The Sweet Success of Public Health Is In All Of Our Hands
By Dr. Vitali Pool, Director of Scientific and Medical Affairs
One of the most contagious vaccine-preventable diseases, pertussis, poses a risk for the millions of people living with asthma. On World Lung Day, Dr. Vitali Pool explains how a lifetime of interest in immunization and public health is behind his passion for helping to protect people from infectious diseases.
One of my earliest experiences of the power of science was sweet. I mean that literally. When I was in my first year in grade school, in Estonia, white-coated scientists came to all the classrooms and gave each of us a sugar cube with a drop of red liquid on it. It was a dose of a live oral polio vaccine (OPV). Everything about this was fascinating to me, and the more I learned, the more interested I became. This vaccine was developed in the U.S., and used in the Soviet Union, which further helped to control the disease that affected lives. It showed me that science is an international project – and that when everyone does their part, we can help protect so many people.
As I got older, my interest in science and medicine grew, and I found that the most interesting part of medicine is infectious diseases and epidemiology. In medicine, you often know the etiology, or the cause of the disease. Studying infectious diseases meant searching for, and finding, clear-cut answers. We can identify the routes of transmission, we can see how the organism causes disease, and we can create vaccines to help prevent it.
When I started my career in the state immunization program for the newly independent Estonia, I saw again the importance of international cooperation for public health. We worked closely with countries like Finland, Denmark, and Sweden to acquire the supplies of vaccines we needed to help keep the population protected. I moved into the Epidemic intelligence Service of the Centers for Disease Control and Prevention and discovered a passion for vaccine research. This work eventually led me to Sanofi Pasteur, where since 2008 I have worked to help advance and improve vaccinations against pertussis.
Pertussis, or whooping cough, is one of the most contagious vaccine-preventable diseases. The bacteria that causes it, Bordetella pertussis, is a serious, formidable opponent. It has so many tools to trick our immune system so it can survive and spread. People tend to think of it as a disease that primarily affects children, but its incidence in adults is under recognized and underreported. A single infected person can transmit pertussis to as many as 17 others.[i] When adults do get it, the consequences could potentially include persistent cough, weight loss, difficulty sleeping, vomiting, urinary incontinence, rib fracture, and pneumonia.[i], [ii], [iii]
We have recent, alarming evidence of how quickly pertussis can spread. During an epidemic in 2012, more than 48,000 cases were reported in the United States. We also know that routine immunization can help prevent such outbreaks. Yet it is shocking to me how often these proven, effective interventions are not used. Less than a third of adults in America received a pertussis vaccine in the past 10 years. That leaves far too many people vulnerable to a serious respiratory illness that spreads easily. We also now have data from a large study published in Epidemiology and Infection journal in 2017, that show us that adults living with asthma, of which there are approximately 19.3 million in the United States, are at four times greater risk of getting pertussis.[iv],[v]
As I first learned on the day I tasted that sugar cube during a mass polio immunization campaign, public health benefits from broad participation. So alongside our work to improve our vaccines for helping to prevent diseases, we also focus on making sure that the people who need that protection are getting those vaccines. For World Lung Day, I am pleased to share that the American Lung Association’s Pertussis Educational Campaign, sponsored in collaboration with Sanofi Pasteur, aims to help educate adults living with asthma about the potential dangers of pertussis and the importance of being vaccinated. Anyone living with asthma, or who cares about a person who does, can visit the site to learn more about pertussis and how vaccination can help prevent it.
The COVID-19 pandemic has also brought lessons about vaccination and public health. It has shown us that even highly transmissible diseases can be contained. Behaviors like wearing masks, regular hand-washing, and social distancing not only helped slow the spread of COVID-19, but they also stalled the spread of pertussis; in 2020, very few pertussis infections were reported.[vi] However, immunization rates were also suppressed. I worry that once COVID-19 is more contained and people resume normal life, conditions will be ripe for pertussis to come back with a vengeance. We need to be prepared. We need to all do our part for public health. We need to use the vaccines we have worked so hard to create to help protect the people who can suffer the most.
When everyone does their part to protect public health, the outcome is a treat.
[i] Kilgore PE, Salim AM, Zervos MJ, Schmitt H-J. Pertussis: microbiology, disease, treatment, and prevention. Clin Microbiol Rev. 2016;29(3):449-486. doi:10.1128/CMR.00083-15
[ii] DeSerres G, Shadmani R, Duval B, et al. Morbidity of pertussis in adolescents and adults. J Infect Dis. 2000;182(1):174-179. doi:10.1086/315648
[iii] Centers for Disease Control and Prevention (CDC). Pertussis (whooping cough): clinical complications. Accessed March 11, 2021.
[iv] Centers for Disease Control and Prevention (CDC). Pertussis (whooping cough): Pertussis Outbreaks. Accessed September 15, 2021.
[v] Buck PO, Meyers JL, Gordon L-D, Parikh R, Kurosky SK, Davis KL. Economic burden of diagnosed pertussis among individuals with asthma or chronic obstructive pulmonary disease in the USA: an analysis of administrative claims. Epidemiol Infect. 2017;145(10):2109-2121. doi:10.1017/S0950268817000887
[vi] Centers for Disease Control and Prevention (CDC). Water, Sanitation & Environmentally-Related Hygiene: Coughing & Sneezing. Accessed July 16, 2020.