Thinking big about child health and vaccines

Cornelius Rau

Accompanying a childhood vaccination team in a remote part of Brazil spurred Cornelius Rau, SM ’23, toward the goal of improving child health on a large scale

May 4, 2023 – For four weeks in 2011, Cornelius Rau would wake up every morning at dawn to the sounds of birds and insects in the vast Brazilian rainforest. After a quick coffee, he’d start hauling blue cold boxes to a small metal motorboat on the Xingu River; inside were vital vaccines that he and a group of Brazilian nurses were delivering to the indigenous peoples of the area. There were no roads in this protected indigenous territory, the first of its kind in Brazil, so he and the nurses would motor several hours upriver every morning from a health post to remote villages to vaccinate young children against diphtheria, tetanus, pertussis, measles, and other diseases.

Rau was in Brazil on a semester exchange program as part of his medical school training. During his time in the rainforest, he came to greatly admire the work of the nurses, who had developed a rapport with the local population over many years. Not only were those relationships key to indigenous communities allowing the vaccines to come to their village in the first place, but they had led to one of the highest childhood vaccination rates in the entire country. “There was one nurse who had done it for a couple of years and they trusted her, so she was the only one actually allowed to vaccinate,” Rau recalled. “It was mind-blowing to see how you could provide health in a setting that others would consider too hard to reach.”

The experience in Brazil inspired Rau to think about how to improve health on a larger scale. Now graduating with a master of science in epidemiology at Harvard Chan School, Rau hopes to combine his new skills in biostatistics and epidemiology, his clinical experience as a physician, and his training in anthropology to address challenges such as ensuring that kids around the globe get their vaccinations.

“Vaccines are one of the most important interventions in the history of public health—you buy a vaccine for a dollar or two, and you can protect someone for life, and even eradicate diseases worldwide,” he said. What really inspired Rau to pursue a public health degree was seeing the rapport between the nurses and the indigenous communities, and seeing laughing children line up for their shots. “I couldn’t do something just to produce pretty graphs,” he said. “It’s these patient stories and encounters that makes this close to my heart.”

Life-changing experience in Costa Rica

Rau grew up in southwestern Germany. Eager to learn about other cultures, he spent six months in Costa Rica after high school volunteering at a local community center. The experience was life-changing. “Many of the children were from immigrant families, and parents were working two or three jobs,” he said. Even though Costa Rica is known for its comprehensive health and social security system, many of the families struggled from a lack of resources. “I realized it was very different from the way I had grown up in Germany,” he said.

Back home, Rau entered a six-year combined BA-MD program at the University of Münster to become a physician, taking every opportunity to return to Latin America. In addition to the semester he spent in Brazil, he also did a clinical internship learning about primary care for children in the suburbs of Lima, Peru.

After earning his MD in 2013, Rau went on to study for a master’s degree in anthropology at the University of Cambridge. His experience in Brazil had convinced him of the importance of having cultural expertise in working with marginalized populations.

In the following years, Rau completed a fellowship on child immunization with the Pan American Health Organization in Washington D.C., and worked as a consultant for the World Health Organization in Geneva. Compiling statistics about childhood immunization coverage, Rau noticed challenges in how some countries were reporting their data. To dig deeper, he and colleagues analyzed data from 194 countries around the globe, finding that while the quality of the data improved from 2000 to 2019, about one-fifth of the data contained potential quality issues. The study was published in February 2022 in PLOS Global Public Health.

It’s crucial, Rau said, to vaccinate against important childhood diseases right after birth, providing several shots within the first year of life. “You need a strong public health system to do that,” he said. “In fact, the coverage of three doses against diphtheria, tetanus, and pertussis is an indicator of how robust the entire immunization system is.” While some countries such as Costa Rica have high rates of childhood vaccination, health systems in other countries struggle to provide that basic level of care, particularly since the COVID-19 pandemic.

Learning the language of numbers

After completing a five-year pediatric residency focused on neonatology, intensive care, and vaccine research in Germany last year, Rau felt he needed stronger training in statistics and epidemiology, and decided to pursue a master of science in epidemiology at Harvard Chan School. “I realized how important it is to speak the language of numbers,” he said. “As a clinician, you have all of these stories about patients and can craft narratives, but what convinces policymakers is getting the numbers right and knowing what you can and can’t do with them.” In his epidemiology classes over the past year, he has learned how to crunch numbers while applying them to real-world examples such as tuberculosis in European refugee communities or measles outbreaks in Madagascar. “I wouldn’t consider myself a statistician, but it’s helped me fill in this piece of the puzzle,” he said. “Now the first thing I read are the methods sections of papers.”

Rau has particularly appreciated courses that combine statistics and policy, such as one he took on leadership development in global health taught by Menschel Senior Leadership Fellow Roman Macaya, former head of the Costa Rican Social Security Fund, which provides public healthcare in that country. During the class, Macaya invited the former president of Costa Rica, Carlos Alvarado Quesada, to talk to students and to participate in a fireside chat that Rau moderated. Talking to the young world leader, who is passionate about public health and climate change, was a heady experience for Rau, reminding him of where he began his own public health journey.

After graduation in May, Rau hopes to apply his unique blend of clinical experience, anthropology, and epidemiology to solve challenges related to childhood vaccination. “I would love to contribute to taking this cross-disciplinary perspective to global child health, and work in a setting where people from all kinds of countries come together,” he said. “I think it is super-essential that clinicians, social scientists and data people all work together; you need all of these people to listen to communities, understand what’s going on, and improve things.”

Michael Blanding

Photo: Kent Dayton