By Shivani Majmudar
Medill Reports

As COVID-19 unraveled the world, many scientists and leaders struggled to find direction amid unprecedented uncertainty. For Dr. Richard Novak, though, the situation was all too familiar.

Novak, 66, heads the Division of Infectious Diseases at the University of Illinois-Chicago and has led HIV clinical care and vaccine research efforts for more than 25 years. Serving on the frontlines when HIV peaked in Chicago in the 1980s, he learned how to care for stigmatized patients suffering from a deadly illness with no available treatment at the time. All of it prepared him to confront similar challenges during COVID-19.

“My experience with HIV taught me how to approach [COVID-19] and learn more about it,” Novak said. The basic organization and operations for vaccine clinical research are the same, whether the virus is HIV or COVID-19.

“It won’t be solved overnight, but at least I knew what steps needed to be taken,” he said.

Growing up, Novak was fascinated by biology and the natural world. After college, he initially pursued a graduate degree in genetics, but quickly realized that experience was not for him. As with many children who aren’t quite sure of their career path, Novak eventually heeded the advice of his mother and applied to medical school.

As a medical student at Rush University, Novak took particular interest in tropical diseases such as malaria and dengue fever. It combined his passions for science and traveling — something he still enjoys today.

But when he completed his fellowship training in infectious diseases amid the HIV epidemic, he took on the emergency and became known as the “HIV doctor” at the University of Illinois-Chicago. Since there was no treatment during the first terrible years, Novak found himself managing his patients’ secondary infections and doing what he could to improve their quality of life.

“It was overwhelming at times,” he said. “We saw a lot of deaths.”

What struck Novak the most, though, was how social stigma impacted patients’ access to care. HIV primarily infected marginalized people in society at the time, such as gay men and injection-drug users. He had colleagues who refused to care for his HIV patients.

Recognizing how stigma might prevent others from even seeking out much-needed medical attention, Novak built the University of Illinois HIV/AIDS Community Clinic Network in 1989. He brought compassionate, comprehensive HIV care — including mental health counselors, case managers and needle exchange programs — to the neighborhoods that needed it the most.

“Our clinics hid behind nondescript storefronts to fly under the radar,” he said. “We raised awareness through word-of-mouth.” Today, HCCN runs six clinics across Chicago.

When COVID-19 emerged, Novak took to the pandemic frontlines again and saw the same stigma reappear around those infected. People and doctors alike were afraid of patients with COVID, he said.

But this time, the stigma went far beyond just marginalized populations. Marginalized populations, however, continue to have worse outcomes because of the social inequity they experience.

“Poverty and social injustice have a lot to do with how people respond to healthcare,” Dr. Novak said.

In August, UIC began its Phase III clinical trial of the COVID-19 vaccine created by biotechnology company Moderna Therapeutics. It’s one of 89 test sites for approximately 30,000 participants across the country. UIC has emphasized the importance of making their patient population reflective of those most vulnerable to the infection — 75% of their 305 patients are Black and Hispanic.

Despite Novak’s experience in clinical vaccine research, COVID-19’s unprecedented speed and magnitude posed a unique challenge.

“It’s been quite busy processing 300 patient samples in just eight weeks,” said Nanu Kunwar, one of Novak’s lab assistants.

But the team remains optimistic that their work now will be worth it.

“It’s exciting to be part of this moment in history,” said Mahmood Ghassemi, Novak’s lab director and colleague for 20 years. “We’re all doing our best and hoping something positive will come out of vaccines we’re testing.”

The trial involves more than just giving people the vaccine. It’s still a research study, Novak said, and requires a tremendous amount of data collection.

Patients are monitored carefully for several weeks after they receive the vaccine to watch for signs and symptoms of COVID-19 infection or other possible side effects from the vaccine.

“It’s anticipated that most people will get COVID-19, but the point is to see who gets really sick with it and if patients who got the vaccine had milder symptoms than patients who didn’t,” Novak said.

So far, there have not been any serious complications with UIC’s study. In the coming weeks, Novak plans to start another Phase III clinical trial at UIC with Johnson & Johnson’s COVID-19 vaccine.

Even in the midst of these trials, though, it’s still too early to guarantee what the future of the coronavirus looks like, Novak said. More research needs to be done to answer questions regarding the longevity of the virus and whether it will be seen seasonally like the flu.

“But what we do know is that if we have vaccines available, at least we’ll have the option to keep the virus from rearing its ugly head again.”

See related: The race for COVID-19 vaccines: A deep dive into Moderna’s frontrunner candidate

Shivani Majmudar covers health, environment and science at Medill. You can follow her on Twitter at @spmajmudarr.