An Indefatigable Warrior for the Lives of Children in the Developing World

It took years of research in Asia and Africa for Alfred Sommer, recipient of the Dan David Prize, to build consensus that Vitamin A can help lower child mortality rates.

Professor Alfred Sommer, who was awarded the Dan David Prize Sunday, will never forget the moment that changed his life and the lives of tens of thousands of children in developing countries.

In 1982, Professor Sommer was going over the statistics from a series of studies of blindness that he had conducted in Indonesia over a period of several years for Johns Hopkins University in Maryland. Sommer, a prominent ophthalmologist and epidemiologist, noticed that many Indonesian children suffered from xerophthalmia, a condition in which the eye fails to produce tears. Those who suffer from the disease are at risk of night blindness and eventually, of total blindness.

“I tried to find the most affordable and practical way to treat the children to prevent night blindness in the early stages,” Sommer said in an interview with Haaretz. In one study that was conducted over eighteen months among 3,500 children, he found that Vitamin A was effective in preventing blindness. “I tried to find out specifically why certain children in some villages suffered from the vitamin deficiency and were going blind, while children in other villages didn't suffer from the deficiency and weren’t going blind.”

In the data-processing stage, when Sommer was 40 years old and had returned to the United States to serve as a professor of epidemiology and ophthalmology at the Johns Hopkins Bloomberg School of Public Health, he was amazed to discover something surprising. In a tracking study of 4,000 Indonesian children over time, the group of children being tracked was smaller at each point in time. He quickly grasped the meaning of that statistic: the children who had become blind had not suddenly disappeared. They had gradually died off.

Sommer, who had proved that administering Vitamin A improved the children’s sight, realized right away that the vitamin could do much more; it could keep the children from dying. Work on the ground quickly proved him right. “I realized that the dryness of the eyes was not only a symptom of a Vitamin A deficiency, but a symptom of a severe deficiency that could increase the chances of the child dying,” he says. Later on, he even showed that the more severe the Vitamin A deficiency, the higher the risk of death. An article published in the medical journal The Lancet in 1982 about his revolutionary finding became a major article in the field, but did not get much publicity. “My article was completely ignored,” he said. “It presented thinking outside the box.”

Sommer says he does not believe pharmaceutical companies caused his article to be ignored. “In my estimation, it had nothing to do with pressure from the pharmaceutical companies,” Sommer says. “It was colleagues in the medical community who ignored it. Even though the essay appeared as a major article in the periodical, no editorial accompanied it, and no response to it, not even a letter to the editor, was published later on.”

The knives came out

Sommer realized that he would have to furnish incontrovertible proof that administering Vitamin A could prevent child mortality. A controlled experiment he conducted on 450 villages in a region of Indonesia provided that proof, finding that giving only two doses of Vitamin A to babies aged one to six months led to a 34-percent decrease in infant mortality by one year of age.

When Sommer published an article on the topic in 1986, also in The Lancet, the responses were particularly harsh. “That was where the knives came out,” he said. “Many scientists were skeptical of the results and couldn’t accept the fact that only two doses of the vitamin, which costs only two cents per dose, could have such a significant effect on the children’s mortality rates. They claimed that the children were poor, lived in poor neighborhoods and were exposed to many risk factors, and so it was inconceivable that the vitamin was such a good solution. My colleagues were really angry. I was surprised at how forceful their opposition was.”

But Sommer didn’t give up. Under the shadow of the opposition, he began several studies in Asian and African countries to reproduce the results of the previous studies and prove his theory beyond any doubt. In one study in Mumbai and in the Tamil Nadu district in India, he even succeeded in showing that three doses of a Vitamin A supplement led to a 50-percent decrease in child mortality by age five.

In 1992, when the advantages of administering Vitamin A became clear beyond all doubt, the ethical aspect of his studies became problematic. “It was no longer ethical to withhold Vitamin A from some of the children as the control group,” he said. A round-table discussion he began with professionals who had participated in studies on the topic for the Rockefeller Foundation resulted in uniform guidelines stating that Vitamin A should be given to all children in poor countries to prevent mortality.

Later that year, the WHO adopted Vitamin A as an accepted treatment for preventing child mortality in poor countries. An independent UN report determined that Vitamin A was effective in reducing mortality by 23 percent in children aged six months to five years. A World Bank report found that Vitamin A was one of the most effective and economical medical interventions that had been identified until that time.

According to Sommer, the reason so many children suffer from Vitamin A deficiency is that the vitamin comes from animal sources such as beef and eggs, which poor populations cannot afford to buy, rather than in fruits and vegetables, which are more affordable.

Treatment with Vitamin A is now funded by UNICEF, with half a billion pills distributed every year in at least 60 countries that are defined as major targets for treatment, where more than 70 children per 1,000 births die before age five. In some countries, a decision has been made to add Vitamin A to foods.

Memories of Pakistan

Over the years, Sommer developed a love for numbers and statistics. A random memory of a study that he conducted as a young epidemiologist during the 1960s while he worked in eastern Pakistan for the American Center for Disease Control later saved millions of Americans from getting the smallpox vaccine when biological terrorism was feared after the attacks of September 11, 2001.

Although the last case of smallpox was documented in Somalia in 1977, specimens were still being used in research laboratories and as a threat of biological warfare. “When they told me that two million Americans were going to be vaccinated for smallpox, I remembered a study claiming that a person could be vaccinated against smallpox even six days after becoming infected. A few days later, I remembered that the study was mine, and I managed to find the data.”

The study, which was conducted in Pakistan in the 1970s during a local smallpox epidemic, was resurrected and sent to the highest-ranking microbiologists and infectious-disease experts in the U.S. When the study was presented at a meeting that took place at the Institute of Medicine of the National Academies after the events of September 11, it was decided not to vaccinate Americans as long as the virus did not appear.

In April 2003, during his term as dean of the Johns Hopkins Bloomberg School of Public Health, Sommer criticized the intention of members of the U.S. Congress to reduce medical research grants through the National Institute of Health for research considered “politically sensitive,” including studies intended to prevent the spread of the HIV virus among prostituted Asian women and men who wish to undergo sex-change operations. Sommer spoke out against high-ranking NIH officials who instructed researchers who requested grants to remove sensitive words from their proposals.

Sommer is still studying ways to prevent blindness. He deals mainly with public health, an area that is becoming more significant in ophthalmology and in medicine in general. He shares the million-dollar Dan David Prize in the Future category with economist Professor Esther Duflo of the Massachusetts Institute of Technology.