Dr. Robert Edelman has long had to field questions - from his own parents - about why he's not a "real" doctor, seeing patients, prescribing medicines and curing their ills.
His response: "I'm a real doc, except you don't see what I do every day."
Edelman's lifework is vaccine research - long one of medicine's most undervalued pursuits, even though vaccines have helped conquer some of the world's worst diseases.
But now, with bioterror a household word and infectious diseases such as SARS scaring millions around the globe, the discipline is getting more respect - from the scientific community, the federal government and even Edelman's parents, who keep seeing their son quoted on television.
"All you need is one vaccine," said Edelman, 66, associate director of clinical research at the University of Maryland's Center for Vaccine Development. "You've made an impact on potentially tens of millions of people. Take that to bed with you at night."
With increased funding and new technology, vaccine research is thriving, scientists say.
"I think it's a very exciting time for vaccinology," said Dr. Regina Rabinovich, director of the infectious diseases program at the Bill & Melinda Gates Foundation. The Seattle-based foundation has committed more than $1 billion since 1999 to developing new vaccines and expanding access to existing ones worldwide.
"It's definitely more robust," said Dr. Myron M. Levine, a prominent vaccine researcher who heads UM's Center for Vaccine Development.
Since Edward Jenner developed the first vaccine, for smallpox, in 1796, vaccines have been some of the most successful public health interventions ever, wiping out smallpox and protecting people from scourges including polio, mumps and measles. Children in this country now receive about two dozen shots by age 6.
But vaccine research practically became a victim of its own success. Over the years, it came to be viewed as something of a scientific backwater as the epidemics that afflicted earlier generations faded into memory. Some ambitious scientists began to look elsewhere.
Yichen Lu, principal research scientist for the Harvard AIDS Institute and the Harvard School of Public Health's immunology and infectious diseases department, has heard the field degraded by prominent scientists. "They think that doing vaccine research doesn't require a lot of brain power," he said. "My point of view is that, 20 years after AIDS, we haven't been able to come up with a vaccine."
Tedious and expensive
Because vaccine-making is based in large part on trial and error, and there is no universal blueprint for how to do it, the process can be tedious and expensive. Scientists have had difficulty getting funding - most drug makers considered vaccines for Third World diseases such as malaria or cholera unprofitable. The work also requires a multidisciplinary team of researchers who might spend half a career or more on a single vaccine, with no guarantee of success and a high risk of failure.
The emergence of AIDS in the early 1980s was a sobering reminder that infectious disease was not a distant threat. Since then, outbreaks of Ebola, West Nile virus, severe acute respiratory syndrome and other illnesses have driven the point home.
"It's become clear over the last decade or so, or even longer, that infectious diseases are not going away," said Emilio A. Emini, head of vaccine development at Merck Research Laboratories, which recently began work on a SARS vaccine.
In the post-Sept. 11 world, the federal government has emphasized the need to develop, produce and stockpile the safest and most effective vaccines against deadly bioterror agents such as smallpox and anthrax.
Officials have earmarked more than $1 billion to that end at the National Institutes of Health alone. The Bush administration has proposed, in Project BioShield, to create a guaranteed market for those who make the vaccines.
"There's a great influx of resources, and that means there are a lot of people who are going to be working on problems related to these agents that wouldn't otherwise have been involved," said Dr. Francis A. Ennis, director of the Center for Infectious Disease and Vaccine Research at the University of Massachusetts Medical School.
Maryland institutions have benefited from the largess. In February, the Johns Hopkins Bloomberg School of Public Health received a $30 million grant from the Global Alliance for Vaccines and Immunizations to speed development of several new childhood vaccines. Last summer, UM's Center for Vaccine Development got a $22 million federal grant for new vaccines against anthrax, malaria and other diseases.
That's welcome news for researchers such as Dr. Wilbur Chen, who even before going to medical school became intrigued by the field while he was a lab technician at the Food and Drug Administration, working on vaccines against meningitis and influenza.