A Conversation With Dr. Wilbur Chen on Federally Funded Research and Global Health

In this episode of "The UMB Pulse" podcast, hosts Charles Schelle, MS, and Dana Rampolla chat with Wilbur Chen, MD, MS ’08, the Frank M. Calia, MD Endowed Professor of Medicine at the University of Maryland School of Medicine (UMSOM) and chief of the adult clinical studies section at UMSOM's Center for Vaccine Development and Global Health.

Chen highlights the importance of federally funded research and the importance of global health efforts for local stability. 

In addition, Chen addresses current concerns such as the resurgence of measles in the United States and the avian flu outbreak, emphasizing the need for widespread vaccination and sustained research. The episode provides a comprehensive overview of how the University of Maryland, Baltimore is driving forward public health initiatives that have both local and global implications.

00:00 Introduction to UMB's Mission
00:42 Meet Dr. Wilbur Chen
02:59 Dr. Chen's Journey into Infectious Disease Research
09:59 The Importance of Indirect Costs in Research
18:16 Current Research and Global Health Impact
25:12 Measles Outbreaks in the U.S.
35:45 Avian Flu and Its Implications
47:55 Global Health Challenges and Future Pandemics
58:11 Conclusion and Final Thoughts

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Chapters

• 0:00 Introduction to UMB's Mission
• 0:42 Meet Dr. Wilbur Chen
• 2:59 Dr. Chen's Journey into Infectious Disease Research
• 9:59 The Importance of Indirect Costs in Research
• 18:16 Current Research and Global Health Impact
• 25:12 Measles Outbreaks in the U.S.
• 35:45 Avian Flu and Its Implications
• 47:55 Global Health Challenges and Future Pandemics
• 58:11 Conclusion and Final Thoughts

Transcript

Copy of Dr. Wilbur Chen on Federally Funded Research and Global Health 

Charles Schelle: [00:00:00] We have a saying at the University of Maryland, Baltimore, that we're changing the future today. That we have a responsibility as the state's public health, law, and human services university to help shape the future in ways that benefit not only Marylanders, but society in general. We do that through groundbreaking research and education, treating patients, and through community outreach, just to name a few ways. Given the recent changes at the federal level, where funding for critical research is being withheld, that is a challenge right now to make sure that we're not losing progress. So that's what makes this conversation with Dr. Wilbur Chen particularly timely and important. 

Dana Rampolla: Dr. Chen is a professor of medicine at the University of Maryland School of Medicine, and he's a renowned expert in infectious diseases and vaccinology. He will tell us shortly how he got to that position and why. He's the chief of the adult clinical studies section within the Center for Vaccine [00:01:00] Development and Global Health, more commonly called the CVD, as you'll hear him refer to it multiple times. 

He's also an alumnus. learning has masters degree in clinical research in 2008 from UMB and 

Dr. Chen has and continues to serve on several key committees and task forces, including being a core member of the National Institute of Allergy and Infectious Diseases Data and Safety Monitoring Board. That board ensures the safety and integrity of clinical trials.  

 He also served a four-year term ending in 2024 on the CDC Advisory Committee on Immunization Practices. That committee is a very prestigious board that makes recommendations for the safe use of vaccines for Americans. Now folks around here at UMB, you will likely remember Dr. 

Chen for keeping the community regularly updated during the pandemic when he also served on the Governor's COVID-19 Response Team. So we'll not only dive into his research, but we'll also demystify some of the [00:02:00] processes, including how indirect costs and grants help fund research.  

Charles Schelle: It means a lot that everybody tunes into the UMB Pulse, and we want this to keep on happening, so please subscribe and like our videos on YouTube, and give us a five star rating and review on your favorite podcast platform. And with that, enjoy our conversation with Dr. Wilbur Chen.  

Jena Frick: You're listening to the heartbeat of the University of Maryland, Baltimore, the UMB Pulse. 

Dana Rampolla: Dr. Chen, thank you so much for joining us today. We know your time is limited and valuable. You're a very busy man, so thank you for carving out time to speak with us.  

Wilbur Chen: Oh, I'm pleased to be here.  

Dana Rampolla: Wonderful. Let's dive right in and talk a little bit about you as a person. How did you get started in infectious disease [00:03:00] research? 

Is this something that as a budding scientist coming up through high school, the bug just hit you? Or did this grow as you, you know, began and continued to study medicine?  

Wilbur Chen: Yeah, I think we can take this question. With an answer that goes really far back. So I am the son of two immigrants who came to the U. S. from Taiwan from the early 1960s. They came to the U. S. to pursue Ph. D. degrees. And I grew up as a child in the 70s and 80s again, scientists back, parents. And so, when I went to high school I did get the opportunity to do some research over the summers at the NIH. So I kind of continued to explore scientific research. 

When I went to college I actually worked part time in the clinical microbiology lab of Boston University Hospital. [00:04:00] And really enjoyed that experience. During that time, oftentimes the clinicians would come down and do plate rounds with me and we would talk about some cases and I would pull out plates and we would review them and then they would tell me about the kind of the patient histories and those sorts of things. 

I thought that was really fantastic. You know, kind of how the microbiology that I was doing you know, they were allowing me to see patients. the kind of clinical context for why these were important. So when I finished college, I did not go directly into medical school. I actually spent two years working at the Food and Drug Administration, and this was the early to mid 1990s, and I happened to be working in the lab of bacterial polysaccharides. 

In the Office of Vaccines Research and Review. That's to say that it was basically a vaccine lab. And this was the specific lab [00:05:00] that was tasked with reviewing the newer vaccines that were being launched at that time, which was the Hib conjugate vaccine. And what was coming soon was pneumococcal conjugate vaccines. 

And the reason why I mentioned that is because people in my field understand that those. Conjugate vaccines were remarkable because of how they were able to make these vaccines. highly effective for very young children. And so, and then we started seeing that these for pneumococcal vaccines could be extended to older adults as well. 

So basically a huge improvement in vaccines through a technology that we basically call protein conjugate conjugation of polysaccharides. And so again, that was a remarkable experience, even though it was just a short two years, [00:06:00] such that I felt like, wow, vaccines research seems to be a really exciting field. 

So I went to medical school already with the notion during those four years that I was probably going to do infectious disease with my microbiology background, and then more specifically, wanted to focus on vaccines research. And so I never looked back. I plowed ahead, and the only kind of decision point during medical school was, did I want to pursue a pediatric background? 

Or internal medicine adult infectious disease background when I pursued my residencies and then my subspecialty training in infectious diseases, but either of those pathways would have still probably taken me to doing vaccines at the end. So right now I'm an adult infectious disease physician that does vaccine research. 

But actually a lot of my vaccine research is directed not [00:07:00] just at adults, but also because of these pathogens afflicting young children, pediatric vaccines as well. So it's kind of, you know, a pretty straightforward path that I think, you know, goes. As far back as just my parents showing me the love of science and scientific discovery. 

Dana Rampolla: That's wonderful. And of course, we're excited because you are also an alum of the University of Maryland, Baltimore. And how did that fit into your trajectory?  

Wilbur Chen: Well, actually, it's a very conscious decision that after my residency in internal medicine to come to the University of Maryland, Baltimore, the School of Medicine. 

Because it has a very strong infectious disease training experience, and specifically because of the Center for Vaccine Development and Global Health, which again, has been established since 1974 and is really a an extremely strong institution it's really [00:08:00] bar none the foremost kind of institution if you want to do vaccine research it's the CVD. 

Dana Rampolla: That's terrific. Well, you certainly balance a lot of research. We kind of gave a nod to that in our introduction. So tell us, what does a week look like in the life of dr. Wilbur Chen? Between research and your federal committees, work groups, it just sounds like your job never ends.  

Wilbur Chen: Yeah, well, it's always a balancing act between all the different commitments. 

You know, I'm committed to my research programs that I have funded. Many of them are funded by the NIH federal funds, but I also have some research projects that are funded by the Gates Foundation and by Welcome Trust. So two large kind of charitable foundations that really are concentrating on global health and science. 

And apart from that I also have a hat that I wear on this campus where I am the co director of the K 12 program. So [00:09:00] really it's a commitment to junior faculty to help mentor them and train them so that they can make that transition from being a junior faculty member. So, I'm really committed to that aspect as well. 

And then I have a little bit of clinical duties because I have a travel medicine practice that I run. Which again, really synergizes with what my research is doing, which is trying to develop vaccines, and then once they are actually licensed, we can implement them and use them in the travel clinic, because these are people who are going to far flung areas of the world where they might be at risk for getting some of these infections. 

So, it's actually allowing me to put these vaccines into use locally, even though most of these vaccines are intended to be used kind of wide scale for populations outside of the U. S. 

Charles Schelle: I want to start by setting the stage About what these projects are and why they matter, especially [00:10:00] on a global scale, how something across the world can impact us right here and we've had these new directives by the federal government where they're withholding funds that have already been appropriated by Congress, new grants from NIH are not being awarded. 

And then there's something called indirect costs, and those are being scrutinized to and the general public. Is finding out what those are, and they probably never heard about that term in their lives be before this year. They are being challenged in courts, so we'll have to see if these court orders are being followed. 

For the average person, they may not understand exactly what's going on, why it ma matters. Some people might believe it's an issue of overspending and waste. Others might see it because they just don't know how the funds are being used. So with all of that said of what's happening right now, just start off by sharing with the listeners some of the major research that you're doing now that's federally funded and how that connects to everyday [00:11:00] people. 

Wilbur Chen: Yeah, so, I don't know if I'm going to answer this in the right, in the best way possible, the clear, the clarity that I want but you know that I'd like to just mention that, you know, this indirect cost that is being discussed is really acknowledging the huge infrastructure That an organization, a university provides for the researcher. 

And so when an individual like myself writes a research grant, we are thinking about specific personnel, materials and supplies that would be directly used for the research. But we're not accounting for the fact that I've got a climate controlled office. That's heated and cooled, that has electricity, that has Wi Fi  

That has you know, is behind a well established firewall to keep all of my records secure, and all of that requires an infrastructure that the university has to put [00:12:00] into that and it's increasingly more difficult to have an IT infrastructure that is resilient against cyber attacks more and more. 

So you can imagine that there is a lot that goes on in the background that the university has to provide that is not being accounted for with the direct costs of my grants. There are, you know, the parking facility, the lawns get that good mode, the fact that, you know, we have the hallways clean, the trash taken out all of these things, again, you're thinking about infrastructure. 

That we, you know, some people may just assume is there, but is our real costs to a university or any organization. Baltimore may not be the most expensive location, but it is an urban city. And again so. All of this means that there are a lot of other costs that are [00:13:00] indirect. And so I think that has to be acknowledged. 

And 15 percent has not traditionally been sufficient to really be able to do. recover those true costs that are being spent, whether I get grants or not. So, you know, I think that's kind of one, one thing that you know, when we talk about indirect costs how did the government come up with 15 percent as appropriate? 

And if that's the case, Then I think that there has to be a mechanism in the future for persons like myself to then directly cost out what is the cost of this infrastructure that I get to enjoy I'll have to probably start paying rent for my office being using, you know, I'm using this office. 

I don't pay rent right now, but if we're not going to be able to cover it with an indirect cost. Rate, then probably the [00:14:00] university will have to levy a rental or something like that. And I'll have to put that on my grant. I'll also have to put other things on my grant as well. That will be part of the infrastructure, but then it will be a direct cost rather than indirect cost. 

Is that appropriate? You know, I again would have to have Other people that are better in the know to be able to be in the conversation as to how we would change, you know, the way that we are structuring grants and talking about direct costs versus indirect costs. I'll just segue as a physician. 

So, you know, we oftentimes say, what is the cost of a person getting an illness, a disease? You know, so okay, the cost is they're hospitalized. So the hospitalization fee the cost of the medications that they have to take and whatever their indirect costs of getting ill as well. So if a child gets ill, and [00:15:00] they have to remain at home. The parent probably has to take time off of work. That's an indirect cost of that illness. And they may lose work hours. So if they are an hourly wage worker, they will lose however many hours. And if it's multiple days, it might be multiple days worth of work. 

That's an indirect cost for many economists kind of even looking at the cost of illness. You're also looking at the indirect costs of other inconveniences during an illness or a disease. So I think, again you know, when we think about cost there are other things, you know, that, that are oftentimes not discussed that are a reality as part of the problem. 

Charles Schelle: Some of the examples that, that I've read that included like, as you mentioned about power, well, going a step further, you need to keep samples refrigerated at a certain temperature, right? And so that's part of it. Or if there are animals [00:16:00] involved, you need to pay for their care and their food and their water to make sure everything's, you know. 

Going according to standards as well, we should note that in recent days, the federal judge granted a preliminary injunction to stop the across the board caps on these costs, but we still have to .See if there will be compliance with that order and if those will be, you know, released and the caps won't go into place. Have you had Any research impacted by either the guidelines or just the process that's going on right now? 

Wilbur Chen: I have not directly been impacted. But I think that most of the faculty here at my center are looking at what are the prospects of their continuation of funding? You know, we don't know, first of all, if we have a five year grant, whether we're going to get the next year's grant money, whether it might be reduced. 

And then for new grants that we would like to submit, or maybe we're in the submission [00:17:00] process we don't know if they will be successful. There may be less funding initiatives for us to apply to or federal funding. I mentioned that I have Gates Foundation, Welcome Trust, but there are other sources of funding as well. A lot of them are traditionally federal funding sources. So NIH, CDC, or even DOD, and a lot of those federal funding sources may start to dry up or really be limited, which means that you've got a pool of people who are competing against a smaller amount of funds available. And so that becomes much more competitive, which means also that for junior faculty members, younger scientists that aren't established as well. They may be ill equipped to compete against the senior scientists that are really well established. So, you know, part of the consequence is that you might have a chilling effect on the next generation of [00:18:00] scientists until we can correct the situation. 

Because I think a lot of scientists are really you know, junior scientists are really you know, progressing in their own fields. 

Dana Rampolla: Wilbur, I have a couple of questions for you about your specific research, and I'd like to start off just to give you the opportunity to share if there's any recent advances or breakthroughs that you're particularly excited about. 

Wilbur Chen: Yeah, several things that I'm working on, you know, one thing is that I'm working with our sister site in Mali, a country in West Africa. It's in the meningitis belt of sub Saharan Africa. And for since at least 2015, we've been developing a pentavalent meningococcal conjugate vaccine, which is supposed to address all of the so called serotypes of meningitis that cause invasive meningitis disease in Sub Saharan Africa. 

Well, [00:19:00] it's gotten to the point in the past year that we've done a phase three clinical trial. That we're completing right now. Um, that this vaccine was licensed last year and W. H. O. Recommended for sub Saharan Africa, and it was based partially on the phase three study that we just completed. 

Some of the recommendations were adjusted because of our data as well. We're presenting these data at at an international meeting next month. But it's really just a representation of how we've been able to collaborate. Across the world in specific for this one with our sister site, CVD Mali who's been a great partner. 

And this is the way that we try to address kind of, you know, the important global health problems where they actually occur is we partner with collaborating sites that, that are afflicted. And so, you know, And it also provides us the [00:20:00] opportunity to be able to mentor, teach, educate the next generation of scientists locally for those nations. 

And so a lot of Malian scientists have come here to UMB to get their advanced degrees, their PhDs, and then we send them back and they, they become prominent scientists in their own right in Mali. So that's kind of the, you know, kind of exciting is that we continue to be. Able to partner with sister sites like that on important issues. 

This pentavalent vaccine study will be published next week. There's an embargo but it'll be published in the Lancet. So we're really happy about that. And then we'll have a follow up publication as well for the two year persistence of this vaccine. So it's really kind of moved along and this is kind of, again, 10 years coming to fruition. 

On the other end of the spectrum, we've got another vaccine that we're developing a pentavalent meningococcal conjugate vaccine, which [00:21:00] is supposed to address all of the so called serotypes of meningitis that cause invasive meningitis disease in Sub Saharan Africa. 

Well, it's gotten to the point in the past year that we've done a phase three clinical trial. That we're completing right now. That this vaccine was licensed last year and W. H. O. Recommended for sub Saharan Africa, and it was based partially on the phase three study that we just completed. 

Some of the recommendations were adjusted because of our data as well. We're presenting these data at at an international meeting next month. But it's really just a representation of how we've been able to collaborate. Across the world in specific for this one with our sister site, CVD Mali who's been a great partner. 

And this is the way that we try to address kind of, [00:22:00] you know, the important global health problems where they actually occur is we partner with collaborating sites that, that are afflicted. And so, you know, And it also provides us the opportunity to be able to mentor, teach, educate the next generation of scientists locally for those nations. 

And so a lot of Malian scientists have come here to UMB to get their advanced degrees, their PhDs, and then we send them back and they, they become prominent scientists in their own right in Mali. So that's kind of the, you know, kind of exciting is that we continue to be. Able to partner with sister sites like that on important issues. 

This pentavalent vaccine study will be published next week. There's an embargo but it'll be published in the Lancet. So we're really happy about that. And then we'll have a follow up publication as well for the two year persistence of this vaccine. So it's really kind of moved along and this is kind of, again, [00:23:00] 10 years coming to fruition. 

On the other end of the spectrum, we've got another vaccine that we're developing here at CVD, which is intended to prevent typhoid and non typhoidal salmonella, NTS, which is also another kind of disease and pathogen that afflicts Sub Saharan Africa, especially very young children. It's, it causes invasive bloodstream disease, and it's similar to Hib and pneumococcus. 

So, this is a vaccine that is really specific for Sub Saharan Africa. We finished two phase one studies and we're now in the midst of a phase two study in Africa, in actually three sites in Africa our sister site, Mali, but also in Kenya and in Mozambique. And again, we're working with local partners that are really terrific scientists. 

But we have a vision for taking this in the next few [00:24:00] years. To a phase three pivotal efficacy study. And if that's successful, then hopefully we'll be on a licensure pathway in which we might have a vaccine again developed by the CV, CVD, that might be licensed within maybe what five to 10 years. 

So that's really exciting. And again, it is addressing a real problem in sub Saharan Africa. So that's another vaccine that we're really proud of. I've also got a number of research programs on um, enteric diseases. So these are diarrheal diseases. So cholera, shigella, Enterotoxgenic E. coli, Campylobacter. 

And so I've got you know, a few Shigella studies that I'm wrapping up and writing manuscripts and a couple of enterotoxgenic E. coli manuscripts as well. These are all kind of smaller studies that we did here in the U. S., but should any of these be kind of [00:25:00] successful vaccines, we would want to progress them and take them to Sub Saharan Africa or Southeast Asia, where we see a lot of diarrheal disease. 

So again, I'm trying to provide you the um, this ideation that CVD, we work here in the U. S. and in Baltimore. But our vision is that, you know, we have no walls. We really work globally. We're always trying to do what we can here in Baltimore, but immediately go out to the places where people are afflicted the most and we want to kind of, make sure that we're making scientific discoveries that actually are changing people's lives. 

Dana Rampolla: Well, and if we're listening to the news right now, we're hearing how some of the talk is that this type of research and aid, some people may feel that this shouldn't be happening. We should be focusing strictly here at home. What's your response to that? Why should we be continuing to do research in other parts [00:26:00] of the world? 

Wilbur Chen: Yeah, I think that, you know, when we talk about research such as the stuff that I'm doing, which is preventing diseases through vaccines we're talking about protecting people's lives. We're also talking about a way to generate stability in a population, and stability can be political stability, but it can also be kind of the ability for a person to enjoy economic mobility. 

To move up or down. And if you have countries and populations where they have less of an ability to stay stable, that presents a security problem for the rest of the world because that population will perhaps not be stable and migrate, not be stable and have political unrest and civil war. And again, those diseases may continue to spread worldwide. 

So I think that there are a number of [00:27:00] reasons where we as U. S. citizens would want to be interested in protecting the rest of the world, because it ends up that if the rest of the world is stable, then we can also enjoy stability at home too.  

Dana Rampolla: Thank you for sharing that. I want to shift for just a little bit and talk about something else that is happening here at home, which is also on the news quite a bit. 

We keep hearing about measles cases in the United States with that notable outbreak just recently in Texas. There was another exposure reported in Philadelphia. I think that was on March 4th. So just a few days ago, what's driving this resurgent and how concerned should we be?  

Wilbur Chen: Yeah. So, you know, what I'm hearing and seeing is that there are populations in these places where they're having outbreaks that have had a pretty low vaccine uptake for measles containing vaccines. 

And we know these measles vaccines are highly effective, but [00:28:00] you know, it needs two doses to get to 95 percent protection where again, that still means that even despite vaccination, there might be one in 20 people that might be susceptible to getting measles if you have the entire population being exposed to measles. 

So, in other words, it means that you need to have pretty high uptake and protection. in your population to continue to reduce or have no spread of measles in that population. In areas of West Texas and other areas, We've seen that measles vaccination rates have dropped below 80%. So, what's going to happen is that you're going to have these measles outbreak in these populations now in populations that are highly vaccinated. 

You still may have a risk of people. Having measles but it might be only among the immune compromised who again [00:29:00] don't respond as well to vaccination. Or again, that one in 20 case where again, even despite being a healthy person getting those two doses you just didn't respond, but that's, you know, again, a very small percent. 

5 percent or less. So again, if a person has received two doses of measles vaccine, they have nothing to worry about, especially in our population that's highly vaccinated. But for those other populations that are that have very low uptake, I know that public health authorities and CDC officials have also sent representatives to those populations to try to see if they can increase vaccination rates. 

So I know that they're holding vaccine clinics, also trying to speak to those populations and talk about, you know, what are the risks of vaccination and then what are the true benefits. Because unfortunately, there's a lot of vaccine hesitancy that is driving [00:30:00] the low uptake of vaccination, and that's become worse and worse over the past few years. 

And again we need to counter that with you know, true data. And again, there's unfortunately a lot of misinformation and outright lies that are being promoted. And again, that's what we have to work against.  

Charles Schelle: You know, I think with measles, it's one of those things where maybe people don't understand the difficulty of having measles, how dangerous it can be and how contagious it is because it was eradicated and we didn't have to worry about it for so long. 

And so like in the case of the person in Philadelphia according to the health department, that person first traveled. on a plane I don't know if it was from another country or another state, but they arrived through JFK. So, just paint us a picture, like if there's one person with measles on an airplane, how contagious is that? 

Wilbur Chen: Yeah. Measles is probably one of the most contagious pathogens [00:31:00] that we know of. The way that we think about it is that it has an R naught or basically a reproductive value of somewhere between 14 to 19 which means that that it can be highly infectious. The way to illustrate that number is basically, if a person were to come into an enclosed office space like my room right here, And they were infectious with measles and they were to breathe into this space. 

And then leave. This space, this airspace would be infectious for the next two or three hours. So if another person walked into this room, and that person was already gone but walked into this room, they potentially could get infected with measles if they were not vaccinated. So, that, that shows you how highly contagious it is. 

This person having kind of, flown in a plane, an enclosed kind of cylinder You know, potentially could have exposed a number of people on that plane because of [00:32:00] recirculating air to measles. So hopefully the people on the plane were highly vaccinated. But again, for people who were, who didn't receive their full two doses they might be at risk for getting measles. 

Same with this person walking through the airport terminal. The people around this person may have been inadvertently exposed by infectious breath. And so again, so that's kind of the things that public health officials are tackling when they're trying to respond to these measles outbreaks.  

Charles Schelle: And when we hear about air circulation, contagious and everything for people maybe not familiar with measles, they're thinking, oh, this sounds like how we thought, you know, with COVID spreading. 

So, if someone is on a plane, would a mask afford extra protection through that since we're dealing with that similar environment?  

Wilbur Chen: Yeah. I think a mask and a well fitting mask that's like an N95 mask with a better kind of filter mesh, would [00:33:00] be better than nothing. The best situation were to, were if the measles infected person to, were to wear the mask. 

It's less effective for the person who's not infected, who's trying to protect themselves from a person who's infectious, because we unfortunately have other mucous membranes that are exposed, so our eyes. Ears and whatever else. And then we can also, you know, if we were to unmask because we were going to drink or eat or something like that breaks that barrier. 

So it's much more important if we know a person is infected for them to wear the mask again, filtering right where their breath is coming out. But it is a measure that is better than nothing. I do wear a mask when I'm on a plane. If I think that that I might be exposed to a pathogen again, if COVID is raging and I'm on an international flight. 

But I recognize that it's really not the optimal situation. But there is no kind of correction of an optimal situation because I don't know who [00:34:00] is infectious at that time.  

Dana Rampolla: I personally have never known anyone to have had measles, and I think many of our listeners might be in the same situation. 

As Charles said, we haven't had cases for a long time. So for the If a person who's listening, who says it's not that big of a deal, it's kind of like chicken pox or the cold. Give us a little bit of information about why it is important.  

Wilbur Chen: Yeah. Well, so, you know, it is a febrile illness that is encountered typically by kids. 

But again, we can have it now circulate in adults that are unvaccinated. So you get a fever and you get this very kind of you know, remarkable rash that's throughout the body. You feel terrible. And then oftentimes you recover. Now, that's the oftentimes, but there are some people that will get hospitalized. 

And they have a very severe pneumonia as a result of getting measles. And then there's one in a thousand people that will die from measles. So again, you know, [00:35:00] one in a thousand doesn't sound like a lot, but if you've got a thousand people that are encountering measles and you have one death, we've already had one death maybe two deaths. 

We were not, I wasn't really sure about the reporting and this was, I think just last week. But there was certainly one death that was reported due to measles. So that's kind of again about right you know, one in a thousand cases. So I think that again to say that it's just like chicken pox, which again, in children is. 

milder less severe, but in adults can be severe and cause pneumonia, hospitalization and death. You know, I think that we need to understand that these traditionally were, yes, childhood diseases that we encountered daily, but those were at the time when we didn't have vaccines available, and then a lot of people did die of vaccine preventable diseases. 

during those times. And we're now in a different era where we've [00:36:00] really eliminated some of these. And most physicians nowadays during their training have never seen measles before. It used to be that people would see measles every day. And so, you know, again, it's the same with polio. People don't really understand how devastating polio was, how fearful people were in the 50s and 60s. 

Whenever it came to the summertime, because that's when poliovirus infection surged, that people sometimes didn't really know if they were going to make it through the summer without being infected and possibly being debilitated for life and having a crippling, you know, paralysis or something like that. 

So again, that was a fear that people grew up with routinely that has disappeared from people's consciences now. And so, you know, I still see it in developing country settings where we're still seeing measles research and we're still seeing [00:37:00] infants dying from it routinely, unfortunately and that's why, you know, for me, it's important for me to continue to promote these vaccines, but it's too bad that we've had near elimination here in the Americas. 

And now we're seeing a resurgence. So we're really taking a back step. 

Dana Rampolla: Can you vaccinate as it's getting closer, to their town does it work? 

I know you said you have to get the two doses in.  

Wilbur Chen: Yeah, absolutely. Absolutely. They should immediately talk to their pediatrician and have their child vaccinated and caught up with all the rest of their childhood vaccinations if they've also declined other vaccinations. I imagine that a child that hasn't received their measles vaccine probably had declined other vaccinations as well so I think it would be a great opportunity for that child to get caught up. 

Well, moving to another outbreak, you've had experience working with the avian flu. What is, other than the price of eggs, what is [00:38:00] happening now with the latest avian flu outbreak? How's it different from the previous ones?  

I started kind of, um, avian influenza research back in 2005. 

Wilbur Chen: And this was when kind of, uh, H5N1 first broke out, and this was in mostly Southeast Asia, had not reached the U. S. But we knew that it was something that was endemic in migratory birds, and that's where, again, these avian influenza viruses are in birds, avian and migratory birds you know, have a very large migration flight pathway. from the summer to the winter. They may, you know, summer in the southern hemisphere and then winter in the northern hemisphere and vice versa. And that's really taking them from the Arctic all the way to the, you know, to the equator and back within a year's time. And their flight You know, might take them [00:39:00] from, you know, again, northern parts of Russia, all the way down to the tropical areas of Southeast Asia. 

The migratory path means that, again, they will fly to the backyards. Of while they're flying to rest overnight, you know, to the backyards of some of these farms or in a suburban backyard where again some people might have pet chickens or ducks or other domesticated animals. And so they'll share the pond and the lake and the water and whatever else that's just my great migratory birds. 

That's just, you know, kind of how they are. And because they're flying across, you know, large areas of geographic areas that's what they do. Some of the migratory pathways, you know, from the Arctic overlap with the migratory birds that fly from the Arctic and then along the the Western seaboard of the US.[00:40:00]  

And so again, you know, the Arctic and then some of them fly up and down, like, Arctic to Southeast Asia, but some of them also fly from the Arctic down to the western seaboard of the U. S. There are other ones that fly the central U. S. and others that fly the eastern U. S. So you can imagine that, again, these migratory pathways overlap, and so these birds trade these infections, these viruses. 

Eventually, by the 2010s Avian H5 influenza virus was introduced to the U. S., and again, it was kind of predictable. Because of migratory birds, the way that they fly and their landing and training and eventually what we're seeing right now is that they're now entrenched in many of our domesticated animals because they first were flying along the western and central you know, pathways of the U. 

S. And landing in farms. Dairy [00:41:00] cattle got infected because of their, you know, close proximity. Chickens get infected are domesticated animals. Humans inadvertently get infected. Probably migratory birds, but again, because they are farm workers or working around dairy cattle or whatever else inadvertently get infected. 

We're eventually going to get to the point where these viruses are so commonly transmitted among our domesticated animals and back and forth, perhaps to, to humans inadvertently, that eventually we might have enough mutations in the virus that it gains the ability to be very efficient, transforms to a human virus. 

Remember, it started out as an avian virus and it eventually can mutate. have enough mutations that basically it is efficient in humans and we call it a human virus. That's kind of what happened in [00:42:00] 2009, which was not an avian virus, but it was originally a swine virus that also had some avian components as well. 

And then became a human virus. So 2009 H1N1, that was a pandemic as well. And that was because of, again, we know how these influenza viruses eventually become humanized so that they become efficient and can afflict humans. So that's kind of what we're looking at with avian influenza is that we've been studying it for now two decades and more. 

And it was predictable. So I've been kind of on the end of trying to develop vaccines against avian influenza viruses, and we have a number of candidates that we've evaluated with the federal government's help. And these are actually vaccines that are now stockpiled by the U. S. government. BARDA is the kind of group, the federal agency that kind of stockpiles them, but these are stockpiled [00:43:00] and they represent H5N1. 

Viruses H7 and nine viruses. You know, so we are pre positioning ourselves to be able to respond to whichever virus eventually does break out in humans right now. I know that they are trying to manufacture. A vaccine matches very closely to the ones that are, you know, being transmitted among dairy cattle so that we have a very closely matched vaccine and those clinical studies are probably in progress right now. 

I haven't been involved with them. Barta is the agency that's now taking it up less so by NIH. So, but this is the kind of activity that's going on really to be prepared for what we perceive. As an inevitable pandemic that will be coming,  

Charles Schelle: You mentioned the vaccines and so I'm thinking like, then how do you get this under control? 

 What's the, I guess, plan for the [00:44:00] vaccinations? Are we trying to do it on the front end of it and trying to vaccinate migratory birds, which should be fun as they try to fly away when you catch them? Or is this something where, you know if I have a dog or a cat, is this a vaccine that I'm going to have my vet give my pets every year or however often that it would , be needed? 

Wilbur Chen: Yeah, I can only give you my thoughts because there are other people in higher levels of government and, you know, advisory that are thinking about this specifically. Influenza viruses are smart. They've been with humans or on the globe, you know, in the world for centuries, not just, you know, in the past few decades. 

So, and these viruses are smart in the sense that they rapidly mutate. And that's why we have to kind of adjust our seasonal influenza vaccine to an annual vaccine every year where we switch out the components. So I don't think that a strategy to vaccinate migratory birds is [00:45:00] ever going to work because you can vaccinate them, but the virus is going to mutate and what we call shift and drift. 

And those will then be the newer viruses and we won't be able to catch up with it. We can't even catch up with the human ones from year to year because we have to do an annual one. Now it's interesting that you mentioned dogs and cats and other domesticated animals.  

So I think that, you know, again trying to prevent avian influenza into important animals in our economy and our agriculture could be a very important way to address this issue. 

And I think, you know, we could have programs where we're vaccinating our dairy cattle. We could have programs where we're vaccinating our egg laying hens and other poultry kind of production facilities, you know, part of our food systems I've heard that the problem with vaccination again is that it may not completely eradicate the [00:46:00] infection. 

It also causes it to be more difficult to identify whether a chicken is infected or not, because sometimes they'll be testing the blood of the chicken. And is it due to vaccination or the infection? You know, that's kind of the question. So I've heard that argument as well. Although I think that we've got better technologies now than 10 years ago and 20 years ago that we might be able to have better systems to vaccinate. 

How many vaccines do we have to kind of manufacture to be able to do this? So if you wanted to vaccinate the entire population of the U. S. It's 210 million. How many food animals would you have to vaccinate? I've heard some crazy statistics, but think about how many chickens that you might eat in a year. 

Collectively, right? Chicken wings, chicken breast, chicken thighs. That's a lot of chickens. per person times [00:47:00] 210 million, right? Dairy cattle, we drink a lot of milk. I drink a lot of milk. And so I'm wondering how many dairy cattle that is. That's a lot of vaccines to manufacture. Is there a market for them so that manufacturers will be enthusiastic to make them? 

There has to be a market force, maybe. You know, to generate the enthusiasm to make these vaccines highly available. And we're only talking about the U. S. now, but now we're talking, let's say, okay, now we wanted to also protect our Canadian neighbors. We want to protect the rest of the world. Because we import you know, export a lot of our agriculture or foods. 

So again we're talking about now you know, larger systems in which we would have to vaccinate. So that's kind of the complexity in my mind. I think it's an interesting question, which I think is very valid how we can address this avian influenza problem overall with vaccines. I think it has to be a [00:48:00] combination of vaccines, but other interventions. 

Is my idea. Of course I love vaccines and I think vaccines are always part of the answer. But I don't know. Again. How much can be done with just vaccines alone?  

Charles Schelle: Yeah, and I know everyone's seeing the effect of it from the food part of it seeing the price of chicken and eggs and that's a real economic cost, but I don't know how often people realize how important chickens are for other things. 

Dana, you have family in florida I lived in florida for a little bit, but something called sentinel chickens that placed throughout a county because they are your signal to see if West Nile virus or encephalitis is spreading or other mosquito borne diseases. So we need chickens alive to tell us if there's something else coming down the pike other than bird flu. 

Dana Rampolla: Yeah, my family's just opting to raise their own chickens. So we have a lot of little mini chicken farms in [00:49:00] our Florida family yards. So I guess the big concern is that not only does it reduce the chicken population, it's effect, which in turn affects the egg population, but , they're not transferable directly to humans, but they're evolving some way to become. 

Wilbur Chen: That's right. At least right now, avian influenza viruses are not efficiently transmitting from human to human. That's good news. But as I said you know, we know these viruses continue to mutate and it seems to me an eventuality that it'll learn to be able to be efficient at infecting humans as well as, you know, it learned to be efficient to infect cows at some point so, and now we're seeing them in cats as well. 

In these dairy farms. So, you know, I think again, we need to be pre positioned for the eventuality that it might [00:50:00] come into humans. Now, you know, when COVID broke out, you know, I was a betting person that I thought the next pandemic was going to be avian influenza. But of course, now we, it was a coronavirus. 

So, so again, who knows what the next pandemic will consist of? Mhm. But it could be a different coronavirus. It could be an avian influenza or some other pandemic influenza. It also could be some of these other emerging viruses that we're seeing throughout the world. Ebola, some people hear about those. 

Zika, you know, is another kind of virus that's mosquito borne. Chikungunya, dengue. You know, these are all mosquito borne viruses very important for the tropical areas of the world. But because of global warming you know, the areas of the world that are affected by this, these mosquito borne infections is becoming broader and broader such that they're entering into subtropical areas and [00:51:00] maybe eventually entering into temperate areas of the world. 

So southern tip of of Florida and parts of southeast Texas. Have had introductions of malaria and dengue again because it's warm enough that we can see these mosquitoes able to persist and cause these infections and infect humans. So with global warming, the trend is that we'll probably see continue to see that kind of encroachment of these emerging pathogens that we see throughout the world enter into the U. S.  

Dana Rampolla: Wilbur, can you share a little bit how, once you, doc, people know that these infectious diseases are out there, they are on the horizon, what do you do to kind of start to think about developing those vaccines and testing them? 

What's the process for that?  

Wilbur Chen: Yeah, that's a great question. That's what we do all the time at the CVD internally, is we ask ourselves, [00:52:00] What are the emerging pathogens that we're seeing throughout the world that are continuing to expand and threaten human populations, and are there vaccines that potentially could be available, and should we start maybe developing one from the grassroots, or maybe can we partner with another academic group? 

Or another small or large biotech to see if we can advance their vaccine candidates. And it might be therapeutic candidates as well if it's an antiviral or something else. So we're always kind of looking at that. It's basically trying to assess through surveillance. That is being conducted throughout the world, and some of it is our own surveillance that we put together that we're implementing in other areas of the world, where we try to identify what's the biggest burden of disease that's causing diarrhea, that's causing malaria, that's causing whatever, [00:53:00] and what can we learn about these pathogens, and now do we need to pivot our research priorities To be able to address them. 

So again, just kind of mentioning within the CVD. We are recognizing the importance of climate change, global warming, and we're trying to pivot to try to see if we can kind of grow some of the programs that we have internally try to partner with people and see if we can get ahead of this because we know that it is happening. 

What is it going to do? And so I already mentioned that it's already causing the expansion of mosquito populations to extend further geographically. Also global warming is causing more kind of rainfall and flooding, more severe kind of swings between drought and flood and hurricanes and cyclones and those sorts of things. 

So what that does is that increases the risk [00:54:00] of diarrheal diseases. Which is with. Access to you know, sanitation, hygiene and clean water and the clean water again is the key because if you have flooding conditions then your well can become contaminated. Your clean water systems can be contaminated your sewage. 

Again, if it's not treated well, the under flooding conditions, the sewage can basically be spread easily with the flood water. Throughout. So you can have an entire population exposed to raw sewage because of flooding. And again, that causes an outbreak of diarrheal disease. So the bottom line is that we think that global warming is actually a critical question that we need to grapple with. 

In the next few years and decades, because it will become increasingly important on a lot of different fronts.  

Charles Schelle: Absolutely. You know, some people [00:55:00] think in terms on a very personal level and not on a global level. But when you look at these things, think about, like, if you want to go on vacation. And a nice tropical climate. 

Think of all the symptoms that you just listed that could ruin your vacation, diarrhea, other sicknesses, mosquito borne illnesses. So, maybe if you want to not get sick on vacation in these nice tropical climates, support vaccines, support the research that we do, and let your representatives know that you want to enjoy your vacation and not come home with dengue fever. 

Wilbur Chen: That's right. Global problems can be local problems. I think that again the idea is that, you know, we don't live in isolation because of our ability to cross borders. You know, I mean, 50 years ago and 100 years ago borders were more important. And the fact that the U. S. was, you know, separated from Europe and other countries [00:56:00] because of huge oceans, I think that's not you know, going to be helping us. 

As much these days because of you know, the ability to jump on a jet and be from one place to another within hours that you could have importation of these infections and then the globalization of even our food. So, you know, kind of going back to, you know, we are able to enjoy raspberries and strawberries in the winter. 

Right. And that's because we're importing a lot of our fruits and vegetables. So that, you know, it used to be that our parents probably grew up with again, seasonal vegetables where in the wintertime, we were just eating root vegetables, and that's all we had. And, you know, whatever was in season was what we got. 

But now we can get anything with that we, our hearts want when we go to the supermarket at any time of the year. And it's because of the globalization of our foods. So that means again our foods could get contaminated. And we could have [00:57:00] importation of infectious diseases, such as salmonella. You know, you hear about these tainted salmonella products all the time. 

It's in fact, CDC says it's one of the top foodborne illnesses in the US, salmonella. But there are a lot of other things. So again, globalization thinking globally if you want to protect yourself locally is kind of the way that I want people to think, because really even though we think that there's a border, Those borders are very porous, and again, a lot of things are coming back and forth. 

And I'm not trying to get political about kind of migration and this and that. I'm talking just about the fact that we do jump on a jet and can go to another country in hours, and that we get our food from other countries all times of the year. It's coming from somewhere else. And so that means that we, again, are exposed. 

Even though we think that it's a problem of somewhere else. It's actually a problem that's brought to us very frequently,  

Charles Schelle: right? I mean just [00:58:00] think about the invasive pests that we've had to contend with have we had to You know have PSAs about killing spotted lantern flies You know, five, five, 10 years ago, or even 10 years ago, you know, stink bugs and how annoying those are. 

Dana Rampolla: Yup. The kudzu vine that used to only be down in the south, that's now migrating northward.  

Wilbur Chen: That's right. Strangling all of our vegetation. It's terrible. Yeah.  

Dana Rampolla: Well, my husband and I were just talking the other day about the types of food, exactly what you just said, Wilbur, that we were served by our grand, grandparents versus what we have now and that you can get anything year round, but then what's at jeopardy by importing that food, because it's not coming to us fresh, it's being picked in a raw state and chemicals and, you know, things have been applied to it in that transit aid to keep it safer, but also, and when I say safer, I mean, to keep, pests at [00:59:00] a minimum and that sort of thing, but also to ripen it. 

So like, what is the quality of that food? We live in a bizarre world right now. Well,  

Wilbur Chen: I think going back to that notion is that, you know, we've got the USDA and the FDA that are federal agencies that are tasked with trying to keep our foods safe. And that means again, if we ripple their ability for that simple function, that means that we could be again, more susceptible to some of these infections and tests and whatever else, because we don't have the system in place that is needed to protect us. 

So it's kind of, you know, either we stop buying imported products completely and go with just local, which some people do. But again, just recognizing that, again, a lot of the products that we are able to enjoy are internationally [01:00:00] sourced, and there's a huge system that's in place to try to protect us as well, that perhaps is under recognized. 

Charles Schelle: Again, looking at what we want versus what we need, you know, a lot to think about, a lot to package up. Thank you for sharing so many different insightful things with us today, helping us to learn a little bit about a lot of these pathogens that are out there and giving us an education.  

This has been an incredible conversation, like Dana said. Just learning more about the vaccination process, the research, what goes into it. This is the economy that builds Baltimore right now. 

Charles Schelle: And we're glad that you're part of it and keep doing the work that you're doing.  

Wilbur Chen: All right. Well, thank you so much. 

Jena Frick: The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB Office of Communications and Public Affairs [01:01:00] production, edited by Charles Schelle, marketing by Dana Rampolla.