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Decoding Disease

Annie De Groot ’78's goal is to eradicate some of the world’s deadliest illnesses by making vaccines—and health care—available to everyone.

by Aimee Swartz ’98

Earlier this year, as Annie De Groot ’78 ushered a mix of the elderly, the immune-compromised, and the panicked along the snowy streets of Providence, Rhode Island, to receive the swine flu vaccine at a free health-care clinic, she remembered an experience as a young medical student working on vaccination campaigns in West Africa. Annie De Groot ’78 believes medicine and social justice go hand in hand.

“We took our vaccine from village to village and brought the sickest children back to the bush hospital in our medical truck—terrified, and if not crying, then deathly ill,” recalled De Groot, now an infectious disease doctor specializing in vaccine development. “One child was so ill she couldn’t swallow, and at one point during the ride, her mother started weeping. That small child was dead from measles by the time the truck pulled in.”

The despair De Groot felt over seeing a child die from a preventable disease—along with countless other experiences reflecting the tremendous disparities between the rich and the poor in their access to health care—has fueled her passionate belief that medicine and social justice go hand in hand. To her, there is nothing as effective as vaccination in improving human health, especially in developing countries. “A vaccine can stop children from dying from influenza right here in Providence and from measles in places as far away as Timbuktu,” she says. “Especially in Africa, an AIDS vaccine that will stop HIV transmission is the only hope we have in protecting the next generation of children, who are now dying in droves, as they once were with measles.”

That conviction has shaped De Groot’s position as a forerunner in immunoinformatics, a field of research that uses mathematical models and computer science to study how the body’s immune system responds to pathogens and diseases, such as HIV. “There are more than 200,000 different strains of HIV, and you need a computer program to analyze the huge number of gene sequences for that many strains,” De Groot explains. “I think of HIV as a language, and all the strains as dialect. Understanding the disease at this level is needed to develop vaccines that invoke the most precise and protective immune response.”

De Groot’s experience as a researcher and a clinician, combined with her empathy for the forgotten and underserved, has made her uniquely suited to solving some of the world’s most intractable public-health problems. Since 1989, De Groot has received more than $26 million in funding for her research work from the National Institutes for Health (NIH). She’s been nationally recognized as a leading woman in science, having received the prestigious Eli Lilly Award from the National Foundation for Infectious Diseases, and she was named among the “best and brightest in science” by Esquire magazine. Recently, AIDS Project Rhode Island honored her for her work in West Africa.

“Annie is not only brilliant, but she has an incredible, sometimes brutal, work ethic. Nothing will stand in her way—she truly is indefatigable and more committed to her work than anyone I know,” says William Martin, chief information officer/chief operating officer of EpiVax, and De Groot’s longtime collaborator. “She has the intelligence and the drive to really make a difference and help a lot of people.”

De Groot, who lives in Providence with her children, Xeon, 20, and Amanita, 16, splits the majority of her time between EpiVax, the biotech company she co-founded in 1998 with the tagline “Science without Fear,” and the University of Rhode Island’s Institute for Immunology and Informatics (I’Cubed), a research institute she was tapped to lead in February 2009.

At the top of her priority list is the clinical development of the GAIA AIDS vaccine, a project she began conceptualizing in the early 1990s while still a research fellow. Unlike standard protective vaccines from the past century, which typically are made from either weakened or killed whole forms of a virus or bacteria, the GAIA vaccine contains epitopes. These highly selected pieces of HIV’s molecular structure are most likely to trigger a very specific immune response that protects the body from the virus. This is different from many of today’s “whole-killed” vaccines, which come with a risk of unwanted immune responses. What’s more, the GAIA vaccine has the unique potential to protect against all strains of the virus and at all stages of the pandemic, she says.

With the GAIA AIDS vaccine under development, De Groot has been shuttling back and forth between Providence and Mali to help build the country’s first HIV clinic to be located within a village. More are planned, and as they are developed, these clinics will be where villagers will receive the vaccine in clinical trials and where, eventually, they may be immunized. To ensure that the vaccine will be free, De Groot has been developing it in collaboration with EpiVax’s not-for-profit arm, known as the GAIA Vaccine Foundation. Unlike for-profit companies, the foundation will not have to charge large sums of money for the vaccine to recoup research and development expenses. As a result, De Groot notes, “our vaccine is accessible, universal, and truly global because it is based on the premise that everyone, regardless of where they live or who they are, is entitled to the same provision of preventive health care.”

Moving forward, she would like to see vaccines for a broad range of other illnesses, from tuberculosis to malaria, developed in the same way, with the idea of achieving social justice through medicine. “Access to health care, including vaccines, is a universal right that should not be limited by geography or circumstances of birth,” she says.

In addition to the GAIA vaccine, De Groot and her team at EpiVax are excited about their discovery of Tregitope, for which they were recently honored with the Innovation in Biotechnology Award from the American Association of Pharmaceutical Scientists. Tregitope is a naturally occurring molecule that regulates an unwanted immune response. “Sometimes the immune system gets confused and starts attacking things we really need. With multiple sclerosis, for example, it starts attacking the nerves; with juvenile diabetes, it’s the pancreas. It attacks a transplanted organ because it sees it as an invader,” De Groot explains. “Tregitope acts like an off switch that can shut down immune responses we don’t want but preserve the ones we do.”

A sense of responsibility
De Groot’s commitment to social justice struck early. Born in rural Windsor, Massachusetts, she was the second of five children and knew at a young age that she wanted to make a difference. “I remember thinking as a child that there were ‘noble’ professions: building houses for people who had none, teaching, and healing the sick. I knew I wanted to do something to make things better,” she says. After De Groot finished grade school, her family moved to Chicago. It was during the city’s great political upheaval and student unrest of 1969 that De Groot, then a first-year in high school, was made keenly aware of the prevalence of racism and social inequalities she had never before witnessed. It motivated her to become involved in Vietnam War protests. “It certainly opened my eyes to a kind of struggle that I would not—could not—forget,” De Groot says. “Although I was a minor figure in the movements back then, they really instilled in me a sense of responsibility to speak up where others could not and to do my part to make change in the world.”

It wasn’t always clear, however, that studying medicine was the way to do that. As the daughter of a doctor, De Groot at first rebelled against the idea of becoming a physician, and with few female doctors to serve as role models, she wasn’t sure she’d even be accepted into the profession. “Back then, and still today—although to a lesser extent—being a physician was not a normal career path for women,” she says. “I worried it would be too hard or that I wasn’t good enough at science. I thought I would be a teacher.”

At Smith, De Groot developed a love for anatomy, botany, and histology, along with a deep appreciation for the struggles women physicians faced early on. During her senior year, De Groot wrote a historical account of women and medicine and took a Five College course with renowned feminist and ethics scholar Janice Raymond, from whom De Groot first learned about the abuses of women in some medical practices. De Groot considers those Smith experiences as pivotal to her later success: “Smith gave me the freedom and confidence to explore topics that had a big impact on my medical career,” she says.

A year after graduating from Smith, De Groot enrolled at the University of Chicago Pritzker School of Medicine. Following her residency in internal medicine at Tufts New England Medical Center in 1986, De Groot completed two three-year fellowships in immunoinformatics and infectious disease. She then joined Brown University’s medical faculty in 1992, and, armed with a grant from the NIH to jumpstart her research career, opened the school’s first HIV/TB research laboratory. Within her first year at Brown, she developed the epitope-mapping technology that today remains at the core of the GAIA AIDS vaccine.

Over the next twelve years, even as her professional profile grew and she gained recognition for her research work, De Groot remained true to her commitment to helping people. She provided care for hundreds of women with HIV and AIDS at two correctional facilities and a public hospital for the urban poor in Boston. Working with HIV-positive patients, she witnessed how easy it is for the virus to thrive in communities hit hard by poverty, violence, racism, and other social inequalities. “Many of my patients have had such difficult lives with so much abuse,” she says. “I was deeply affected by their strength, their joys, and their sorrows.”

She was also outraged by what she calls the correctional system’s prejudicial and, at times, inhumane treatment of patients, which motivated her to launch the Infectious Diseases in Corrections Report, a forum for discussing how to best manage infectious diseases in the correctional setting. Although her outspokenness and advocacy sometimes got her into trouble—she was once escorted off prison grounds and told not to come back—she is widely credited for improving prison care for HIV and AIDS patients.

Along the way, De Groot has become a trusted confidante of many of her patients and can still remember the names and life stories of some of the first people she treated as a young doctor. “If my job is to take care of people, then getting to know them is part of the work that I have to do,” she says. “Learning more about my patients helps me set priorities: Is it more important to find safe housing, or start a new drug? Is it more important to reunite patients with their families than to urge them to move to a city where they might have access to care? Which intervention will save their lives?”

For De Groot, the country’s recent health-care debate brought to light many of the issues she’s spent nearly two decades fighting for, and she’s cautiously optimistic about the outcome. “I’m encouraged by the reform legislation,” she says, “but I believe it will be years before the most disenfranchised and at-risk patients will have equitable access to health care.”

Still, she sets out every day with the hope that her work, along with her passion and willingness to work extremely hard, will help close that gap and save lives. “I do what I can,” she says modestly, “here and everywhere.”

Fall ’10 SAQ