Pneumonia is the fourth-leading cause of death in the United States and caused 55,180 deaths in 1976. It is estimated that there are as many as 750,000 cases of pneumococcal pneumonia in our country every year, and that the economic cost of such pneumonias is a billion dollars annually.
Prior to the development of Dr. Austrian's vaccine, scientists had prepared less complex vaccines, using first, whole bacteria and later, capsular polysaccharides, but had had little success in achieving their acceptance.
When antibiotics came into use for the cure of pneumococcal infections, even these attempts were abandoned. But Dr. Austrian never lost sight of the fact that prevention is more important than cure.
The surveillance studies which he conducted revealed that despite antibiotic therapy, there were still, in the 1960s, almost half as many deaths from pneumonia in the United States as there were at the turn of the century. Dr. Austrian also established that persons over 50 years of age and those with chronic debilitating diseases were the largest group at risk.
In developing techniques for a pneumococcal vaccine, Dr. Austrian established that of 83 known types of pneumococci, 14 types were responsible for 80 percent of the pneumococcal infections in man, and that the outer coatings or capsules of these organisms should be included in an effective vaccine.
Dr. Austrian devised such a vaccine and then played a major role in the successful clinical trials which resulted in its licensure.
For his persistent, dedicated efforts which permitted the development of a vaccine that soon may significantly reduce human disease caused by the pneumococcus, this 1978 Albert Lasker Clinical Medical Research Award is given.
Meningitis is an inflammation of the layers of tissues covering the brain and spinal cord, and is a leading cause of acquired mental retardation. There are an estimated 20,000 cases of bacterial meningitis in the United States every year. The disease hits all age groups, especially infants and children, who are the most vulnerable.
When it was discovered that children, especially those between the ages of 6 and 12 months, are most susceptible to meningococcal diseases, because antibodies against meningococci are lowest at those ages, Dr. Gotschlich directed his efforts to methods of eliciting protective antibodies.
For this purpose, he devised innovative chemical techniques which permitted the development of an effective vaccine.
In 1969–70, a high incidence of meningococcal disease among army recruits afforded an opportunity to test this vaccine. It proved to be 90 percent effective, and its routine use, since 1971, for immunization in military training centers has almost completely eliminated meningococcal disease from this high-risk population.
For the first treatment of a polysaccharide vaccine to prevent meningitis which offers the bright hope that high risk populations of adults and children will, in the future, be spared the ravages of this disease, this 1978 Albert Lasker Clinical Medical Research Award is given.
Acknowledged as the father of immunochemistry, Dr. Heidelberger is responsible for determining that the materials enveloping the virulent pneumococcal bacterium are carbohydrates. This determination led to greater understanding of one of the mechanisms by which invading bacteria develop in the body and cause disease.
Dr. Heidelberger further determined that the slimy materials which envelop the pneumonia bacteria are composed of complex chemical substances, made up of polysaccharides (sugars), and they cause the system to form antibodies that protect the body against pneumonia bacteria.
Dr. Heidelberger then validated the importance of his chemical and immunological discoveries by conducting, with others in 1945, clinical trials of a pneumococcal vaccine, which firmly established the tremendous potential value and efficacy of polyvalent polysaccharide bacterial vaccines.
For Dr. Heidelberger's pioneering work, which formed the basis for the subsequent successful development of today's practical vaccines against the pneumococcal diseases, this 1978 Albert Lasker Clinical Medical Research Award is given.
Termed "Captain of the Man of Death" by Sir William Osler, pneumonia remains the only infectious cause of death among the ten leading causes of death in the United States today.
As I entered medical school just prior to the introduction of the first effective drug for treating pneumococcal infection, I was exposed to a tradition at the Johns Hopkins Hospital of reviewing annually the patients with pneumonia, designed, in Osler's words, "to make the cases teach the lessons of the disease." Several years later, it was my privilege to spend a year in the laboratory of Dr. Colin M. MacLeod, who, had he lived, might be here in my stead. It was he who, in addition to his fundamental role in delineating with Avery and McCarty the genetic function of DNA, first demonstrated conclusively with Dr. Heidelberger the efficacy of vaccines of pneumococcal capsular polysaccharides.
These early experiences aroused my enduring interest in the pneumococcus and in the illnesses it causes, an interest that persisted despite the impact of penicillin in improving the outlook for those with pneumococcal infections.
Clinical investigations conducted in the 1950s, a time when concern with such infections had waned, showed clearly that antibiotics were not the final solution. If those at high risk were to be spared, it would be necessary to improve their treatment or to prevent them from becoming ill. Because the groundwork for a prophylactic vaccine had already been laid, the latter approach was followed; and, as a result of the efforts of many individuals, a highly complex vaccine is now available for preventing a significant portion of pneumococcal infection. The challenge for the future of this and of most other infectious diseases remains to discover how pathogenic microbes injure the hosts they invade and how to prevent or to correct such injury.
To have been permitted to work in these areas of biology and medicine has been a privileged existence. In accepting this 1978 Albert Lasker Clinical Research Award, I am most grateful. I do accept it on behalf of all who have contributed so much to this undertaking.
Bacterial meningitis is a terrifying disease, and many people at home and abroad have worked hard and long to bring us to the point where an effective vaccine against epidemic meningococcal meningitis exists. On behalf of all, I gratefully accept this high award. I am certain that this recognition will add further impetus to this area of research and fervently hope that other forms of this ugly disease will soon be preventable.
The development of polysaccharide vaccines to prevent pneumonia and meningitis, while clearly an example of so-called applied research, is, however, immediately dependent on free-ranging basic investigations. This moment, which so clearly illustrates the intimate connection of basic research to clinical advances, is a fitting time to give recognition as well to the public at large and to the private sources which support the biomedical research community. In my own instance, I would like to acknowledge the generous support of the United States Army Medical Research and Development Command, the World Health Organization and the Hochschild Foundation. Lastly, I wish to draw attention to the entrepreneurial spirit and warm support of the pharmaceutical industry; notably, the Merieux Institute and Merck, Sharp, and Dohme, which played a major role in the successful development of the meningococcal vaccine.
I was greatly surprised and, naturally, very pleased and honored to receive this second Lasker Award, and am very grateful to the Foundation for it.
In the remaining minute and three quarters available, I would like to give a bare outline of the background of the studies for which the award was given me.
First, there was the enormous stimulus of working with Oswald Avery at the then Rockefeller Institute.
Second, Lloyd D. Pelton's failure, in a massive experiment in the early 1930s, to demonstrate the value of pneumococcal capsular polysaccharides in preventing pneumonia in the unvaccinated Civilian Conservation Corps camps.
Third, without the self-sacrificing cooperation of scores of medical students at the College of Physicians and Surgeons, already overworked by the accelerated wartime schedule, the basic micro-quantitative data on antibody formation due to the vaccine could not have been obtained.
Fourth, the wartime monitoring and field tests of pneumonia at the Sioux Falls camp under the direction of Colin M. MacLeod before and after the vaccination of 8500 persons, one half of the camp's personnel, made this one of the best-controlled and best-documented epidemiological studies in medical history.
Thus we lean on our predecessors and co-workers, and they, too, deserve much credit for our present successes.
Thank you, again.