Q&A with Dr. Carol Baker
Every year, the Albert B. Sabin Gold Medal is given to a distinguished member of the public health community who has made extraordinary contributions in the field of vaccinology or a complementary field. This year's award will honor Dr. Carol Baker for her contributions to the health of pregnant women and babies through groundbreaking research on group B Streptococcus and dedicated advocacy for maternal immunization. Dr. Baker is currently an Adjunct Professor of Pediatrics at McGovern Medical School at The University of Texas Health Science Center at Houston.
Did you always know you wanted to be a researcher?
No. I learned in high school and college that science was not my gift when it came to making good grades. The humanities, and especially course that required analyzing ideas, got me excited: history and literature. I entered medical school convinced I would become a full-time clinician.
What initially made you interested in researching Group B streptococcus (GBS)?
When I returned to Houston for pediatric residency in a program with nearly 15,000 births annually, I saw newborns who developed devastating signs of illness, often at or within a few hours of birth and accompanied by respiratory distress. About one in four died. Also, infants a few weeks or months of age, presented with fever, poor feeding, and decreased activity for only a few hours and had meningitis. When cultures from these babies grew gram-positive organisms, I wondered why since dogma was these infections should be caused by gram-negatives, especially one called E. coli. My persistent curiosity got indifferent responses from faculty so I began to “collect” the bacteria from cases and study the timing, clinical signs and outcome of these infections, which turned out to be caused by a generally unrecognized human pathogen, GBS.
You must be proud to know that your research informed guidelines for the preventive use of antibiotics during childbirth that have resulted in a more than 80 percent reduction in infant GBS disease.
Of course I am proud that I played a role in initiating and informing U.S. guidelines, but unfortunately, early-onset GBS cases still occur so implementation must continue to improve.
What is your ultimate end goal?
My goal is to see perinatal GBS disease become rare, that is pregnancy-related (e.g., amniotic fluid, uterine, bloodstream), newborn (e.g., bloodstream, pneumonia in the first days of life) and young infant (7-89 days of age) disease.
Does antibiotic resistance impact the prevention of GBS disease in infants?
Fortunately, not yet because these infections still can be prevented by treating GBS-positive women with intravenous penicillin during labor. The potential for resistance, however, remains.
How can we prevent resistance in the future?
The best way is to make sure that women who answer yes to a question about penicillin allergy are then asked “what happened?”. If the woman only had a rash or mild reaction, she should receive a drug called cefazolin (this should be most women answering yes).
When do you think a GBS vaccine will be available to protect newborns? What are the challenges in developing a GBS vaccine?
I am the worst person to ask because the first time I was asked this was in the late 1980s and I confidently said five years. Now that there are two large vaccine manufacturers pursuing GBS conjugate vaccine development, I think the answer may well be 10 years.
What originally motivated you to support immunizing expectant mothers, even at a time when many physicians were against it?
I wanted babies to have a chance to live and to do so without the consequences of some GBS infections (e.g., cerebral palsy, hearing loss, blindness, learning disabilities). Based on the scientific evidence at the time, it was the right thing to do. It still is 4 decades later.
What would you tell an expectant mother who is hesitant about vaccination?
I would explain to her what the vaccine is for. For example, influenza vaccine will protect her, her fetus and her newborn against influenza infection, and that this vaccine has been shown to be safe in millions of women and effective in preventing preterm labor, stillbirth and infant hospitalization caused by this serious viral infection. If she declined vaccination, I would try again at her next visit.
What is the best approach to reassure parents who may have concerns about vaccines?
First, treat their questions with respect and empathy. Second, spend time to explain how we know the vaccines are safe and effective, using stories rather than statistics, and if there is something currently in the media like an epidemic of a vaccine preventable disease, to explain why this happened.
Do you have any advice for students embarking on medical or researcher careers?
If it’s your dream, do everything you can to make it happen no matter how discouraging others may be, no matter how hard you have to work, and follow Langston Hughes’ advice, “The only way to get a thing done is to start to do it, then keep on doing it, and finally you’ll finish it…”
Learn more about Dr. Baker and the 2019 Albert B. Sabin Gold Medal here.