COVID-19 vaccine for infants: antibodies persist a year on

COVID-19 vaccine for infants: antibodies persist a year on

During the COVID-19 pandemic, immunisation of infants has been a highly contentious and confusing issue. From initial advice that children would be less severely affected, to the FDA’s emergency-use-authorisation of the BNT163b3 and the mRNA-1273 vaccines in June 2022, public health messaging has been mixed. Powerful rhetoric surrounding vaccinating children has also had a worrying effect on routine immunisations. However, a recent study published in Science Translational Medicine by researchers in the US suggests that, following “safe and immunogenic” vaccination, antibodies against variants of concern (VOC), as well as T-cell responses, “persisted for 12 months”.  

The study in context 

SARS-C0V-2 has infected “close to 600 million” and caused “more than 6 million deaths”, the study reports. Although vaccines were developed in record time, we continue to engage with variants and widespread infection, dangerously coinciding with an increase in other disease infections. Furthermore, the authors note that vaccination has not been widely accepted, for a variety of reasons.  

Children younger than 5 years old were originally excluded from vaccination due to “stringent age de-escalation clinical trial protocols” and initial data about infection. However, COVID-19 can cause “severe disease” and death in children, and the emergence of the “more transmissible” variants increased disease incidence in the paediatric population. Neonates were “one of the most affected age groups”. Despite “controversy”, recent data demonstrate the “immunogenicity and efficacy of mRNA SARS-CoV-2 vaccines” at lower doses.  

As these doses are scaled proportionately to those of adults, and immune responses have been observed to decline over time in adults, it is important to “determine whether vaccine-induced antibody responses are durable and of sufficient breadth to protect against infection” with new VOCs.  

COVID-19 in rhesus macaques  

The research involved two groups of 2-month of rhesus macaques (RMs), at weeks 0 and 4. To establish efficacy at one year after initial immunisation, the 2 groups and an added control group of age-matched non-immunised RMs were “exposed to a high-dose heterologous challenge” with the ‘Delta’ variant.  

7 of the 8 control RMs “exhibited severe interstitial pneumonia and high virus replication in the upper and lower respiratory tract”. By contrast, the vaccinated RMs had “faster viral clearance” and “mild to no pneumonia”.  

Limitations of the study include “relatively small group sizes” and the “short follow-up period after SARS-CoV-2 challenge”. Furthermore, the authors acknowledge that “infant RM studies cannot replace human infant vaccine safety and dosing studies”. However, the similarities in “infant physiology and immune development” support a reasonable comparison.  

What does this mean? 

The authors hope that their results will provide a “valuable contribution to efforts to alleviate” parental concerns. The findings add to current data to “provide strong support to initiate SARS-CoV-2 vaccination in infancy and incorporate new SARS-CoV-2 vaccines into the global routine paediatric vaccine schedules to curb the SARS-CoV-2 pandemic”.   

For more on the safety and efficacy of vaccinating children against COVID-19, come to the World Vaccine Congress in Washington next year.  

 

Pfizer/Valneva Lyme disease vaccine persists 6 months on

Pfizer/Valneva Lyme disease vaccine persists 6 months on

On 1st December 2022 Pfizer and Valneva reported antibody persistence data 6 months after the completion of a vaccination schedule with their Lyme disease vaccine candidate, VLA15. This was reported in both children and adults, the first time that antibody resistance data are reported in paediatric populations for this vaccine candidate.  

Moving through the Phases 

As we reported earlier this year, Phase II in April 2022 produced “positive immunogenicity and safety data”. As a result, the investigations continued, to evaluate the persistence of antibodies 6 months after the study of a Month 0-2-6 and Month 0-6 vaccination schedule. This was done in healthy adults and paediatric participants.  

Data were collected in 96 health adults and 81 paediatric participants (5-17 years of age) for the schedule involving vaccination at months 0-2-6, and 84 healthy adults and 78 paediatric patients for the month 0-6 schedule.  

Although antibodies did decline over time, they remained “above baseline”, confirming persistence 6 months after the completion of both schedules. Antibody levels generally remained higher after the 3-dose schedule, compared to the 2-dose schedule. The statement also indicated that “no vaccine-related serious adverse events (SAEs) and no safety concerns” were observed in the follow up.  

Several months ago, Pfizer and Valneva initiated a Phase III study, VALOR. Enrolment is taking place across Europe and the US, with up to 6,000 participants over the age of 5 expected to receive 3 doses of VLA15 or a saline placebo, followed by a booster dose.  

Validation of the vaccine 

Dr Juan Carlos Jaramillo, CMO at Valneva, is “pleased with these antibody persistence data”. They “further validate” the 3-dose vaccination strategy for the Phase III study and the “acceptable safety and tolerability profiles of our vaccine candidate”.  

“Lyme disease continues to spread, representing a high unmet medical need that impacts the lives of many in the Northern Hemisphere, and each new report of positive data takes us a step closer to potentially bringing this vaccine to both adults and children who could benefit from it.”  

Dr Annaliesa Anderson, SVP and CSO of Vaccine Research and Development at Pfizer agreed, suggesting that “rates of Lyme disease continue to increase globally”.  

“These six-month antibody persistence data are encouraging, and we hope that the data generated from the Phase III studies will further support the positive evidence for VLA15 to date.”  

To hear from speakers from both Pfizer and Valneva at the World Vaccine Congress in Washington 2023 get your tickets now.  

Africa CDC gets mpox vaccine donation from Republic of Korea

Africa CDC gets mpox vaccine donation from Republic of Korea

During a bilateral meeting between Dr Ahmed Ogwell Ouma, Acting Director General of Africa CDC, and Korea Disease Control and Prevention Agency (KDCA) Commissioner PECK Kyong Ran it was announced that the KDCA will donate a batch of the mpox vaccine to Africa. The meeting took place at the 7th Global Health Security Agenda Ministerial Meeting held in the Seoul, the Republic of Korea.  

Mpox in Africa 

The African CDC emphasises that mpox has been “endemic for decades in some African countries”. However, with recent outbreaks in other countries, the WHO declared it a PHEIC in July 2022. The statement from CDC suggests that this decision “sparked a more coordinated international response”, yet Africa “has yet to receive vaccines”. As we noted in an earlier article, this is a frustration for health leaders in Africa, who called for attention at the “source”.  

Collaboration with Korea 

Dr Ahmed Ogwell Ouma welcomed the collaboration behind the donation. It comes after an agreement signed in April 2022 through a MoU between Africa CDC and KDCA.  

“We appreciate this gesture and assure that these mpox vaccines will be prioritised in the most affected African Union Member States.” 

The MoU reportedly established a “joint plan of action” to promote cooperation in “areas of mutual interest”. As we have previously noted, Africa produces a very small percentage of the vaccines it requires. This is hopefully changing through knowledge and technology transfers, which will enable the continent to be less dependent on wealthier areas for vaccines. This inevitably and unfortunately results in vaccine nationalism and hoarding, rather than equitable access.  

The announcement of this donation comes days after the Republic of Korea was congratulated on obtaining ML4 in the WHO assessment of its Ministry of Food and Drug Safety.  

To hear more from experts on the future of vaccines and viruses in Africa at the World Vaccine Congress in Washington, April 2022, get your tickets today.  

Marking World AIDS Day 2022: “equalise” theme

Marking World AIDS Day 2022: “equalise” theme

1st December 2022 is World AIDS Day, with global communities observing it under the theme “equalise”. This year, the WHO is calling on “leaders and citizens” to identify and address the inequalities that challenge progress in “attaining the global goal to end AIDS by 2030”. The theme highlights the importance of ensuring that essential HIV services reach the most in need and at risk. This includes children.  

COVID-19 forced us back 

Earlier in the year we reported on the UNAIDS report that suggested that the “global AIDS response is under threat”. UNAIDS Executive Director Winnie Byanyima suggested that during 2021 a life was lost to AIDS every minute. Furthermore, the growth in the number of people with access to treatment was slower than in previous years.  

The WHO’s most recent statistics reinforce the urgency of UNAIDS’ report: 

  • Of the 38 million people living with HIV, 5.9 million people who know they have HIV are not receiving treatment. 
  • A further 4 million people living with HIV have not yet been diagnosed. 
  • While 76% of adults overall were receiving antiretroviral treatment that help them lead normal and healthy lives, only 52% of children living with HIV were accessing this treatment globally in 2021. 
  • 70% of new HIV infections are among people who are marginalized and often criminalized. 
  • While transmission has declined overall in Africa, there has been no significant decline among men who have sex with men – a key population group – in the past 10 years. 
Mpox makes matters worse 

Current WHO data shows that the percentage of people confirmed to have mpox and be living with HIV is high: 52%. Data reported to WHO suggest that people with mpox with untreated HIV “appear to be at risk for more severe disease than people without HIV”.  

“The current response to mpox shows that transmission can move quickly in sexual networks and within marginalized populations. But it can also be prevented with community-led responses and open attitudes to address stigma, and health and well-being can be improved, and lives can be saved.” 

Goals for the future 

With the shared goal of ending AIDS as a public health threat by 2030, the clock is ticking on collaborative action. Thus, the UN describes the impetus for “all of us to work for the proven practical actions needed to address inequalities and help end AIDS”.  

WHO Director General Dr Tedros Adhanom Ghebreyesus emphasised the importance of “global solidarity and bold leadership” to ensure that “everyone receives the care they need”. For Dr Meg Doherty, WHO Director of the HIV, Hepatitis, and STI programmes, access should not be a barrier to “health for all”.  

“In order to end AIDS, we need to end new infections among children, end lack of treatment access to them, and end structural barriers and stigma and discrimination towards key populations as soon as possible.”  

Vaccines on the scene 

During the World Vaccine Congress in Europe in October 2022, we spoke to Dr Christian Brander of Aelix Therapeutics, to learn more about the possibility of vaccines for HIV. You can watch his interview here or click here to read more about the results of trials to this end.  

For updates on HIV vaccines at the World Vaccine Congress in Washington 2023, get your tickets now.
 

WHO: Monkeypox virus gets rebranded as Mpox

WHO: Monkeypox virus gets rebranded as Mpox

The WHO announced in November 2022 that, after “consultations with global experts”, it will begin using a preferred term “mpox” for monkeypox. While the word monkeypox is “phased out” both terms will be used simultaneously for one year. This move is made in attempts to tackle “racist and stigmatising language” surrounding the recent outbreak of the disease.  

What’s in a name? 

The International Classification of Diseases (ICD) and the WHO Family of International Health Relate Classifications take charge of assigning names to new and existing diseases “through a consultative process”. This includes WHO Member States. Following the process, WHO held consultations with a range of groups, from experts to the general public. Consequently, WHO Director-General Dr Tedros Adhanom Ghebreyesus recommended the following: 

  • Adoption of the new synonym mpox in English for the disease. 
  • Mpox will become a preferred term, replacing monkeypox, after a transition period of one year. This serves to mitigate the concerns raised by experts about confusion caused by a name change in the midst of a global outbreak. It also gives time to complete the ICD update process and to update WHO publications.   
  • The synonym mpox will be included in the ICD-10 online in the coming days. It will be a part of the official 2023 release of ICD-11, which is the current global standard for health data, clinical documentation and statistical aggregation. 
  • The term “monkeypox” will remain a searchable term in ICD, to match historic information. 

Considerations for these recommendations included “rationale, scientific appropriateness, extent of current usage, pronounceability, usability in different languages, absence of geographical or zoological references, and the ease of retrieval of historical scientific information”. The process was accelerated through standard steps.  

The previous name 

Human monkeypox was named in 1970, before the WHO published its “best practices in naming diseases” in 2015. The virus that causes the disease was identified in captive monkeys in 1958. In this publication, new disease names should be assigned with the aim to minimise “unnecessary negative impact” on “trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional, or ethnic groups”.  

In August 2022, experts convened by WHO agreed to align the names of the individual “clades” of mpox with best practices. The formerly named Congo Basin clade became Clade 1, and the former West African clade became Clade 2.

For a range of discussions on mpox and public health concerns at the World Vaccine Congress in Washington next year, get your tickets now.
 

Group A strep kills child in England with another recovering

Group A strep kills child in England with another recovering

In November 2022 it was reported that a child, around the age of 6, had died after catching an infection caused by the group A streptococcus bacteria. Another child was hospitalised and is showing signs of recovery after the bacteria outbreak at a primary school in Surrey.  

Surrey outbreak 

The CDC suggests that group A strep is the cause of several different infections, ranging from minor illnesses to serious and “deadly” diseases. It is highly contagious but treatable with antibiotics. In England and Wales, it is a notifiable disease, which means health professionals must report suspected cases to local health protection teams in order to facilitate fast treatment and effective outbreak control.  

The UKHSA confirmed on 24th November that a child had died, with “precautionary” measures being taken to protect staff and pupils at the school. The school described the “shock” to the community and emphasised that the staff would be seeking health advice so that they could act on it and support parents. Ruth Hutchinson, director of public health for Surrey County Council, offered “sincere condolences” to the school community.  

Experts weigh in 

Dr Timothy Jinks, Head of Interventions for the Infectious Disease team at Wellcome tweeted a link to the BBC story, suggesting that it was news that “shouldn’t be happening”. Identifying the problem of AMR as having “undermined usefulness of half of the commonly prescribed drugs” against GAS, he suggested that illness “should be prevented with vaccines” and referred to the Strep A Vaccine Global Consortium (SAVAC).

SAVAC describes GAS as the “biggest infectious killer that no one has heard of”. It causes an estimated 517,000 deaths each year, largely in low- and middle-income countries. SAVAC is working towards the development of “safe, globally effective, and affordable” vaccines to protect against GAS.  

We will hear more from Dr Neeraj Kapoor, the Director of the Group A Strep and Periodontitis Vaccine Programmes at Vaxcyte, on progress towards GAS vaccines next week at the World Vaccine and Immunotherapy Congress.  

 

Universal flu vaccine hopes renewed in new data

Universal flu vaccine hopes renewed in new data

A study published in Science in November 2022 has given experts in the UK reason to predict that a universal flu vaccine might be available sooner than previously hoped. Scientists in the US shared evidence that their experimental mRNA vaccine offered broad protection against all 20 known influenza A and B virus subtypes in mice and ferrets.  

The potential to face flu 

Influenza viruses evolve constantly, and, as the authors of the study acknowledge, this can “make targeting optimal antigens difficult”. One solution to this difficulty is broadly neutralising antibodies, but “they present their own pitfalls”, such as “limited cross-reactivity” and the need for multiple injections.  The paper suggests that it is particularly difficult to be successful in creating “effective prepandemic vaccines” without certainty of which virus subtype will cause the next pandemic.  

Thus, researchers developed a nucleoside-mRNA-lipid nanoparticle vaccine encoding haemagglutinin antigens from “all 20 known influenza A virus subtypes and influenza B virus lineages”. In animal studies, involving mice and ferrets, the multivalent vaccine “elicited high levels” of cross-reactive and subtype-specific antibodies” that reacted to all 20 encoded antigens.  

“Our studies indicate that mRNA vaccines can provide protection against antigenically variable viruses by simultaneously inducing antibodies against multiple antigens.”  

The antibodies reportedly remained at a stable level for up to 4 months. According to Professor Peter Palese of the Icahn School of Medicine in New York, the mouse and ferret models “are as good as animal models get”. Therefore, the animal data is “promising” and a “good indication of what will happen in humans”.  

How soon could we see this vaccine? 

Professor Palese told New Scientist that the key benefit of mRNA vaccines is the potential to easily scale them up, compared with other approaches. However, for Dr Albert Osterhaus, “further exploration in clinical studies” is needed. He refers to “previous studies” that demonstrate the difficulty of predicting what clinical data might bring.  

Experts in the UK have indicated that the data so far is promising. Professor John Oxford of Queen Mary University told BBC’s Radio 4 that expecting to see it next winter would be “stretching it” but that he would “put [his] cash on the winter afterwards”. 

“I cannot emphasise enough what a breakthrough this paper is.”  

Professor Oxford hopes that, with mRNA technology, we can tackle the “two beasts of the jungle, the respiratory jungle”: flu and Covid. Although we tend to “underestimate these big respiratory viruses”, we must “get a grip” on them, and influenza will be the next “big beast” for us to tackle.  

Questions remain 

The Telegraph suggests that we still need to understand how to “judge efficacy and potential regulatory requirements for a vaccine against possible future viruses that are not currently circulating”. This was the sentiment conveyed in a complementary commentary to the study. Although this is a promising step, further data is required before we get ahead of ourselves, particularly as we aim to “get a grip” on influenza. 

We will hear more on approaches to influenza at the World Vaccine and Immunotherapy Congress next week in San Diego. To join us, get your tickets now.  

Relief from UTIs offered by sublingual vaccine

Relief from UTIs offered by sublingual vaccine

A research paper published in Science Advances suggests the possibility of UTI prevention through a sublingual vaccine. The paper, released in November 2022, details the success of the vaccine in mice and rabbits, indicating that there is hope for human solutions. Researchers from Duke University in the USA believe that their vaccine, which targets the uropathogenic Escherichia coli (UPEC), the cause of 80% of uncomplicated UTIs, can be a gentler alternative to antibiotics.  

UTIs  

The authors suggest that the “major health problem” of UTIs affects “millions” every year. Specifically, 50% of all women are believed to suffer from a UTI in their lifetime. The current option for managing this is “long-term antibiotic use”. 

There are risks associated with antibiotic taking, particularly for gut microbiota. The study describes how, in addition to drug-specific adverse effects, prolonged antibiotic use alters the microbes’ “metabolic activity, gene expression, and protein synthesis”, as well as reducing “diversity” as a whole. However, risks are not limited to the direct effects of the drugs, but the growing resistance to them. Modelling suggests that by 2050, “current practices would result in 10 million additional deaths per year by infection”.  

Antibiotic resistance compounds the effects already associated with prolonged antibiotic resistance use, making it likely that safe, effective treatment and prevention of UTIs will become increasingly challenging.” 

UPEC have become “increasingly resistant” to common antibiotics. Therefore, the study infers an “urgent unmet need” for a “more effective form of UTI prevention”.  

Vaccine potential 

With this “unmet need” in mind, the authors considered the possibility of a vaccine that “raises protective, long-term antibody responses against UTI-causing bacteria”. With no such vaccine available, and “significant” barriers to its development, their task seemed a “major challenge”. 

“An ideal vaccine candidate would elicit immune responses that are specific to UTI-causing bacteria to avoid adverse effects to the microbiota while also targeting a broad range of UTI-causing pathogens.” 

The assumption that protection against UTIs relies on “systemic responses in the blood and mucosal responses in the urogenital tract” suggest that the vaccine should: 

  • Be able to raise simultaneous responses against multiple highly specific and carefully selected epitopes targeting only pathogenic bacteria 
  • Be able to elicit mucosal responses 
  • Feature efficient dosing regiments that facilitate compliance and minimise cost 
Vaccine design 

With a supramolecular approach the researchers assembled multiple selected B cell epitopes from UPEC into “sublingually immunogenic nanomaterials”. This method of administration is “known to elicit antibody responses in the urogenital tract”, but it is hard to “raise robust immune responses against short peptide epitopes” this way, as peptides are “poorly immunogenic via the oral mucosa”. However, they were able to demonstrate with model epitopes that supramolecular peptide nanofibers “bearing polymer modifications modulating mucus adhesivity” can raise “strong systemic and mucosal antibody responses”.   

In the study the authors mine the “unique advantages” of their platform. In mice the vaccine elicited “robust anti-UPEC antibodies that were not cross-reactive against commensal E. coli. Furthermore, it was “as effective as high-dose oral antibiotics” at protecting mice from “lethal challenge with UPEC”.  

“We report a novel vaccination strategy, enabled by biomaterial design, that provides long-lasting, antibiotic-level efficacy against UPEC.” 

Vaccine benefits 

As the tablet can be self-administered and is stable at room temperature, it is easy to store, deliver, and administer. This has the potential to “lower costs of vaccine delivery”, suggests Sean Kelly, an author of the paper. Co-author Professor Joel Collier intends to “conduct biodistribution and safety studies” before clinical trials. His team are “actively seeking partners to accomplish this”.  

For more on the benefits on novel delivery methods get your tickets to the World Vaccine and Immunotherapy Congress in San Diego next week! 

WHO launches AMR strategy in Africa during awareness week

WHO launches AMR strategy in Africa during awareness week

In November 2022 the WHO launched a strategy to “respond to the urgent problem of antimalarial drug resistance in Africa”. This coincided with World Antimicrobial Awareness Week, which aims to “improve awareness of the growing threat of resistance to antibiotics and other medicines”. This strategy is focused on malaria to address reports of “emerging parasite resistance to artemisinin”.  

Malaria treatments 

Artemisinin is the core compound of “the best available medicines to treat malaria”. It is derived from the sweet wormwood plant, Artemisia annua, and its antipyretic properties have long been recognised. The active agent was isolated in the 1970 and has since been used to rapidly treat malaria. Alongside artemisinin there are “worrying signs” that some parasites may be resistant to drugs that are frequently combined with the treatment.  

“Vigorous measures are needed to protect their efficacy.”  

Although these are concerning updates from WHO, Dr Pascal Ringwald, lead author of the strategy and a Coordinator in the WHO Global Malaria programme advised health care providers to “continue to prescribe and use ACTs to treat confirmed malaria”. ACTs are artemisinin-based combination therapies, which Dr Ringwald suggests remain the “best available treatment” for “uncomplicated P. falciparum malaria.  

“Rising resistance” 

The WHO statement suggests that this parasitic resistance to artemisinin has been observed in the Greater Mekong subregion and “several areas in Africa”. Although the “treatment remains highly efficacious” there are fears of “lacking” data and “contradictory findings”. The statement also indicates that Africa’s “heavy reliance” on ACTs could have “serious consequences” if we experience a “full-blown treatment failure”. Dr Dorothy Achu, WHO’s Team Leader for Tropical and Vector Borne Diseases for the WHO African Region, states that “we don’t have that many options for malaria drugs”.  

“Any threat to these drugs could lead to lots of cases and deaths, which we obviously want to avoid.”  

To assess the extent to which this would affect cases, researchers at Imperial College London produced a model in 2016. They estimated that we would see 16 million more malaria cases each year, resulting in up to 80,000 additional annual deaths. The economic consequences could hit an estimated U$ 1 billion.  

Strategic approaches 

The WHO strategy reportedly “builds on lessons” from previous plans and “complements existing strategies”. Among these are “broader efforts” against AMR. 4 pillars will be initiated, with 20 interventions in total. These are displayed in WHO’s infographic below. 

“All of these interventions require strong health systems and investments in primary health care, which are the backbone of any successful response to malaria.”  

Vaccines 

As we explored with Dr Charlie Weller in an interview several months ago, vaccines present a “huge” but “under-recognised” potential for our AMR toolbox. She also highlighted the importance of a “coordinated and multifaceted approach” against pathogens that are currently drug resistant, but also those that are “on a trajectory” to become so.  

For more on malaria vaccines and therapies at the World Vaccine and Immunotherapy Congress this month, get your tickets now. At the World Vaccine Congress in Washington next April, we will have sessions dedicated to addressing the burden of AMR. We hope you can join us!  

Hepatitis E vaccination campaign offers hope in South Sudan

Hepatitis E vaccination campaign offers hope in South Sudan

Reported by Epicentre, a group “embedded” in Médecins sans frontières (MSF), progress is being made in a joint vaccination effort in South Sudan. Alongside this vaccination campaign is an Epicentre study to “evaluate the effectiveness in real conditions” of the vaccine that has demonstrated promise in clinical trials. It has been recommended for use in outbreak responses by the WHO since 2015. 

Hepatitis E 

The WHO describes hepatitis E as an inflammation of the liver caused by infection with the hepatitis E virus (HEV). An estimated 20 million HEV infections each year cause around 3.3 million symptomatic cases of hepatitis E. The WHO also estimates that hepatitis E caused around 44,000 deaths in 2015. 

The virus is transmitted through the faecal-oral route, largely through contaminated water. It is prevalent in East and South Asia but exists worldwide. Large outbreaks occur in situations where water and sanitation are inadequate, such as in mass displacement camps. With no specific treatment for hepatitis E, it has a fatality rate of up to 25% among pregnant patients and increases the risk of spontaneous abortions and stillbirths. Although there is a vaccine in China, it is not yet available elsewhere. The vaccine, Hecolin, has been shown highly effective in clinical trials.  

Dr Monica Rull, Medical Director of MSF, describes the fight against hepatitis E as “long and frustrating”. In recent decades MSF has responded to outbreaks in displacement camps, attempting to “control the disease in challenging conditions”. It is made harder by seeing the “devastating impact on extremely vulnerable communities”.  

“With the experience of this vaccination campaign, we hope to change the way we tackle hepatitis E in the future”.  

Bentiu camp 

Bentiu camp is in Unity State, South Sudan. It was established in 2013 and has around 112,000 people. Hepatitis E outbreaks began in 2015 and worsened in 2021 due to “extreme flooding” and an increase in displaced people. MSF has a hospital in the camp and has seen 759 confirmed cases, with the unfortunate deaths of 17 patients.  

The Ministry of Health of South Sudan requested that MSF help efforts to control the outbreak through a large-scale vaccination campaign. Although Hecolin has been recommended for outbreak responses by WHO, this is the first time it has been used in response to a public health emergency.  

Real time, real conditions 

Alongside the mass vaccination programme, Epicentre is studying “coverage and acceptance” as well as the effectiveness and safety of the vaccine. Dr Robin Nesbitt, an epidemiologist at Epicentre, suggests that 91% of the target, 24,469 people, received the first dose of the vaccine in March 2022. 95% received the second dose in April 2022. It is hoped that generating this additional data through ongoing studies will “allay some fears associated with the introduction of newer vaccines”. Furthermore, Epicentre aims to contribute to the “relatively sparse data” on the vaccine in pregnant women, who “suffer the most serious consequences” of infection.  

Dr John Rumunu of the South Sudan Ministry of health observed the “successful implementation and the community’s enthusiastic response”.  

“I hope the vaccine will help reduce infections and deaths from hepatitis E in Bentiu and beyond.”  

The collaboration between the Ministry of Health and MSF will complement outbreak control measures, such as improving water and sanitation services. Additionally, MSF hopes the campaign will “encourage other countries to use the vaccine” in the future to address any further outbreaks.  

For more on hepatitis at the World Vaccine and Immunotherapy Congress in San Diego 2022 get your tickets now.  

New collaboration: AI steps up to pandemic plate

New collaboration: AI steps up to pandemic plate

In November 2022 CEPI and the University of California, Davis announced a partnership agreement to “advance and expand the application of ‘SpillOver’”. This is a viral ranking app that compares the risks presented by animal and human viruses. With funding from CEPI the app will go to the “next level”.  

SpillOver 

The database reportedly ranks hundreds of “virus, host, and environmental risk factors” to identify viruses with the highest risk of zoonotic spillover. UC Davis researchers developed the open database with data from 509,721 samples from 74,635 animals across 28 countries and public records. Then, the data were used to “rank the spillover potential” of 887 wildlife viruses.  

With up to US$1.76 million from CEPI, the app’s database will expand to include “new risk factors”. These include viruses that infect domesticated animals or those “harboured by reptiles and amphibians”. The UC Davis One Health Institute will also “pioneer a new system” with the support of artificial intelligence, to analyse “multiple sources” in search of data. 

Viral top trumps 

Recent findings published in PNAS and based on over 30 risk factors indicate that Lassa virus is the highest risk pathogen after SARS-CoV-2. There are currently no licensed vaccines against Lassa fever, but a collaboration between IAVI and CEPI aims to address this.  

As well as developing vaccines against known diseases, CEPI states that it is possible to develop “prototype vaccines” against different virus families. These can then be adapted quickly as a new virus is identified. CEPI hopes to build a ‘library’ of vaccine candidates in time for Disease X. This is part of the $3.5 billion 100 Days Mission, a “plan to compress vaccine development timelines to 100 days”.  

Viral families 

Dr Melanie Saville, Executive Director of Vaccine Research and Development at CEPI, suggests that “most viruses that cause disease in people are descended from one of around 25 families”.  

“There are viruses out there that we don’t yet know about, also known as Disease X, but which are likely to come from one of these 25 or so viral families”.  

Through the partnership with UC Davis CEPI hopes to “home in” on these viral families. Thanks to globalisation, we are more “vulnerable to the rapid spread of new zoonoses”. Thus, the identification of “another pandemic disease” is predicted to come any time soon. Additionally, the risk is “further heightened by our warming climate”, which expands the range of disease-carrying creatures and increases their interaction with human populations. Dr Jonna Mazet of UC Davis is “thrilled” to be collaborating with CEPI to “create a healthier future for us all”.  

“Together we will use cutting-edge methods to dramatically increase the amount virus data available for risk ranking. This is a critical step forward in streamlining vaccine pipelines with the power to revolutionise epidemic and pandemic preparedness.”  

For more on preparation for Disease X at the World Vaccine Congress in Washington 2023, get your tickets now.  

 

CEPI-Gavi-WHO collaboration during Ebola outbreak

CEPI-Gavi-WHO collaboration during Ebola outbreak

Over a month after the declaration of an Ebola outbreak in Uganda in September 2022 the WHO, CEPI, and Gavi issued a statement on the situation. Observing the spread to 7 districts and acknowledging the government-led response, these organisations have “outlined a plan”. The plan will “accelerate research”, “ensure access to investigational doses” and “facilitate scaling up and access to any subsequent licensed vaccine”.  

Vaccination hopes 

The statement in November 2022 identifies the importance of vaccination in outbreaks such as this one. However, as there are no licensed vaccines or therapeutics for the Sudan ebolavirus, all efforts are being directed towards the candidates that might be suitable.  

“By embedding research at the heart of the outbreak response, we can achieve two goals: to evaluate potentially efficacious candidate vaccines, and to potentially contribute to end this outbreak, and protect populations at risk in the future.”  

Vaccine and therapeutics trials have been designated to the Makerere University Lung Institute. With support from WHO, CEPI, and Gavi, there should be enough doses for trial “and beyond”. Candidates in consideration include vaccines from the University of Oxford and the Serum Institute of India, and the Sabin Vaccine Institute and BARDA. Further overall support has been offered from organisations such as Africa CDC, UNICEF, and the African Vaccine Regulatory Forum (AVAREF).  

A statement of intent 

The statement outlined a series of goals that are “likely to evolve” as the outbreak continues. 

  • Short term support to the Ministry of Health of Uganda’s outbreak response, including support of a randomised clinical trial to evaluate vaccine candidates.  
  • Mid-term allocation of resources to “plan for and to reserve sufficient manufacturing capacity” for the scale up of vaccine candidates, potentially through a “risk-sharing mechanism”. This might involve manufacturing additional vaccines during the trial to “ensure that doses of a vaccine found to be efficacious” is readily available.  
  • Longer term exploration of pathways to ensure that licensed SUDV vaccine(s) are available via the Ebola stockpile.  
  • Commitment to a mechanism to “ensure equitable access and funding for SUDV vaccines research, outbreak response, and preventative vaccination”.  
Guiding principles 

The collaborators have committed to be “guided by the following principles”: 

  • Leverage organisational strengths towards a common goal. 
  • Country driven and country engaged. 
  • Decision making which is evidence-informed and considers access. 
  • End-to-end approach based on access and equity.  
  • Efficient resource allocation.  
  • Research integrity and ethics.  

As the outbreak continues to claim lives across more areas, the importance of this collaboration is clear. Furthermore, the emphasis on following the leadership of the Ugandan ministries is of note; will they be able to maintain this approach? 

For more on tackling Ebola with vaccines come to the World Vaccine Congress in Washington 2023.  

 

Nature study: vaccine selfishness cost lives

Nature study: vaccine selfishness cost lives

From the start of the COVID-19 pandemic it was clear that each of us would have a different experience. When the vaccines were developed in record time, it came as no surprise that “vaccine nationalism” became prevalent. Described by WHO Director General Dr Tedros Adhanom Ghebreyesus as a “me-first approach”, vaccine nationalism is assumed to have caused a needless loss of life across the world. Now, a study in Nature has put a number to it. 

The world in numbers  

By the end of 2021 the spread of vaccines was heavily imbalanced. Some countries had achieved over 90% coverage in adults, but others had below 2%. As we explored in our post on global vaccination, Africa had the slowest vaccination rate of any continent. In mid 2022 just 25.5% of the population was at single dose.  

Hoping to better understand the effect of these inequalities, researchers in the UK used an “age-structured model of SARS-CoV-2 dynamics, matched to national data from 152 countries in 2021”. The aim was to “investigate the global impact of different potential vaccine sharing protocols that attempted to address” the inequity caused by hoarding.  

“We found that greater vaccine sharing would have lowered the total global burden of disease, and any associated increases in infections in previously vaccine-rich countries could have been mitigated by reduced relaxation of non-pharmaceutical interventions.”  

The study 

The authors note that lower-income countries were “mostly dependent” on donations and sharing schemes. This relied on the good will of countries who had already achieved higher levels of coverage. The study reports that although stockpiling or vaccinating and boosting lower risk groups were appealing, sharing vaccines has “markedly higher payoffs per dose in reducing infection and mortality”.  

For countries that were able to vaccinate large percentages of their population, restrictions could be relaxed and a “return to pre-pandemic-like” habits was seen. Despite this, the “estimated waning of vaccine efficacy” and emergence of new variants provoked booster campaigns in these areas. Caught between a rock and a hard place, countries had to evaluate the benefits of preventing “high levels of new global infections” by sharing vaccines or playing domestic catch-up with boosters. The model suggests that some “non-pharmaceutical mitigation measures” may have been necessary alternatives to boosters in some areas.  

The study is retrospective, but the authors believe that “robust” conclusions can still be drawn. Based on “simulations fitted to historical infection and mortality estimates and from varying the distribution of vaccination between countries while maintaining the total vaccine supply”, their suggestion is that a greater level of vaccine sharing would have seen “sizeable benefits”.  

The ugly truth 

The study reveals that a “more equitable approach” to vaccine distribution throughout 2021 would have “reduced the level of global mortality associated with COVID-19 disease”. This might have come at the “cost” of “increased or prolonged” non-pharmaceutical interventions.  

“In total, we estimate that a full vaccine sharing scenario would have prevented 295.8 million infections and 1.3 million deaths worldwide (as a direct result of COVID-19) by the end of 2021”.  

The study has been described as a significant step in pushing for “vaccine coverage” by Dr Oliver Watson at Imperial College London.  

“That’s really important for engaging political will and framing big political decisions.” 

As we continue moving forward it remains to be seen if we will learn from this evidence and make vaccine equity a priority in the future. Unfortunately, this seems an unlikely prospect, particularly considering recent outbreaks. For example, monkeypox demonstrates a sustained unwillingness to address the “larger reservoir of infection”.  

“Our results reinforce the health message, pertinent to future pandemics, that vaccine distribution proportional to wealth, rather than to need, may be detrimental to all.”  

For more on vaccine equity at the World Vaccine Congress in Washington 2023, get your tickets now.  

 

 

 

WHO publishes first list of fungal priority pathogens

WHO publishes first list of fungal priority pathogens

In October 2022 the WHO published a report that highlights the “first-ever” list of fungal priority pathogens. This is a “catalogue” of 19 fungi that “represent the greatest threat to public health”. Known as the FPPL, this list is the first global effort to “systematically prioritise fungal pathogens. The report also acknowledges the “unmet research and development (R&D) needs and the perceived public health importance”.  

“The Who FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.” 

Threats and treatments 

Although fungal pathogens are a “major threat to public health” there are only “four classes” of antifungal medicines available with limited future candidates. These threats are becoming “increasingly common” and resisting the treatments that are available. The WHO’s statement indicates that we are ill-prepared with sufficient diagnostics. Those that are of an adequate level are “not widely available or affordable globally”.  

The most vulnerable to invasive fungal infections include patients with prior illnesses or “underlying immune system related conditions”. For example, patients with cancer, HIV/AIDS, or post-primary tuberculosis infection are at greater risk of invasive fungal infections.  

Increasingly present 

The WHO identifies evidence to suggest that the “incidence and geographic range” of these diseases are expanding due to global warming and globalisation. Furthermore, the COVID-19 pandemic saw an increase in reported incidence of invasive fungal infections among patients in hospitals. Dr Hanan Balkhy, WHO Assistant Director-General, AMR, described the threatening increase: 

“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide.”  

Although this is clearly a worrying phenomenon, we have devoted “very little attention and resources” to fungal infections. Thus, data are scarce. If we cannot know the “exact burden” of this threat, an appropriate response is unlikely.  

The FPPL is divided into three categories: critical, high, and medium priority. However, WHO “emphasises that the FPPL must be interpreted and contextualised”. This is because some pathogens are of more concern in “regional or local contexts”. Throughout the report the phrase “no vaccine is available” emphasises how important further research will be. If we are unable to prevent cases, then our reliance on appropriate treatment is greater.  

Calls for evidence and action 

The report emphasises the need to continue compiling evidence “to inform the response to this growing threat and to better understand the burden”. It also calls for “coordinated action”. Dr Haileyesus Getahun, WHO Director, AMR Global Coordination Department, hopes the “inform and improve” the response to these pathogens.  

“Countries are encouraged to follow a stepwise approach, starting with strengthening their fungal disease laboratory and surveillance capacities, and ensuring equitable access to existing quality therapeutics and diagnostics, globally.” 

There are three primary recommended points of focus within the strategies proposed. They are focused on: 

  1. Strengthening laboratory capacity and surveillance 
  2. Sustaining investments in research, development, and innovation 
  3. Enhancing public health interventions for prevention and control 

The statement from WHO links resistance to antifungal medicines to “inappropriate antifungal use across the One Health spectrum”. Further collaborative efforts are required across this spectrum to address the “impact of antifungal use on resistance”.  

To hear more about preparing for priority pathogens at the World Vaccine Congress in Washington 2023, get your tickets now.
 

British farmers call for bird flu vaccinations

British farmers call for bird flu vaccinations

After security measures against avian flu were lifted in Great Britain in August 2022 the outbreak has continued to affect farmers and their stocks. In October the BBC reported that farmers were calling for the inclusion of vaccination in the response strategy. One man in particular, Mark Gorton, has experienced severe loss to his stock. His demand for vaccination has prompted a response from official sources, indicating that discussions are taking place. 

The latest on the outbreak 

The Department for Environment, Food, and Rural Affairs (DEFRA) states that the “risk of incursion” of highly pathogenic (HPAI) avian influenza H5 is now “high” in wild birds across Great Britain. The risk to “poultry with stringent biosecurity” has been increased to “medium” but for poultry with “suboptimal biosecurity” is “high”. Responsive measures give weight to DEFRA’s indication that this is Britain’s largest ever outbreak. 

On 24th October 2022 HPAI H5N1 was confirmed at several locations. This means that a 3km Protection Zone and a 10km Surveillance Zone must be declared around the premises. Furthermore, “all poultry on the premises will be humanely culled”.  

Calls for shots 

Mark Gorton is the managing director of Traditional Norfolk Poultry. He described the strain of flu as “extremely virulent and infectious”. The BBC suggested that 6 of the Norfolk outbreaks were on farms that Mr Gorton runs. He describes losing 100,000 birds, around 10% of his stock.  

“We’ve never known it as bad as this” 

Although it is usually expected to “die out over the summer”, Mr Gorton indicated that it is “actually getting worse”. Despite best efforts, security measures are proving ineffective, and Mr Gorton wants to be allowed to vaccinate his birds.  

“There are vaccines available, but unfortunately it is legislation that is preventing us from using them.”  

Official position 

Mr Gorton suggests that “vaccination is the only solution”. However, Richard Irvine, the UK’s deputy chief veterinary officer, said it is “not part of the disease policy and approach”. Instead, he and colleagues hope that “scrupulous biosecurity” will protect birds from the flu. One issue with the vaccine is the closeness of a match with the virus in circulation.  

Mr Irvine implied that there are “international” conversations being held about the use of vaccines against bird flu. There is more work to be done to provide “answers from the science” at an “international level” to ensure that vaccination is the best course of action. However, these discussions take place while farmers continue to suffer huge losses.  

We will discuss avian influenza during the veterinary sessions at the World Vaccine Congress in Washington next year. To join us, click here for tickets.

 

Merck finds frozen Ebola vaccines to test in Uganda spread

Merck finds frozen Ebola vaccines to test in Uganda spread

As Uganda’s Ebola outbreak continues to claim lives the need for a vaccine grows greater. The outbreak was announced in September 2022, since which at least 28 deaths have been reported, with more suspected. Despite Uganda’s quick and efficient response, the international community is calling for accelerated research into vaccines against the ‘Sudan’ iteration of the virus. In October 2022, Science reported that Merck, the “pharmaceutical giant”, might be able to contribute to this.  

Science investigates 

The report suggests that “repeated inquiries” were needed to confirm the information. Conflicting insights were exchanged, during which time it was initially suggested that the vials had expired and been destroyed. However, eventually Merck “acknowledged” that it has “up to 100,000 doses” of an experimental vaccine. Frozen in Pennsylvania, the vaccine doses target the Sudan ebolavirus. According to Science the vaccine was developed in 2015 and 2016, following success with a Zaire ebolavirus candidate. It was frozen and not tested on humans but has been shown effective in monkeys.  

Dr Mark Feinberg led the Zaire Ebola vaccine programme at Merck. He described this discovery as “amazingly good news”. Dr Feinberg is now President and CEO of IAVI, which is also developing a Sudan ebolavirus candidate.  

Merck’s vaccine enters the scene  

Dr Nicole Lurie of CEPI indicated that the “potential availability” of this vaccine is “potentially game changing”. It comprises the gene for the surface protein of the Sudan ebolavirus, incorporated into vesicular stomatitis virus (VSV). Other developers of a Sudan Ebola vaccine include the Sabin Institute and the University of Oxford. However, there is now a “wildcard”, says Dr Lurie. This might be the most promising candidate, according to scientists who addressed Science. VSV vaccines have demonstrated “more robust and durable protection” than chimp adenoviruses.  

We look forward to hearing more from Merck on the subject of Ebola at the World Vaccine Congress in Washington 2023. To get your tickets click here.  

Exclusive interview with Dr Jerald Sadoff

Exclusive interview with Dr Jerald Sadoff

After a fantastic few days at the World Vaccine Congress we at Vaccine Nation are just getting our breath back and reflecting on the amazing interviews that we were able to secure on-site. One such interview was an early morning meeting with Dr Jerald Sadoff of Janssen. A long-serving and highly regarded member of the vaccine community, he kindly offered us a brief insight into his work and opinions on the COVID-19 pandemic. We are delighted to share this insight with our community.

Introduction to Dr Sadoff

Although some may (rightly) argue that Dr Sadoff needs no introduction, he very kindly outlined his most recent experience for us. This includes contributions to a COVID-19 vaccine, among 13 other vaccines he has worked on. During his 50 years in the vaccine community he has “done the spectrum” of service, from big Pharma to non-profit.

Lessons from COVID-19

It may be a cliché, but with someone like Dr Sadoff in the hot seat we were keen to hear his thoughts on what lessons we should be learning from the pandemic. His initial response is a positive reflection on the international collaboration that ensued: “everybody stepped up to the plate”. In particular, he recognises the work of the regulatory agencies who “must have been working 25 hours a day”!

However, he admits that there were “limitations”. For example, because of the pressing and immediate need for the vaccines, we had to move at an appropriate speed. Thus, we had to take a chance and weigh the risks to human life and economic consequences against that which was “impossible to know”.  What we did know, he suggests, is that the burden on human health and economic stability was great.

Dr Sadoff also considered the policy side of the pandemic. For him, the messaging was unclear, resulting in confusion. Scientific uncertainty is “not an easy message to give”. In conclusion, he would much rather be on the development side than the policy side!

What next? Variants or future threats?

We then asked Dr Sadoff about where our attention should be directed going forward. Should we “chase” variants or should we prepare for a future pathogen? His answer was a tactful “you have to do both”! We can’t rest on our laurels with the potential for future threats growing daily, but we also have to evaluate what we want to achieve from vaccines for variants. Overall, it depends on what the “goal” is for policy makers and the vaccine community.

He was clear that we “shouldn’t use flu as an analogy” – a position maintained by a number of well-regarded health experts. However, it is possible that we will have to conceive annual updates, or respond to new mutants, in a similar fashion to our approach to the flu.

Why WVCEU?

Our final question is the rather self-indulgent “what are you excited about at this Congress?” and you will likely hear it a lot. It is important to us to understand exactly why these esteemed vaccine thought- and action-leaders come to our event so that we can continue to support and promote their work. Dr Sadoff’s answer touched on the fact that it is encouraging to see interest in “learning” and “going forward”. Furthermore, he was pleased to participate in discussions in which “new data” and approaches to other diseases were presented. Last, and by no means least, he reflected on the importance of meeting with colleagues.

 

Thus concluded our interview before Dr Sadoff hurried off to rejoin the plenary. It was a real privilege to speak to him, and we hope you gained as much from the interview as we did. We look forward to meeting again in the future to hear more.

If you would like to join us at our Congress in Washington in 2023 then click here to purchase tickets in advance. For more on COVID-19 and how we can emerge from the pandemic successful click here.

Vaccine efforts: the thorn in Polio’s side?

Vaccine efforts: the thorn in Polio’s side?

Original efforts for Polio eradication have been unsuccessful. Gavi reports that it was “supposed to be eradicated 22 years ago”, yet in 2022 we continue to face obstacles in the way of this goal. In October this year, the Global Polio Eradication Initiative (GPEI) will be fundraising at the World Health Summit, in the hopes of raising $4.8 billion. This would go towards vaccination and global surveillance programmes in 50 countries. However, Gavi suggests that although “high income donor countries” have an opportunity to help Polio meet its match, the “outlook is uncertain”.  

Polio prevails 

The virus is endemic in Pakistan and Afghanistan, with recent cases occurring in Malawi and Mozambique. In addition, recent cases of vaccine-derived polio in the US and UK offer a “stark reminder” of the effects of globalisation on viral threats. These recent occurrences have given strength to calls to maintain focus on polio vaccination, but there is confusion about the implications of “vaccine-derived” and complications caused by the amplification of anti-vaccine movements during the COVID-19 pandemic.  

Active campaigns 

It’s no secret that the increase in vaccine awareness during the recent pandemic has facilitated and encouraged a dangerous growth of anti-vaccine movements, easily exploiting vaccine hesitancy. However, this is not a unique problem, and as Professor Peter Hotez identifies, allowing it to take root in countries like the US will have global implications. How can the rest of us be expected to gladly receive vaccination programmes that the so-called world leader can’t deliver for itself?  

Before COVID-19  

It isn’t just a COVID-19 problem, though. Gavi recalls the Taliban’s ban on door-to-door polio vaccination in 2018. This caused 3.3 million children to miss out on their polio vaccines. Although the ban has been lifted it set a precedent of mistrust and confusion that prevails. Furthermore, political instability and conflict are hurdles that health workers are expected to overcome. 

“Populations most in need of humanitarian assistance are often the hardest to reach.”  

Gavi also notes that international enthusiasm “fades over time” as immediate aid is more appealing than a “long-term recovery process”. This is a phenomenon known as donor fatigue and has “devastating consequences”.  

“If appropriate measures are not urgently taken, immunisation recovery programmes and continued aspirations to meet polio eradication will become a more distant target.”  

Pushing forward 

Gavi demands a “call to action” of “synchronised” responses. The efforts to address polio must acknowledge “political and structural challenges” or they will contribute to workforce fatigue and have no real effect on eradication.  

“Complacency and insufficient funding will pose a major challenge to reach 370 million children annually for the next five years and our collective success”.  

To hear more from Gavi at the World Vaccine Congress in Washington 2023 get your tickets now.  

Reports of increasing dangerous pathogen labs

Reports of increasing dangerous pathogen labs

An article in Nature in October 2022 suggested that “in the wake” of the continuing COVID-19 pandemic and its human and economic consequences, an increase in high-level biosafety laboratories is expected. Although this might be framed in a positive and prepared light, the publication indicates that “researchers are concerned” about this uptake in facilities for a variety of reasons.  

Facilities for the future 

Of the global goals to create laboratories, India’s are described as the “most ambitious”. It is currently building 5 biosafety-level-3 (BSL-3) facilities with a further 9 in its sights. Additionally, 4 institutions are reported to have indicated an intention to construct BSL-4 labs. At the moment, India only has one in operation. Furthermore, the government has “committed” to building 4 national institutes of virology, 2 of which will be able to handle BSL-4 pathogens.  

  • BSL-3 facilities are “designed so that scientists can safely work with potentially lethal and inhaled pathogens in a contained environment”. At these locations experiments take place in sealed, filtered workspaces.  
  • BSL-4 laboratories enable scientists to “work with fatal pathogens that can spread through aerosols, and for which vaccines or treatments are lacking or limited”. These are isolated from other areas of a building and have a “dedicated air supply”. Researchers are required to shower and change upon entry and before exiting the site.  

Local researchers believe that these facilities are critical for a country of India’s size, particularly in the context of the pandemic. In other locations, such as Kazakhstan, Singapore, and the Philippines, the construction of BSL-4 facilities is anticipated. In the US, roughly “a dozen maximum-containment facilities” will be joined by another BSL-4 lab. We are even led to believe, with “scant” details, that Russia will build 15. These developments will take time, but plans are underway across the world to expand and improve preparedness and responsiveness.  

Global inequalities 

During the pandemic varying abilities to conduct research and development became even clearer across the world. Investigating SARS-CoV-2 has to be done at a BSL-3 or BSL-4 facility, which meant many brilliant minds were unable to exercise their powers to their full potential due to infrastructural inequalities. Dr Bharati Pawar is India’s minster for Health and Family Welfare, and she believes that the “weakness of health systems” across the world were exposed by the pandemic. 

“In this light, the critical element of any preparedness programme is lab preparedness.”  

As well as pandemic preparedness, researchers are hoping that these labs will promote research into vaccines and treatments for infectious diseases that are particularly damaging in the new locations. Examples include tuberculosis and dengue virus. Dr Kathrin Summermatter of the University of Bern’s BSL-3 lab believes that “lab capacity to study endemic diseases” is crucial. Not only will the labs improve research quality, but, according to Nature, they will “improve working conditions” for scientists who can conduct their research in local facilities with greater ease.  

Concerns and costs 

Despite the apparent benefits of increasing our capabilities to prepare for future pandemics, “some scientists” are worried that the “huge cost” of maintaining BSL-3 and BSL-4 facilities will be too much to meet. Dr Illich Mombo, working at the International Centre for Medical Research of Franceville in Gabon, indicated that only 10% of the lab’s budget is used for experiments. The other 90% is used for facility upkeep.  

Others are concerned about biological risks, such as the nightmarish potential to create more dangerous pathogens or allow microorganisms to escape. The article in Nature refers to a study that demonstrated that in the Philippines “biosafety officers had only a weak understanding of biosafety”. Thus, the plans to build a BSL-4 lab are daunting.  

Tension between risk and reward 

The obvious benefits of developing a greater understanding of some of our most dangerous health threats are tightly bound to the risks of such research. For example, gain-of-function studies might increase a pathogen’s potential to harm humans through modification. However, some scientists expect safety practices to improve with increased capacity.  

If you would like to learn more about the importance of pathogen research in preparing for future threats, get your tickets to the World Vaccine Congress in Washington, 2023.  

Oxford study shows meningitis vaccine leads to herd immunity

Oxford study shows meningitis vaccine leads to herd immunity

In October 2022 a group of researchers from the University of Oxford reported the results of their study into the effects of the UK’s meningitis vaccination programme. The study, published in Clinical Microbiology and Infection, found that the vaccine “substantially reduced carriage of the W and y meningococcal groups, and sustained low levels of the C group”.  

The study 

Researchers took throat swabs to assess the prevalence of meningitis causing bacteria before and after the vaccination programme through two cross-sectional studies almost 4 years apart. These two studies were the UKMenCar4 study, from September 2014 to March 2015, and the Be on the TEAM study, from March 2018 to November 2018. In 2015, in response to rising meningitis rates, the UK updated its vaccine campaign with quadrivalent MenACWY vaccines. The programme also enrolled teenagers between the ages of 14 and 19, a group within which transmission is known to be highest.  

In total data from 24,062 students from 15-19 were included. The results revealed: 

  • C, W, and Y meningococcal carriage decreased from 2.03% to 0.71%; 
  • carriage of the W group decreased from 0.34% to 0.09%; 
  • carriage of the Y group decreased from 1.6% to 0.5%; and 
  • carriage of the C group remained rare (0.07% to 0.13%). 
Positive findings 

Professor Matthew Snape of the Oxford Vaccine Group described the “fantastic enthusiasm of the UK public for taking part in research”.  

“The results show us that by immunising teenagers with MenACWY vaccines we not only protect them directly, but also reduce the risk of all others in the community suffering from meningitis and sepsis due to these bacteria.” 

He also highlighted the importance of immunising teenagers rather than infants, to “get more benefit out of each dose”. Professor Martin Maiden, lead author, believes that these studies have been “crucial” to the wider world applications of the vaccines.  

“This work helped to interrupt an epidemic that would likely have affected thousands of individuals.” 

Dr Tom Nutt is the chief executive of Meningitis Now, which contributed to the Be on the TEAM study. He warned that the “devastating disease can strike anyone at any time and leave havoc in its wake”. He hopes to “redouble our efforts” to encourage greater uptake of the free MenACWY vaccination. Dr Caroline Johnson, Public Health and Mental Health Minister, is glad that the programme allows young people to protect “themselves and in turn all age groups”.  

“Vaccination remains the best line of defence against infectious diseases”. 

We will hear from Professor Matthew Snape at the World Vaccine Congress in Europe 2022. To join us get your tickets here.