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For Vaccines, What’s Coming Down the Pipe Next?

Imagine a world without AIDS, TB and malaria. It seems impossible, given that these are the world’s top three infectious disease killers. Yet right now we have a historic opportunity to eliminate these diseases as public health threats.

Defeating these diseases has been at the forefront of global health efforts since the new century began, backed with the political will of Millennium Development Goal 6 and the resources that followed.

Progress has been made across the board, but if we stop now, we risk losing gains we have made. However, if we want to finish the job and eradicate these diseases, we need new vaccines. From smallpox to polio to whooping cough, vaccines have traditionally offered a high impact and cost-effective means of preventing disease and death. No disease in history has ever been eradicated without a vaccine, and this time will be no exception.

Right now, we don’t have the tools to finish the job

Tuberculosis is a perfect example of a disease against which we do not have an effective vaccine. The BCG vaccine, still widely used around the world, only protects children against the more severe forms of TB, such as TB meningitis. The vaccine’s effects wear off by adolescence, and it does not prevent pulmonary TB – the most common form of TB.

TB can only be eliminated if we have an effective TB vaccine. The urgency is clear – 1.4 million people globally die from this disease every year and will continue to do so unless we have an effective tool to prevent it.

The need for an HIV vaccine is also clear: a tool that could prevent millions of infections every year Despite advances we have achieved thanks to organizations like the Global Fund, the HIV/AIDS pandemic is still outpacing our ability to treat and prevent it. There are still around 7,000 new infections every day – 97% of them in low- and middle-income countries. Access to antiretroviral therapy is improving, but for every three people accessing treatment, there are five new infections.

We also know that even a modestly effective malaria vaccine would protect hundreds of thousands of people from disease and death each year. Bednets, drugs, and other tools already being used are having a significant impact on the burden of malaria around the world. A vaccine would be used in addition to, rather than as a replacement for, what we’re already using to stop malaria.

A long road worth travelling

Political will to invest into research and development is crucial. The challenge for advocates often stems from the fact that development of vaccines is a difficult and long-term undertaking. Against the backdrop of four or five year election cycles and the need to demonstrate immediate impact, this makes outlining our case all the more difficult.

What we sometimes forget is that all of the life-saving tools we have today haven’t always been around. Vaccines against pneumonia and diarrhoea didn’t appear by accident, they were the result of concerted global efforts and investment. They had to go through the development process too. The recently introduced rotavirus vaccine, which can prevent diarrhoea, took 33 years to develop.

This needs to happen again, and the good news is investment is working. The last few years have seen an encouraging, even exciting, flow of good news from vaccine researchers across the world working on the three diseases.

Progress!

TB vaccines are a great illustration of the advances we have made in the development of new vaccines. Worldwide, twelve vaccine candidates are currently undergoing clinical testing, and there is a robust pipeline of next generation candidates in earlier stages. The two most advanced TB vaccine candidates are undergoing pivotal trials in two distinct and important populations – healthy infants and adults with HIV. ACTION’s recent delegation to South Africa took parliamentarians to see this important work.

Research into HIV vaccines has stirred in recent years, providing clues to how a future vaccine could one day work.

In 2009 results emerged from a study in Thailand, which showed that a vaccine could reduce the risk of HIV infection, in this case by around 30% - the first proof that a preventative vaccine is possible. Researchers are now working to understand how the vaccine worked and why it worked in some people but not in others.

Work is also being done to identify new broadly neutralizing antibodies that can fight HIV. The immune systems of a small proportion of HIV-infected people can make potent antibodies that block the HIV virus. By identifying and studying these antibodies, vaccines can be designed that have the same blocking effect. Trials have shown that these antibodies can prevent HIV infection when administered to monkeys - proof of principle for an antibody-based vaccine.

Writing in today’s Guardian, David Kaslow, director of the PATH Malaria Vaccine Initiative, shares his excitement about what’s next for malaria vaccines.

The most advanced malaria candidate, GlaxoSmithKline’s RTS,S is currently in Phase III clinical development—making it the first malaria vaccine candidate to advance this far. Results published so far show that it provides additional protection against clinical and severe malaria for infants and children in settings where bed nets are also widely used. While it has not been shown to block malaria transmission entirely, if rolled out this vaccine would be used in addition to, and not as a substitute for, other interventions.

The upsurge of research activity in the past ten years has been largely due to the emergence of Product Development Partnerships (PDP), non-profit organisations that bring together the know-how and resources of the public, private, academic and philanthropic sectors to drive the development of new products that are appropriate for use in developing countries.

Call to ACTION!

Of course there’s still much work to be done and scientific challenges remain significant. For instance, researchers are hesitant to make bold predictions on when vaccines will be ready to use.

But perhaps the biggest challenge of all is maintaining the political will to support vaccines. Sustaining interest and financial support at a time when money is tight and there are so many worthy causes is certainly testing. In addition, new discoveries and vaccine candidates put extra pressure on resources, as human trials are the most expensive part of the development process.

The impact new vaccines could have to turn the tide against these epidemics, saving millions of lives as well as bringing down treatment costs, makes the term ‘investment case’ seem a little too crude. We choose to tackle these global challenges, not because they are easy, but because they are hard, and we know what can be achieved if we succeed. 

This year and beyond, RESULTS UK and the ACTION Partnership will work with our civil society partners and parliamentary champions to ensure our governments don’t turn off the tap at a time when vaccines against these deadly diseases seem much closer than they once did.