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A visionary in the fight to prevent AIDS

Doctor, scientist, HIV-infection expert, Ann Duerr's international experiences fuel her commitment to pursue a vaccine
Dr. Ann Duerr
As a key decision maker for the world's largest program to test a vaccine to prevent HIV/AIDS, Dr. Ann Duerr oversees the logistics of the HVTN's vaccine trials, which are carried out at sites in 13 different countries on four continents. Photo by Todd McNaught

In the fall of 1974, her bachelor's degree in biochemistry from McGill University in the bag, Ann Duerr packed up and boarded a plane to begin an overland trip to Indonesia. Like many adventurous young travelers, she expected a year of postgraduate travel to faraway lands would open her eyes to a world very different from her own comfortable upbringing. The self-described "science-fair whiz kid" never expected the trip would trigger a dramatic rethinking of a career path she had planned since childhood.

"I had always wanted to be a scientist — my dad was a scientist," said Duerr, now the associate director for scientific support for the HIV Vaccine Trials Network, which has its core operations center housed in the Clinical Research Division. "I had thought that I'd become a laboratory investigator, but my experience in Southeast Asia was life-changing. I knew I had to devote my future to addressing the problems of the developing world."

An unconventional path

As one of the key decision-makers for the world's largest program to test a vaccine to prevent HIV/AIDS, Duerr has more than lived up to the promise she made almost 30 years ago. The global epidemic she confronts each day has claimed more than 28 million lives, many of them in sub-Saharan Africa. Duerr's day-to-day work involves overseeing the logistics of the network's many vaccine trials on human volunteers — no small task for a program whose work is carried out at sites in 13 different countries on four continents.

"This is the public-health issue of my lifetime," she said. "It feels very good to be devoting my energy to it."

Duerr is the first to admit that her path to her present position — which included time spent in a cell-biology lab to earn a doctorate, and stops in Cairo to learn about parasitic diseases and Atlanta to work at the Centers for Disease Control (CDC), to name a few — was an unconventional one. But Dr. Larry Corey, HVTN principal investigator, said that Duerr's broad training is what makes her perfect for her current position.

"Ann brings a wealth of experience and commitment to the international HIV arena," he said. "She has trained in basic science, epidemiology and medicine and has worked in international health for more than 15 years. She has boundless energy, as evidenced by the pace of her speech and her walk. This enthusiasm for clinical research has energized the people who work with her."

Despite the commitment to a career in global health made during her trip to the Middle East and Asia after college, Duerr decided to continue with her original plan to obtain a graduate degree in biology at the Massachusetts Institute of Technology. She reasoned that a good foundation in basic cell and molecular biology would provide her with a deeper understanding of the deadly infections she hoped to someday eliminate. She completed her registration for MIT by the light of an oil lamp at an inn in Bali with no electricity or running water. Her thesis research, conducted in the lab of Dr. Frank Solomon in MIT's cancer center, focused on understanding the microscopic skeleton — known as the cytoskeleton — that provides the structure for cells to move and divide.

Growing global awareness

After taking a summer course in parasitic diseases shortly before finishing her doctorate, Duerr decided to pursue postdoctoral work in Cairo studying schistosomiasis, a disease caused by parasites that can lead to liver disease and bladder cancer. More than 200 million people worldwide are infected, mostly in developing countries with contaminated water supplies.

"In the transition, I realized that to work on human diseases I needed to be a physician," she said. Not one to shy from hard work, Duerr entered the Health Sciences and Technology program, which is jointly run by Harvard and MIT, and obtained her medical degree in three years. She completed her residency training in preventive medicine at Johns Hopkins University through a program that also allowed her to earn a master's degree in public health.

In her second year of training at Johns Hopkins she joined the faculty as an instructor, dividing her time between Baltimore and Rwanda, where she studied mother-to-child HIV transmission. Her travels to Africa, and introduction to the magnitude of the AIDS problem there, also prove life-changing.

In 1991, while in the midst of a research project that was one of the first to use a DNA-based method to track the transmission of HIV from infected mothers to their infants, Duerr received a job offer she couldn't pass up: chief of the HIV Section in the Division of Reproductive Health at the CDC. There, she oversaw several large international studies to study the clinical course of HIV infection in women and to identify how the virus is spread to women at risk. Positioned to pursue HIV vaccine

Because many of the early studies on HIV infection conducted in the United States and Europe had focused on men, her group, in collaboration with other CDC scientists and university researchers, followed 1,500 women for seven years to characterize the infection in women. Another of her early projects was to design a study involving 625 couples in Thailand, which examined factors that influence sexual transmission of HIV as well as factors associated with HIV resistance in some women. Later, she began to focus on intervention studies, including one in Malawi that examined whether a series of interventions among breast-feeding mothers could reduce the transmission of HIV to their children. Another study was designed to explore prevention options for at-risk women who are unable to successfully negotiate condom use with their partners.

About five years ago, Duerr decided that HIV vaccines — what many experts consider to be the only intervention capable of stopping the epidemic — were her real passion.

"I became convinced that vaccines are the thing that is going to make the difference," she said. "I wanted to move into a position that would allow me to work on HIV vaccines and was just waiting for the opportunity."

Expertise and enthusiasm

That chance arose in 2003, when Corey and HVTN director Dr. Judith Wasserheit invited Duerr to become of a member of their team. She arrived at the center last January. Duerr describes her position as a lead for scientific administration within the network, which includes overseeing the multitude of issues associated with the design and implementation of clinical trials to test new vaccines as well as deciding where promising new vaccines will be tested.

Wassherheit said that Duerr brings internationally recognized expertise on HIV infection, particularly in relation to women and reproductive health, as well as an infectious enthusiasm for her work that makes her an excellent colleague and mentor.

"Ann is a fireball in terms of her intellect, her energy and her passion for research to help end the HIV pandemic," she said. "She has a wonderful combination of training that bridges from the laboratory bench to clinical/epidemiologic research in developing countries."

To those who question why it is taking so long to find an effective preventive vaccine for HIV infection, Duerr reminds them that successful vaccines for many other major diseases were years in the making.

"A vaccine for polio wasn't developed until 47 years after the virus that causes the disease was discovered," she said. "HIV was discovered in 1983. It's true that HIV presents some unique challenges with respect to vaccine design. But most things that are worth doing are not easy."

AIDS enterprise

Duerr is encouraged by a recent coming together of organizations and individuals dedicated to HIV-vaccine research, an effort described in a 2003 article in Science co-authored by Corey and Wasserheit. Known as "the Enterprise," the movement aims to coordinate a more collaborative global approach to vaccine development, testing and implementation.

She is confident that effective vaccines are on the horizon.

"It's just a question of time, she said. "We've done fantastically well with treatment, but people are impatient for the next step. We have to remember that before drugs like the HIV protease inhibitors were licensed, it seemed we weren't making much real progress in treating HIV infection — it was the dark hour before dawn. We've made real progress."

The grim statistics she faces at work each day — as well as the face of the godchild she co-parents whose mother died of AIDS — inspire Duerr to work toward even greater progress. In turn, she hopes to inspire those around her. "I hope I can be a catalyst and use my talents for organization and my enthusiasm to make a difference," she said.

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