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.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. 

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. On World Polio Day last week, the World Health Organization officially declared that type three poliovirus has been eradicated—making it the second of the three strains of the virus to be wiped out. Naturally-occurring cases of the last remaining virus strain, type one, are now limited to Afghanistan and Pakistan with a total of just 33 new cases last year. Though much progress has been made toward eradicating this disease, the number of confirmed cases this year has risen to 88 in those two countries as violence and mistrust have hindered vaccination campaigns. Cases caused by the vaccine itself have also thwarted eradication efforts. The National Institutes of Health and the Bill and Melinda Gates Foundation will jointly invest US$200 million over the next four years to develop genetic-based cures for sickle cell disease and HIV. Both partners have vowed that the cures will be both affordable and available in low-resource countries hit hardest by the two diseases, particularly in Africa. This partnership reflects growing concerns that scientific advances such as gene therapies and genome-editing are prohibitively expensive and therefore out of reach to most patients. This collaboration aims to move gene-based therapies into clinical trials in the United States and countries in sub-Saharan Africa within the next seven to ten years and eventually make treatments for sickle cell disease and HIV available in the hardest hit areas. After a two-day meeting in Okayama, Japan, health ministers of the world’s twenty largest economies issued a declaration endorsing the rapid achievement of universal health coverage (UHC), more effective support of healthy ageing, increased attention to health emergencies and their causes, and more forceful action on antimicrobial resistance. The G20 Health Ministers Declaration goes well beyond the general commitments made by G20 leaders to advance global health goals after their two-day meeting back in June. As part of the commitment to UHC, the health ministers recognized the importance of access to medicines and vaccination and reaffirmed pledges to end HIV, tuberculosis, and malaria, among other measures.

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. A landmark study found that men whose HIV infection was fully suppressed by antiretroviral drugs had no chance of infecting their partner—suggesting that if everyone with HIV were fully treated, there would be no further infections. Of the nearly 1,000 male couples across Europe who participated in the study, in which one partner with HIV was receiving treatment to suppress the virus, there were no cases of transmission of the infection to the HIV-negative partner during sex without a condom. According to Professor Alison Rodger, co-leader of the paper published in The Lancet, these findings “provide conclusive evidence for gay men that the risk of HIV transmission with suppressive ART [antiretroviral therapy] is zero” and that the study’s findings “support the message of the international U=U campaign that an undetectable viral load makes HIV untransmittable.” The Global Polio Eradication Initiative (GPEI) unveiled a new five-year strategy on Tuesday, which includes the use of novel oral polio vaccines—several of which are being developed by PATH and its partners—as well as the adoption of smartphone technologies to assist in disease surveillance and faster response. GPEI is also planning to establish a regional hub in Amman, Jordan to allow for easier coordination and increased technical support for polio vaccination programs in Afghanistan and Pakistan, two polio-endemic countries. Additionally, as part of the new strategy, GPEI is expanding its partnership with development institutions such as Gavi, the Vaccine Alliance. These new approaches, among others, will be implemented by GPEI under its new strategy from 2019-2023 in the hopes that this new strategy will be its last, with wild poliovirus successfully eliminated by 2023. The new strategy is currently facing a funding gap of US$3.27 billion, which organizers hope to fill with a pledging conference in November. On Wednesday, the US Food and Drug Administration (FDA) approved the first vaccine against dengue fever. The vaccine, Dengvaxia, has generated much controversy in recent months due to post-marketing research performed by its manufacturer, Sanofi Pasteur, which showed that the vaccine offers protection for people who have already had at least one bout of dengue, but increases the risk of severe infection in children who were dengue-naïve, or never infected when they were vaccinated. The FDA ruled that Dengvaxia can only be administered to individuals between the ages of 9-16 living in parts of the United States where the dengue virus is endemic, and that it can only be given to children and young adults who had one previous laboratory-confirmed case of dengue. Identifying these individuals with prior infection is currently a challenge, because there is no point-of-care diagnostic test available, though Sanofi officials say they have to have one ready for FDA submission by late 2020. Sanofi will earn a priority review voucher (PRV) by bringing Dengvaxia to market. A PRV is an incentive created to encourage pharmaceutical companies to develop drugs and vaccines for neglected diseases and, in exchange, allows a company to expedite the review of another product it wants to bring to market or sell the voucher to another company.