Breakthroughs Blog: Polio

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. There is new hope that yaws, a chronic, disfiguring childhood disease, could be eradicated by 2030 with a renewed focus and hopefully, some new tools, especially given the emergence of resistance in the last few years to azithromycin, which has been used as an alternative to penicillin for yaws treatment since 2012. Despite the need for new tools to address the remaining burden of the disease, there are disappointingly few in the pipeline. There is one drug, linezolid, being evaluated that, like azithromycin, is easy to transport and administer, as well as an updated mass community treatment approach with azithromycin. Although the bacteria that causes yaws is tricky to target with a vaccine, ongoing research on a syphilis vaccine that targets the same bacteria that causes yaws could offer cross-protection. With underreported cases also a barrier to eradication, new, robust tests are also a major gap in the tools in our arsenal. The first human trial of a new vaccine against the deadly Nipah virus began last week after the work, which started in 2017, was paused during the COVID-19 pandemic. South Asia faces the greatest burden of Nipah virus, the priority pandemic pathogen that can be fatal in up to 75 percent of cases. There are currently no treatments or vaccines available against Nipah. The new vaccine, ChAdOx1 NipahB, which was developed using the same viral vector vaccine technology as the University of Oxford and AstraZeneca’s COVID-19 vaccine, will be evaluated over the next 18 months in a trial led by the Oxford Vaccine Group and funded by the Coalition for Epidemic Preparedness Innovations (CEPI). The World Health Organization (WHO) recently prequalified the novel oral poliovirus vaccine type 2 (nOPV2), the first prequalification of a vaccine being used under WHO's emergency use listing. nOPV2 was developed by an international consortium, which included GHTC members: Bill & Melinda Gates Foundation and PATH, and is as safe and effective as its predecessor, the oral polio vaccine, but more genetically stable, meaning it is much less likely to lead to vaccine-derived outbreaks. Nearly 1 billion doses of the vaccine have been administered across 35 countries since the rollout began in March 2021, and it has already played a key role in addressing outbreaks of type 2 variant poliovirus. WHO's decision now paves the way for even more countries to receive the vaccine.The Novo Nordisk Foundation, the nonprofit holding of Novo Nordisk and Novozymes, has announced a new grant of $25 million to the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X). With this grant, the Novo Nordisk Foundation joins major governments and foundations in supporting the work of CARB-X to accelerate the early-stage development of innovative tools to prevent, diagnose, and treat drug-resistant bacterial infections. Efforts are focused on the most dangerous bacteria, which have been prioritized by the World Health Organization and the US Centers for Disease Control and Prevention, the syndromes with the greatest morbidity and mortality across the world, and the performance characteristics that clinicians and patients need the most. Since 2016, CARB-X has funded 93 projects in 12 countries, with 19 projects having advanced into or completed clinical trials; 12 actively in clinical development, including late-stage clinical trials; and two diagnostic products on the market.  

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, the US Food and Drug Administration’s (FDA’s) scientific advisers recommended that the next round of COVID-19 vaccines include only the newest variants that have become dominant worldwide, the XBB strains of Omicron, echoing recommendations from the World Health Organization’s vaccine advisers and European regulators. After the FDA makes the final decision, vaccine developers say updated shots could be available within months. The recommendation is based on the idea that the XBB variants are different enough from each other to push the immune system to make more diverse, cross-protective antibodies as opposed to keeping the original strain in the shot, which can cause people’s immune systems to respond more strongly to that strain because of previous, repeated exposure rather than the new strains included in the dose.Researchers at the University of California San Francisco and the National Institute of Biological Standards and Control in the United Kingdom have developed two novel oral polio vaccines, the first new vaccines for polio in 50 years. The vaccines are made from weakened poliovirus that has been genetically engineered to reduce the development of mutations to the active form of the virus, which have been a major challenge of oral polio vaccines, leading to outbreaks of vaccine-derived polio even in countries where the disease was previously believed to have been eliminated. To address those outbreaks as well as uneven vaccination rates worldwide that have led to the continued circulation of the virus, the new vaccines can hopefully be part of the World Health Organization’s most recent push to eradicate polio globally.A phase 3 trial recently published in The Lancet found that Valneva’s FLA1553 vaccine candidate for chikungunya disease was generally well-tolerated and produced an immune response in 99 percent of study participants in chikungunya-endemic regions. There are currently no approved vaccines or effective antiviral treatments for the disease caused by chikungunya infection. The vaccine developers hope that this candidate could become the first vaccine available for people living in as well as travelers to chikungunya-endemic regions or regions at risk of an outbreak. The vaccine could become even more important as climate change is expected to drive the global spread of mosquitoes—and therefore mosquito-borne viruses like chikungunya—to new areas.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email.The AMR Action Fund has announced its second investment, this one of $US7.5 million in European biotech company BioVerys, which is developing an antibiotic (about to enter phase 2 trials), to combat hospital-acquired pneumonia, pneumonia associated with ventilators, and blood stream infections originating from pneumonia. The investment underlines the fund’s role in filling massive gaps in the need for new antibiotics to address the growing challenge of antimicrobial resistance (AMR). The fund, which was created by several of the world’s largest drug companies, works as a venture capital fund with the goal of generating four new antibiotics over ten years. It first invested last year in two small American biotech companies also working towards therapies that can address drug-resistant infections.The Pan American Health Organization has confirmed that vaccine-derived poliovirus type 2 has been detected in wastewater samples in Canada, joining the United States, the United Kingdom and Israel as high-income countries that have detected the virus in wastewater. The Canadian National Microbiology Laboratory, which detected the virus through retrospective wastewater tests, will test archived samples from September and October 2022 through the end of February 2023 to obtain more details about the spread of the virus. This news comes as a reminder that as we enter 2023, new polioviruses, including vaccine-derived poliovirus type 2, continue to emerge around the world.In the midst of China’s severe COVID-19 outbreak, the World Health Organization’s (WHO’s) Director General Dr. Tedros Adhanom Ghebreyesus is expressing concern about possible underreporting and underrepresenting of data, and urging the country to use all available COVID-19 vaccines, including mRNA vaccines that have been shown to be more effective than Chinese-made COVID-19 vaccines. This concern comes following the release of a report by WHO’s Technical Advisory Group on Virus Evolution that found, through working with the Chinese Center for Disease Control and Prevention, there have been no new variants circulating in the country. Full and transparent data sharing on cases, deaths, hospitalizations, and comprehensive, real-time viral sequencing are essential for WHO’s efforts to carry out risk assessments for China and around the world, as well as to understand the evolution of SARS-CoV-2 and the emergence of mutations of variants of concern.

2021 was a year of significant progress in the global effort to eradicate polio, despite challenges due to the COVID-19 pandemic. Unfortunately, as we sit toward the close of 2022, the outlook is less optimistic. Recently, polio has been popping up in the news with increasing frequency as outbreaks have occurred around the world. In observance of World Polio Day on October 24, GHTC is reflecting on the biggest news about this year’s polio outbreaks and on the connection between this year’s outbreaks and polio vaccines, as well as the potential of new vaccines to contribute to eradication. The development of a vaccine against polio was one of the most important and impactful medical technological breakthroughs of the last century and since then, more than 2.5 billion children have been vaccinated through the Global Polio Eradication Initiative, a public-private partnership led by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation, and Gavi, the vaccine alliance. Two types of vaccines are used for polio. The oral polio vaccine (OPV) is used in mass vaccination campaigns in low- and middle-income countries, while the inactivated polio vaccine, which is more expensive and complex to administer, is used in most high-income countries. One of the largest remaining challenges in global polio eradication efforts is that in rare cases, the use of OPV in areas of low vaccine coverage can lead to vaccine-derived polio, which partly accounts for the recent rise in cases. For a short time after OPV immunization, children have the weakened vaccine-virus in their bodies and excrete it. In areas of low immunization, if the excreted vaccine-virus circulates for an extended period of at least a year, it could change genetically to the circulating vaccine-derived poliovirus.Vaccine-derived polio has emerged due to outbreaks of the type 2 virus, which was removed from the oral vaccine by WHO in 2016 after it was declared to be eradicated. In 2020, in response to vaccine-derived outbreaks, WHO granted an emergency use authorization for a novel oral vaccine that is aimed at type 2 poliovirus (nOPV2) and is less likely to lead to vaccine-derived cases. The first-ever vaccine authorized under WHO’s Emergency Use Listing process, nOPV2 was rolled out in March 2021 and doses of the vaccine have already been delivered in over 20 countries. However, supply constraints and challenges in vaccine uptake need to be addressed for nOPV2 to be rolled out more widely. Full immunization throughout populations would prevent the spread of vaccine-derived polio, highlighting the importance of employing polio vaccines in order to prevent the outbreaks we have seen this year.Read more about this year’s spate of outbreaks:"In new setback for eradication campaign, poliovirus from Pakistan shows up in Africa" (Science, 2/17/2022)"Polio is found in the U.K. for the first time in nearly 40 years. Here's what it means" (NPR, 6/22/2022)"Wastewater monitoring identifies polioviruses in New York City" (STAT, 8/12/2022)"The Guardian view on polio: we have the tools to tackle this old enemy" (The Guardian, 8/16/2022)Read more coverage about vaccine-derived polio:"What to know about polio, a disease once again vying for attention" (STAT, 7/26/2022)“New polio cases highlight the urgency of eradication” (Think Global Health, 8/16/2022)"Polio was almost eradicated. This year it staged a comeback." (The New York Times, 8/18/2022)"Polio spread in Israel, US, UK highlights extremely rare risk of oral vaccine" (The Times of Israel, 8/21/2022)“Polio Is Exploiting a Very Human Weakness” (The Atlantic, 9/16/2022) Read more about nOPV2:"New polio vaccine against strain that threatens eradication is safe and generates immune response" (MedicalXpress, 12/10/2020)"WHO nod to first emergency use vaccine can tackle rising vaccine-derived poliovirus cases" (Down to Earth, 12/16/2020)“Independent experts advise move to next use phase for novel oral polio vaccine type 2” (GPEI press release, 10/10/2021)"The polio threat continues to grow—but a new vaccine could make a difference" (Time, 8/31/2022)“Supply issues a major challenge to polio vaccination programs” (MedPage Today, 10/4/2022)“Opinion: The US needs to prepare to introduce the novel oral polio vaccine” (The BMJ, 10/4/2022)Read more about polio funding:"Opinion: Polio eradication is in sight. Don’t stop funding it now" (STAT, 10/16/2022)“Gates Foundation pledges $1.2B to eradicate polio. Here’s why it’s been a struggle for decades” (Associated Press via PBS News Hour, 10/16/2022)“Bill & Melinda Gates Foundation pledge $1.2 billion to eradicate polio” (Reuters, 10/17/2022)“Global leaders commit $US2.6 billion at World Health Summit to end polio” (UNICEF press release, 10/18/2022)More information about World Polio Day can be found here.