Pat Winokur, Department of Internal Medicine
Pat Winokur's interest in infectious diseases began in college while taking a course on molecular biology, then a relatively new and emerging field in science. "Molecular biology started in viruses and bacteria," she says, "and I really liked this new technique for studying organisms. As I went through medical school, I realized that I really enjoyed the types of cases you see in infectious diseases—patients of all ages and infections that occur in all parts of the body. It's a challenging specialty that draws from both the basic and clinical sciences."
Last fall, Winokur and her colleagues received a seven-year, $23.7 million contract from the National Institutes of Health (NIH) to lead clinical trials of promising new vaccines and therapies for a variety of diseases. The University of Iowa was one of only eight sites nationwide selected to serve as Vaccine and Treatment Evaluation Units (VTEUs), each aimed at responding quickly to public health needs. Winokur talks to fyi about her work, vaccine development, and what she likes best about academic medicine.
Is vaccine research a “hot” area of study right now?
I think a lot of the push from NIH has been in response to emerging public health threats. NIH has always been interested in vaccines, and this granting mechanism actually has been in place for a number of years. That said, I think their interest has escalated in recent years with SARS, pandemic flu, and threats from bioterrorism, which has led to an interest in getting answers more quickly than with more traditional mechanisms.
What led to the University being named a site for a VTEU contract?
We've had a history of working with NIH as a sub-contract site. We’ve studied the smallpox vaccines; different influenza vaccines, including avian influenza; and also a herpes virus vaccine. Our investigators have broad expertise in the basic science of many of these pathogens, as well as a history of performing clinical trials. We've always had very strong recruitment for our trials, and we've had a history of having very high-quality data. The data we collect is accurate, and our patient population is very compliant—they show up as scheduled and they keep the data sets clean. So NIH had very good impressions of our previous work because of those factors, and I think that played a major role in our being chosen as one of the final eight sites.
Why do Iowans make good study participants?
We often conduct trials of products that are of interest, so often people are familiar with the disease and they're interested in helping develop a cure or prevention. Oftentimes we've been helped by the fact that the newspapers are writing articles about pandemic flu or bioterrorism. We come up with a vaccine that intrigues the population, and people want to participate. They feel like they're contributing to something that benefits their community and society as a whole. This was particularly true with the smallpox vaccine—people felt they were helping the country. Same with pandemic flu—people felt they were contributing to medical knowledge that is beneficial to the country and the world.
In some vaccine studies in our over-65 age group, the participants understand that sometimes their bodies don’t respond as well to vaccines. But they also understand that the more we can learn about those vaccines, the more likely we can improve the response in that particular population, resulting in their better health. They're contributing to the health of their age group.
What is the status of a bird flu vaccine?
In April 2007, the Food and Drug Administration (FDA) approved a vaccine for the H5N1 avian influenza virus. However, it is not one of our best vaccines—it requires two very high doses. With the “regular” influenza vaccine available each year, people receive one dose that contains 15 micrograms of flu protein. This avian influenza vaccine required 90 micrograms of protein, and you have to get it twice. The vaccine was well tolerated, so that's good. However, it’s hard to make enough vaccine. The companies that produce vaccines can only produce so many infected chicken eggs [the flu strains used to make flu vaccines in the United States typically are grown in specially prepared chicken eggs]. If we could get a vaccine that uses fewer micrograms and fewer doses, we would have more doses for our population.
Is this FDA-approved vaccine only for health care workers or emergency personnel?
There were no restrictions on who is eligible for the vaccine, other than it was approved for adults ages 18 to 64. If there came a time where the vaccine was needed and only a small number of doses were available, the government would be involved in deciding who has priority.
Are public attitudes changing toward vaccines? It seems that every year more people get a flu shot.
I think there is still a population that is very reticent to take vaccines. There remains a strong concern, especially among some parents of young children, that vaccines can be associated with other diseases. There has been a lot of research that’s gone into whether vaccines are associated with autism, for example, and there's no association that researchers can find. But some parents remain suspicious, and it can be difficult to challenge that assumption.
What do you like most about your job?
The thing I like best about academic medicine is that every day is different. Some days I'm working on clinical trials, writing the study protocol or recruiting subjects and getting them enrolled in a study. Some days I'm in the clinic seeing patients. And some days I'm teaching medical students. Today, I gave a lecture on the signs and symptoms of infectious diseases. I really like that variety and enjoy being involved in all three aspects.
What would your colleagues be surprised to learn about you?
We just built a log cabin up near Monticello, Iowa, on an acreage that we own. The cabin is on the north fork of the Maquoketa River, with limestone bluffs overlooking the water. It's a beautiful area.
Did you build it yourself?
Oh, gosh, no—we're not that talented. (laughs) We spent time there over the Christmas holidays and ended up being getting snowed in. But it's been a fun pastime.
by David Pedersen