Next-Generation Vaccinologists: Dr. Sue Ann Costa Clemens on Training Future Global Health Leaders

Her early work as a pediatrician, particularly in low- and middle-income countries where limited access to care generates overwhelming demand, convinced Dr. Sue Ann Costa Clemens that prevention measures like vaccines are critical. She became a vaccinologist, contributing to the development of more than 20 vaccines, and was knighted Commander of the Order of the British Empire and Commander of Order of Rio Branco and Medical Merit of the Federal Republic of Brazil for her work. 

Yet she describes her most important “legacy work” as training the next generation of vaccinologists through programs at the University of Oxford and the University of Siena, where she launched the first master’s degree in vaccinology. 

In this Q&A, she outlines the essential skills for next-generation vaccinologists and how graduates are transforming global vaccine development and delivery. 

You are a pediatrician by training. What drew you to vaccinology? 

It was the perspective of impacting health by preventing disease and consequently lowering the burden on the health care system. As a pediatrician, we work in health care clinics and hospitals, and we see that the health system is always overcrowded and overwhelmed. Especially in the lower and middle-income countries, working in poor communities, we see that prevention can really contribute to lowering this burden. 

You also created the first master’s degree in vaccinology and drug development at the University of Siena. What drove you to focus on developing the next generation of vaccinologists? 

I think what really triggered that was meeting with Nelson Mandela in South Africa. We were in a meeting [about] financing vaccination to every child, and at that time I was already working with vaccine development. We could see that there was a lack of qualified professionals that understood vaccine or product development from end to end.  

During that meeting, Mr. Mandela was really stating that it’s great that we finance, but we need to leave a legacy, and this legacy is education. We cannot just go to certain regions, certain countries, do development, and then go back to wherever we came from. I am a physician, I am a scientist, but above all, I am a professor, an educator. I really believe, and I quote his words, that education is the most powerful weapon to change the world. And immunization is one of the most cost-effective tools. 

How can training programs like the one you helped develop close the gap in vaccine access and decision-making powers in these regions? 

We really teach from end to end — from vaccine design and construction up to immunization, which goes through the entire development. Once you have the product, that doesn’t mean anything. What is the value of the vaccine? It’s immunization. If the vaccine is not in our arms, or [delivered by] oral vaccine or nasal vaccine, it doesn’t have any impact.  

Our alumni are making a difference working in ministries of health for their countries, where decision-making is taking place. In regulatory affairs, industry, and organizations where strategies for public health involve immunization, equity and access, and information is being taken to help LMIC countries. We are very proud of contributing to this and see that our students are surpassing the teachers. 

What lessons have you drawn from the COVID-19 pandemic, and how do those lessons inform how we train future global health professionals? 

Being on the frontline of vaccine development, we really could feel the day-to-day pressures and map the big gaps. One of the gaps is site readiness and how to keep the sites warm. Because the next epidemic and pandemic will come. It’s not if it will happen, but when. We need to have sites warm and ready to respond. 

We also need laboratories for clinical trial assays. We could see that the laboratory for clinical trial assays, they are concentrated in the U.S., in Europe, and this increases the budget and takes a lot of time to get the samples analyzed. Moreover, we have a lot of losses with the sample sizes too. Another big point is the integration of regulatory affairs, the regulatory agencies, very early in the development. Regulatory was something that really was seen, I would say, for the first time in the development of a product and the importance of it. 

Another big point is communication, the fake news, et cetera, and how to communicate to the public. It doesn’t help if we bring a vaccine to licensure and it doesn’t reach the population. Communication is a key factor. We need to know how to reach the target groups and [ensure] that they get the benefit of it. We need to be able to answer their questions. 

Do you think interest in vaccinology overall has grown? Or is it getting harder to find scientists who want to devote time and focus to the field? 

That’s a very complex question. Vaccinology is a big field, but I think yes, interest has grown. It’s different in different fields, because it also depends on financing. You need to have sustainable funding to do something that impacts your interest, right? We are in a moment right now in the world where there are big funding cuts, but we still can see that post-COVID in the middle-income country (MIC) private sector, they really woke up for vaccine development. Usually in the MIC countries, the vaccine production comes from the governments, and the private sector really invests in drug development and generics. Now there is a huge interest [in vaccines], and that really stimulates and promotes the researchers’ interest.  

Another point where interest grow a lot is having the end in mind — how you take your product from the bench and bring it to the population. Before, I saw a lot of researchers who didn’t think about the impact, how this molecule will impact lives, save lives, and improve the quality of lives. This has changed. The researchers come [thinking] more about how they reach the population, and they understand that generating evidence is part of it and will help with public health policies that drive the use of the product. 

What sort of skills and what types of science will be most valuable to vaccinologists in the future? 

After COVID, AI is a key aspect in vaccine development. We do have the first vaccine construct developed by, created by AI via the Institute of Protein Design. Deep learning about how AI can support vaccine development from the protein design, but also shorten clinical trial development, and how this impacts monitoring regulatory and supporting the health care systems. We need to really identify where to use it and how to use it, but it always needs to be supervised by humans. 

Secondly, deeper understanding of immunology, because that is driving the path for the new platforms that we are using in vaccine development. I would also say data generation — data, data, data — because yes, what drives a product, the interests of a private company or biotech or academia, is data. 

What lessons would you share with young professionals who aspire to follow in your footsteps? 

I think the very basic one is to love what you do. Whatever you select to do, you really need to love that, because that will be for the rest of your life. And then it’s just part of your life — it’s not a burden on your day-to-day. And then one needs to focus. We need to be experts in something. You will find the niche of your expertise, and then focus, and that will really drive your success.  

The selection of good mentors is very important because we need to be humble. We don’t know it all, and we should always be ready to learn.