Orin S. Levine may be heading for trouble with the Disney people.
At lectures, Dr. Levine, a pneumonia expert, uses a homemade slide that illustrates his predicament — Nemo, the little lost movie clownfish, next to the words “Finding Pneumo.”
Pneumonia is the biggest killer of the world’s children. It kills two million a year, more than AIDS, malaria and measles combined. It carries off many adult AIDS victims in poor countries and, even in rich ones, is the final shove through the gates of death for many of the elderly and sick.
If an avian flu pandemic emerges, pneumonia will stroll its killing fields, finishing off the wounded.
Yet it gets no respect.
Dr. Levine, a professor at the Johns Hopkins Bloomberg School of Public Health, thinks he can prove that. Another of his slides calculates how often pneumonia ought to be mentioned in Google news searches, based on how many people it kills. In reality, it registers as hardly a blip.
A disease’s Rodney Dangerfield problem may seem comical, but it can have serious consequences. Dr. Levine leads a worldwide effort to raise money for more pneumonia vaccines. He is seeking a tiny fraction of the amount spent on AIDS, tuberculosis and malaria, but it is still proving a struggle.
Part of the problem, he argues, is that pneumonia specialists “have a collective inferiority complex because our disease is so hard to diagnose.”
Whether in rural Guinea-Bissau or a teaching hospital in Manhattan, doctors virtually never have the luxury of perfect methodology, taking a sputum sample from deep in the lungs, growing it in culture for a few days, putting every critter in the petri dish under a microscope and performing genetic tests.
Instead, any child whose chest is fluttering with the struggle for breath and whose lungs make the crackling-paper sound of leaking fluid is immediately carpet-bombed with antibiotics.
If a blood test is even done, it is wrong 90 percent of the time.
“You only pick up the pneumos that can reach the blood,” Dr. Levine said. “And the antibiotics mess up the results.”
Another problem for the field is that almost every word in it is unpronounceable, including causal bacteria with names like streptococcus pneumoniae and haemophilus influenzae and the unfortunate moniker of the organization that Dr. Levine heads, pneumoADIP.
It stands for Pneumococcal Vaccines Accelerated Development and Introduction Plan. It was underwritten by $30 million from the GAVI Alliance, formerly known as the Global Alliance for Vaccines and Immunization.
Dr. Levine shrugs.
“Give me $30 million and you can call me anything you want,” he says.
In the last decade, huge progress has been made in preventing pneumonias with vaccine instead of treating them with antibiotics. The science is far ahead of the better-known hunts for AIDS and malaria vaccines.
Prevnar, a vaccine for infants that protects against seven strains of bacteria, has been sold in the United States since 2000. It costs about $250 and earns almost $2 billion a year for its maker, Wyeth Pharmaceuticals of Collegeville, Pa.
A version that protects against nine strains of pneumonia that Wyeth made for a clinical trial in Gambia was a resounding success last year, preventing one death for every 200 children vaccinated.
Wyeth, GlaxoSmithKline and other major vaccine suppliers have said they are willing to tailor their vaccines for poor countries and build factories to manufacture millions more doses, as long as someone promises beforehand to buy them at a price that allows the suppliers to break even. Low-cost pharmaceutical companies in Brazil, China and India are also interested in the market.
Donor countries — with the exception of France and the United States — have committed about $1 billion. With another $500 million, Dr. Levine said, pneumoADIP could start offering contracts.
But there is some danger of time running out for pneumoADIP itself.
“They could be in the position of picking up a couple of billion and then having to convince the powers that be that they need to survive,” said Dr. Keith P. Klugman, a pneumonia specialist at the Emory University school of public health.
In the interim, Dr. Levine keeps touring the world asking for money and showing his goofy slides. The one he uses to illustrate how few pneumonia cases are officially diagnosed is as offbeat as the clownfish — the eyes of a hippopotamus peering out of the water.
“It’s the same idea as ‘just the tip of the iceberg,’ ” he said. “But that metaphor works in Finland better than it does in Africa. There are no icebergs in Congo.”
Copyright 2006 The New York Times Company