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 PAHO TODAY          The Newsletter of the Pan American Health Organization   -    November 2005

QUOTED AT LENGTH

Jon Kim Andrus

Chief, Immunization Unit
Pan American Health Organization

 Jon Kim Andrus
Photo by Armando Waak/PAHO

Jon Andrus returned to PAHO as head of the immunization program in February 2004 after a 10-year absence from the organization, having worked with Ciro de Quadros on the polio eradication campaign in the Americas from 1989 to 1993. A graduate of Stanford University, Andrus received his medical degree in 1979 from the University of California at Davis and practiced family medicine for two years in the National Health Service Corps. In 1985, he went to Africa with the Peace Corps. He later trained at the Centers for Disease Control and Prevention before joining PAHO's Expanded Program on Immunization, where he coordinated polio surveillance. In 1993, he became Southeast Asia regional coordinator for polio eradication for the World Health Organization in New Delhi and later served as chief of vaccines and biologicals for Southeast Asia. He is a commissioned officer in the United States Public Health Service and a recipient of the USPHS Distinguished Service Medal.

What drove your interest in public health?
I grew up in a medical family. My grandfather was the second doctor in our small town [King City] in California in the Salinas Valley, and my father was a primary care doctor who grew up working with his father. When I was young I would go on house calls in the country with him, and I knew from a young age I wanted to be a doctor. I felt fortunate when the families we helped showed us great appreciation. Then, after getting my medical degree and working in the National Health Service Corps in a rural county in California, I realized I could do much more for many more people by going into public health. I went into the Peace Corps and was assigned to Malawi, running a hospital in a poor area with a lot of malnutrition.

How did field work overseas affect your outlook?
Of course I learned many things about public health and international medicine, but I realized that the practical side of things was essential. Having enough food in the hospital to feed patients and having enough gas for the Land Rover to take nurses where they had to go was equally important. You need the operational side working well to support the medical side.

What got you interested in immunization?
Well, 1986 was the Immunization Year in Africa, and we had a huge injection of enthusiasm. I saw the power of immunization to prevent disease and protect children, and I realized that this could benefit all health services. The community mobilization, the support, the benefits of saving lives—that was when I fell in love with immunization. Then, working on disease eradication made it the best job in the world. I like being back in PAHO, where we have a real commitment to the vaccine program and where we have continued to lead the world, from smallpox to polio eradication and now measles and rubella elimination.

Was there a downside to living in Africa and Asia?
I had three bouts of malaria and hepatitis E, as well as a back injury that led me to come back. I went to the University of California at San Francisco to teach and continue working on immunization programs and advising on polio eradication. But I was always happy to work in the field and to be able to make a difference. I think it's important to meet the operational challenges in the field and the challenges at the policy level. We have to focus on technical cooperation, equitable vaccination, effective management, surveillance, research, evaluation, and lots of other factors. As I said, I love coming to work every day.

How is your work at PAHO different from earlier assignments?
In Africa and Southeast Asia, the poverty is enormous, and so are the challenges. We have large pockets of poverty here [in the Americas], and these are also challenges. But the commitment you see in the people who work in vaccination is outstanding, and the potential impact of what you're doing makes it more exciting. I think we have the best staff in the world in the vaccine program, with a high esprit de corps and total support. Every single day, I look forward to coming to work. I feel very fortunate to be able to make a difference in people's lives, and I think we're all passionate about what immunizations can do.

What brought you to PAHO originally?
After working in Africa, I went to the Centers for Disease Control and took the Epidemic Intelligence Service course, and I was an EIS officer in the Oregon State Health Department. Then I went back to Atlanta and was seconded to PAHO, working on the epidemiology of polio. Ciro de Quadros asked me to continue here, and I was lucky to be involved in the eradication of polio from the Americas. There was a lot of work and a lot of travel. My daughter was about 6 months old at the time, and I was gone for about six weeks. When I came home, she didn't recognize me.

You won the Public Health Service's highest award. What was it for?
The citation was for leadership and technical contributions in eradicating polio in Southeast Asia. I was responsible for coordinating polio eradication in Bangladesh, Bhutan, Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand. They had crowded conditions, open sewers, high birth rates, and low immunization coverage and about 60 percent of the reported polio cases globally. We succeeded in getting political commitment for national immunization days in these countries, and we got funding from USAID, Rotary International, the Danish government, and others. We vaccinated millions of children, and polio incidence dropped by 65 percent in Southeast Asia from 1992 to 1999. [Editor's note: According to WHO, global eradication efforts have reduced the number of polio cases from 350,000 annually in 1988 to 1,349 in 2005. Six countries remain polio endemic: Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan. However, poliovirus continues to spread, with 10 previously polio-free countries reinfected in late 2004 and 2005: Angola, Cameroon, Chad, Eritrea, Ethiopia, Indonesia, Mali, Somalia, Sudan, and Yemen.]

What are your priorities for immunization in the future?
This is a very exciting time for us. We are focusing on the elimination of rubella by 2010, but it could be done a year or two ahead of that target if we have the political commitment. Vaccination Week in the Americas has been successful, and we plan to continue and expand it. And there are new vaccines in the pipeline that have the potential to prevent more diseases. Bill Foege spoke of eventually having a single vaccine with all the antigens [against diseases], and that's still a long way off because there are so many technical issues and vaccines are so different—some are taken orally and others injected, some are live and others are killed-virus vaccines or lyophilized [freeze-dried], and so on. So we need more research before we reach that point of one vaccine. There's also interesting new research, with aerosol measles vaccine under study in Mexico, a vaccine to prevent deaths from severe diarrhea caused by rotavirus, and of course HIV and malaria vaccine research. Pneumococcal disease is very important and kills more people than AIDS and TB combined, but the vaccine is very expensive. More countries are now doing influenza vaccination, and this continues to be important, especially if there is a highly pathogenic avian flu pandemic. We have to help the countries make informed decisions on vaccines, because there are economic and logistics considerations and the practical questions of sustaining and financing vaccine programs with enough political commitment.

What are the major challenges after the successes of polio and measles?
Vaccination is one of the best public health interventions, but the challenge is to make it equitable so everyone can be protected. You have to combine the scientific side with the practical side. Our revolving fund, for example, is a tremendous success story and the backbone of our technical cooperation. We can guarantee a vaccine supply at bulk prices with this fund, which is now capitalized at $30 million. Last year countries spent $150 million buying vaccines at lower prices through the fund. The challenge of equity and self-sustaining vaccine programs is key for me.

Do your children plan to follow your path as a public health doctor?
Ihave two daughters who are 16 and 13, and my proudest moments were when they were born. One loves teaching, and the other one wants to be a chef, and that's great. I encourage them to follow their own path. Neither is interested in medicine, but both have a passion for helping others.

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