Meet The Scientist podcast: An interview with Gabriela Gomez, senior director of global access at IAVI

The first episode of Meet The Scientist, IAVI’s new podcast series, will explore the importance of economic modeling and epidemiology in tuberculosis (TB) vaccine research and development (R&D) and global health access in general. Listen to learn more about how IAVI is using economic modeling and epidemiology to develop affordable, globally accessible vaccines and antibodies.

In Amsterdam, we sat down with Gabriela Gomez, senior director of global access at IAVI, to discuss her work using modeling to understand the potential impact of a new TB vaccine. As the COVID-19 pandemic has waned, TB once again has become the leading infectious cause of death in much of the world. In 2021, an estimated 1.6 million people died as a result of TB disease, making a new TB vaccine all the more vital. Gabriela Gomez also uses modeling to better understand how a new TB vaccine can be developed and distributed in an equitable and accessible way.

See below for a full transcription of the podcast.

Hello. I’m Shaun Palmer, a communications specialist with IAVI in our Europe office in Amsterdam, and I’m pleased to be joined by Gabriela Gomez, senior director of IAVI’s access team, for the first episode of IAVI’s new Meet The Scientist podcast series. Today we’ll be talking about Gabby’s work with the access team and her career as an infectious disease epidemiologist and health economist and what this work means for TB vaccine development. Great to have you here today, Gabby.

Thank you. Thank you for inviting me.

My pleasure, my pleasure. So, to begin with, let’s hit the ground running, and I was wondering if you could tell us a little bit about what the focus of your work and your role is at IAVI.

Sure, yes. So I joined IAVI about a year ago, and I work in the global access team. As you mentioned, Shaun, I lead most of the health economics work that we do across disease areas, but work mainly in HIV and TB. And within this role, I tend to be in contact with regional and national immunization technical advisory groups, stakeholders, communities, key opinion leaders, and it’s really about understanding the future pathways for delivery of our products, whether it is for HIV, for TB, or other emerging infectious diseases. I have some projects that look at acceptability and feasibility considerations, really based on early target product profiles that are being developed as we speak. And I develop demand forecasts. So these are tools that really help in the discussions when we look at country or regional partners or potential manufacturers. And we work very closely with partners globally and locally to look into investment cases. So how to make these advances that we have at IAVI accessible at a country level and how to get them to the countries.

Your work here really gets to the core of IAVI’s mission to translate scientific discoveries into affordable and globally accessible public health solutions. And I know you’ve been working in the field of global health for over two decades now, and so I was wondering as well, what really motivates you to get up every day and contribute to global health research and development in the way that you do?

Yeah, so currently I really like my team and I really like IAVI, what we are doing, the energy that we have. So every day I feel that there is a bit of a challenge because we work with excellent professionals with different backgrounds, very different ways of communicating from different parts of the world, but everyone is really working to achieve the same goal, but with a never-ending energy. It really motivates me to work with the new products that we have. And I see that those products for me, is really about how do we make them accessible in the next 5-10 years. So for me, the work that we are doing today is really to make a difference in the next 10 years at a very local level. So that’s mainly what really gets me up every day.

That’s wonderful to hear. And I mean, your work now is of course very much focused on access across IAVI’s portfolio. But you’ve also spent much of your career working in TB and what has your work in the TB field involved?

Before coming to IAVI, I worked, as you say, in TB, I worked in TB vaccines, but I also worked in therapeutics. I worked with different organizations that were developing shortened treatments, whether it was for drug sensitive TB, MDR TB or extremely drug-resistant TB. But my focus has always been working with global stakeholders, countries, or product developers to understand how to introduce these new technologies, whether they were therapeutics or vaccine or prevention. And before I used to work a lot more in a country-specific way. So informing investment cases, looking at what is the impact at a population level. What is the best way to introduce these technologies that have the greatest number of cases averted, the greatest number of deaths averted, the greatest impact economically with cost savings, whether it is to governments or to the patients and trying to inform policy decisions to introduce these new technologies.

And so specifically, looking at your work in economic modeling, why is that so important for TB vaccine development and access?

So, modeling in general is a simplified version of reality and we really use it to understand a system. When we are looking at, for example, TB vaccine R&D, we really use modeling to estimate what would be the potential impact. And we present, we explore the characteristics of the products and the different ways that it could be introduced in a country and what are the characteristics that drive the impact that we are seeing. And we use all this information and this understanding of this system to make an investment case so that we can show the potential returns of developing such a technology. And then when we are looking at access, we get a bit more specific and we can work with countries to see what will be the most efficient way of introducing a future TB vaccine. For example, ways that are cost-effective so we ensure that those who need it most receive it. So it is equitable, but it also benefits the health system with cost savings and it benefits also the patients at a global level.

We can also use this type of modeling to help make the case for global organizations to plan on having timely financing and procurement pathways. So really preparing for introduction, but taking into consideration that once the vaccine is developed it needs to arrive to the countries. An example that we can see recently was the global investment case for TB vaccines where economic modeling was central on the evidence that was produced to build this investment case and we see that it was shown with this modeling that we need new TB vaccines to end TB. So without any actions at the moment, we will expect to have up to 32 million TB deaths between 2000 and 22,050 and that will result in really big economic losses of up to 17 trillion. While with a vaccine, modeling can show that there are substantial benefits, whether it is 372 billion in net economic benefits or benefits that are health benefits, between 40 and 76 million cases and five to 9 million deaths that can be averted over the same time. If we use these new technologies, these new TB vaccines across adults and adolescents, and really, economic modeling can help you make this case, show the potential impact that we can have should we develop these technologies.

Some really powerful data coming out to demonstrate the power of new TB vaccines in ending TB and of course the need to invest in them there. And have you found that over recent years that the focus on TB vaccines from the global health community has changed? Is there increased attention?

Oh, definitely. At the moment we have a great opportunity in the R&D space for TB vaccines. There are very few vaccines in the late-stage development, but it’s the first time that we actually have vaccines in the late-stage development. So, there is a lot of enthusiasm and traction in the global health community to ensure that these vaccines cross the line so really are developed, are registered, and are accessible to high-burden countries and communities. It is a very special time in the TB vaccine space. So, I feel quite thrilled to be part of this unique moment that we are at.

Yeah, and likewise I’ve joined the space much more recently but it’s wonderful to see kind of this perhaps inflection point that we’re at in the field and looking ahead later in the year. We’ve just had World TB Day and we’re leading up to the United Nations High Level Meeting on TB in September. So how can we as a community really come together in making our demands clear for new TB vaccines and really use the work of modelers and epidemiologists in making our demands?

So, I think that at the moment the big gap and the big ask will be to support a big effort into planning for country introduction and there are all the trials that are going to start and that need to be funded, especially the big Phase III trials. And I think there is a gap between those trials and the country introduction where we really need to start thinking very soon about what our role is and how to coordinate within the community, whether it is the financing mechanisms aligning supply and demand, the risking investments, especially for the Phase III trial. All these will need to have collaborations and actions that are coordinated in our group. Our group as in our community group. And if we want to ensure that these TB vaccines are developed, are registered and are part of the country planning in the next few years.

And I think the opportunities are now to advocate for these efforts and this coordination and these resources that are needed, I think really important considerations for us all to be having in mind as we do approach this milestone in September and make sure we are putting our best foot forward in terms of what we’re demanding. And you also mentioned that for the first time we have multiple candidates in late stage testing. It’s a really exciting time for the field. I was wondering if you could just share some thoughts as well. Why is it so important that we do have multiple candidates here? That we have a really full pipeline in development.

So, we hope that all candidates will prove effective, but there is a risk that some candidates might not. So, what you want is to have multiple shots on goal, basically to have several opportunities, should they all prove effective, that will be excellent for the field and especially because that will also mean that you have a choice and a broader supply capacity so that more people can have access to different candidates. That is for the late-stage candidates, of course, early in the pipeline. So early development, we have a lot fewer candidates, so there is not so much movement there. And that is something that we need to also focus on because the next generation of TB vaccines is clearly not ensured and we cannot really afford another 100 years for new Phase III trials.

Yeah, very well said. And you’ve also spoken about how we need to ensure that we have equitable access, that those who need the most can access them. And you just mentioned now as well about the need to have choice in a broad supply capacity. It’s important to have multiple candidates in development. And I was just wondering if, in a few words, if you could kind of explain what does equitable access really look like for TB vaccines in the next 5-10 years?

So, equity in access for TB vaccines really looks at those people, at those countries that are high burden. Countries need to have priority. They are the ones with the highest burden and the highest need. And then the equitable access will mean not equal access, but it will mean that we prioritize those countries with highest needs.

Yeah, thanks for explaining that so clearly. So, looking a bit more broadly at your work as a researcher within the access team here at IAVI, what do you really hope your work and efforts here are going to accomplish for access to global health innovations across the board?

Yeah, well, within the global access team we are working to achieve timely and adequate access. So that means both accelerating the introduction of this technology. So, from the moment that you have registration to make it available as quickly as possible. And currently this kind of work is what I’m hoping is all about collaborations through to really get from the product developer, from the manufacturer to the country. So, at the moment, we are mainly working on how to bridge that gap, to align supply and demand, to plan for investments and to encourage financing and procurement mechanisms, so that once the products are developed, that we get them to the countries as quickly as possible. And then from the country really working in collaboration with who is really leading the country introduction, guidance, and investment cases at that level.

You just touched upon collaborations as well and of course collaborations are so vitally important at the organizational level here across the board to make sure that these technologies are accessible. But just thinking back to some of your personal collaborations over your career throughout your own education, I was wondering if you could tell us about a scientist who you’ve looked up to and who’s really informed your own work.

Sure. So, I don’t know, with this kind of question I would have thought of answering with some inspirational big figure. But as you mentioned for me, I look up to my collaborators and the mentors that I have had past and present. A person that has really changed the way that I see the world and work and both academic and in global health is my Ph.D. supervisor. So, Geoff Garnett. he has been a mentor for 17 years. He is a sounding board for any change in my career but especially he has been an absolute role model. Not only he’s a great academic and a great strategist working with the Gates Foundation, but in particular he’s an absolute rock in his community. He spent a lot of time sharing the knowledge with the community where he lives, whether it is in the north of England or in the Pacific Northwest, in the U.S. And he will be mortified to hear me talking like this about him because he’s very modest. But I do think that he has been excellent in shaping the way that I see and how to give back to the community and how important it is to keep yourself grounded. But in general, I actually do think that I look up with all my fellow scientists and fellow colleagues here at IAVI. I take note every day of their dedication, energy, creativity, and a lot of humor.

That’s great to hear, I mean, it’s wonderful to hear the gratitude you have for your colleagues there. You mentioned about taking things forward here and I know you work quite closely with young researchers yourself as a supervisor now and I was wondering if you could just share some insights to anyone who’s listening who might be interested in pursuing a Ph.D. in access and modeling-related work. What would you tell them or what would you have liked to have heard yourself when you were in their position?

I will say something like you never know where you will land. But I think it is an extremely rewarding career path. Starting a Ph.D. is a big endeavor, so that needs to be a really thought through decision. But once you engage, you get access to all these people that are extremely rounded professionals, very motivated, and it’s a very rewarding career path. I would also say that exposure, exposure to different cultures, different settings, whether it is academia or industry, are really key because in the future we will not be able to develop these products only in industry or only in the public sector. We will have to create these collaborations and learning during your formative years how to talk to different people from different backgrounds will be quite important. So, a variety of settings, a diverse exposure will be key during your formative years. But I think that in the future it will be an area that I think will continue to expand as we become more and more aware of the needs to prevent future pandemics, ongoing epidemics, and the key role of equity in ensuring that we all have a healthy future.

Some really motivating words for anyone interested in the field here. Great opportunity to enter a dynamic, ever important area of work for the global health world at large. So, before we wrap up, I just wanted to pose one final question to you. Not related to your work per se, but simply what is one thing that people would be surprised to know about you?

Well, being Venezuelan of origin and having worked in the U.K. and in sub-Saharan Africa, I think people might be surprised to know that my first venture in the field of epidemiology and where I really fell in love with epidemiology was in the middle of the desert in Sahara in Tozeur, Tunisia. And it was just luck I was there studying nutrition and my supervisor redirected me to an epidemiology survey because we were short of staff. And from that moment on, I fell in love with epidemiology. And that’s the moment that I decided that I wanted to work in global health and to eat a lot of Harissa.

Some powerful realizations to have in the desert. And to paraphrase what you said before, you never know where you’re going to land in your career, but you also never know where an inspiration will strike. Well, a big thank you for joining us today, Gabby, for the first episode of IAVI’s new Meet the Scientist podcast series. It’s been a pleasure to talk with you and to everyone who is listening, thank you for joining us and please subscribe and look out for the next episode.