for them?

Vaccines work, and vaccine-preventable diseases are bad. We’re really lucky there are so few cases left of some of the terrible killers of the past. But we need to maintain a strong program to make sure we don’t go back to where we were. The success story in the United States with elimination of congenital rubella syndrome and interruption of transmission of rubella, which we announced last year, and the 50th anniversary of polio vaccine development — these are just historic times. But we could easily go back to the days of 20 or 30 years ago, and I don’t want that to happen on my watch.

I think the older pediatricians remember measles, they remember polio, they remember Hib meningitis. My whole … pediatrics rotation was doing lumbar punctures on children to assess whether they had Hib or not. I don’t want to go back to those days, and we need pediatricians to continue to be the front line of immunization. It really makes a difference.

When you’re not heading the NIP, what do you like to do for fun?

I’m a big reader. I don’t exercise as much as I should, but that’s on the list. And I have a wonderful husband that I love to spend time with.