The Health of the World

Drawing on his experience as a public health and immunization expert with the CDC and his current role with pharma giant Merck, Dr. Mawuli Nyaku ’03 shares a hopeful outlook on COVID-19 vaccine adoption.

By Daniel F. Le Ray

r. Mawuli Nyaku ’03 remains strikingly optimistic that COVID-19 vaccines will see widespread adoption, even as the global pandemic persists and more and more Americans decline once-standard vaccinations.

“When I look at the immunization system in the United States, what I’m happy about is that [those who choose not to vaccinate] are a small minority,” said Nyaku. “So although I think there is some negative sentiment around COVID-19 vaccines, I think a significant part of the population will be getting them provided clinical trials demonstrate safety and efficacy.”

A seasoned public health expert and epidemiologist, Nyaku has led multiple efforts to boost vaccine coverage in the U.S. and worldwide for the U.S. Centers for Disease Control and Prevention (CDC). He is now global director of medical affairs for pediatric vaccines at the pharmaceutical giant Merck, which has two COVID-19 vaccines and one antiviral therapy in the pipeline. He also served as one of Conn’s health advisers last summer, helping the college develop protocols so that it could reopen with students, faculty, and staff in the fall.

Nyaku says that clinical trials are due to start this year, and though Merck won’t be the first to market, he hopes that its considered approach toward a single-dose shot will reach more people more quickly.

“We’re really thinking critically, because we recognize that this is not the last pandemic we’re going to have around coronaviruses. Making sure we’re getting this right the first time is critical,” said Nyaku.

A PREMED MAJOR at Conn, public health wasn’t always in the cards for Nyaku, but he had an eye-opening experience with the Holleran Center’s Program in Community Action, which bridges classroom study and community engagement.

In a class with Professor of Human Development Sunil Bhatia, students were asked to choose a location in New London, go there, and watch what happened.

“I thought it was the most ridiculous assignment. Why would anyone in their right mind just go sit somewhere and stare into space?” recalled Nyaku, who has joined Bhatia for a campus lecture on vaccine skepticism. But his professor’s insistence on the pragmatic value of observation has become integral to Nyaku’s work.

On that bench in the New London train station, Nyaku first realized that an “ethnography” approach, as he calls it, is key to medical professionals understanding disease—why it is so prevalent or how it affects different parts of a population. And when considering a treatment regimen, he still takes this tack.

“The societal perspective is really critical,” he explained. “You don’t just come up with an intervention in a vacuum. Public health strategies are “not going to work if you don’t truly understand the root” of people’s behavioral differences.

Nyaku went on to receive master’s degrees in public health and in business administration, and a doctorate in epidemiology and international health. His career at the CDC also began during this time when Nyaku contacted several CDC scientists and offered to help with their research. One Friday evening, “I got a phone call from one of the principal investigators [on tropical diseases]. She basically asked me if I could get on a plane to Nigeria the next day.”

Nyaku said yes.

On the ground in Nigeria, he helped conduct a survey of certain neglected tropical diseases caused by parasitic worms.

“These diseases affect some of the poorest people on earth—about a billion people are at risk at this point in time,” said Nyaku. Providing the incorrect treatment can also result in death, so “you need to know what the actual disease burden is, and then you tailor your intervention according to that.”

After his success there, Nyaku was recruited by the CDC’s Division of Parasitic Diseases and Malaria to provide technical assistance to ministries of health in under-resourced countries. From there, Nyaku was accepted to the CDC’s prestigious Epidemic Intelligence Service (EIS), which offers a two-year field program on responding to epidemic outbreaks. Posted to Michigan, Nyaku responded to airborne and foodborne outbreaks, led efforts to prepare communities for environmental disaster, and even investigated a case of contaminated steroids that had been put into circulation by a compounding pharmacy.

Working these cases taught Nyaku a lesson about the nature of bureaucratic competition, as well as public health.

“It gave me a good grounding in public health and how complex it is, because it’s not just the state—you have CDC involvement, the local health departments, and the county health departments [to work with]. It’s complex, and everyone doesn’t always trust everyone else in those situations.”

Nyaku’s experience in disease outbreaks and public health was put to good use this year, when he was asked by Conn President Katherine Bergeron to serve on a panel of alumni charged with guiding the college as it discussed reopening safely. The panel convened weekly to deliberate on how best to bring students, faculty, and staff back in the fall.

“We had in-depth discussions around the current scientific evidence on COVID-19 and considerations for resuming classes in the fall,” said Nyaku.

“I was more than happy to leverage my extensive experience from conducting and leading several infectious disease outbreak investigations and, most importantly, to give back to the college in a time of need. The plans currently in place are extremely rigorous and should severely limit disease transmission.”

You don’t just come up with an intervention in a vacuum. Public health strategies are not going to work if you don’t truly understand the root of people’s behavioral differences.

ISSUES OF VACCINE adoption and coverage took center stage in Nyaku’s subsequent roles with the CDC’s domestic and global immunization divisions.

Domestically, he traveled to Pacific island territories such as Guam, the Marshall Islands, and Micronesia to understand why vaccination rates were lower there than in the continental U.S. Science skepticism was not the issue.

“In the Pacific islands, they all want vaccines, but it’s a matter of access,” explained Nyaku. “In an island group that might have hundreds of small scattered islands, one ship might go to the farthest islands only once every six months.”

In the global immunization division, Nyaku led efforts to increase immunization rates worldwide for children in their “second year of life,” adding a second measles vaccine in countries that only had one, for instance. In many cases, the primary issues with getting a vaccine were education and access.

“You’re basically creating a new vaccination point, which was really confusing parents,” he said. “Many parents have returned to the workforce, making it more difficult to attend a doctor’s appointment, while others may simply have misunderstood new healthcare practices.”

This work paved the way for a better understanding of why some people in the U.S. decide not to vaccinate their children against diseases like measles. Nyaku prefers not to call these people “anti-vaxxers.”

“At one end of the spectrum are individuals who believe that vaccines cause harm, and most of those individuals truly believe that and, most likely, would never want to see a vaccine around them. However, there are also those who do believe that immunizations prevent infectious disease—they just don’t have all the answers.”

Painting everyone as an anti-vaxxer may serve only to drive away those who just want to know it is safe, those who only want more information about what they’re putting into their children’s bodies, “and this may cause them to swing to the other side of the spectrum,” said Nyaku.

There’s another factor at play as to why Americans shun certain vaccines: the many diseases that vaccines have stamped out now seem like remnants of a bygone age.

“When you don’t see disease, then you start asking yourself, why am I taking this vaccine?” Nyaku said. “People forget that, prior to vaccines, there was substantial morbidity and mortality related to vaccine-preventable diseases. Until we had the recent measles outbreaks, many young physicians had never seen a case of measles.”

NOW THAT COVID-19 is rampant, demand for vaccination will be high. However, there will be skepticism about the efficacy of any vaccine, even if it’s championed by the CDC, because faith in the CDC has waned. Yet Nyaku says the CDC’s response to the coronavirus crisis has, all things considered, been robust.

“For me, the CDC is really a beacon,” he said. “There are very brilliant medical officers and public health professionals within those walls; they do fantastic work and very rigorous science. And around the world, most countries’ governments look to the CDC for guidance.”

Of course, responding to any international health crisis will inevitably include missteps, and Nyaku does see some missed opportunities.

“We have a very good idea of what [COVID] transmission looks like and how to mitigate it, and we’ve had the experience of seeing what is happening in different countries. That combination really should have set us up for success.” Thinking back to the bureaucratic hurdles he faced in Michigan, Nyaku says that in the U.S., “you can’t just put a blanket recommendation or ruling in place—what New York City does is very different from what Hawaii’s doing.”

One thing that Nyaku believes would have helped the CDC fight the pandemic more effectively is expanded testing.

“You have a lot of people who are asymptomatic or pre-symptomatic and they end up spreading the disease. Should you blame them?” he asked. “Maybe that person wanted to get a test and they couldn’t get it, or maybe that person was very careless. It’s hard to say.”

What is certain is that public health in general has been significantly disrupted, from basic preventive medicine to food security to healthcare for chronic conditions. Inequity issues across race and socioeconomic status are also increasingly pronounced.

“You see higher rates of disease in minority populations, and these same populations don’t have access to adequate healthcare services. That in conjunction with unemployment issues really exacerbates” the spread of disease.

As an expert in pediatric immunizations, Nyaku is also concerned about COVID-19’s impact on society’s youngest.

“There are lots of children who have not had their childhood immunizations because their healthcare provider is closed or they are not taking in any patients, and I worry about another surge in vaccine-preventable diseases.”

During his early days at the CDC, Nyaku recalls feeling frustrated when he learned of vaccine shortages, because “I knew there were people or kids who were not going to get the vaccine. I would get so upset.” Now, heading up Merck’s pediatric vaccine division, he has firsthand experience of how heavily regulated the process is—under normal circumstances, the development of a new shot can take 10 years and many billions of dollars.

He describes Merck’s approach to COVID-19—which encompasses an antiviral therapeutic and two one-dose shots—as “a step in the right direction. Public health is really the centerpiece.”

In terms of upcoming vaccines, Nyaku stressed that although there are conspiracy theorists who may never be convinced to get immunized, as long as sufficient numbers of people do, coverage will be widespread and a so-called “herd immunity” effect will be in place.

As clinical trials move forward, next steps include determining how to distribute future vaccines equitably.

“That is a topic that is heavily debated right now,” Nyaku confirmed. “When we have successful COVID vaccines, what should be the order of priority? Should we start vaccinating frontline healthcare workers, emergency responders, and adults who have comorbid conditions?”

Issues of access, he added, are being considered across the globe; a drug in development with Oxford University and AstraZeneca, for instance, will specifically target low- to middle-income countries first.

“What I’m hoping for is that vaccines come out, they have high safety and efficacy rates, and they’re able to offer immunity extremely well,” said Nyaku, ever positive. “And I’m very optimistic that most people will get vaccinated.”