A group of friends and colleagues of Adel Mahmoud, MD, PhD (1941-1918) gathered at the College of Physicians of Philadelphia on February 27, 2019, to remember Dr. Mahmoud’s legacy. He was remembered as a colleague who would have great discussions and debates with his peers on issues related to science in general and immunizations in particular. Some remembered him as the kind and wise professor who mentored public health students at Princeton and medical students at Case Western Reserve University. He was described as the consummate professional at Merck and in his collaboration with different government institutions like the Centers for Disease Control and Prevention and the National Institutes of Health.
The following morning, the Wistar Institute hosted a symposium on the science, history and advancements of vaccines. While the presenters were from different organizations, they all shared a connection with Dr. Mahmoud. Some were his former students. Others consulted him when times were tough in their research on a particular vaccines. And others talked about his advocacy for reducing the burden of vaccine-preventable diseases on children all around the world.
There were many stories and anecdotes about Dr. Mahmoud told by the symposium presenters as they were talking about topics like the HPV vaccine, the rotavirus vaccine, advances in understanding how shingles has come to be such a burden in the United States and the future of vaccine technology. Ken Frazier, Chairman and CEO of Merck, warmly remembered his conversations with Dr. Mahmoud. He joked that Dr. Mahmoud once came into his office and pointed to an article about the hiring of Mr. Frazier as the first African American in a leadership role at Merck. “And where is Egypt?” Dr. Mahmoud asked. (Dr. Mahmoud was born in Egypt in 1941.)
In talking about the rotavirus vaccine, Dr. Kathrin Jansen from Pfizer shared her conversations with Dr. Mahmoud. At the time, a rotavirus vaccine was taken off the market after an increased risk of intussusception (a potentially fatal intestinal condition) was detected in post-marketing surveillance. The obstruction to detecting the increased risk in that vaccine was that intussusception was so rare that it would require tens of thousands more children in pre-market clinical trials in order to detect a significant difference between the vaccine and placebo groups. That large a clinical trial would be very costly, and the company might never recover the costs of the vaccine development and the clinical trials if intussusception became a problem for the new vaccine.
As Dr. Jansen put it, Dr. Mahmoud had seen the ravages of rotavirus in developing nations, and he advocated for the new vaccine and the large clinical trials that would be needed to make sure it was safe. In the end, the clinical trials involved about 70,000 children at different sites around the world. The paperwork from case reports could be staked up taller than the Sears Tower in Chicago, she said. With that large a number of participants, any adverse event that was significant could be detected between the placebo and vaccine groups. None was, and the newer vaccine has been hailed as a success in preventing a terrible childhood disease and reducing its burden around the world.
The symposium ended with a discussion about the latest anti-vaccine groups and individuals whose misinformation is helping vaccine-preventable diseases make a comeback in places where those diseases were previously deemed eliminated. Dr. Paul Offit talked of his experiences with those groups and how people like Dr. Mahmoud and others in the room continued to work toward developing life-saving vaccines despite the detractions.
All in all, the two events were a great remembrance of all the achievements of Dr. Adel Mahmoud. His friends and colleagues really conveyed the essence of who he was, and who he continues to be through his work, his mentorship and the wisdom he passed on to all who listened.