There was a time not too long ago when nearly 400,000 children were dying each year of bacterial meningitis and pneumonia in developing nations all over the world. Yet a safe and effective vaccine against the culprit organism, Haemophilus influenzae type b (Hib), had virtually wiped out the problem years earlier in the U.S. and other industrialized countries.
In parts of Africa and Asia, numerous obstacles limited the vaccine’s use. And many children who survived the diseases, meningitis in particular, were left with crushing disabilities, such as mental retardation and deafness.
Dr. Rana Hajjeh, a longtime medical epidemiologist at the Centers for Disease Control and Prevention, worked nearly nine years to close this tragic gap. Using a remarkable combination of gentle force, science and cultural sensitivity, she led a global campaign that convinced 60 countries to adopt the vaccine’s use.
Coworkers who watched her pull it off called it a “superhuman” feat. World health experts, meanwhile, estimate it will save the lives of 7 million children by 2020.
“It’s her passion and empathy, as well as her strong scientific and public-health base that enabled her to do this. Dr. Hajjeh was on the ground in a zillion countries listening, learning what the concerns were and fixing what needed to be fixed,” said Dr. Anne Schuchat, the assistant surgeon general for the U.S. Public Health Service. “She is a scientist and a doctor, but she is also a mother and a very passionate person, and was able as one person to bring many different groups together.”
Now Hajjeh, a 21-year employee of the federal government, is helping foundations and world health organizations spread other vaccines that are lagging in developing countries.
“She is a tireless public servant, one who always enjoys addressing challenges and making a difference through preventing disease around the world,” said Dr. Rima F. Khabbaz, director of the CDC’s Office of Infectious Diseases.
In 2005, Hajjeh became director of the Hib Initiative, a consortium of four organizations funded by the GAVI Alliance, a public/private global health partnership. Born in Lebanon, she studied medicine at the American University of Beirut. She completed her residency in internal medicine and infectious diseases at Emory University in Atlanta and fell in love with public health during her training at the CDC as an Epidemic Intelligence Service officer.
“With clinical medicine you have a patient, you treat them, they improve, and it’s a relatively instant reward. But in public health, you have to be patient, because the reward involves providing services to a large group of people and it takes time,” she said. “We all go into medicine thinking we will save lives, but you really do it on a large scale when you are working on interventions at the population level—especially in many of the developing countries.”
Yet even she admits knocking down the barriers complicating the Hib Initiative required an extraordinary amount of persistence. “In public health, and global health in particular, you really need to have an optimistic outlook on things because the challenges can be daunting, and stay focused on what the real goal is,” she said.
The Hib bacterium, first described in 1892, is a source of major bacterial infections, including meningitis and pneumonia. Pneumonia continues to be the number one cause of child mortality globally, and these deaths can be largely prevented by Hib and pneumococcal vaccines. Despite its name, Hib is not related to the influenza virus. The diseases with which Hib is associated typically occur in children under five years of age and are transmitted through coughing and sneezing.
One of Hajjeh’s most daunting tasks was to convince countries that their children were dying from preventable diseases. Their hospital labs and disease surveillance systems had failed to do a good job of detecting Hib, and by 2004 only 13 of 73 countries eligible for GAVI grants were advocating use of the vaccine.
Her team collected and disseminated the data needed to help countries build the case and made available a five-in-one vaccine that included Hib, which made immunization less costly. Among the countries eventually adopting its use were India, Pakistan, Bangladesh, Uganda, Kenya, Malawi, Nigeria, Sudan and Senegal.
The Hib Initiative officially ended March 20, 2014, but its lessons have propelled Hajjeh into a number of new projects. Recently she helped her team at the CDC secure a grant to investigate the impact of a meningitis vaccine now being deployed in sub-Saharan Africa.