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Professor Kim Mulholland
Professor Mulholland is an Australian paediatrician with extensive experience in research leading to or evaluating the introduction of new vaccines in the developing world. Between 1989 and 1995 he lead the Haemophilus influenzae type B ( Hib) vaccine research program in the Gambia, which involved three Phase 2 trials of Hib vaccine, a maternal immunization study and a large Phase 3 trial. The latter study formed the prototype for future pneumococcal vaccine trials.
Between 1995 and 2000 Professor Mulholland worked at the World Health Organization (WHO) in Geneva, assisting with the design and oversight of Gambian and South African pneumococcal trials. He also established a pneumonia trialists group that established standardized methods and definitions for pneumococcal carriage and radiological pneumonia in vaccine trials. Since 2000 he has worked in at the London School of Hygiene and tropical Medicine, the Menzies School of Health Research in Darwin and Murdoch Childrens Research Institute.
During that time he has established pneumococcal research programs in Fiji and Vietnam. He currently leads the Bill and Melinda Gates Foundation-funded PneuCarriage Research Project, based at Murdoch Childrens, as well as field studies in Fiji (PCV10 impact study), Mongolia (PCV13 impact/effectiveness study), Laos (PCV13 impact study), Indonesia (PATH funded pneumococcal Whole Cell Vaccine evaluation) and Vietnam (PCV10/PCV13 schedules study). In addition, Professor Mulholland remains involved in Hib and PCV impact studies in the Gambia.
Pneumococcal vaccine research and development:
- Vaccine impact in Asia – As had been the case with Hib vaccines, there is a strong body of opinion in Asia that true pneumococcal disease is so rare in Asia that vaccine introduction is not warranted. Prof Mulholland's group believe this view may be incorrect and are studying the epidemiology of childhood pneumonia in several countries to examine the issue.
- Schedules – Following on from the Fiji work, important questions emerged about the new pneumococcal conjugate vaccines in abbreviated schedules, the prospect of further reduction of the schedules, and the need for a head-to-head comparison of the two vaccines.
- Serotype replacement – The emergence of serotypes not included in the vaccine in vaccinated communities was predicted and proved to be an important issue.
Rotavirus – Since 2006 the Institute has supported a rotavirus surveillance project in Fiji. This project defined for the first time, the erratic epidemic nature of rotavirus disease in Pacific Island states. This led to the introduction of the Rotarix rotavirus vaccine in Fiji in 2012, and MCRI is now leading a project to evaluate that introduction.
Human Papilloma Virus (HPV) – Following the dramatic results of an epidemiological study of HPV and Cervical Cancer, momentum developed within Fiji for the introduction of HPV vaccine. In 2013 the Cervarix HPV vaccine was introduced in Fiji and Murdoch Childrens is working on a project to evaluate the impact of vaccine introduction.
Typhoid – While typhoid has long been recognized as a problem for Fiji and other Pacific nations, the dramatic increase in cases since 2007 has now placed Fiji in the highest category of typhoid endemic countries, along with countries like Nepal and Pakistan. The paradoxes of typhoid in Fiji and the lack of objective epidemiological, clinical and microbiological information were highlighted in the meeting. This led to an AusAID funded project to implement the recommendations of the meeting and get to the bottom of the problem. Murdoch Childrens is now leading a project to address this. Use of the new typhoid conjugate vaccines remains a possibility, but there are currently no definite plans.
Pneumonia - The use of both Hib and pneumococcal vaccines is primarily to prevent pneumonia. Yet pneumonia has proved to be extremely difficult to define, and as a result epidemiological studies are few and confusing. To address this, and to enable pneumococcal vaccine trials to be undertaken with agreed and comparable endpoints, in 1998 the WHO established a group to standardise the radiological diagnosis of pneumonia. The definition established has been used for all pneumococcal and Hib vaccine studies undertaken since, and has provided remarkable comparability in studies from Argentina to Africa to the Philippines.
Generic vaccination issues - It is well known that some vaccines are less effective in developing countries than in developed countries. The reasons for this are unclear. Murdoch Childrens is currently working on strategies to improve vaccine responses. In recent years much has been written about the non-specific effects of immunization on overall mortality. Most of the data come from a single group in Guinea Bissau. Professor Mulholland has been involved in this work since 2000 when he led a WHO mission to investigate the research.
Pneumococcal Vaccine Research and Development
1. Vaccine Impact Studies:-
a) New Vaccine Evaluation Project, Fiji. Co-principal Investigators Associate Professor Fiona Russell and Professor Mulholland in collaboration with the Fiji Ministry of Health. Funded by Australian Aid.
b) Evaluation of the impact of national pneumococcal conjugate vaccine introduction in Lao PDR. Co-principal Investigators Associate Professor Fiona Russell and Professor Mulholland in collaboration with WHO and the Lao Ministry of Health. Funded by the GAVI Alliance
c) Evaluation of the impact of national pneumococcal conjugate vaccine introduction in Mongolia. Principal Investigator Professor Mulholland in collaboration with WHO and Mongolia Ministry of Health. Funded by the GAVI Alliance.
d) Nasopharyngeal carriage surveillance in children hospitalised with respiratory illness or pneumonia to evaluate the direct and indirect effects of pneumococcal conjugate vaccine programs in Lao, Mongolia and Papua New Guinea (PNG). Principal Investigator Associate Professor Russell. Collaborating with WHO Western Pacific Regional Office, Lao Ministry of Health, Lao-Oxford- Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Institute of Medical Research, PNG and Mongolia Ministry of Health. Funded by the Bill and Melinda Gates Foundation (BMGF)
2. Vaccine Scheduling Studies:-
a) Vietnam reduced dose pneumococcal clinical trial. Led by Professor Mulholland and funded by the Australian National Health and Medical Research Council.
b) Vietnam study extension funded by Bill and Melinda Gates Foundation.
3. Serotype Replacement Studies:-
a) PneuCarriage follow-up study “monitoring pneumococcal carriage and vaccine impact'. Co-principal Investigators Dr Satzke and Professor Mulholland. Funded by Bill and Melinda Gates Foundation.
4. Indonesian Pneumococcal Project – Pneumococcal carriage in Indonesian infants ahead of the Streptococcus pneumonia whole cell vaccine efficacy trial. Principal Investigator Professor Mulholland, in collaboration with Universitas Padjadjaran. Funded by PATH.
5. Centre of Research Excellence in Pneumococcal Vaccinology. Project led by Professor Mulholland and funded by National Health and Medical Research Council.
6. Typhoid: Assessment project funded by Australian Aid and led by Professor Mulholland
Professor Mulholland has co-authored a book called ' Pneumonia in Children: Epidemiology, Prevention and Treatment' with Martin Webber.