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. The National Institutes of Health has released a fact sheet on the impact of sequestration. The fact sheet states that, due to budget cuts, approximately 700 fewer research project grants will be awarded this year compared to fiscal year 2012. New statistics show that the vaccine MenAfriVac™—developed through a partnership between the World Health Organization and PATH—has significantly reduced the number of cases of meningitis A in Africa. The most recent meningitis season marks the lowest number of cases in ten years. Scientists at Virginia Tech and the University of Florida are making progress in developing a new species-specific insecticide that would be lethal only to insects that carry malaria. Though they have seen positive results, the scientists still think it will be four to five years before they are ready to submit the compound for federal approval. Drugmakers in Japan have agreed to release data on experimental compounds for possible use to create drugs to combat malaria, tuberculosis, and neglected tropical diseases. The pharmaceutical companies are part of a five-year partnership called the Global Health Innovative Technology Fund.

In this guest post, Regina McEnery from IAVI Report writes about the planned closure of the New England Primate Research Center and its effects on the community of HIV researchers who conduct primate studies. As animal facilities go, the New England Primate Research Center (NEPRC) had attained a legendary status on the roster of US biomedical research institutions. A good number of important discoveries have been made within its walls in the half century it has been around. Researchers working there generated some of the earliest evidence that AIDS is a viral disease, and subsequently discovered the simian immunodeficiency virus (SIV), which causes the monkey version of AIDS. It was there, as well, that scientists demonstrated that a vaccine can prevent the transmission of SIV, suggesting that an HIV vaccine is possible. Nor were the NEPRC’s contributions to science confined to HIV and AIDS. The facility has hosted research of profound relevance to everything from cancer to neurological disease and addiction. But lately it had become increasingly clear that this storied institution’s best days were behind it—so far behind it, in fact, that the Harvard Medical School (HMS), which oversees the center, decided it should be shut down. Its decline was slow and fueled largely by management and money problems, rather than the quality of its research. The NEPRC has, for example, been cited at least four times since 2010 by the US Department of Agriculture (USDA) for failure to comply with the requirements of the Animal Control Act. The most recent citation, issued last year, related to a cotton-top tamarin found dehydrated after an employee neglected to provide sufficient water to the squirrel-sized monkey. After examining its recent health history, the NEPRC veterinarian decided to euthanize the monkey, according to the USDA report. The New England Primate Research Center, which had attained a legendary status on the roster of US biomedical research institutions, will be closing. Photo courtesy of IAVI Report. John Harding, acting director of the Division of Comparative Medicine within the Office of Research Infrastructure Programs (ORIP)—the National Institutes of Health arm that provides the core grants for all national primate research centers—notes that it is “ very uncommon to find violations of the sort where animals died.” Still, HMS’s decision to wind down the facility by 2015 has upset the close-knit community of primate researchers. “We were all shocked,” says Ron Veazey, a professor of pathology at the Tulane National Primate Research Center in Louisiana. “Very few people can say, ‘we saw this coming.’ In an ideal world, all those [NEPRC] investigators will be able to transfer projects to other primate centers and everything will go on. But we can’t be sure.” The NEPRC decision to phase out its research also raises serious questions about the future of the approximately 130 projects it hosts—many of which relate to AIDS. Ditto for the 2,000 or so primates housed at the facility in Southborough, MA. The closure is likely to be widely felt throughout the field of HIV research, especially in the areas of vaccine and drug development. “Literally every class of HIV drug, with the exception of protease inhibitors, was first tested in monkeys,” noted Veazey. Louis Picker, a professor of pathology/molecular microbiology and immunology affiliated with the Oregon National Primate Research Center, says he was upset by the decision to shut down the NEPRC—where he did research during his laboratory and pathology medicine residency at Beth Israel Deaconess Medical Center in Boston. But he wasn’t surprised. “You could see the writing on the wall when this first started, two to three years ago, with the mishandling of the animal issues.” Picker says that Harvard’s response to the animal care issues—replacing NEPRC director Ron Desrosiers and two on-site veterinarians—served to drive investigators away rather than fix the problem. HMS, however, did not single out the animal care issues in explaining its decision. In evaluating its long-term needs, HMS says, it concluded that closing NEPRC would be more beneficial and efficient than pouring more resources into maintaining and renewing its supporting grant. “We were surprised,” says Harding. Yet Harvard’s decision, he says, should not be viewed as a signal that interest in funding nonhuman primate research is waning. “In fact, we see a continued need for this.” If anything, says Harding, the recent termination of the large HVTN 505 trial suggests more nonhuman primate research is needed. Still, even researchers personally unaffected by the closure of the NEPRC find its disappearance from the HIV research map hard to take in. “Personally, I see it as a loss for Harvard and for the New England research committee,” said Ana Aldovini, a scientist at Boston Children’s Hospital who once used the NEPRC, but now collaborates with Tulane. “I can’t imagine it not being a loss.” A longer version of this article is available at www.iavireport.org.

In this guest post, Angeline Nanni—director of Market Access at Aeras—reflects on World Immunization Week. Through the heroic efforts of infant and childhood global vaccination programs, childhood diseases that once caused millions of deaths across the globe have been thwarted. Hope has overshadowed fear as preventive vaccines help the healthy to remain free from deadly diseases and allow whole communities to thrive. In honor of World Immunization Week, we applaud those at national health departments, the Gavi, the Vaccine Alliance, United Nations Children’s Fund, the World Health Organization, and others whose dedication, expertise, and political will have led to ambitious and successful immunization campaigns. Remarkable results of global and national vaccination campaigns and programs have led to: Smallpox eradication. Polio endemic in only three countries as opposed to 125 countries 25 years ago. Measles deaths worldwide reduced by 78 percent between 2000 and 2007. Additionally, estimates show that an additional 1 million children’s lives will be saved every year with the accelerated introduction of vaccines against pneumococcal disease and rotavirus. The MenAfriVac® vaccine is expected to prevent 437,000 cases of meningitis over the next 10 years, saving 43,500 lives and approximately $570 million. Significant progress is being made in research and development efforts for new vaccines against TB. Credit: PATH/Evelyn Hockstein Immunization has saved the lives of more children than any other medical intervention in the last 50 years. However, one in five children still do not have access to these lifesaving vaccines. The majority of these children lives in the poorest countries and regions of the world, and faces the highest risk of exposure to life-threatening, vaccine-preventable diseases like measles and meningitis. We must make a concerted effort to ensure that vaccines are available and accessible to all who need them, as laid out in the Global Vaccine Action Plan. This Plan, which was endorsed by the World Health Assembly in 2012, provides a framework for achieving the vision of delivering universal access to immunizations for all people, at affordable and sustainable prices. While many generations in developed countries have benefited from vaccines, newer generations have never experienced the death and devastation caused by vaccine-preventable diseases. This has led to complacency, skepticism, and misinformation about the safety and value of vaccines. We cannot let this undo the tremendous gains that have been achieved through vaccines. We cannot go back to a world where children die, families are devastated, and communities are vulnerable to diseases that could be prevented by routine and safe vaccinations. The extraordinary success of vaccines in saving millions of lives and improving health throughout the world has the potential to protect millions more from other deadly infectious diseases, like tuberculosis (TB). The deadly combination of TB and HIV and increasing rates of drug-resistance are making this disease more difficult to diagnose and treat, and more deadly. There has been important progress in developing new drugs and diagnostics, but TB will remain a global threat without new, more effective vaccines. Prevention through vaccination would be the most cost-effective tool to mitigate these global epidemics. Recent economic and health impact modeling demonstrates that a 60 percent efficacious adolescent and adult preventive TB vaccine, delivered to a mere 20 percent of the population, could potentially avert as many as 40-60 million new cases of TB over the course of 26 years and would be cost-effective. A significantly improved infant vaccine could potentially avert 5-10 million cases of TB over that same time period. Significant progress is being made in research and development efforts for new vaccines against TB. To date, more than 16 TB vaccine candidates have been tested in human clinical trials, and scientists are doing basic research to discover effective correlates of protection for TB vaccines. As researchers continue developing TB vaccine candidates and moving them through preclinical and clinical studies, we are simultaneously working on early access strategies to maximize public health impact and be better prepared to accelerate vaccine delivery to reach those hardest hit by the TB epidemic. Vaccines have made the world a vastly different place by reducing the incidence of disease, providing freedom from worry and fear of the death and disability that they cause. Vaccines hold the key to a healthier and wealthier world for all of us. This week we recognize the success of critical vaccine implementation efforts. We support more scale-up of these implementation efforts, the goal of universal coverage, and the research and development of new vaccines to prevent even more disease and deaths. We look forward to the day when TB is also added to the list.

In this guest post, Jamie Rosen—media and communications manager at Aeras—writes about a new film series that features personal stories of people affected by tuberculosis (TB) worldwide, and the urgent need to develop new vaccines and other tools against the disease. Aeras is excited to share the trailer for a series of short films exposing the underreported global epidemic of TB and the movement for innovation to improve our tools to fight it. In the TB community, as in other areas of global health, we are constantly seeking ways to help people comprehend the scale and the individual tragedy of this disease, to understand the difficulties of treating it, and to inspire people to do what it takes to adequately address it. Aeras has been working with filmmaker Mo Scarpelli and her crew over the past several months to produce four films. Each film will focus on the story of one individual interspersed with expert interviews, and will feature footage from five countries around the world. The first film will focus on an American multi-drug resistant TB survivor; the second on an Indian TB doctor; the third on a South African woman who volunteered for a clinical trial; and the fourth on a British researcher working to develop new TB vaccines. Aeras is grateful for the advice and participation of many people who are working tirelessly to take care of today’s TB patients and foster hope for a better future—one with more effective diagnostics, drugs and ultimately vaccines against this rapidly evolving disease. If this trailer inspires you, please go to www.aeras.org and spread the word. For more information or to organize a screening, please contact Jamie Rosen at jrosen@aeras.org.