Q&A: March of Dimes Expert on a COVID-19 Vaccine Going Global

Sixty-five years ago, Jonas Salk, with a team of scientists from the University of Pittsburgh and support from March of Dimes, developed the first safe and effective vaccine against polio. Today, the world faces the COVID-19 pandemic, and as the number of COVID-19 infections and deaths continue to rise, there is an urgent need for a vaccine.

Typically, vaccines take years of research and testing before being made available, but the urgency of COVID-19 has pushed scientists to work to compress that process—without compromising safety or good science.

Dr. Rahul Gupta is senior vice president and chief medical and health officer, as well as interim chief scientific officer for research and global programs, at March of Dimes—an 80-year-old organization that fights for the health of all moms and babies around the world. “We strongly believe that the mothers and babies are the cornerstones of any civilization,” Gupta says.

This Thursday, Gupta will join a panel hosted by the Maternal Health Initiative at the Wilson Center featuring experts from Pitt, the Jonas Salk Legacy Foundation, the CDC Foundation and others to discuss how we can learn from the past epidemic that Pitt helped halt.

The conversation is on Oct. 15, 2020, 10 a.m. to 11:30 a.m. ET. It is free and open to the public, but participants must register.

As a preview to the event, Pitt Magazine senior editor Ervin Dyer spoke with Gupta about ensuring the safety of and access to a COVID-19 vaccine, building trust with underserved populations, keeping mothers and babies healthy and more.

How does the March of Dimes monitor the safety and effectiveness of a potential COVID-19 vaccine?

We’ve learned you've got to make sure there's a trust in the manufacturing process and data process—you've got to make sure that people are willing to take the vaccine.

Surely there could be side effects that are unrecognized, because at this time with the COVID-19 vaccine candidates, we're not testing millions, we're testing thousands and sometimes just tens of thousands. So, when we start to give it to billions of people around the globe, there will be some unrecognized side effects.

The important piece would be, do we have systems robustly in place to recognize that? Do we have the transparency and honesty in government to say that and level with people? And then we need the trust of the public to know that that vaccine is safe to the extent we can make it safe. These are all factors that March of Dimes continues to work on with our federal partner agencies.           

Are there other agencies that you work with to build confidence of having a safe vaccine?

Certainly. We have an equitable maternal health coalition at March of Dimes that includes at least a few dozen national groups, including the Academy of Pediatrics and the American College of Obstetricians and Gynecologists as well as groups such as Black Mamas Matter Alliance, Human Rights Watch and several others.

We're working with community organizations and March of Dimes supporters across 50 states. We work with academia, with universities—and part of that work is because we're also engaged in research, which is part of the history of March of Dimes. So, because of this outreach, we've been able to develop the confidence of the research community, the academic community, as well as community-based organizations across the nation.

Why is it important that we focus on mothers and mothers to be?

We strongly believe that the mothers and babies are the cornerstones of any civilization. We cannot have a society be sophisticated, engaged and successful if we don't value our moms and our children—and we're not doing that a great deal lately in this country. Today, the United States has one of the highest maternal mortality and morbidity rates in the developed world, we have a mom dying every 12 hours around the clock as a result of childbirth, we have a baby dying literally every half hour, we have over 21,000 infants who don't get to see their first birthday. On top of that, the U.S. has a preterm birth rate that has been rising for five years; it’s to the point that one in 10 babies born is preterm.

And, these statistics are worse for Black American women, correct?

If you're a Black woman in this country, you're three to four times more likely to die during childbirth than a white woman. If you're a Black woman in this country, you're 50% more likely to give birth to a preterm infant. Unfortunately, we have this unique American phenomenon where not everybody is affected and impacted equally. There are some inherent and structural aspects that make certain populations, certain Americans, much more vulnerable than others. We stand alongside all moms and infants. We especially believe that we can never even begin to address these issues unless we take it from the lens of equity and start to address that.

And how about pregnant women and a COVID-19 vaccine? 

We know that there's a great percentage of women of childbearing age in this nation who are going to get pregnant in the next 12 months, and they have to be a target for vaccinations to make sure that even if they cannot get the vaccine during pregnancy—because that has not been studied yet—they must get the vaccine prior to becoming pregnant so they can protect themselves, their unborn child and the child after birth. So, we do think this population needs to be targeted, especially in underserved communities, so that we can make sure that there are fewer complications from this pandemic during pregnancy.

What you described acknowledges structural divisions largely shaped by race and class. When you have these kinds of issues, how does March of Dimes then begin to plan for equitable distribution of a vaccine?

I think the first step is talking to people, making sure that there is a trustworthy process that's ongoing. And then in communities, it's very important to work with others to build that confidence.

Hear more from Peter Salk, Rahul Gupta and other experts at the Oct. 15 virtual panel, “Rolling Out a Vaccine for COVID-19: Present Prospects and Lessons from the Past.” Register now.

Here's the problem: The populations who are having the worst outcomes through COVID-19 are African Americans and Hispanics. They're the same people who are often having to decide whether to go to work and risk getting COVID-19 or risk being unemployed. It’s not a fair choice. It’s important that these groups have a trustworthy organization that is nonpartisan, to be able to give the facts on the vaccine’s safety and efficacy.           

So, it's important for us to make sure that we talk straight to folks and tell them the importance of protecting themselves and empowering themselves with a safe and effective vaccine. On the other hand, we need to give them the promise that we will fight for them. When we do see troubles or issues come up with a vaccine during the process or distribution or supplies, we will be there standing right beside them to do that.

Paradoxically, the populations—at least what we’re seeing from surveys—that are most skeptical about the vaccine, are the same populations that need it the most. We need to understand that, and we've got to make sure that we are all working to ensure that equitable distribution occurs, otherwise, the consequences are dire and ones that our country cannot afford.

What do you imagine distribution and accessibility to a vaccine will look like?

One of the things I encourage folks to do is look at other routes of distributing the vaccine. So, I think what we're going to find is that the vaccine is going to be available not only at your doctor's office, but at your local health department, at your pharmacies. Perhaps there will be other sites that can be designated, perhaps an EMS station, schools and other places.

We have to be creative. We have to meet the people where they are. The days of waiting for people to come to the four walls of the doctor's office for a vaccine, especially during a pandemic, are over. It's important that we figure out whether we do drive-through campaigns or all kinds of creativity to be willing to make sure that your group, your jurisdiction, your population is making sure that they're protected.

Read firsthand accounts from patients who participated in the polio vaccine clinical trials at Pitt.

As we think about a vaccine rollout, talk about some of the lessons from rollout of the polio vaccine.

I think the school model is one example. We could have school vaccine clinics, as long as the parents provide permission. More than likely, there will not be a charge, so that removes the economic barrier. So, we now need to do what we did very similar with polio: We need to find sites—whether they're schools, whether they're health departments, whether they're offices, whether they're hospitals and clinics—and make it easy for people.

Local health departments can start to send teams to offices and businesses, and have employees bring their families with them. Businesses and other sites can be used as point of care sites for vaccination clinics, and they can have a variety of hours.

What should we begin to be conscious of, or to think about when we're planning for global rollout of a COVID-19 vaccine and protecting marginalized communities around the world?

First of all, polio did not get eliminated from most of the world, just because we eliminated it in the United States. These diseases are only a plane flight away. We found that out the hard way this time around with COVID-19.

So, we have to ensure the elimination—or at least the control of this pandemic—across the world. Just to take care of it in the United States does not address the populations of the world.

The first step we have to do is we have to get back to the workings of the World Health Organization; we have to ensure that once we have a reasonable vaccine that's safe and efficacious, we are going to help. Obviously, we're going to help Americans first, but we're going to help everyone we can help, especially marginalized populations across the world. We're one of the very few developed nations that has not done that yet on an international basis with regards to this pandemic. That's a commitment we need to make, because we have been leaders of the world, and we need to continue to remain in that stage.

Now, for March of Dimes, we are reaching out, we're working to help fund some of the countries like Senegal, Cameroun and Rwanda. These nations have many challenges. COVID-19 is slower in its spread, but the curfews are causing a lot of economic hardship. In some parts of Africa, as a result, there's an increase in sex trade, and people on the ground are worried that we may see a resurgence of HIV as a result of COVID-19, so they're asking us for help. So, one of the things that March of Dimes has done is we're helping provide the resource, the technical assistance, so we can start to register pregnant women and monitor their COVID-19 status over time.

The U.S. right now is enduring a lot of the burden of the pandemic disease across the globe. We have about 20% of the illnesses of the world and 20% of the deaths, but I think there will come a time where we're going to have to provide support to other countries to ensure, regardless of the vaccine challenges—whether it's cold chain maintenance or otherwise—that we can provide global support, just like we have done over the last so many decades. This is not new for us to help other nations to defeat this type of a scourge; we need to maintain our leadership in that.

This interview has been edited for length and clarity. Watch Pittwire in the coming days for interviews with more of the panel’s participants.