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Feature

All quiet on the vaccine front?

Posted on: 22 Oct 04

Summary

Vaccines represent one of the most effective weapons in the armoury of modern medicine. In an age where the benefits of healthcare interventions in relation to their costs are frequently debated in the media, it is easy to forget the tremendous health contribution that vaccines have made and the millions of lives they have saved.

Introduction

Vaccines represent one of the most effective weapons in the armoury of modern medicine. In many industrialised countries they have virtually eradicated diseases that were major killers a century before. In an age where the benefits of healthcare interventions in relation to their costs are frequently debated in the media, it is easy to forget the tremendous health contribution that vaccines have made and the millions of lives they have saved. Nevertheless there remains an urgent need for more effective vaccination programmes, particularly in the developing world (1).

 

The benefit of vaccines and the consequences of controversy

Before the implementation of mass vaccination programmes a range of diseases routinely killed or harmed many infants, young children and adults. For example, prior to pertussis immunisations in the US, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths (2).

 

There are a number of examples that highlight the importance of maintaining high immunisation coverage around the world. A 1998 study published in The Lancet revealed that in eight countries where immunisation coverage for pertussis was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained (2).

 

There is increasing concern amongst healthcare professionals of the damage that organisations and individuals who campaign against vaccination can cause. The reports they present about the link between a particular vaccine and adverse problems are often not independently and scientifically validated, and the lack of information leads to public concern that they are not being adequately informed. In Kano, Nigeria a scare over the safety of the oral polio vaccine led to a halt in vaccinations during the summer of 2003. At the time, there were considerable fears that sub-Saharan Africa was on the verge of the largest polio epidemic in recent history (3). The World Health Organization (WHO) and its partners had to work hard to rebuild the confidence of communities in the safety of the vaccine and the support of local leaders was key to the resumption of regional immunisation activities a year later (3). In the UK controversy over the MMR vaccine, the combined vaccine against measles, mumps and rubella, has led to fears that there will be a resurgence of these diseases.

 

Some healthcare experts have stated that because vaccinations have now been used for such a long time the public has forgotten the devastation that the diseases they are designed to prevent can inflict. For example, the influenza pandemic between 1918 and 1919 caused an estimated 40-50 million deaths worldwide - more deaths than occurred during World War I (4). This event was a major reason for the drive to introduce annual flu vaccinations in different countries and yet countries still need to run major public relations campaigns every year to persuade people of the benefits of vaccination.

 

Reinvigorating vaccine development

A number of public health bodies have sought measures to encourage further development of new vaccines by industry, because they fear that market forces might dissuade companies from investing in this area of research (5). As some diseases, such as influenza, can occur as unpredictable events with an uncertain geographical distribution there are worries that companies might feel that these diseases do not offer sufficient incentives for large scale investment in vaccine R&D and that their efforts could pay off more in other areas (5). There is a particular worry that manufacturers are becoming less interested in vaccines that are typically low-margin and predominantly used in the developing world (1). For example, there has been a steady decline in the number of licensed manufacturers of yellow fever vaccine over the last few years (6).

 

The calls for the reinvigoration of vaccine development have also come from within the pharmaceutical industry. In February 2004, Raymond Gilmartin, Chairman, President, and CEO of Merck gave a speech at the Harvard Business School where he highlighted the decline in vaccine manufacture and argued for more public-private partnerships to stimulate innovation in this field (7). Mr. Gilmartin also spoke about the need for vaccines to tackle diseases that were endemic in the developing world such as malaria, tuberculosis, and HIV (7). However, even when new vaccines were produced and their prices were low, problems with infrastructure and training of the individuals administering them often created additional obstacles to overcome (7).

 

Outlook

The positive impact that vaccines have had is often forgotten and their existence taken for granted. The importance of vaccines in preventing disease needs to be highlighted through regular public education campaigns, so that the public do not become influenced by unsubstantiated claims over the safety of vaccines. Any decline in immunisation coverage can result in a dramatic resurgence of diseases that were previously thought to be under control, with all the terrible consequences in terms of morbidity and mortality. Furthermore, the development of future vaccines needs to be encouraged by the creation of a system that achieves social objectives but allows companies to be commercially successful. 

 

References

1. Kermani F. (2004). Neglected and Emerging Diseases: The Next R&D Challenge. Chiltern International. http://thepharmyard.networkpharma.com/shop/product.php?xProd=206&xSec=96

 

2. National Immunization Program (NIP). Centers for Disease Control and Prevention (CDC). What Would Happen If We Stopped Vaccinations? http://www.cdc.gov/nip/publications/fs/gen/WhatIfStop.htm

 

3. Anon (2004). Global Polio Eradication Initiative welcomes immunization campaign in Kano, Nigeria. World Health Organization. 3 August 2004. http://www.who.int/mediacentre/news/en/

 

4. Anon (2004). Pandemic preparedness: An influenza pandemic. World Health Organization. http://www.who.int/csr/disease/influenza/pandemic/

 

5. Firdaus U. (2004). Status of Vaccine Development for an Influenza Pandemic. 5 October 2004. ASEAN-Disease-Surveillance.Net.

http://www.asean-disease-surveillance.net/ASNNews_Detail.asp?ID=2038

 

6. Glass S., Batson A., and Levine R. (2001). Accelerating New Vaccines. The Global Alliance for Vaccines and Immunization. http://www.vaccinealliance.org/site_repository/resources/18IssuesPaper.pdf

 

7. Lagace M. (2004). Injecting New Life into the Vaccine Industry. 1 March 2004. Harvard Business School Working Knowledge. http://hbswk.hbs.edu/item.jhtml?id=3946&t=innovation&nl=y

 

Dr Faiz Kermani

Last updated on: 27/08/2010 11:40:18

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