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There is an old proverb that says opportunity knocks only once. But if you are Myron M. “Mike” Levine, MD, DTPH, opportunity knocks until its knuckles are sore.
by Jennifer Litchman

As a boy, Mike Levine was interested in biology and the sciences. His father, a college biology professor, introduced him to microscopy, and father and son conducted microscopic experiments at home. Although he entered City College of New York as a 15-year-old freshman, Dr. Levine was no Doogie Howser. A pre-med major, Mike Levine spent more time playing lacrosse, going to parties, and chasing girls than planning his medical career.

"My college friends have told me that I often spoke of an interest in tropical medicine and the developing world, and while I’m not surprised given where I am today, I certainly don’t remember speaking of such at the time," he says.

Dr. Levine, professor of medicine and director of the University of Maryland Center for Vaccine Development (CVD), was a 19 year-old college graduate when he entered the Medical College of Virginia. Married at 22, Dr. Levine had his medical degree by the age of 23. Four decades later, Dr. Levine is at the top of his field, leading a program that is the largest academic vaccinology training center in the world, internationally renowned for its work in immunology. But what is perhaps as interesting as the path Dr. Levine took to get where he is today are the paths not taken. For Dr. Levine’s life is a textbook case of missed opportunities.

Every summer during medical school, Dr. Levine managed to wrangle a fellowship in different parts of the world - tropical medicine in Costa Rica, diarrheal disease and malnutrition in Pakistan, tropical skin diseases in Paris, and general medicine in Israel. These fellowships offered Dr. Levine his first opportunity to live abroad and experience first-hand the very real problems of the developing world. Moreover, these fellowships had a deep impact on him and reinforced his desire to help relieve suffering in the developing world.

After a pediatric residency and a pediatric infectious disease fellowship at Albert Einstein Hospital in New York, Dr. Levine was recruited by the Epidemic Intelligence Service (EIS) of the Centers for Disease Control (CDC) in 1970. "This was during the Vietnam War," says Dr. Levine. "I was thinking of joining the Navy, in the hope of being assigned to one of the overseas research units. However, when the CDC contacted me, I felt that the EIS was to be a good way to fulfill my military obligation while doing something of great interest. Upon being commissioned as a public service officer, I was assigned to the enteric diseases branch, which deployed me to the University of Maryland School of Medicine Division of Infectious Diseases, initially on short-term duty."

Dr. Levine started his career at Maryland with a fellowship under Dr. Richard B. Hornick, then head of the division of infectious diseases, to work on a Shigella vaccine. The CDC subsequently assigned him to El Salvador to continue his work on the vaccine, as Central America was experiencing a full-fledged Shiga dysentery pandemic at the time. But Dr. Levine never got to El Salvador. As the governments of the United States and El Salvador grappled with bureaucratic delays, the administrative details were never worked out, and Dr. Levine’s temporary duty in Baltimore became a little less temporary. He was promoted to assistant professor of medicine and pediatrics in 1972, although he was still officially a CDC employee on assignment.

At about this time, East Pakistan (now Bangladesh) was in the throes of an annual seasonal cholera epidemic. The CDC recruited Dr. Levine to go to East Pakistan to work for several years at the Cholera Research Laboratory in Dhaka. He agreed, and arrangements were made; but eight weeks from departure, civil war broke out, thus thwarting his plans to live and work overseas.

But opportunity knocked yet again when the CDC asked Dr. Levine to look into enteric infections in Morocco as a World Health Organization consultant. This finally seemed like the chance for which he had been waiting. According to Dr. Levine, "This was right in the middle of the Cold War; so there was a lot of unrest in the world. Just as I had made up my mind to uproot my family and move to Morocco, terrorists crashed a birthday party for Morocco’s King Hassan and machine gunned the dais, killing the French ambassador. I decided that this was not a good time to move my family to Morocco, and we stayed in Baltimore."

But because of his work with both the division of infectious diseases and the CVD, Dr. Levine was becoming an expert in the evaluation of live oral Shigella and typhoid vaccines. At this point in his career, Dr. Levine needed to conduct field trials, and in the spring of 1973 he visited Central and South America as a Pan American Health Organization consultant, selecting Peru as the country in which to set up a field unit. He left the CDC the same year and joined Maryland’s faculty on a full-time basis, fully expecting to develop a field unit in Peru. He submitted a grant request to the United States Agency for International Development (AID), and spent the 1973 - 74 academic year at the London School of Tropical Medicine and Hygiene, receiving his DTPH while waiting for his grant to be approved.

In 1974 relations between the United States and Peru were severely strained; AID decided not to fund Dr. Levine’s grant. Although the Levines were ready for their move to Peru - all of their boxes were in storage - the final decision was out of his hands, and Dr. Levine would again be remaining stateside.

But out of all these missed opportunities came the seed for the opportunity of a lifetime - the beginnings of the center for vaccine development. It all started with a one-year research contract from the National Institute of Allergy and Infectious Diseases (NIAID) to develop a research ward to test vaccines on community volunteers. Dr. Levine and the division of infectious diseases prepared the containment facility, hired staff and nurses, established policies and procedures, and bought bunk beds. The faculty wanted the ward to have a collegial dormitory atmosphere. The facility, named the clinical research center for vaccine development (CRCVD), initiated its first clinical study, a Phase I trial of a mycoplasma vaccine, in October 1974.

After a year of work on viral vaccines, the NIAID awarded the CRCVD a four-year contract to support the unit. And while this pleased Dr. Levine greatly, he still couldn’t ignore the feeling that he was at a critical juncture in his career. "I was very gratified by the center’s success, but couldn’t help feeling restless. I missed being overseas doing field work and studying the diseases in which I was most interested - shigellosis, typhoid fever, cholera and E. coli," he says. And as luck would have it, Dr. Levine was about to experience one of his most critical life moments. Dr. Stanley Foster, head of the CDC smallpox eradication program in Bangladesh, asked Dr. Levine to travel to Bangladesh to help with the final push of the eradication program in August 1975. Dr. Levine was vaccinated against smallpox, took three months off, and went to Asia to help in the struggle to interrupt the human-to-human transmission of this devastating viral disease. "I absolutely loved the work in Bangladesh," he says. "It was exactly what I wanted to be doing. I never knew what surprises each day would bring as I traveled around the countryside, chasing rumors of smallpox cases," he continues. "I also did a lot of thinking and contemplated my future and the CRCVD’s future."

Upon his return to Baltimore, Dr. Levine contacted the NIH project officer and asked that the scope and focus of the CRCVD be expanded. "My goal was to expand the unit to include laboratory support for ancillary immunologic and microbiologic studies, and modify the work scope to allow investigator-initiated clinical research protocols on bacterial enteric infections," Dr. Levine says. "Another objective was to attract other investigators for work on fundamental aspects of vaccine development." Dr. Levine also wanted to establish collaborative research projects in developing countries where enteric diseases were prevalent. The NIH agreed to modify the contract accordingly, and to acknowledge the expansion of activities to include laboratory and epidemiologic field research. In 1976 the CRCVD was renamed the center for vaccine development.

In 1978, Dr. Levine was invited to Chile by the Pan American Health Organization and Chile’s Ministry of Health to consult on endemic typhoid fever and suggest cost-effective interventions. This five-week period marked the beginning of the CVD’s ongoing presence in Chile, and was the first field research unit to be established. 1978 was a watershed year for the CVD for another reason: the CVD developed and clinically tested its first vaccine, a non-living oral cholera vaccine.

The 1980s brought exceptional new faculty to the CVD and name changes to suit the needs of the expanding, multidisciplinary center. Up until this time, the center resided within the department of medicine’s division of infectious diseases. In 1984 the CVD was made a separate division of the department of medicine - the division of geographic medicine. The division of geographic medicine continued to work closely with the division of infectious diseases, and the two sponsored a joint fellowship program for interns pursuing infectious diseases training. That same year Dr. Levine was tapped to be acting head of the department of pediatrics’ division of infectious diseases, and when he accepted the post full-time in 1985, he changed the name to the division of infectious diseases and tropical pediatrics. "This more closely reflected the direction in which we hoped to lead the division, with an interest in the infectious diseases of children in developing countries," he says. "With the inclusion of the department of pediatrics’ division of gastroenterology and nutrition in 1992, the CVD truly became a center that crossed departmental lines."

Fast forward to 1999 when the CVD celebrated its 25th anniversary: by this time the CVD had 29 full-time faculty and a staff of 65 in Baltimore, with approximately 70 more staff at field units in Chile and Mali. It is the only university vaccine center in the world engaged in an integrated organizational structure of vaccinology - from basic science through development of vaccine candidates, clinical evaluation and large-scale field trials of efficacy. The CVD, with an international reputation for genetically engineering and testing vaccines for cholera, typhoid and malaria, has broadened its mission to include vaccinology education and immunization implementation programs.

Although 1997 was a hallmark year for the CVD - it was awarded the first-ever NIH five-year training grant in vaccinology and was awarded a second five-year training grant in emerging infections—2000 has thus far been the pinnacle. This time, however, when opportunity knocked, Dr. Levine almost didn’t answer the door.

In January 2000, representatives of the Bill & Melinda Gates Foundation approached Dr. Levine to discuss developing a measles vaccine that could safely and successfully immunize infants in developing countries. Although he has experience with measles after working for more than three decades in Latin America, Asia and Africa, Dr. Levine does not consider himself an authority on the disease. Therefore he declined to pursue the project. Luckily, the Gates Foundation wouldn’t take no for an answer. They approached him again and asked him to submit a proposal. "This time I was titillated by the entreaty," he says. "I realized that with the CVD’s expertise in live vector vaccinology and mucosa immunization, and with our infrastructure and track record of performing collaborative clinical trials in developing countries, we could indeed devise a rational strategy for developing a vaccine."

Dr. Levine devised a strategy to develop a measles vaccine in collaboration with investigators from the Johns Hopkins University School of Public Health and submitted it to the Gates Foundation. Last August the CVD was awarded a $20.4 million five-year grant that will be used to develop a safe and effective "stealth" mucosa measles vaccine that, for the first time, would protect infants less than nine months old in developing countries, particularly in Africa. The Gates grant now becomes the largest single grant on an annual basis in the medical school’s history.

So while Dr. Levine may have missed out on numerous opportunities over the years, he availed himself of the opportunities that really mattered. And the entire world benefits as a result. 

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