NRC steps up to design vaccine for rare disease
Bacterial infection discovered in Far North ignored by Big Pharma
Back in 2011, public health agencies had a problem: a new type of bacterial infection was breaking out across Canada’s North, and there was no vaccine for it.
The disease is called Hemophilus influenzae type A, or simply Hia. Despite its name, it is nothing like common influenza, which is caused by a virus. This is a bacterial disease, much nastier than flu and sometimes deadly.
In decades gone by there was a lot of trouble with a cousin of this disease, the Type B version, or Hib. But by the 1980s, drug companies had developed a vaccine for Type B, and it has been mostly eradicated in Canada and many other countries.
Somehow, Hia has expanded into the gap left by its stronger cousin, mainly — no one can be certain why — among Indigenous communities in the North.
The Public Health Agency of Canada says there are now more than 300 cases per year.
The agency asked the National Research Council for help in 2011. And that’s how NRC research officer Andrew Cox and his team started designing a vaccine for a disease that is too rare to draw attention from Big Pharma.
“The fear is: Is it going to turn into the Hib story in the sense that it will grow more globally?” he said. “And even if it doesn’t, right now it’s a problem in the North, where people — and little ones, in particular — are dying unnecessarily.
“This is an invasive bacterial disease. You can get meningitis, you can get septicemia, you can lose your leg. And once it gets a hold it really advances quite quickly, a little bit like the meningococcal diseases,” he said.
“The incidence is quite low but the mortality is quite high . ... In the first two years of life, you’re most at risk for this disease.”
But why in the North? Why is this killer bug most dangerous in Nunavut, in Quebec’s Far North, and in the Northwest Territories? (Yukon is, for some reason, less threatened.)
“That’s a key question,” Cox says. “Simplistically, you think maybe it’s the living conditions,” but a firm answer remains elusive. And the disease can also surface in major southern cities as well.
Still, “it does seem to be skewed toward the Indigenous populations being most at risk.”
Cox’s group — mostly in Ottawa and a few in Montreal — knew the basic approach from the start. It involves taking a piece of the bacterium and teaching the immune system to recognize it and mount a defence. In this case, they used the outer membrane of the bacterium, a chunk of carbohydrate. The immune system learns, in effect, to see the outer skin of the bug.
The major work took from 2012 to 2016. No eureka moments, Cox said — just a “slow and steady” series of steps that eventually turned a general concept into details that could be proven to work, at least in mice.
The next step will be for a drug company to test whether it is safe and effective in people, and to make it a commercial product.
“That’s where the so-called Valley of Death is, where a lot of products don’t get through because of the sheer cost and the stringency of the tests,” Cox said.
Ideas don’t always become drugs. NRC called in pharmaceutical companies, Indigenous communities and scientists from across the country for discussions. Out of this, InventVacc Biologicals of Vancouver has been granted a licence to take NRC’s technology to the next step, testing and producing a commercial product.
New drug trials take time, but InventVacc is hoping to get theirs started around 2020, and the trials could take two to four years.
If approved, the vaccine would be given in the first months of life because the risk begins at such a young age.
There are more widespread health problems in the North — tuberculosis, for example — “but this is one thing that we believe we could prevent,” Cox said.
“It’s a gratifying feeling when you think, ‘Yeah, we found a way where we can combat this.’ But I realize there’s still a very long way to go.”