The Vaccine RevolutionIn the recent debates about the quality of health care, its availability, and its cost, it is striking that the major focus was on the mechanisms of payment rather than on actually trying to achieve improved outcomes at lower costs.
Unless inhibited by regulatory and litigation barriers, stem cell technology, personal genomics, and nanotech-based therapeutic and diagnostic systems ? combined with disruptive business models ? will dramatically lower the cost of healthcare beginning in the coming decade. Medicine, in other words, is fast being transformed from an art or a craft into a standardized technology, and standardized technologies inevitably experience dramatic declines in price as they improve in quality and availability.
A driving force behind this trend will be the ability not just to cure, but to prevent, disease. This will not only dramatically reduce the direct costs, but by avoiding side effects, it will eliminate indirect suffering and the related costs.
Over the past century, nothing has done more to prevent disease and promote good health than vaccines. Today, its hard to imagine that Native American civilization was decimated by smallpox, that bubonic plague killed nearly one-third of the European population, or that as recently as 50 years ago, Americans were left paralyzed by the effects of polio.
The recent H1N1 flu scare brought back memories of the great 1919 pandemic that killed tens of millions, including the two founders of the Dodge automobile company in the same week. Mumps, measles and whooping cough were all major threats.
Despite the enormous progress of the past century, the HIV AIDS pandemic now threatens to kill off a whole generation in Africa. But there is now hope for a vaccine even against that deadly disease.
Researchers at the National Institutes of Health recently announced in the journal Nature Medicine1 that they have found a new way to fight the HIV virus. Most vaccines against viruses depend on developing proteins called antibodies, which kill off viruses. But attempts to do this for HIV have not worked.
In fact, the researchers found that some people naturally make antibodies against HIV. The trouble is that the human immune system makes antibodies only when it is exposed to an invading organism ? in this case, the HIV virus ? and it often takes time to make those antibodies. In the case of HIV, by the time the antibodies are available, the virus is too well-established for them to combat the disease.
The hope now is that a vaccine made of those antibodies could trigger the immune system to make more antibodies before a person is exposed to the disease. The NIH scientists are now mounting an in-depth study of these naturally occurring antibodies in an effort to craft a vaccine from them that could save millions of lives.
In another development in this area, published in the Journal of Virology,2 a multinational coalition of scientists is investigating vaccines made from DNA. They have succeeded in immunizing monkeys against HIV with a single dose. A big advantage of the DNA vaccine is that it doesnt carry the same risk of inducing infection that other vaccines do.
In September 2007, a Phase II trial of an another HIV vaccine was terminated when researchers found that it was actually inducing HIV infection rather than preventing it, according to a paper in the Journal of Experimental Medicine.3
Another fruitful area of vaccine research involves cancer. An article published in the journal Clinical and Vaccine Immunology4 highlights a new DNA vaccine that produced antibodies against malignant melanoma, a type of skin cancer that is often fatal. The vaccine works by suppressing a peptide that promotes cell production in skin cancer. In studies on mice, the vaccine stopped the growth and spread of skin cancer.
A vaccine already exists for human papillomavirus, but a new design is in the offing from Johns Hopkins University in Baltimore, according to a paper from the Journal of the National Cancer Institute.5 The existing vaccine protects against 70 percent of the types of HPV that exist, but not against all types.
The Johns Hopkins researchers targeted a protein that is common to all types of HPV viruses and showed that their vaccine could produce antibodies that provide 100 percent protection.
Vaccine research has heated up in other areas as well, including influenza, pneumonia, and malaria.
For example, researchers from St. Louis University6 presented a vaccine last April at the National Foundation for Infectious Disease Conference for Vaccine Research in Baltimore that could protect against all strains of flu, including the common seasonal flu and pandemic influenza viruses such as the H1N1 swine flu. At present, drug companies have to develop a specific vaccine every year for each new strain of flu that evolves.
Progress on a vaccine against pneumonia was announced in the Pediatric Infectious Disease Journal.7 Trials by the National Institute for Health and Welfare showed that the new vaccine prevented the type of pneumonia that is one of the chief causes of death among children in developing countries.
More than a million children die each year from pneumonia, while a far greater number of children survive the disease but are left with permanent developmental difficulties.
Another disease that kills a million people each year is malaria. But a new genetically engineered vaccine from the Walter and Eliza Hall Institute is described in the Proceedings of the National Academy of Sciences.8
By deleting two key genes in the parasite that causes malaria, the scientists were able to halt its spread in the body. Tests on mice produced complete immunity to malaria, which represents a first against this deadly disease. Clinical trials on humans will take place at the Walter Reed Army Institute of Research in Maryland.
What can we expect as this tidal wave of vaccine research is transformed into useful products? Consider the following four forecasts:
First, preventing disease will finally become at least as important as curing disease in the coming decade. Some of the most significant causes of morbidity and mortality in the world are diseases that involve immune system responses ? or failures of those responses. New genetic techniques, along with rapidly advancing knowledge in fields such as molecular biology, are making it possible to create vaccines with unprecedented effectiveness against these diseases.
Second, in the short term, well see the most profound effects from this trend in developing countries. In places like Africa and the Philippines, high mortality rates will be rapidly reduced by the introduction of vaccines for everything from malaria to pneumonia to HIV. Relieved of the burden of costly and debilitating morbidity, those nations will begin to thrive in new ways and will finally have a chance to rise out of poverty. Africa, for example, holds great potential for becoming a "bread basket for the world," but it cannot realize that potential without proper leadership and the rule of law. When people are generally healthy, they are much more able to achieve those goals than when they are sick and dying. So vaccines, in addition to simply preventing an illness, will have a profound economic effect on the developing world.
Third, the explosion of new vaccines will create significant investment opportunities. As vaccines proliferate and prove their effectiveness, the companies that make them, such as Wyeth, will grow and prosper. There are any number of candidates for a break-out hit on the vaccine market, such as the universal flu vaccine or one that prevents various types of cancer. Wise investors will keep tabs on this lucrative market, while being aware that a misstep or mistake in clinical trials could take a potential blockbuster drug and turn it into a public relations nightmare.
Fourth, over the next 10 to 20 years, vaccines will play a big role in bending the healthcare cost curve downward. The Trends editors fully expect to see powerful vaccines against most cancers, including breast and prostate cancer. Similarly, vaccines will make malaria, pneumonia, and HIV as rare in 2030 as polio is today. When combined with advanced diagnostics, stem cell therapies and other medical innovations such as nanobots, the new vaccines will lead to a golden age of good health, and well be amazed that anyone was ever willing to live with todays medical care.
References List :
1. Nature Medicine, August 2009, "Neutralizing Antibodies Generated During Natural HIV-1 Infection: Good News for an HIV-1 Vaccine?" by L. Stamatatos, L. Morris, D.R. Burton, and J.R. Mascola. ⓒ Copyright 2009 by Nature Publishing Group, a division of Macmillan Publishers Limited. All rights reserved. http://www.nature.com 2. Journal of Virology, February 2010, "Characterization of T-Cell Responses in Macaques Immunized with a Single Dose of HIV DNA Vaccine," by G. Arrode-Bruses. ⓒ Copyright 2010 by the American Society for Microbiology. All rights reserved. http://jvi.asm.org 3. Journal of Experimental Medicine, November 2008, "Activation of a Dendritic Cell ? T Cell Axis by Ad5 Immune Complexes Creates an Improved Environment for Replication of HIV in T Cells," by M. Perreau, G. Pantaleo, and E.J. Kremer. ⓒ Copyright 2008 by The Rockefeller University Press. All rights reserved. http://jem.rupress.org 4. Clinical and Vaccine Immunology, July 2009, "Specific Antibodies Elicited by a Novel DNA Vaccine Targeting Gastrin-Releasing Peptide Inhibit Murine Melanoma Growth in Vivo," by J. Fang, et al. ⓒ Copyright 2009 by the American Society for Microbiology. All rights reserved. http://cvi.asm.org 5. Journal of the National Cancer Institute, June 2, 2009, "Concatenated Multitype L2 Fusion Proteins as Candidate Prophylactic Pan-Human Papillomavirus Vaccines," by S, Jagu, et al. ⓒ Copyright 2009 by The Authors. All rights reserved. http://jnci.oxfordjournals.org 6. For more information about a universal flu vaccine, visit the St. Louis University website at: http://www.slu.edu 7. Pediatric Infectious Disease Journal, June 2009, "Efficacy of an 11-Valent Pneumococcal Conjugate Vaccine Against Radiologically Confirmed Pneumonia Amoung Children Less Than Two Years of Age in the Philippines: A Randomized, Double-Blind, Placebo-Controlled Trial," by M.G. Lucero, H. Nohynek, G. Williams, et al. ⓒ Copyright 2009 by Lippincott Williams & Wilkins. All rights reseerved. http://journals.lww.com 8. Proceedings of the National Academy of Sciences, August 4, 2009, "Preerythrocytic, Live-Attenuated Plasmodium Falciparum Vaccine Candidates by Design," by K. VanBuskirk, et al. ⓒ Copyright 2009 by the National Academy of Sciences. All rights reserved. http://www.pnas.org
