Azucena Bardají (Barbastro, Huesca, Spain, 1974) works to reduce the gap between the most advanced discoveries in the field of health and their application to the world’s most vulnerable populations, who, as we know—although perhaps we too often ignore it—don’t benefit much from these advances. But the Spanish epidemiologist not only doesn’t ignore the problem—she is laser-focused on overcoming it. Among other things, she studies diseases that can be prevented through maternal immunisation. “This is an excellent opportunity to protect mothers and their children against diseases that are a major cause of morbidity and mortality, such as pneumonia or neonatal sepsis,” she explains.
“My research aims to understand the impact of diseases caused by respiratory syncytial virus (RSV), group B streptococcus (GBS) and influenza virus, diseases that can be prevented by maternal immunisation, in low-resource countries, and to evaluate the safety and efficacy of vaccine candidates administered to pregnant women to prevent these diseases in their children,” summarises Bardají.
Maternal and child health in low-resource countries is significantly affected by infectious diseases, especially those most closely associated with poverty, such as malaria, pneumonia and HIV. However, the vaccines that could prevent these diseases or the drugs that could treat them are either unavailable or unaffordable to the most vulnerable populations in these regions of the world, which particularly affects pregnant women and children.
Her team helped persuade the World Health Organisation (WHO) to prioritise the use of IPT-SP and mosquito nets to reduce the impact of malaria in pregnancy
Sometimes it takes a major problem like this, which undoubtedly reveals the great lack of international solidarity that still exists on these issues, to make one realise the scale of a problem. This is what happened to Bardají. After completing her residency at the Tropical Medicine Department of the Hospital Clínic de Barcelona, she was offered the opportunity to work at the Centro de Investigação em Saúde de Manhiça (CISM) in Mozambique, and she didn’t hesitate. She admits that that experience got her totally hooked on her current speciality.
Twenty years have passed, and for her it was key to have had as references and mentors such relevant professionals “as the international expert in malaria prevention strategies in pregnancy, Dr. Clara Menéndez; the international reference and former director of the WHO Global Malaria Programme, Dr. Pedro Alonso, and the specialist in tropical medicine, Dr. Manuel Corachán”. Bardají works at the Barcelona Institute for Global Health (ISGlobal). She is also a lecturer on the Master’s Degree in Global Health, organised by ISGlobal and the University of Barcelona (UB).
“The biggest recent breakthrough is the approval of the first maternal vaccine to prevent severe RSV disease in children, a milestone in maternal vaccine research, and with the potential to have a major impact on child health”
In Mozambique, she and Clara Menéndez investigated malaria prevention strategies in pregnancy, such as intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) administered to pregnant women through antenatal services and the use of insecticide-impregnated mosquito nets. “This work showed the protective effect of IPT-SP against clinical malaria in pregnant women, and more importantly the effect of IPT in preventing neonatal mortality,” she says.
As a result of that clinical trial, her team helped persuade the World Health Organisation (WHO) to prioritise the use of IPT-SP and mosquito nets to reduce the impact of malaria in pregnancy in sub-Saharan Africa. This has been instrumental in reducing the number of cases.
Azucena Bardají also coordinated the EU-funded collaborative PregVax Project, specifically aimed at determining whether there are pregnancy-specific immune responses. She explains its importance: “This project collected data from more than 10,000 pregnant women in five Plasmodium vivax endemic countries in the Americas and Asia and demonstrated that P. vivax infection in pregnancy is associated with adverse maternal and neonatal health outcomes and characterised previously undescribed pathophysiological aspects of P. vivax infection (parasite attachment).”
“In sub-Saharan Africa, HIV infection is a major public health problem with more than 25 million people living with HIV”
In the countries where action is most urgently required, she highlights the sub-Saharan African region, which has the highest number of malaria cases and deaths. “In this region, HIV infection is a major public health problem with more than 25 million people living with HIV infection,” she explains.
And what diseases can now be prevented by maternal immunisation? Currently, WHO-recommended maternal vaccines include tetanus, whooping cough (Bordetella pertussis) and influenza virus. In fact, the first maternal vaccine to prevent RSV infection in children was only approved last August, the researcher points out. And there are other maternal vaccine candidates currently in advanced clinical trials to prevent sepsis in children caused by GBS, she adds.
“New technologies hold the promise of a whole new generation of vaccines that can protect populations from devastating diseases that the global community struggles to control”
The field of maternal immunisation research has received a major boost and investment of resources in recent years, says Bardají. “The biggest recent breakthrough is the approval of the first maternal vaccine to prevent severe RSV disease in children, a milestone in maternal vaccine research, with the potential to have a major impact on child health, particularly in resource-poor countries with the highest burden of RSV mortality.”
The emergence of new technologies in vaccine development and passive immunisation strategies using monoclonal antibodies has had an unprecedented impact on the prevention of infectious diseases, as witnessed during the COVID-19 pandemic, she recalls. “These new technologies represent a promising and hopeful platform for a whole new generation of vaccines that can protect populations against devastating diseases that pose a challenge to the global community.”
For now, Azucena Bardají has two dreams. One is “to contribute in the coming years to reducing infant mortality in low-resource countries, especially in Africa, by researching new vaccines against diseases that mainly affect mothers and children.” Her other dream is no less ambitious: “To support and encourage scientific careers for girls and young women, and to contribute to the visibility and leadership of women in science.”
Susana Pérez de Pablos
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