Research Roundup: What we’re reading this week

In this guest post, Ambassador Michael W. Marine, CEO of the Sabin Vaccine Institute, writes about his organization’s 20th Anniversary Scientific Symposium event. In a fitting way to kick off World Immunization Week, several hundred people gathered Friday, April 25th to celebrate significant achievements in vaccinology over the past two decades and to examine solutions for overcoming remaining hurdles at the Sabin Vaccine Institute’s (Sabin) 20th Anniversary Scientific Symposium. Hosted at the Pan American Health Organization (PAHO) in Washington, DC, it was an energized room filled with visionary leaders from humanitarian and health organizations, nongovernmental organizations, pharmaceutical companies, and academia. Sabin’s President Dr. Peter Hotez opened the event by asking, “What do the next twenty years look like for product development and access to vaccine and medicines? What is the outlook for meeting ambitious global health objectives?” PAHO Director Dr. Carissa Etienne then highlighted the remarkable successes in the Americas for the past 20 years. By this March, “17 countries and territories … had added the rotavirus vaccine to their vaccination schedules, 28 had (introduced) the pneumococcal vaccine and 20 the [HPV] vaccine.” Country ownership is nearly complete, with “more than 95 percent of vaccines purchased with national funds.” Still, PAHO Member States are working to ensure that municipal vaccination coverage reaches 95 percent or higher everywhere. From left to right: Dr. Carissa F. Etienne, PAHO; Dr. Donald A. Henderson; Dr. Ciro de Quadros, Sabin; Dr. Anthony Fauci, NIAID; and Dr. Jon K. Andrus, PAHO. Credit: PAHO Dr. Ciro de Quadros, Sabin’s executive vice president, explained how Sabin “is guided by an unwavering belief: Lasting health solutions that benefit every person in a country can only truly be achieved when that nation supports health interventions out of its own budget; builds technical expertise; and maps its health priorities.” He added that in addition to quickening the pace of country and regional adoption of the Global Vaccine Action Plan (GVAP), “integration and cooperation are areas (where) we could all do better.” Via videoconference, Dr. Julio Frenk, dean of the Harvard School of Public Health, shared reflections on the evolution of global health and vaccination. He urged partners to consider how resources could be allocated more efficiently, prioritizing spending where there is the greatest need and where it will have the greatest impact. Dr. Seth Berkley, CEO of GAVI, explained its co-financing model, which “is about building ownership, building sustainability, and ensuring advocacy.” GAVI has notably “immunized 440,000,000 additional children and averted 6,000,000 future deaths.” Addressing vaccine research technologies, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health stressed “the incomparable effects of vaccinology.” He shared some inadequacies of following natural immunity for diseases like HIV and influenza and how scientists are identifying new development techniques for vaccine-based solutions. Adding to the day’s excitement, Sabin’s Dr. de Quadros received PAHO’s highest honor, the Public Health Heroes of the Americas award. On behalf of PAHO, Dr. Etienne stated, “No single person has done more to extend the benefits of immunization in the Americas” than Dr. de Quadros, whose “vision, scientific acumen, undaunted courage, and boundless energy” played a central role in smallpox and polio eradication in the Americas, and the creation of PAHO’s Revolving Fund. Dr. Etienne commented that Dr. de Quadros is a “force for good in the region and in the world;” we at Sabin who work with him each day couldn’t agree more. Dr. de Quadros then chaired a panel focused on how organizations are advancing the GVAP: Dr. Jon Andrus, deputy director of PAHO, recognized that capacity development and assistance with “making evidence-based decisions,” for instance through PAHO’s ProVac Initiative, are essential. Dr. Mickey Chopra, chief of health at UNICEF, underscoring its importance noted “the critical window we have on the GVAP … If we succeed now, the trajectory will be completely different than if we fail.” Manufacturing capacity and technology transfers, along with sustainable financing, such as Sabin’s Sustainable Immunization Financing program, will accelerate progress. Dr. Julie Gerberding, president of Merck Vaccines and representing the International Federation of Pharmaceutical Manufacturers Association, spoke about the challenges facing manufacturers, such as competing priorities and shrinking research and development bases. She urged we “collectively think about and solve for” these issues. Dr. Mahendra Suhardono, marketing director at Biofarma representing the Developing Countries Vaccine Manufacturers Network, explained how the 40 manufacturers in this network are working to take action against many diseases. Dr. Lance Gordon, director for neglected infectious diseases in the Global Health Program at the Bill & Melinda Gates Foundation, commented on the Foundation’s commitment to tackling neglected tropical diseases (NTDs) and spotlighted the recent conference in Paris where $240 million was committed toward fulfilling the London Declaration. Delivering a powerful video message, Dr. Margaret Chan, director-general of the World Health Organization, stated, “countries must lead... they deserve to have the first say about priorities.” Despite a need to streamline and simplify programs, increase sustainable financing, and help people understand the value of vaccines, “the future of immunization looks bright.” This was truly a memorable event, and we hope that through continued collaboration and the commitment of our diverse partners, collectively, we can realize lasting improvements. As Morton Hyman, Sabin’s chairman, closed the symposium, he tasked us with asking ourselves, “how we can do better, how we can challenge the status quo and look at smarter, more collaborative, more efficient models to deliver the gift of good health to all people.” With 20 years of achievements behind us, Sabin looks forward to many years ahead filled with more success in reducing needless human suffering.

In this guest post, Dr. Mel Spigelman—president and CEO of the TB Alliance—writes about advancing the first-ever drug regimen designed to treat both drug-sensitive and some forms of multi-drug resistant tuberculosis (TB) to a global Phase III clinical trial. Receiving treatment for multi-drug resistant TB (MDR-TB), which afflicts nearly half a million people around the world, is one of the harshest experiences modern medicine has to offer. Treatment lasts up to two years, with more than 14,000 pills and daily injections for the first six month of treatment. Side effects range from nausea to permanent hearing loss and worse. Compounding matters is that this treatment only works about half the time, and is even more challenging to administer in patients also receiving therapy for HIV and AIDS. While this sounds extremely bleak, those who experience this care are fortunate. The above situation represents the best MDR-TB care available. Many TB and MDR-TB patients are unable to receive an accurate diagnosis. These patients have an even harder time with drug-resistant TB, and many ultimately die. Based on positive results from earlier clinical studies, TB Alliance is advancing the first-ever drug regimen designed to treat both drug-sensitive and some forms of multi-drug resistant tuberculosis (TB) to a global Phase III clinical trial. Photo: PATH/Gabe Bienczycki Today, however, there is hope. Better yet, those infected with drug-sensitive (or “normal”) TB—eight million people around the world—can also enjoy this hope. By the end of 2014, a new global clinical trial will begin testing the first ever drug regimen designed to treat both versions of TB in 50 sites on four continents. The trial, known as STAND (Shortening Treatments by Advancing Novel Drugs), will test a novel drug combination, or regimen. Traditionally, individual drugs were developed, then added or substituted into the existing treatment, enabling incremental progress. But the STAND trial, which tests a regimen called PaMZ, represents an opportunity to transform treatment. PaMZ promises to shrink the length of time patients are treated by more than a year for some forms of MDR-TB. As a completely oral regimen, it would eliminate injections and reduce the extraordinary demands that a TB diagnosis places on both patients and healthcare providers. Additionally, this regimen was developed for compatibility with commonly used antiretroviral drugs, which would improve patient care for the millions infected with both TB and HIV. With such a vastly reduced amount of medicine, PaMZ is expected to reduce the cost of MDR-TB treatment by over 90 percent in some countries. In the case of drug-sensitive TB, the regimen projects to be competitive with current treatment. Such cheaper, faster, simpler cures would provide amazing benefits not just to patients but for communities and national health care systems overly stressed from such an intractable disease. This regimen has been advanced to date thanks to the commitment of a series of partners including the Bill & Melinda Gates Foundation, the UK Department for International Development the Australian Department for Foreign Affairs and Trade, the US Agency for International Development, Irish Aid, and the Directorate-General for International Cooperation in the Netherlands. Now, as preparations for the STAND trial begin, we call for continuing as well as new support to bring this promising treatment through its final hurdle before it can be made available to the millions in need. TB has afflicted mankind since the time of the Pharaohs. The current first-line treatment for TB was assembled almost half a century ago; while the disease has continued to evolve, new medicines have been few and far between. TB is second only to HIV as the leading infectious killer of adults worldwide, and is also the leading infectious cause of death among people with HIV and AIDS. Hope has been a scarce commodity for TB patients today, especially those who have MDR-TB. We owe it to the millions of these patients—and the millions more to come—to move the STAND trial to the finish line. In this day and age, taking medicine and getting cured should be an easy sprint, not a gruesome marathon. To learn more about the STAND trial, click here.