Funding two global killers

December 6, 2006 at 11:25 am (Alex's Posts)

All the recent discussion of vaccines is very timely, given GAVI’s recent announcement that it will begin funding pneumococcal and rotavirus vaccines.  This announcement has been heralded throughout the international public health community as long overdue, and will hopefully mean a significant scale-up in efforts to vaccinate children against these diseases, responsible for over a million and a half deaths annually, almost entirely in the developing world.

Though I know less about rotavirus, it continues to amaze me that pneumococcal disease (which manifests itself in a variety of ways, from simple ear infections to deadly pneumonia and meningitis) doesn’t get more play in the international media.  It kills more kids than malaria, long considered the greatest scourge affecting children in the global South, and many, many more than HIV.  And the vaccine that’s currently available is very expensive and not entirely appropriate for the developing world – it was developed for a Western, industrialized-country market, and doesn’t cover many of the strains that cause the most death and disease.

And yet, it’s something.  Hopefully, we’re seeing the public health community and the world wake up to this disease, and to the fact that there’s something to be done about it.  A new, more appropriate vaccine will hopefully be ready soon (there are a couple in the works), and let’s hope it’s big news when it is. 

(In the meantime, those seeking to learn more should read this rather fun and entertaining NY Times article on Orin Levine, the director of the PneumoADIP, who’s a big voice on pneumo vaccines and just a generally nice guy.  You have to register, but it’s free.)

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4 Comments

  1. Aman said,

    The other new news out on vaccines for a much more well known area is the malaria vaccine roadmap. A new global strategy was announced a couple of days ago-
    http://www.malariavaccineroadmap.net/

    This is also linked via our site – thdblog.wordpress.com

  2. msoule said,

    Alex-
    Just had a thought on something and wonder if you (or anyone else here) knows the answer.
    So I think that maybe the reason we haven’t done much for a pneumococcus vaccine in the global North is that we have antibiotics to take care of the ear infections, throat things, etc. Pneumococcus is pretty much all over the place, right? And it’s pretty sensitive to the antibiotics that we currently use (I think). So why invest in a vaccine if we have the drugs to take care of the bugs? Answer seems simple enough.
    What about drug-resistance, though? We know that by prescribing antibiotics for things that we are ultimately (in some cases, at least) selecting for the drug-resistant mutants of the pathogen that are inside the medicated host. As we use the antibiotics and select more and more for the resistant bugs, our antibiotics lose efficacy. So we build new ones and try to stay one step ahead. It takes a lot of doing, though.
    What happens in the situation of a vaccine, though? The immune system is prepped for the invasion of whatever pathogen and it takes care of it. Do those drug-resistant mutant strains get the same prevalence they do if we are using antibiotics to basically select for them? In other words, do vaccines lose their efficacy as a pathogen mutates? Or, do vaccines have the same problem as antibiotics in terms of having a selective pressure for organisms that are resistant to the measure we use against them (in the case of a vaccine, the pre-prepared immune system).
    An interesting thought on why we should invest in pneumococcal vaccines in this part of the world.
    Go ahead, accuse me of flip-flopping. Guilty as charged. But my former critique still stands and I still stand by it 🙂

  3. acoria said,

    You’re right on the money. Otitis media (ear infections) is the number-one reason for antibiotic prescriptions in the US, and one of the leading ones in the world. This has contributed to very significant levels of antibiotic resistance among strains of s. pneumoniae which also cause pneumonia and meningitis. This is one argument for a vaccine – bugs don’t become resistant to vaccines, at least not to any vaccines that use current technology.

    Another argument for a pneumococcal vaccine is that it is very, very difficult to distinguish viral pneumonia from bacterial pneumonia in the field in developing countries, let alone identifying antibiotic resistant strains, so one doesn’t always know if antibiotics are even appropriate, but may have no other options. By the time tests are conducted that verify that a child has pneumococcal pneumonia (or another strain of bacterial pneumonia), that child could well be dead, leading to dangerous, “best-guess”, resistance-generating treatment. A vaccine lessens the worries over strain identification and antibiotic resistance signfiicantly, and also simply prevents sickness in the first place, eliminating the financial and emotional burden of having a sick child.

    However, if we’re talking about the industrialized world, the major argument for Prevnar (the existing vaccine) has been its effectiveness against meningitis, which often kills too fast to do anything about it if you don’t recognize the symptoms very early. And, even if it doesn’t kill, it maims horribly – deafness, blindness, neurologic damage, mental retardation, etc.

  4. Jessica Pickett said,

    Michael,

    Just to clarify, there is a pneumococcal vaccine that is already part of the routine childhood immunization schedule here in the US. In fact, Prevnar is a blockbuster product, with over $1.5 billion sales revenue in 2005. The problem is that Wyeth’s existing 7-valent conjugate vaccine does not protect against the disease strains that are most prevalent in developing countries, which is why GAVI’s PneumoADIP is working with Wyeth and other manufacturers to develop and produce a newer vaccine that will confer immunity in those settings.

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