2005 Derek Dunn Memorial Senior Scientist Officer of the Year
CAPT Robert Linkins
CAPT Robert Linkins was selected as the 2005 Derek Dunn Memorial Scientist Officer of the Year for his work to improve the monitoring of measles and to increase measles immunization in the United States. Although CDC began awarding registry grants in 1993, less than 10% of U.S. children were being monitored in 1997. That year, the President directed the Secretary of DHHS to develop immunization registries. CAPT Linkins was asked to lead this effort. As a direct result of his leadership, ~10 million U.S. children now benefit from registry monitoring. Registries automate proven strategies to ensure high coverage by generating reminder/recall notices, assessing immunization needs based on complete histories, and measuring coverage to identify missed immunization opportunities and target at-risk groups. CAPT Linkins organized and implemented a major registry initiative in 1997; >100 national experts gave testimony and 21 parent focus groups were held nationwide. He directed the 1998-1999 effort to set a Healthy People 2010 (HP2010) registry goal to increase monitoring to 95%. Consensus on reaching this goal was gained with federal partners (CMS, DoD, HRSA, IHS, USDA), state/county/city health departments, professional and non-profit organizations, and parent groups. CAPT Linkins chaired a nationwide committee in 2001 to develop a strategic plan for reaching the HP2010 goal, and created an innovative method for measuring progress. Specific partner activities were identified, agreed upon, and funded (~$500,000/year). CAPT Linkins defined CDC’s registry role as a standards setting organization. In 1997 he saw the need to define a “registry” by a set of functional standards. Under his leadership, 12 standards were identified and adopted by stakeholders and the National Vaccine Advisory Committee (NVAC). In 1999 he organized and chaired a national committee to develop minimum specifications for protecting registry data. These specifications are HIPAA-compliant and were approved by NVAC in 2000. In 1999 he chaired a national committee to develop inter-registry data exchange protocols. In 2000 he obtained NVAC funds (~$125,000) to develop and pilot test a data exchange tool in seven registries. From 1999 – 2003 he conceived a formal registry certification process, successfully advocated for its national endorsement, identified certification funding, created a certification body, and led the development and pilot test of measurable certification standards in three states. In 2001 he conceived an innovative method to assess the efficacy of registry de-duplication algorithms through automated sensitivity and specificity assessments, and led the pilot test of his method in four states. In 2002-2003 he led the development of NVAC-endorsed standards of excellence on how registries can improve vaccine management, delivery and assessment, quality assurance, and surveillance. CAPT Linkins recognized the need to justify CDC’s ~$300 million investment in registries (since 1993) by showing their usefulness. In 2000 he led the creation of a sentinel registry network that enables near real-time evaluation of coverage and the impact of policy changes. Eight states now receive CDC funding for sentinel activities ($600,000/year). CAPT Linkins and senior staff in 2000 obtained a Centers for Medicare and Medicaid Services agreement to pay up to 90% of registry costs. CAPT Linkins led the creation of new nationally-representative partner groups: the American Immunization Registry Association, the Committee on Registry Standards and Electronic Transactions, and the Provider and Technical Working Groups. CAPT Linkins wrote 10 peer-reviewed registry articles (one nominated for CDC’s highest scientific award – the Shepherd Award), gave 45 registry talks, co-hosted a registry video with Mrs. Rosalynn Carter that was sent to >55,000 U.S. providers, furnished expert comment to journalists, mentored ~10 fellows, and annually chaired a registry conference of >400 national and international stakeholders. In 2003 he was awarded the first-ever CDC Special Registry Recognition award for his efforts. The results of CAPT Linkins work: All 50 states are building registries. 43% of U.S. children were subsequently actively monitored. Registries have been shown to increase immunization rates as much as 45% in children and adults. Nationwide, they are also being actively used to: Identify and vaccinate at-risk groups: Children were targeted who were: born to hepatitis B surface antigen positive mothers (Rhode Island); vaccine exemptors during pertussis (Minnesota) and measles (New York City) outbreaks; delayed due to vaccine shortages (23 states); non-compliant at school entry (DC); WIC participants (Oregon, Michigan); and recipients of sub-potent (California) / expired (Arkansas) vaccine. Increase vaccine safety: Registries were used nationwide to assess cardiomyopathy and intussusception associations with smallpox and rotavirus vaccine, respectively. Monitor policy impact: Oklahoma evaluated the feasibility and impact of implementing an all inactivated polio vaccine schedule. Oregon evaluated the impact of hepatitis B vaccine policy changes after public concern over a vaccine preservative. Texas evaluated the use of pneumococcal conjugate vaccine in public vaccine recipients. Coordinate preventive care: Rhode Island increased lead toxicity screening by 60% after its integrated immunization registry was used to identify at-risk children. Nationwide implementation of CAPT Linkins’ technical innovations has: Improved data quality: Oregon decreased record duplicates from 50% to <10%. Texas’ registry records were at least as complete as records in all 92 clinics evaluated. Enhanced “gold-standard” coverage assessment: 4/4 states showed that National Immunization Survey estimates are improved when supplemented with registry data. Increased accountability: Annually, registry enrollment and standards achievement are accurately measured to account for CDC’s $25 million/year registry investment. In addition to registry-related cost savings associated with reduced vaccine-preventable morbidity and mortality, estimated annual expenses of >$270 million are avoided by reducing the number of record pulls for immunization checks ($76 million) and school entry ($168 million), and duplicate vaccinations ($27 million). As the nation’s expert on immunization registries, CAPT Linkins’ visionary leadership made immunization registries a cornerstone of U.S. immunization delivery.
2005 Young Scientist Officer of the Year
LCDR Daphne B. Moffett
LCDR Moffett joined the USPHS in July 1999 and quickly demonstrated her leadership skills. She received the VADM Koop Junior USPHS Officer of the Year Award for her exemplary performance and accomplishments in USPHS assignments, civic accomplishments including offices held, demonstrated leadership abilities, and notable contributions to the mission of the USPHS. LCDR Moffett served as chair of the Scientist Professional Advisory Committee (SciPAC) appointed by the Surgeon General. She also served as Chair of the Professional Advisory Committee Chairs (PAC Chair) Board, which consists of the chairs of each of the USPHS Commissioned Corps PACs. She served as Acting CPO following the death of RADM Joseph and stepped up to take on the role of acting SciPAC chair 6 months prior to the start of her term. She has served two terms of service to the PAC and has been the Rules Subcommittee Chair, Vice Chair of the PAC, and COA Category Day Chair. Additionally, she has served as a CV reviewer through the SciPAC and has mentored several new Scientist officers. LCDR Moffett served on the Board of Directors for the national COA (Commissioned Officers Association) and as the Chair of the Public Relations Committee. LCDR Moffett has been appointed to the CDC/ATSDR Commissioned Corps Policy Advisory Committee (CC-PAC) whose purpose is to work with CDC/ATSDR leadership and officers stationed at CDC/ATSDR to determine impact of CC policies and best practices for implementation of Transformation goals, etc. She serves on the Resource Work Group which is working with ORC macro to develop identity messages for the USPHS CC and develop a recruitment campaign. LCDR Moffett has completed BOTC and IOTC and is a member of the Atlanta area Honor Guard. At her agency, LCDR Moffett is the director of the Tri-Agency Superfund Applied Research Committee (TASARC) which is responsible for identifying research needs pertinent to human health effects from superfund sites for EPA, NTP, and ATSDR and for identifying mechanisms to address these research needs. She worked closely with EPA to promulgate the first ever EPA/ATSDR Test Rule which would require companies that manufacture specific chemicals to conduct toxicological studies to investigate toxic effects which would be of interest to public health. LCDR Moffett served as the agency representative to several interagency chemical testing working groups. LCDR Moffett is engaged in many civic activities. She has volunteered her time to the Toys for Joy Campaign, volunteered to collect food items for the Atlanta USO, and volunteered to speak to high school students about her work as a commissioned officer in the USPHS. LCDR Moffett started her PHS career in the Office of Tribal Affairs at ATSDR. Within a few months, she had written an agency training manual ATSDR’s Working Effectively with Tribal Governments and administered the corresponding course to agency staff. Her timely efforts in producing the manual earned her a Citation. She worked closely with tribes, tribal councils, colleagues from Indian Health Service, the Department of Defense and others to answer complex public health problems in a timely and scientifically credible fashion. LCDR Moffett moved to the Division of Toxicology and again immediately looked for ways to support the division and in particular the Computational Toxicology Laboratory. Of her own initiative, she requested additional training in biologically based modeling and proceeded to seek out public health projects in which her expertise could be used. She was recognized for her efforts at a particularly complex site through the award of an Achievement Medal. LCDR Moffett has received over 24 PHS (and non-) CC and agency awards for her contributions to the agency’s mission, public health, crisis response, and service to the PHS. LCDR Moffett is recognized as a good teacher and authority in her field. She was invited to teach a 2-day risk analysis course to government officials in Thailand to assist them in developing their public health expertise in the area of environmental health. She has also been recognized by the agency for her expertise on chemical weapons of mass destruction and industrial chemicals and served as the on-call expert during the National Democratic Convention. She is the lead for Trichloroethylene (TCE) activities and serves as the TCE chemical manager. Because of the increase in her workload and responsibility for agency level tasks, LCDR Moffett has recently been placed in an O6 billet. LCDR Moffett has been an outstanding example of a dedicated, young Scientist Officer. She has volunteered her time and knowledge to serve her peers, her agency, her community, and the PHS.