Closing the gender health gap: the role of maternal vaccines

The gender health gap is a longstanding and persistent challenge in healthcare and health research. Its origins are varied and include the long-underfunded women’s health research, which represented only 5% of global research and development funding in 2020. This lack of funding is alarming since projects focusing on women’s health are essential in overcoming the gender health gap. The gap represents the difference in access to quality health care between women and men, as well as among women of different racial, ethnic, and socioeconomic backgrounds. PROTECT project aims to address some of these inequalities with our maternal vaccine research, led and run by African countries.

The care received by women during pregnancy and the postpartum period can significantly impact their health and the health of their children. While largely harmless to pregnant women, Group B Streptococcus (GBS) is the leading cause of sepsis and bacterial meningitis in newborns if it’s transferred to them during birth. Currently, the most common way of protecting pregnant women from the bacteria is using antibiotics if GBS is detected during pregnancy. Routine screening, as well as easy access to antibiotics, however, are only common in high-income countries, widening the health gap between women depending on where they live. The effects of this are startling, with an estimated 65% of GBS-related stillbirths and infant deaths occurring in Africa.

Fortunately, a powerful tool to address this gap is currently being developed: a GBS vaccine for pregnant women. Once vaccine trials are completed, this vaccine can protect women and stop preventable newborn deaths due to GBS disease.

“Globally, most of the maternal vaccine clinical trial data used in decision making has been generated from high-income countries, although the highest disease burden for vaccine-preventable diseases is in low-income countries,” reminds Dr Nakabembe, PROTECT scientific lead. Reflecting on the importance of carrying out vaccine trials in African countries, she adds: “Setting up vaccine trial infrastructure in Africa provides local context data which is vital to inform policy positions and clinical care guides in Africa.”

Maternal vaccines have great power in bridging the gender health gap, as they are much more cost-effective than routine screening, making them accessible in low- and middle-income countries. With its activities, PROTECT is taking steps to ensure that the eventual introduction of the GBS and other maternal vaccines is successful.

Disease surveillance through pregnancy registries

We are supporting hospital sites in Kenya, Malawi, Mozambique, and Uganda to establish pregnancy registries, which will collect data on pregnancies, deliveries, and infant follow-up. Right away, the collected data will inform the local medical professional’s care for pregnant patients, improving its quality. Later on, having this data gathering infrastructure will enable the sites to carry out maternal vaccine trials.

“The pregnancy exposure registries are used to monitor pregnancy outcomes of pregnant women who receive vaccines,” says Dr Nakabembe. “They provide crucial data relating to the safety of new maternal vaccines.” By monitoring and estimating the GBS disease burden in low-income countries, PROTECT is bringing extra training and increased knowledge about the disease and vaccination to these settings. If we want a vaccine to eventually be impactful, the best way is to build the foundations needed for vaccine trials in places where vaccines will be most needed.

Exploring vaccine confidence and hesitancy

Not forgetting about the importance of eventual vaccine trial participation and vaccine uptake, PROTECT is also exploring vaccine trial participation and vaccine confidence. The social scientists involved in the project are looking into the drivers behind vaccine-related decisions, and the findings will inform future materials aimed at informing people about the benefits of maternal vaccination.

Maternal vaccines have, highlights Dr Nakabembe, “a triple effect of protecting the mother, fetus and newborn from vaccine preventable diseases.” The PROTECT consortium, through its varied activities, is committed to combatting barriers that prevent equal access to safe and effective maternal vaccines for all who need them.

You can learn more about activities and work packages here.