With just under 10 weeks to go until the World Vaccine Congress in Washington this April we are already getting prepared and meeting some of our amazing speakers. We are delighted to share our first interview for this Congress, a conversation with Dr Francesca Micoli of GSK. This was a written interview, and we are very grateful for the time and insight that Dr Micoli put into it!
Introduction and experience
Our first question allows our speakers to introduce themselves to the community, touching on aspects of their work that are significant to them and putting their current roles into context. Dr Micoli emphasises that she is a “chemist by training”.
From 2007, at Novartis Vaccines Institute for Global Health, to her current role at GSK Vaccines Institute for Global Health (GVGH) in Italy, her research has focused on “the development of effective and affordable vaccines against high-burden infectious diseases”. Her work specifically considers diseases that “mainly affect the most disadvantaged regions of the planet”, including Salmonella Typhi, Salmonella Paratyphi A, non-typhoidal Salmonella, Shigella, Group A Streptococcus, and Neisseria meningitidis.
“I have been Technology Platform Head at GVGH, working on two main technology platforms, glycoconjugation, and Generalised Modules for Membrane Antigens (GMMA).”
This has a focus on evaluating “how vaccine design can impact the immune response, supporting rational dosing of improving vaccines”. Since April 2020, Dr Micoli has been Senior Project Leader of the Shigella project. More recently, she has become Director of the GVGH Innovation Academy. This is where a “group of young talented scientists works on many different technology platforms”. The goal here is to “advance them and facilitate the development of vaccines in particular to target AMR in lower income countries”.
“I have many collaborations in place with academic and industrial partners, as I believe that putting together different knowledges and expertise is key to accelerate innovation.
I am proud to be part of GVGH, as part of the Global Health strategy, we have an enormous opportunity, and a responsibility, to use our world-leading scientific expertise to make an impact.”
AMR: addressing through prevention
Dr Micoli will be discussing AMR at the Congress, with a specific view to prevention. We asked about the burden of AMR, and why it is so important to prevent, rather than respond to, the problem.
“AMR is an urgent threat with an increasing impact on global health.”
Although “resistant bacterial infections have been associated with 1.27 million deaths per year”, the burden of AMR is highest in “limited resource settings”. The danger of antimicrobial-resistant pathogens will only increase, Dr Micoli warns, with “the number of deaths exceeding those due to cancer by 2050”.
“Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.”
This challenge needs an “integrated strategy to develop new interventions to fight multi-drug resistant bacterial pathogens effectively”. For this, Dr Micoli believes that “vaccines can have a major role”.
“Vaccines have an unprecedented impact on human health and, differently from antibiotics, can be used for decades with an extremely low probability of resistance emergence. Vaccines could not only prevent or reduce life-threatening diseases and thus decrease health care costs and sequelae remaining after infection resolution, but could also reduce the use of antibiotics, with the potential of decreasing the emergence of AMR.”
With the possibility of “sufficient vaccine coverage” comes “indirect protection (herd immunity)”, which prevents the spread of resistant strains.
Challenges and solutions
As we are specifically interested in the role that vaccines can play, we asked about how they can alleviate some of the challenges associated with AMR. Through specific examples, Dr Micoli outlines the contribution that vaccines have already made!
- “For pneumococcus, several studies have suggested that decreased pathogen carriage and infections in vaccinees substantially reduced antibiotic prescriptions and diminished the circulation of resistant strains.”
- “The introduction of Haemophilus influenzae type b conjugate vaccine has been demonstrated to reduce bacterial carriage in both vaccinated and unvaccinated individuals.” This “resulted in lower levels of transmission and fewer infections, thereby decreasing the need for antibiotics and the number of opportunities for antibiotic-resistant strains to spread”.
- “Rotavirus vaccination is estimated to prevent 13.6 million antibiotic prescriptions every year for children under the age of 5 in lower income countries”.
Although vaccination is a fantastic approach, “AMR is a complex problem and requires a multisectoral approach and an integrated strategy”.
“Greater innovation and investment are required in research, and there are often biological, clinical development-related, and economic challenges which differ from one pathogen to another.”
Furthermore, Dr Micoli points out that “implementation” of already available vaccines should be a focus, particularly in lower income countries. Initiative to “raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers, and policy makers” will “slow the development and spread of drug-resistant infections”.
Vaccine technology
Dr Micoli’s session at the Congress also examines vaccine technology in relation to AMR. We asked her about recent advances that will contribute to our efforts, and what else might be needed. She identifies “great advancements in the field of vaccines” over recent years. Specifically, the “use of technology platforms to accelerate vaccine development” has improved. Some of the approaches that have been significant include:
- Reverse vaccinology
- Novel adjuvants
- Structural vaccinology
- Rational designed bacterial outer membrane vesicles (OMV/GMMA)
- Nanoparticles
- mRNA
- Progress in polysaccharide conjugation
- Bioconjugates
- MAPS
Further advances in “genomics, bioinformatics, genetics, microbiology, immunology, and structural biology” offer promise.
“The possibility to rapidly apply a certain platform to target different pathogens, a better understanding of their mode of action, the opportunity to combine some of them, is certainly simplifying and accelerating the development of more efficacious vaccines at lower cost and increasing the probability to use the most appropriate technology for a certain pathogen.”
Finally, the “One Health approach bringing together multiple sectors and stakeholders engaged in human, animal, and plant health, food and feed production could contribute to fight AMR.”
Access with BactiVac
As a Board member of the MRC-funded BactiVac, the “first bacterial vaccine network, with a lower income country-centric focus”, Dr Micoli has a demonstrated interest in product access. We asked about the issue of access in tackling AMR, and how there might be a way forward.
“AMR is a global issue and must be addressed as such.”
The WHO calls for “equitable and global access to the vaccines that already exist, especially among populations that need them most in limited-resource settings”. However, it can be difficult for vaccines to be introduced in “parts of the world where they can have truly profound impacts”.
Thus, understanding the “relative ‘value’ of vaccines against AMR pathogens is becoming increasingly crucial to inform priority setting for vaccine investment and introduction decisions”.
“For lower income countries, at GSK our purpose is to unite science, technology, and talent to get ahead of disease together. It is important to do end to end access planning in the development process, to ensure clarity on the regulatory, policy, and financing pathway to market and to partner to address complex global health challenges.”
Looking ahead to the Congress
Our final question is about the Congress, what Dr Micoli hopes to get from it and what she is excited about!
“This Congress represents for me the opportunity to meet key experts in the vaccine field, hear about advancements in the field, discuss about needs and think together to ways to address them. This is an opportunity to establish novel collaborations and create further innovation.”
We are so grateful to Dr Micoli for her time and insight in producing this piece. We look forward to her attendance at the Congress in April! To join us for Dr Micoli’s session at the Congress, get your tickets today.
For a previous post that also explores the issue of AMR, read Dr Charlie Weller’s interview from last year.
