When Anil Purohit (Res ’11) opened his first cardiology clinic in Lilongwe, Malawi, a line of 50-some patients stretched out the door. Some had sold items from their homes to pay for transportation there. Nearly all were suffering from serious heart complications.
The third-year cardiology fellow and clinical instructor of medicine has been in Malawi since August 2014 as part of an NIH-funded Fogarty International Center Global Health Program for Fellows and Scholars. (Only 20 clinicians nationwide were selected.) His year-long project focuses on the effects of aspirin as a primary prevention strategy for cardiovascular disease in HIV patients. “Aspirin is the most powerful medication we have in Malawi to treat cardiac illness,” he says. (In place of potassium supplements normally indicated for congestive heart failure, he prescribes three bananas a day.)
But as the only cardiologist in the country, he soon found the heart-health needs of an entire population on his shoulders.
“It took me a month, but I finally realized my role here in Malawi is not to put these bandages in these big holes and to save lives [immediately]. My role here is basically to . . . build capacity and train Malawians.”
In November, Purohit gave a three-day lecture series at the Malawi College of Medicine, teaching medical students and clinical officers (similar to physician assistants) how to interpret electrocardiograms. There were a couple of ECG machines available, he recalls, but no one had ever been taught how to use them. In the clinic, “that’s probably the biggest impact I can make,” he says. “Our role at the end of the day is not to take over. It’s to teach and transfer these skills so that the Malawians can be in charge of their own health.”
Photo courtesy Anil Purohit
Marvin Grubman: A Man, an Island, and a Vaccine
BY JASON BITTEL
For 36 years, Marvin Grubman (PhD ’72) began his workday with a decontamination shower. Then, each night before leaving the lab, he’d take another. And if his work that day meant visiting a room housing an infected animal, that’d be two more showers—one upon entering the room, another before exiting.
That’s just how it goes when your office is on a restricted island where you’re tasked with fighting infectious diseases for the Department of Homeland Security. Grubman was a lead scientist with the Plum Island Animal Disease Center, just off the northeast coast of Long Island, until he retired in 2013.
“It’s not an easy place to work,” he says with a laugh.
Grubman has worked with many diseases throughout his career, but none of them more intimately than a potentially fatal one that infects cloven-hooved animals like cattle, sheep, and pigs. You know it as foot-and-mouth disease.
Not to be confused with hand, foot, and mouth disease, an illness common in children, foot-and-mouth disease is one of the most infectious diseases among animals and is potentially fatal. The virus causes lesions on the gums, lips, and tongue, as well as blisters on the animal’s feet that can result in lameness. Thankfully, it’s exceedingly rare for people to contract foot-and-mouth.
In 2001, the United Kingdom’s livestock industry suffered more than 2,000 cases of foot-and-mouth. Because the virus spreads so quickly—from contact between animals, aerosols, or even inanimate objects like tractors—the UK opted to slaughter more than 10 million sheep and cattle in a desperate attempt to stop the outbreak. Some estimates put the total cost of containment at well over $16 billion.
The goal of the Plum Island facility is to ensure that a similar fate never befalls the United States. And thanks to Grubman, the chance of that may now be smaller than ever.
In 2012, Grubman developed a novel vaccine for foot-and-mouth disease that has two major benefits. The first is that the vaccine contains no active virus, which means it can be produced on the mainland. (The United States forbids any endeavor that would allow the active virus to make landfall, including scientific research—hence Plum Island’s whole Fortress of Solitude-esque setup.)
The second benefit is that the vaccine can be identified in a blood sample, so livestock owners can differentiate between animals that have been infected and those that have been inoculated. This last bit means we’d only have to euthanize truly sick animals in the event of an outbreak, as opposed to every animal exposed to an infected one.
To create the vaccine, Grubman produced the virus’s outer protein shell, or capsid, without the infectious ribonucleic acid center—kind of like a hollow M&M. Once inside an animal, its immune system spots the defanged capsid and creates antibodies to fight off the virus. It took seven straight years of tinkering before Grubman got this latest iteration of the vaccine, a combination of a hollow shell and virus-suppressing interferon, to work properly.
“I remember when we first got the results,” he says. “It was amazing.”
Grubman was amazed that it worked at all, and also amazed that it worked so quickly to protect the test pigs. “This was the first demonstration that any approach could so rapidly protect naturally susceptible animals,” he says.
Larry Barrett, director of the Plum Island Animal Disease Center, called the discovery the biggest news in foot-and-mouth disease research in the last 50 years.
Grubman is a touch more modest.
“There’s still lots and lots and lots to do,” he says, “but, over time, this will be improved and one day soon, hopefully, it can be used in the fi eld.”
Grubman and his wife, Annette, have since moved to Atlanta to be near their daughter, Susan. The couple also has a son, David, who got his law degree from the University of Pittsburgh and still resides in the area. Marvin still serves on the editorial board for the Journal of Virology.
Though he’s been retired for two years now, Grubman keeps in touch with his colleagues at Plum Island to see how the vaccine is progressing. He says one of the things he misses about work is the sheer pursuit of it all, the constant struggle to make the vaccine better, but so far retirement agrees with him.
At the very least, there aren’t as many showers.
Photos courtesy of the Department of Homeland Security.