Breakthroughs Blog: Vaccines

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A new study suggests the Nanopatch vaccine delivery system is more efficacious in protecting against poliovirus than typical syringes or needles. Nanopatch, defined as “a microscopic vaccine delivery platform,” targets immune cells in the outer layers of the skin, as opposed to typical syringes and needles, requiring injection into the muscle. The change from muscle to immune cells results in easier administration of the vaccine as well as a reduction in the required dosage. While initial data on Nanopatch is promising, more research is needed. The World Health Organization has warned that an increase in antibiotic use in livestock will result in increased antibiotic resistance humans, potentially causing one of the biggest threats to human health. The agricultural sectors in both Europe and North America are advancing efforts to curb antibiotic use, but many countries are still lagging behind in efforts to scale back use of antibiotics. While new policies and reform around livestock antibiotic use are needed, experts note there is still a need to treat health complications in livestock, through antibiotic alternatives like animal vaccines, as well as a need for improved diagnostics. The World Health Organization, numerous aid agencies, and relevant stakeholders have announced the first global pledge to end cholera by 2030, following one of the worst outbreaks of cholera in modern history. Cholera is considered a “disease of the poor,” affecting individuals living in areas with poor sanitary and water conditions. The recent outbreak is associated with and exacerbated by weak health systems, poor infrastructure, and a lack of necessary supplies to prevent, diagnose, or treat cholera. The pledge will focus on a multifaceted approach involving improving water and sanitation as a long-term solution and use of an oral, three-year cholera vaccine to provide immediate protection.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week.A new low-cost and heat-stable vaccine—ROTASIL—has been found effective against severe rotavirus in phase III clinical trials. The vaccine, which was developed by the Serum Institute of India and tested in partnership with PATH, had an efficacy of nearly 39 percent in children with severe rotavirus and 55 percent against a very severe form of rotavirus. The vaccine is a hybrid of bovine and human rotavirus and is capable of targeting all five rotavirus serotypes. Indian children face a high burden of rotavirus, as the country accounts for 22 percent of all rotavirus deaths worldwide. {% component type: A GeneXpert machine. (Photo: PATH/Georgina Goodwin)India is rolling out a new program to expedite the diagnosis of pediatric tuberculosis (TB) and multi-drug resistant TB cases to speed treatment. While children generally respond well to TB treatments, a pediatric TB case is usually severe and requires a quick, accurate diagnosis to ensure effective treatment. FIND and the Revised National Tuberculosis Control Program have worked in India to establish an infrastructure to aid in accurately and quickly diagnosing children, developing a courier system to quickly relay samples from clinic to lab for diagnosis and relay results back to the health provider via text message within 24 hours. The organizations have also led an initiative that has added over 600 GeneXpert diagnostic machines throughout India. India’s goal is to make the GeneXpert machines a front-line tool for TB diagnosis.Research conducted by the National Institutes of Health (NIH) and Sanofi has created an antibody capable of killing 99 percent of HIV strains. Fighting HIV is difficult because of the virus’ ability to mutate quickly, which often results in the presence of numerous different HIV strains in a single patient. NIH and Sanofi harnessed the natural defense system of a small number of people who produce broadly neutralizing antibodies,” which can kill up to 90 percent of HIV strains in the body. The researchers combined three antibodies to produce a tri-specific antibody that has proved to be more effective than any naturally occurring antibody yet discovered. The first human clinical trial is planned for 2018.

The 72nd session of the United Nations General Assembly (UNGA) featured a number of firsts: It was the first UNGA for new United Nations (UN) Secretary-General António Guterres, as well as the first for recently elected World Health Organization (WHO) Director-General (DG) Dr. Tedros Adhanom Ghebreyesus. Both used this annual gathering of world leaders to solidify their signature issues in a public forum. DG Ghebreyesus’ signature issue was achieving universal health coverage (UHC), in which all people can access a basic standard of necessary health care without being driven into poverty. DG Ghebreyesus publicly stated at multiple events and in numerous tweets that he views achieving UHC as a political decision to support human rights. Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC. At a US Pharmacopeia event, President Ameenah Gurib of Mauritius discussed drug development as not only a key economic driver in her country, but also as a core part of achieving UHC. South African Minister of Health, Minister Aaron Motsoaledi, speaking at a Stop TB Partnership reception, stated that the fight against tuberculosis (TB) would never be won without accelerated investments in R&D to advance the next generation of tools needed to make treatment more effective. “Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC.” Using the example of TB, it is easy to see that the prospect of achieving overall UHC is dependent on innovations that will increase efficiency and drive down costs. Current analyses indicate that countries would need to spend an average of about 5 percent of their gross domestic product to achieve UHC—a goal that, for many nations, is “aspirational in the short term.” Multi-drug resistant TB (MDR-TB), which typically takes two years or longer to treat, can exact an enormous burden on a country’s financial resources. For example, data from the United States shows that MDR-TB is at least US$100,000 more expensive to treat than standard TB, with an estimated $134,000 spent treating every MDR-TB patient compared to $17,000 for regular TB treatment. Imagine if a new drug regimen could reduce treatment time to under a year. The savings in both human suffering and resources within the health system would be enormous. Fortunately, MDR-TB treatments in development today hold promise to offer faster, simpler, and more affordable solutions. “…It is easy to see that the prospect of achieving UHC overall is dependent on innovations that will increase efficiency and drive down costs.” Beyond the hugely positive impact of new technologies within health systems, global health R&D has other wide-reaching, positive externalities. To explore these, GHTC convened a panel discussion with Dr. Peter Singer of Grand Challenges Canada, Bumpei Tamamura of the GHIT Fund, and Jan-Willem Scheijgrond of Philips. Each of the panelists noted a variety of reasons their organizations view investments in global health R&D as not only the right thing to do, but also as good business. From the perspective of a government-supported innovation agency, Dr. Singer noted that through its investment in global health R&D, Grand Challenges Canada has achieved phenomenal bang for its buck. The agency has supported over 800 innovations with an investment of roughly $200 million. Further, two-thirds of this investment goes directly into low- and middle-income countries (LMICs), where it not only supports technological development, but also builds the human capital and innovation economy that will allow these countries to achieve long-term prosperity. Bumpei Tamamura highlighted how fostering multi-sector, multi-country partnerships can advance a nation’s health technology sector. Supported by both the Japanese government and Japanese pharmaceutical and technology companies, the GHIT Fund views its role as creating the incentives to support partnerships between Japanese companies and their global counterparts to leverage respective strengths. Noting the Fund’s success in supporting product development, Mr. Tamamura explained that the Fund is now looking to expand its portfolio of partnerships into manufacturing and distribution, potentially with developing country counterparts. From Philips’ perspective, Jan-Willem Scheijgrond explained investing in global health R&D is not about charity—it is about good business. He noted that Philips operates under a corporate mandate to improve the lives of 3 billion people worldwide, but can only reach half of those people through operations in developed markets like Europe and the United States. “We need to stop seeing health care as a cost, and instead see it as an investment,” he stressed. For Philips, investing in technologies to serve LMICs is part of meeting its core mandate. By investing in health for low-income groups, Philips helps improve health, create jobs, and lift families out of poverty while simultaneously building a new customer base for other products, especially as income levels rise. This can help build a virtuous cycle for both the public and the company, Scheijgrond explained. “Investing in global health R&D is not about charity—it is about good business.” Ultimately, global health R&D is vital not only to health, but also to achieving overall development in economic and social contexts. It improves the efficiency of health systems, allowing countries to move more quickly toward UHC. It creates jobs and generates economic impact across the world, raising incomes and lifting families out of poverty. It also creates bridges between industry in LMICs and global leaders, setting up the conditions for LMIC entrepreneurs to take their place on the global business stage. When asked to sum up the value of investing in global health R&D, Dr. Singer encapsulated it best: “You can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” “[By investing in global health R&D] you can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” For an UNGA session not explicitly focused on global health, the GHTC secretariat was pleased to see UHC—and the role global health R&D plays in contributing to UHC—recognized so prominently in the multi-stakeholder dialogues. We are looking forward to maintaining this momentum heading into the upcoming WHO Executive Board meeting, where a number of critical issues are on the agenda.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Sanofi Pasteur’s announcement that it will cease work on its Zika vaccine candidate has raised concerns about the future of Zika vaccine development. While the World Health Organization has reported 40 Zika vaccine candidates in development, with six candidates in phase 1 clinical trials, Sanofi was the only major pharmaceutical company working on a vaccine against the virus. Its exit from this space raises questions about who will fund clinical development if these candidates show further promise. Additionally, many unanswered questions remain about the virus’s epidemiology and the target population for a vaccine. While the number of Zika cases is now falling, Zika epidemics will likely reoccur in the future. Because of this risk, developing an effective and low-cost Zika vaccine must remain a priority. Johnson & Johnson and the Biomedical Advanced Research and Development Authority (BARDA) have formed a partnership to develop vaccines and drugs to protect against pandemic influenza. Among its projects, the partnership is seeking to develop a “universal” flu vaccine that protects against all or most influenza strains. This collaborative effort highlights a larger trend in partnerships between the private sector, the US government, and nonprofits to develop vaccines and technologies against emerging health threats for which there is currently limited commercial market. Pakistan has launched its first nationwide vaccination drive for polio, aiming to immunize over 37 million children. Pakistan is one of just three countries where polio cases remain, so this nationwide drive is an important step toward eradication. While polio still remains endemic in Pakistan, the number of cases has reduced dramatically in recent years from 306 cases in 2014 to just 4 today. Pakistan has experienced obstacles in its attempts to eradicate the virus, which include efforts by extremists to target immunization campaigns.