Reducing the burden of diarrhoeal disease

Professor Julie Bines is a paediatric gastroenterologist at the Royal Children’s Hospital Melbourne, Professor of Paediatrics at the University of Melbourne, Group Leader of Enteric Diseases at the Murdoch Children's Research Institute (MCRI) — and winner of the 2021 Eureka Prize for Infectious Diseases Research. Here, she talks about her career in reducing the global burden of diarrhoeal disease, about gender equity, and why she would encourage others to enter the Eureka Prizes.

This article first appeared in the Franklin Women March 2022 Newsletter — you can sign up here.

What is your current role and how did you get to be there?

I am a paediatric gastroenterologist and clinician-researcher focused on reducing the global burden of diarrhoeal disease in children. I studied medicine at Monash University, but it was not until I travelled extensively in Asia and Africa that I appreciated the huge disparities in health, growth and “life” for children in low- and middle-income countries. Disease, such as diarrhoea due to rotavirus infection, was, and still is, a major killer of infants and young children in many countries. When I returned to Melbourne to continue my medical residency at The Royal Children’s Hospital in Melbourne, I worked on the dedicated gastroenteritis ward. It was here in the 1970s that Professor Ruth Bishop and Professor Ian Holmes, and their teams, discovered rotavirus as the major cause of severe dehydrating gastroenteritis in young children.

Oral rehydration solutions were being trialled with the aim to avoid the problems associated with the need for intravenous fluid administration previously used to treat severely dehydrated infants. Thankfully, in Australia, gastroenteritis wards are now a thing of the past as a result of the dramatic impact of rotavirus vaccines in the routine immunisation program. However, almost 45% of the world’s children do not receive a rotavirus vaccine, and the vaccines available do not seem to protect children in low- and middle-income countries as well as they do in high-income countries such as Australia. So there is still work to be done if we are going to defeat this common and devastating infection.

After studying paediatric medicine in Melbourne (FRACP) I spent 3 years in Boston, USA, as Fellow in the Combined Program of Paediatric Gastroenterology and Clinical Nutrition at Boston Children’s Hospital and Massachusetts General Hospital, Harvard Medical School. This was a formative experience for me. I was able to learn from some of the “greats” in paediatric gastroenterology, nutrition and science, who were inspiring and generous with their time. I made lifelong friends and colleagues who opened my eyes to the power of collaboration.

My husband and I decided to return to Melbourne soon after the birth of our son in Boston. I am not sure our collective parents would have forgiven us if we deprived them of their first grandchild! There were no clinical positions available in paediatric gastroenterology in Australia when I returned, so I switched my full focus to research. Based on the work in energy metabolism in cystic fibrosis, which I started in Boston as a post-doc at Massachusetts Institute of Technology (MIT), I completed a Doctor of Medicine (MD) at the University of Melbourne. As a clinician-researcher, I have found the opportunity to address clinical challenges through research motivating and satisfying.

I was appointed as a consultant for WHO to investigate the significance of rare cases of intussusception (twisting of the bowel) found in young children who received the first licensed rotavirus vaccine in the USA. This consultancy provided me an opportunity, as a paediatric gastroenterologist, to contribute to global child health, and has resulted in an ongoing involvement across various gut-related infections and global efforts to develop vaccines to prevent these infections. I took on the development of the novel neonatal rotavirus vaccine, RV3-BB, at MCRI after the development of an earlier version of this vaccine unfortunately had been halted. This vaccine has now been shown to protect from severe gastroenteritis in babies from birth in low- and middle-income countries and has the potential to make a major impact on global child deaths due to diarrhoea. This work was awarded a Eureka Prize in 2021, which was a wonderful acknowledgement of the four decades of research by dedicated clinicians and scientists who have been committed to this dream.

How does your work contribute to the field and/or the overall health and wellbeing of the community?

Diarrhoea is a major killer of children worldwide, with rotavirus the most common cause in children under 1 year of age. Despite the success of rotavirus vaccines in high-income countries like Australia, around 45%, or over 80 million, children worldwide do not have access to a rotavirus vaccine. Barriers include vaccine cost, gaps in supply, logistical challenges and ongoing concerns regarding vaccine safety. Also, the level of protection offered by the current rotavirus vaccines is reported to be lower in low-income, high-child-mortality countries compared to that observed in high-income, low-child-mortality countries.

The RV3-BB vaccine, developed from healthy babies in Melbourne, has the potential to provide protection at the earliest possible time – from birth – and hopefully make it easier to administer when mothers and their babies are with a midwife or at hospital. We are working with emerging country vaccine manufacturers so that the vaccine can be affordable for use in low- and middle-income countries to help prevent the more than 250,000 deaths that occur each year due to rotavirus disease.

What project would you love to get off the ground, or skill would you develop, if you had the opportunity?

There are so many interesting and important questions that remain unanswered or unexplored. I am fascinated by the complexity of the gut and how it impacts a wide range of body functions that extend beyond the gastrointestinal tract; in particular, the factors that act as barriers to the effectiveness of oral vaccines, such as rotavirus vaccines, and whether oral vaccines given to newborns can have additional beneficial effects, such as promoting immune development.

Another area I would love to see gain traction is the effort to address gender inequity in global health. Women make up 70% of the global health workforce but are grossly under-represented in leadership roles. Much of the work done by women in healthcare globally is underpaid or unpaid work, and should be appropriately recognised. The Women in Global Health Network is working to address gender inequity and bias in healthcare, and we have just launched an Australian Chapter with the hope to advocate for gender equity in healthcare in Australia and within our region. It would be terrific if this could gain momentum and lead to real change at a global level.

What are your loves outside of work?

I love to be outdoors, enjoying the natural beauty of the bush. My favourite times are spent with my family, including my very cheeky labrador Archie.

Congratulations on your 2021 Eureka Prize for Infectious Disease Research! Why would you encourage others to enter the Eureka Prizes?

Australia conducts fabulous science by fabulous scientists. The Eureka Prizes present a great opportunity to showcase your hard work and achievements to a broad audience. It is really inspiring to hear the stories of innovation and achievement across a range of topics from people with a diverse range of age, skills and backgrounds.

What is one piece of advice you could pass onto others following their own career in the health and medical research sector?

I never had a “life plan” but have always been keen to seek opportunities that might address key gaps in understanding or provide an opportunity to work with like-minded people who are fun to collaborate with. You need to be genuinely interested (or even passionate) about what you do to justify the time and effort required to achieve a successful outcome. But be kind to yourself and to others around you, and be sure to take a break.