“The sickness made my body swollen. My whole family was worried. I went to different hospitals and was told that I have anemia. I drank medicines for anemia, but still nothing.”

These are the words of a young hospital patient in The Gambia, who was diagnosed with rheumatic heart disease (RHD). Her story is featured in a documentary film produced by the International Vaccine Institute (IVI) in collaboration with the Strep A Vaccine Global Consortium (SAVAC).

RHD is a devastating chronic condition that disproportionately affects young people and children in countries with limited access to healthcare. One of its common causes is the delayed or inadequate treatment of a Group A Streptococcus (Strep A) infection, such as strep throat or scarlet fever.  Strep A bacteria can cause a wide range of illnesses, from mild infections like strep throat to severe invasive diseases. According to research published in The Lancet Infectious Diseases, invasive Strep A infections and their complications are responsible for 518,000 deaths and 1.8 million new cases annually.

Despite its significant burden in low- and middle-income countries, there is still no approved vaccine for Strep A.

Organizations such as IVI and the Murdoch Children’s Research Institute (MCRI), whose executive leadership is represented on the SAVAC steering committee, have been actively engaged for several years in advancing the research and development of a Strep A vaccine. The film, “Paving the Way for a Strep A Vaccine that Benefits the World,” showcases how the SAVAC partners are working to support vaccine development and engage local communities in clinical trials.

“I deal with Strep A complications a lot,” says Dr. Maria Louise Gomez, Medical Officer at Medical Research Council Unit The Gambia (MRCG) at the London School of Hygiene and Tropical Medicine. “Strep A, we know, causes lots of infections, less severe [to] more severe. The long-term complications of it mostly affecting kidneys and the heart. We do see a lot of cardiac patients and most of them are primarily from rheumatic heart disease. Most of them are children and they have to be on medication for life.”

For many of these children, Gomez explains, RHD becomes a lifelong burden, limiting the children both socially and physically and impacting their families.

RHD may require complex cardiac surgery, but such treatment is extremely costly and often unavailable in some countries, including The Gambia. Many cases could have been prevented if an affordable and effective vaccine against Strep A had been available.

“Rheumatic heart disease and rheumatic fever have largely disappeared from wealthy countries,” explains Prof. Andrew Steer, co-chair of SAVAC. “Interest from vaccine developers has dropped off so what we need to do now is to help developers get their vaccines as quickly as possible through the development process.”

This was the driving force behind the formation of SAVAC. Born out of a series of World Health Organization meetings, SAVAC is a global collaboration between IVI, MCRI, and a broad international network of experts.

To enhance local research capacity and provide a foundation for conducting clinical trials, dedicated sentinel sites in The Gambia, Malawi, India, and Fiji were selected to collaborate under the mission of SAVAC.

“In a country like Fiji, 0.6% of gross domestic product annually is taken up in care for people with rheumatic heart disease. It’s probably similar to other parts of the world but we just don’t have data,” says Dr. Jerome H. Kim, Director General of IVI and co-chair of SAVAC. “SAVAC 1.0 helped to generate the global investment case – what we call the full value of vaccine analysis for Strep A. At the same time, we were also trying to understand: Would there be safety issues? What would be the other potential benefits?”

“We finished SAVAC 1.0 and there was a real feeling that there was unfinished business and that there was more to be done,” Prof. Steer explains. “This led to the launch of SAVAC 2.0, with an expanded scope and three strategic components.”

These strategic components are:

• Establishing epidemiology and clinical trial sites in low- and middle-income countries.
• Engaging with industry to promote investment and activity.
• Engaging with non-industry stakeholders to ensure the need for future vaccine deployment is understood.

Watch the full documentary to discover how the SAVAC consortium is working to advance Strep A vaccine research and development, and engage communities worldwide.

by Elena Krivovyaz

Last updated: 14 July 2025