Meet the Scientist: Dr. Gaudensia Mutua on IAVI’s Lassa fever vaccine development program

In this episode of Meet the Scientist, IAVI’s podcast series, we sat down with Gaudensia Mutua, a medical director with IAVI in Nairobi, Kenya, to discuss her work in support of IAVI’s Lassa fever vaccine program. We delved into the value of community-engaged scientific research before looking ahead to the future of global health and vaccine development in Africa.

Tune in to learn about Gaudensia’s rich medical career — from community-based HIV vaccine research to overseeing IAVI’s Lassa fever vaccine studies.

Below is a full transcription of the podcast.

Welcome to the latest episode of IAVI’s Meet the Scientist podcast series. I’m Sydney Slouka, a communications specialist with IAVI in New York City, U.S. Earlier this year, we spoke with Dr. Gaudensia Mutua, a medical director with IAVI in Nairobi, Kenya, about her rich career in medical research spanning nearly three decades.

After dedicating seven years to hospital work, Gaudensia transitioned to research and joined the University of Nairobi for 16 years, specializing in HIV-related studies and leading critical vaccine trials. She is now a key leader in IAVI’s Lassa fever program, which has advanced to Phase 2 clinical trials.

Join us as we dive into Gaudensia’s work at IAVI and her broader contributions to medical research. First, we asked Gaudensia to share a bit more about herself and her experience at IAVI.

I started off my career in emergency medicine. I trained at the University of Nairobi, and I have worked almost my whole life in Kenya. So, when I started off as a doctor, I was working at an emergency department in a private hospital. But for me, I felt that that wasn’t really what I wanted to do. It wasn’t a perfect fit for me. And so, I would say that the turning point for me was in 2001. My friend and fellow doctor, she was my classmate and my roommate in medical school. She was the first person in Kenya to go public about participating in an HIV vaccine study. And you have to realize that at that time, HIV was still very stigmatized. So, she faced a lot of backlash from the community, even from her own colleagues and even for me. I have to say that I didn’t understand at that point why she would want to participate in a vaccine trial and particularly HIV vaccine trial. I wondered why she would expose herself, too, by coming out to the public and declaring that she’s a study participant.

I started to reflect a little bit more because I was looking for opportunities to leave clinical practice and perhaps do something else. And then in 2004, the organization that was conducting those HIV vaccine studies, which is KAVI Institute of Clinical Research within the University of Nairobi, advertised for a position for a physician to run a community-based research site and I applied for that position, and I was interviewed and got the job. And from 2004, all the way until 2020, I worked at the University of Nairobi. I worked mainly in a community-based research site. I specialized mainly on HIV vaccine research and also other HIV-related studies. In that site, we saw more than 3,000 participants in the course of those 16 years during various studies.

Also, critical to my work in 2014, there was the major Ebola outbreak in West Africa. And that created for me an opportunity to also be involved in Ebola vaccine research and the two vaccines that we actually tested eventually went ahead to be licensed. In 2020, an opportunity came up to join IAVI and that is when I made the switch from an investigator to working for a sponsor organization. And since joining IAVI, my focus has been on Lassa fever. For those who are not familiar with the disease, this is also a viral hemorrhagic disease very much like Ebola. It causes a lot of bleeding, but unlike Ebola, it is a disease that is constantly present. Ebola comes in outbreaks, but Lassa is constantly present in West Africa. And so, for the last four or so years, I have been involved in overseeing studies and testing a candidate vaccine against Lassa fever and so that’s really a summary of my professional life and how I have found myself in this space.

Let’s learn more about Lassa fever. Why is it dangerous and what, if any, treatment and prevention options are available?

So, Lassa fever is caused by a virus that is part of the diseases that we call zoonotic diseases. It’s one of the diseases that jump from animals to humans, so it circulates mainly among rats. And because of contact between rats and human beings, particularly around the homestead, you get a transmission from the rats to human beings. The majority of people who get the infection actually do not become sick from it, but about 20% of people who get the disease, who get the infection, become ill.

The most severe form of the disease involves bleeding from various parts of the body, bleeding into the major organs of the body and there is also a complication of Lassa, which is deafness. Some people who get Lassa will go deaf, and that deafness can be permanent. The other complication of Lassa is among pregnant women. It can cause miscarriages. It can cause death of the mother and even in pregnancies, late pregnancies, it can lead to death of the fetus, so it can be a serious disease for those who develop complications.

For the most part, it occurs in West Africa, sometimes in seasons. You may find that there are certain seasons where the disease becomes more common and for the most part, this is a disease that has been neglected and that’s why IAVI’s work in this area has the potential for public health impact. As far as prevention, there are approaches that have to do with minimizing contact with rats, making sure that rats do not come into contact with your food, and they’re not coming into contact into your house.

Treatment options are limited. There is a drug that is available, and that is used for treatment but for them, as far as vaccines are concerned, we do not have a vaccine against Lassa virus and that’s where the work that IAVI is doing is groundbreaking and we are hoping that this candidate vaccine will be able to move to licensure.  

In addition to leading medical research and clinical trials, we also wanted to discuss another aspect of Gaudensia’s research. Throughout her time at IAVI and beyond, Gaudensia has been a committed community-engaged scientist. Let’s hear a bit more about her experience working closely with community members and supporting capacity strengthening across Africa.

So that is actually the two areas in my field that I absolutely enjoy. So, for instance, community engagement is something that was part and parcel of my work in KAVI, working at the University of Nairobi because as I said, this was a community-based research center and one of the things that I learned is that communities will always start from a point of mistrust and caution because they are not familiar with a research process. And some of the measures that we implemented are based on good participatory practices. We work with communities, building relationships, building trust and building partnerships with communities and it has been very rewarding to see people moving from a point of mistrust to a point of collaboration and that comes upon just investigators being very transparent about the work that they do.

Investigators being able to communicate clearly and in simple language the work that they are conducting in communities and it’s also about communities taking ownership of the health problems that they face and becoming stakeholders in the approaches to mitigate those health problems. I think the work particularly in HIV brought me in contact with vulnerable populations particularly the MSM [men who have sex with men] community which had largely been neglected and had been criminalized in my country and trying to highlight those vulnerabilities.

It also brought me in contact with an adolescent population who also have unique vulnerabilities to HIV, and HIV for those of us who are working in sub-Saharan Africa is still a major problem. We still have almost 40 million people in the world living with HIV, and for us in Africa these numbers are not just statistics — they are friends, they are relatives, they are neighbors, and so it’s really a personal engagement to work with communities that are uniquely vulnerable to HIV. The other area of course is capacity building and again there is capacity building even within communities. So, most of our communities are not familiar with the research, our work involves building that capacity, helping them understand the research process so that they can be meaningful partners in the research process. The other capacity building that we have been involved in is just building the research ecosystem. A lot of the work that I did was really not necessarily in a state-of-the-art research institute. I actually worked in a refurbished shipping container.

And for me that is an indication that you don’t necessarily have to wait for very high-level state-of-the-art infrastructure. You can still do very high impact research within a very modest setting. But over time we have been able to transfer technology, particularly technology in the lab to conduct laboratory assessments for the blood samples that we collect.

We have also been able to mentor next generation investigators. As I said, for 30 years that have been in the vaccine development space, we still do not have an HIV vaccine, so we have to build the next generation of investigators that will take over from us once we are no longer able to continue in this space. I think, to me, these are the two most rewarding aspects of my work — just working with communities and building trust and also thinking about the next generation of investigators that will take this work forward.

Next, we asked Gaudensia to elaborate on some of the challenges communities face with respect to vaccines and vaccine research, particularly the growing issue of vaccine hesitancy.

So, for me vaccine hesitancy has become a global phenomenon, and it’s fueled by just misinformation that is spread particularly through social media.

From my own personal experience, I grew up at a time where I could see survivors of polio. We had students that you would see in the school yard, we had teachers that were survivors of polio that would go around with difficulty walking, walking with their calipers, and for a long time this was part of our normal experience.

In the last 20 years or so, I can say that I have not actually encountered a survivor of polio. And so that tells what a successful vaccination campaign is about. I also grew up at a time when we used to get vaccines against smallpox. That is also another disease that has been more or less eradicated, so there’s no more need for vaccinations against smallpox. And so, vaccine hesitancy for me is a heartbreaking thing to deal with because it really underscores the fact that people do not necessarily appreciate the public health impact of vaccinations. And that’s because a successful vaccination program leads to an elimination of a disease and people might find it difficult to appreciate the absence of a disease. For most people who have been born at a time when polio is not so evident, they may have, perhaps, the luxury of questioning the interventions that have led us to this point. I am increasingly concerned that more and more people are joining into this global phenomenon of vaccine hesitancy and are being fed with a lot of misinformation. And this might actually scale back the successes that we’ve had in our vaccination program, so certainly, this is something that concerns me on a daily basis.

Rightly said and great example regarding polio. We were also curious to hear how Gaudensia has addressed these challenges and what strategies may be effective for researchers to have productive conversations with community members.

There’s no shortcut — you cannot disregard people’s concerns. Community engagement still remains our primary approach to addressing this issue and this is part of the reason why I actually agreed to be part of this podcast. I think it’s important for people to meet the people who are involved in vaccine development. We are people that are really invested in the health of our communities. By holding this podcast, we are bringing people into our space and helping them realize that vaccine development does not occur in secrecy. We are subordinate to a lot of national and international regulations. We are subordinate to international standards of ethics; safety of vaccines is our primary concern and we do not churn out vaccines that are harmful to populations. We are hoping through these exercises to create channels of communications, to create platforms for people to engage with the scientists that are involved in vaccine development so that they can ask questions, and we are more than willing to engage with those who have questions and who have concerns about the vaccines that are available. But we really want to get the message out that we estimate that more than four million people — their lives are saved every year from vaccination, we really want to push the agenda that vaccines are a powerful public health intervention.

As we wrapped up the interview, we also wanted to look ahead to the future and ask Gaudensia how she envisions this field evolving throughout the next 5-10 years.

In thinking about what the next 5 to 10 years looks like to me, there are a couple of things that I’d like to see. As I mentioned, we still don’t have an HIV vaccine and I fear that people might think, because of all the successes we’ve had in the treatment for HIV, that people might stop prioritizing HIV vaccine development, but it’s important to remind people that there’s still about 40 million people that have HIV. There’s still about a million people that get infected every year and so we still have a lot of work to develop a vaccine. I think that the current approaches are going to bring new energy into the field. So, I’d like to see donors continuing to support the HIV vaccine development space because I think the fact that we don’t have a vaccine is not a reflection of lack of effort. It really is a reflection of just what kind of virus we are dealing with. So that is one area that I would really like to see still moving forward in the next 5 to 10 years.

For Lassa, I really do expect, you know, I have a lot of optimism for the candidate vaccine that we are testing. So, within the next 5 to 10 years, I would like to see a vaccine that goes into licensure and I’m hopeful that this is something that we in IAVI will be able to achieve.

And then just reflecting on vaccines in general and Africa specifically. It’s interesting to realize that Africa accounts for almost 25% of the disease burden in the world. And yet only 4% of these clinical studies, these high impact studies, are conducted in Africa. So, I would like to see a little bit more of that being done. I’d like to see growth of the capacity strengthening that we have done. I’d like to see vaccines being manufactured within the continent so that we are able to service the people that need the interventions the most. So, if that can happen, and we can have a new generation of investigators, I feel that my work in this field will have been worth it. I would not like to see what we have invested in for so many years not growing or not having an impact on the disease burden in the continent. For me, that is what the future would look like and that is what success would look like for me.

Thank you so much for joining us, Gaudensia, and for sharing your impressive experience in the field. We are at such an exciting moment for global health, and we are looking forward to what’s ahead.   

I really do appreciate this opportunity to just be here and reflect on the work that we have done and also to recognize that we are building on the work other investigators have done. I’m really grateful for this opportunity and I look forward to further engagement.

You have been listening to IAVI’s Meet the Scientist podcast. We hope you join us for the next episode.