It is my great pleasure to be interviewing Dr. Mathu Santosham, a pediatrician and

public health professor here at the Johns Hopkins Bloomberg School of Public Health,

who has had a tremendous career in developing and

promoting vaccination for young children.

Dr. Santosham thanks so much for joining me.

>> Thank you for having me.

>> So I want to start with a little bit of a personal story, a little embarrassing

personal story which when I started as a pediatric resident, I'm a pediatrician.

And we realized- >> And which year was that?

>> That would have been 1996.

So when I started as a pediatric resident in 1996 and

I realized that we were vaccinating against Haemophilus influenzae type B,

I realized I didn't really know what that was very well.

>> I did my residency at what was then called Baltimore City Hospital,

now called Bayview.

And my very first day as an intern, 1971,

these are days in Baltimore that were very different.

They were seeing lots of diarrhea, lots of pneumonia, lots of meningitis.

A nine-month-old baby came in, obviously very sick, was crying,

has had some seizures.

And even to me who had never seen a case of meningitis,

it was obvious this child had meningitis

because there is a thing called fontanelle on the top of kids' heads.

That was bulging, that's a very clear sign.

And I will never forget that child went on,

we obviously gave that child antibiotics.

And that child had tremendous neurological problems afterwards.

We used to have about 20,000 cases in the US a year of meningitis, and

our mortality rate at that time was between 5 and 10% in the United States.

And in developing countries it was more than 50%.

>> So this is a bacteria that is called Haemophilus influenzae because early

on it was confused for the influenza virus >> That's correct.

>> But it's really a bacteria that is very serious.

There's another infection that kids get that is particularly known for

this bacteria which is epiglottitis.

And I was taught as a pediatric resident to always be on the lookout for

epiglottitis, but I never saw a case.

>> Right.

>> Have you seen a clinical case of epiglottitis?

>> Yes. >> Can you just explain what that is?

>> Yeah. >> People may know the epiglottitis

is that piece of flap of skin that when you swallow it protects the breathing,

the lungs from what you're swallowing.

>> Right, a lot of people may know what croup is, a lot of children get croup.

In some ways you can think of epiglottitis as a more severe form of croup

because croup affects the vocal cords and lower down.

Epiglottitis is the infection of the epiglottis.

And if the child gets epiglottitis it swells up and

pretty much closes the airway.

And we saw many, many cases of epiglottitis right here in Baltimore,

both at Johns Hopkins and at Baltimore City Hospital where I worked.

And if you don't establish an airway immediately, which meant that we'd

often have to put a needle in here to make sure the child can breathe.

And if you didn't do that, the child would die.

And then you'd have to start IV immediately.

And I'll just tell you a personal story.

As I was doing my residency and saw so

many kids with Haemophilus influenzae in Baltimore.

One of my biggest fears, because my children were born at that time,

was this disease.

And I kept thinking wouldn't it be nice if we could just get a vaccine just right?

>> You did the first study to show that they could be protected with antibodies.

>> That's right.

>> And then one of the first studies

to show that a vaccine could generate those antibodies and save lives.

>> Absolutely.

>> What was it like, when you realized that this was working, how did you feel?

>> I have to tell you a story related to this.

We have what's called a DSMB, a Data and Safety Monitoring Board.

They are the ones that have all the data, they know the groups.

And I know exactly the date that we broke code, August 2nd, 1990.

It was on the fifth floor of this building.

They broke code, and they announced to us, this vaccine has 100% efficacy.

And I was so excited, for the first time, the world had a vaccine.

We had a way to prevent this disease, I couldn't control myself.

I just was running around excited, called my wife, called everybody that I knew.

>> So the vaccine became licensed.

>> Yes.

>> And became part of the recommended immunization

schedule which is what I saw when I was a pediatric resident.

And I never saw a case, a single case of something that was so

common that you would see cases all the time.

How much of an impact did that vaccine have?

>> Just to put this in context, we would see this once a week, it was just common.

Now, if there's case of Haemophilus influenzae,

which might occur once in three years or something some immunocompromised,

there's a case conference.

We have case conference of very rare diseases that you hardly ever see.

Most of our residents have never seen a case.

And that's why I'm a little scared because people, and

even the general public can become very complacent.

Because they often think, well what's the big deal?

And then there's all this anti-vaccine groups who are claiming all kinds of side

effects, and that's a whole different story, anti-vaccine is just a big story.

But it is very important for the general public to

understand that even though they don't see the disease now, if we stop vaccination,

you are going to have epidemics of Haemophilus influenzae type B disease.

And you're going to see kids who are permanently damaged,

public needs to understand that.

>> So I looked up some of the statistics.

Within ten years of the vaccine being introduced,

this disease had basically disappeared.

>> Yes. >> More than 99% reduction.

>> Absolutely.

>> So how does that make you feel about public health?

>> When I first decided when I finished my residency in the 70s,

public health was not a proper field at all.

A lot of people felt sorry for me.

>> [LAUGH] >> I obviously couldn't get into

a fellowship.

>> [LAUGH] >> He's doing this.

And there was some visionaries like Carl Taylor and Tim Baker.

And my former Chief at Baltimore City Hospital they said, no matter,

that's to really make a difference.

You can roll up your sleeves, give shots, take care of, you'll save lives,

no question.

But if you really want to make an impact you need to get into public health.

And I'm so glad my mentors pushed me to do that.

>> So this vaccine started in the United States, and then spread around the world.

>> It's now in every country in the world.

>> And would it be fair to say that

hundreds of thousands of lives have been saved.

>> Absolutely, in fact GAVI's projections says by 2020 7 million lives

would have been saved because of this vaccine.

>> 7 million lives. >> Yep.

>> That's incredible.

It's really incredible.

Thank you so much for joining me, this has been really a tremendous opportunity.

>> Thank you for having me.

>> Incredible

Santosham Interview

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