PhRMA 2013 Research & Hope Awards: Dr Linda Fu and team

pharmaphorum's Rebecca Aris interviews Dr Linda Yu-Sing Fu, who leads the Children's National Medical Center Vaccine Program, which has recently won a 2013 PhRMA Research & Hope Award.

This week, the Pharmaceutical Research and Manufacturers of America (PhRMA) announced the recipients of the 2013 Research & Hope Awards, which honors outstanding achievements in vaccines research and immunization by individuals and research teams in the biopharmaceutical sector, academic / public research and health care provider communities.

"Over the last century, vaccines have transformed the public health landscape in the United States and around the world, preventing disease and improving the quality of life for multiple generations," said PhRMA President and CEO John J. Castellani. "PhRMA is proud to honor the recipients of this year's Research & Hope Awards. These inspiring collaborators within the biopharmaceutical ecosystem have helped drive the latest advances in vaccines and immunization to the benefit of patients everywhere."

pharmaphorum is pleased to interview Dr Linda Fu, who led the Children's National Medical Center Vaccine Program in Washington DC. The Children's National Medical Center Vaccine Program has been awarded with PhRMA's 2013 Research & Hope Award for Patient and Community Health.

Award recipient: Children's National Medical Center Vaccine Program, under the guidance of Dr Linda Yu-Sing Fu

Company: Children's National Medical Center

Award: The PhRMA Research & Hope Award for Patient and Community Health

Reason for winning the award: The Children's National Medical Center Vaccine Program is receiving the award for its efforts to increase awareness of the importance of childhood immunisation. The team is also being recognized for raising the quality of immunisation delivery to an at-risk population in the District of Columbia, ensuring that a generation of children are protected from a range of preventable diseases.

Interview summary

RA: Doctor Fu thank you for agreeing to take part in the interview. Can you please tell me about your work in the practicing space that led you being awarded the 2013 Research and Hope for patient and community health?

LF: As I understand it, the award is being given to me and the immunisation team at Children's National Medical Centre to recognise our past efforts to improve immunisation rates among at risk populations in Washington DC, and also our current efforts to expand these activities to a national sample of paediatric practices.

In six health centres in Washington DC, which predominantly serve poor and publically insured children, we put into place the Centres for Disease Control and Prevention's recommended interventions to improve immunisation rates among children. We implemented these changes over several months, tested them and adapted them to fit our specific circumstances and workflows. After 12 months, we found a 16% point increase in early childhood immunisation coverage among our patients, which we were able to maintain beyond 18 months. What we are currently doing is looking at how we can disseminate these interventions more broadly. We now have close to 40 practices across the US who we've created resources for and have been coaching over the last several months about immunisation delivery quality improvement, Besides trying to increase rates for these practices, we're really trying to determine the most effective and efficient methods of disseminating best practices and guiding other paediatric practices in uptake of the CDCs recommendations.

"...healthcare disparities are really related to the socioeconomic status..."

RA: What healthcare gaps and disparities do you see faced in children across the Washington DC Metro region?

LF: I think the situation in the DC Metropolitan area is actually very similar to that facing other urban areas, in that healthcare disparities are really related to the socioeconomic status and cultural factors of the paediatric population influencing how they utilise healthcare systems. So for the most part, I think we do a great job of immunising children who are in the system who actually see a physician on a regular basis, a primary care physician on a regular basis. This is because in the US we have the vaccine for children's programme, which really allows providers for the most part to administer vaccines to children regardless of insurance status. However, there is definitely a gap for indigent and affluent populations in terms of how they access the medical home, and the preventative services that go along with it, including immunisations. Children from low income households are more likely to go, for instance, to an emergency room for non-emergent care that is better provided in the medical home. This is not only costing the overall system more, but it means that children see their primary care provider less frequently and get, for instance, less anticipatory guidance, fewer reminders to come back for their physical exam and shots. And then if the paediatrician provides shots at sick visits they are at higher risk of being overdue for vaccines. So I really do think that the remedy is to incentivise and educate families to identify and seek out medical homes, and really disincentivise use of emergency services except for emergencies.

RA: What disease areas that can be resolved by immunisation present the greatest risk to children?

LF: Unfortunately, due to pockets of geographical locations with vaccine refusal, and global travel, we are really seeing a resurgence of immunisation preventable disease in the US and around the world. The ones that come to mind most are measles, bordetella pertussis, polio and haemophilus influenzae type B. All of these are potentially life threatening in children; they cause various problems including meningitis, encephalitis, paralysis, whooping cough, pneumonia. I think there are people who are hesitant about vaccines or often forget or too young to know about how potentially devastating diseases are, such as smallpox in those who are infected. For instance, in the case of smallpox, people should be educated on how successful immunisation programmes eradicated a terrible disease.

"...we are really seeing a resurgence of immunisation preventable disease in the US and around the world."

RA: What challenges are associated with raising awareness in the area of childhood immunisations in the District of Columbia?

LF: I think that those of us who work in the public eye, in work related to immunisations, are really victims of the successes of our predecessors, in the sense that collectively we have been so effective at immunising children that the public and even our younger medical trainees have actually never seen many of the immunisation preventable diseases. This makes some families and providers a little cavalier, and maybe forget in terms of the actual risks and costs of not vaccinating, overestimating these costs and then really underestimating the benefits in terms of disease prevention. We see people using alternative vaccination schedules that are proposed by both parents and doctors that are not really based on any science at all, but a general feeling that there are too many shots for little children and their bodies can't handle it. This goes contrary to any evidence – there really is not a great risk in following the immunisation schedule. But on the other hand, there is high risk for a child whose vaccines are delayed in terms of being exposed to a vaccine preventable disease, and becoming infected, and either becoming sick himself or transmitting disease to other vulnerable populations.

RA: What increase have you seen in childhood immunisations in DC as a result of your work, and what does this mean for the wider community?

LF: Well as I said, as a result of putting into place immunisation best practices we were able to achieve a 16% increase in immunisation rates, and we were able to sustain that beyond 18 months, and what we did was release basic changes, we didn't do anything ground breaking. We put into replace reminder recall phone systems, for instance, to tell patients to come in who are due or overdue for a vaccine. We improved reporting to our immunisation registry, and we trained our staff to give vaccines at sick visits in addition to well visits. So it was very basic changes, and we did it in a high risk population, so I think what this indicates is that other practices can do these things as well if the will is there.

RA: How has your work changed the quality of immunisation delivery in the region?

LF: Since implementing the immunisation quality improvement activities at Children's National Medical Centre we've collaborated with the DC Department of Health Immunisation Programme to train other practices within the city. We've also gone to annual conferences in the city as well as trained paediatricians in their practice site. And at this point, we've actually trained providers that care for pretty much over 50% of the paediatric population in the District of Columbia. So we have really been able to spread our learning and the things that we have achieved locally.

"...as a result of putting into place immunisation best practices we were able to achieve a 16% increase in immunisation rates..."

RA: What changes would you like to see for childhood immunisations in this area over the next 10 years?

LF: I would love to see a national immunisation registry, so that if a child receives vaccines from multiple providers, for instance because he or she moves or doesn't have a medical home, and gets shots at various places, every time he or she accesses a paediatric doctor, that provider can see what the child has received in the past and administer any missing vaccines as appropriate. I think we're moving in this direction towards better integration but slowly.

It would be wonderful if this integrated system would be accessible to every electronic medical record platform, so that providers actually access it and utilise it, and for these systems to have prompts for providers to order vaccines when they are due and forecasting to let them tell families when the next set of vaccines are due. That, I am sure, is further off in the future than in the next decade.

Finally. I'd like to see some sort of addressing of public opinion towards vaccine. Some sort of smart collaboration between public health and media such that positive scientifically accurate and balanced news and portrayals of the benefits of vaccines get more time than negative portrayals about overblown or inaccurate risks of vaccine. I think that's very important, because it colours the norms in society regarding vaccination.

RA: Finally then, what does winning this award mean to you and the team?

LF: First off, I'm very grateful to Pfizer who is currently funding in part the immunisation delivery research that I conduct, and of course the Children's National Medical Centre where I work for giving me the opportunity to do this research. I'm very thankful to pharma for recognising not only the value of the basic science immunisation development, but also the importance of immunisation delivery, research and programmes.

"...success of immunisation programmes really relies on all of us as citizens doing our part..."

Immunisations are one of the most important public health advances in the recent past, but success of immunisation programmes really relies on all of us as citizens doing our part and contributing productively by getting ourselves and our children immunised. Roughly 80 to 95% of a population must be immunised for herd immunity to be effective and to protect our vulnerable populations who cannot be vaccinated due to age or health conditions. So for paediatric providers, that means we need to make sure we're using all the tools available to us to ensure that we are reaching out to children when they need vaccines and then immunising them appropriately when they do come to us for care.

RA: Thank you very much for your time.

LF: Thank you.

About the interviewee:

The Children's National Medical Center Vaccine Program is led by Dr. Linda Yu-Sing Fu. Dr. Fu is a general pediatrician at Children's National Medical Center and an Associate Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences. Dr. Fu's research and advocacy interests focus on reducing barriers to childhood immunizations. She is Principal Investigator of a multi-center behavioral trial comparing the effectiveness of knowledge diffusion strategies for enhancing immunization delivery among a national sample of pediatricians. Dr. Fu also studies the psychosocial reasons for parental vaccine refusal and she recently received funding from the National Institute of Child Health and Human Development at the National Institutes of Health via the K23 mechanism to examine the influences of social networks on normative values regarding HPV vaccination acceptance among parents of early adolescents.

Dr. Fu received a ScB degree from Brown University (1996), MD from the University of California, San Diego (2000), and M.S. in Clinical Research from Tufts University (2005). She completed her pediatric residency training and a clinic research fellowship at Tufts Medical Center.

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country's leading innovative biopharmaceutical research and biotechnology companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier, and more productive lives. Since 2000, PhRMA member companies have invested approximately $550 billion in the search for new treatments and cures, including an estimated $48.5 billion in 2012 alone.

How can we raise further positive awareness of vaccinations?