Recent worries over the reemergence of once-quelled illnesses like whooping cough, and 2015’s deadly Ebola outbreak has refocused attention on public health’s major frontline defense against infectious diseases: vaccines.
“They’re really the best preventative tool we have in public health,” says epidemiologist and School of Public Health (SPH) Assistant Professor Nicole Basta.
SPH actively participates in vaccine research across Minnesota and around the world to protect us from historical, current, and future biological threats.
Basta devotes particular attention to determining the most effective strategies for using vaccines in vulnerable populations.
“There are so many barriers to developing and ensuring access to new vaccines, as well as understanding how well they protect people and the best way to use them,” says Basta. “I work to determine how to design more efficient vaccination strategies to get the maximum benefit.”
A Global Fight
The countries most heavily hit by infectious diseases and in need of vaccines are often also the ones least capable of providing them.
“The highest disease burden and suffering due to infectious diseases is in many of the most resource-poor countries,” says Basta.
A case in point is what’s known as “the meningitis belt” in Africa, which lies just below the Sahara Desert and stretches from Senegal to Ethiopia. For more than a century, the region’s 400 million people have endured a yearly, dry season outbreak of meningitis.
Since 2009, Basta has been working along side several international groups to test MenAfriVac, an inexpensive meningitis vaccine created specifically for the region. The vaccine was created by the global health organization PATH and the World Health Organization with support from the Gates Foundation.
A major part of Basta’s epidemiological work has been a study of 800 people in Mali to determine how long protection from the new vaccine lasts. Protection from older vaccines typically declined after one year. Recently, her analysis has shown MenAfriVac protects for longer and lasts for at least two years.
The vaccine itself is made with a component from another vaccine for tetanus, which is still a deadly problem in Mali. With that in mind, Basta’s also been checking to see if the meningitis vaccine protects against tetanus as well, and her analysis has shown that it does.
“You’re getting a two-for-one punch with this new vaccine,” says Basta.
Local Vaccine Issues
Back home, Basta has also helped combat meningitis here the United States. In 2014, as researcher at Princeton University, she worked to deal with an outbreak of meningitis B.
To fight the disease, the FDA gave Princeton special permission to distribute a vaccine only approved for use outside of the United States.
“This was a really unique opportunity to learn about the impact of this new meningitis B vaccine,” says Basta. “We did a whole series of studies with the Princeton students to see how well the vaccine would protect against the outbreak strain.”
Bata found that only 66-percent of students had an immune response against the outbreak strain after getting two doses of the vaccine.
“While the outbreak ended soon after the vaccination campaigns, these results raise some questions about whether the vaccine really will be comprehensively protective in other outbreaks,” says Basta.
Becoming More “Flu-ent” in Influenza
Aside from seemingly random meningitis outbreaks, one of the most prominent infectious disease risks across our country each year is the flu.
Not surprisingly, Basta has completed work to help us be smarter about using flu vaccines.
“I collaborated with mathematical modelers to try to predict the benefits of just targeting school children, who really are the ‘super spreaders’ for flu,” says Basta.
The CDC recommends that almost everyone six months of age and older get the annual flu vaccine, but research has shown that only 50-60 percent of people actually follow the advice. Basta’s study revealed that if we specifically focused on vaccinating at least 70 percent of school children, we could prevent far more cases of the flu than we do now, even if no adults get the shot.
But in America, there are misconceptions surrounding vaccine use, causing it to decline.
“We have a big problem with trying to increase vaccine uptake,” says Basta.
According to Basta, many Americans have grown up without ever seeing anyone afflicted with the diseases we commonly vaccinate against, like pertussis, commonly known as “whooping cough.” As a result, more and more people are foregoing vaccinations for themselves or their children, erroneously believing the diseases are gone; in reality, these diseases have been suppressed by the herd immunity generated by previously high rates of vaccination. The trend in skipping vaccinations has resulted in increased cases of once rare diseases like pertussis.
It all suggests that when it comes to vaccines, vigilance is essential to intelligently research and address the ever-changing nature of infectious diseases.
In terms of where to base vaccine research, Basta says SPH is an ideal place. Before coming to SPH, the NIH awarded Basta a five-year, “Early Independence Award”, a yearly $250K grant given to promising young researchers to pursue their own studies. With that award, she was looking for a great place to perform research.
At SPH, she found faculty who routinely engage in primary epidemiological and policy research, and also readily partner with the University’s Medical and Veterinary Schools, as well as various governmental programs.
“The U brings together everything I need to build a successful research program into one place,” says Basta.
The research Basta and her SPH colleagues are focusing on covers a cadre of current and emerging public health concerns. Key among them is global health.
“We are now so closely globally linked through travel, so a disease that emerges is really a problem for all of us,” says Basta.
Basta believes issues like disease dynamics — such as the seasonality of meningitis outbreaks in Africa — and climate change are collectively contributors to the state of global health, and also distinct public health issues themselves.
“We need to understand what factors shape those dynamics that we observe currently in order to predict what’s going to happen in the future as the global climate, population, and other factors change,” says Basta. “One thing we know about infectious diseases is that we can never become complacent. Even when we have the upper hand against diseases, there are always changing dynamics that can bring even greater challenges.”