Vac­cines ver­sus su­per­bugs

Financial Mirror (Cyprus) - - FRONT PAGE -

But vac­cines also have a cru­cial role to play in pro­tect­ing us against a far dead­lier and far more pre­dictable threat: dru­gre­sis­tant in­fec­tions.

In con­trast to un­ex­pected, rapidly spread­ing out­breaks such as the Zika epi­demic, an­timi­cro­bial re­sis­tance is like a slow-mo­tion car crash that has al­ready be­gun. Re­sis­tant pathogens cause about 700,000 deaths ev­ery year. If we fail to take the nec­es­sary pre­cau­tions, they will be killing some ten mil­lion peo­ple a year by 2050.

De­vel­op­ing new an­tibi­otics and putting in place meth­ods to ex­tend the life­spans of ex­ist­ing med­i­ca­tions will help main­tain a sup­ply of ef­fec­tive treat­ments. But vac­cines of­fer a unique op­por­tu­nity. By re­duc­ing the num­ber of in­fec­tions, they limit the need for med­i­ca­tion.

And be­cause the use (or overuse) of an­tibi­otics is what leads to drug re­sis­tance, the pres­sure on the pipe­line of ef­fec­tive treat­ments will be al­le­vi­ated.

Un­for­tu­nately, the value that vac­ci­na­tion can pro­vide in this area has yet to be prop­erly recog­nised. As a re­sult, we are not mov­ing fast enough to de­velop the types of vac­cines that could be used to pre­vent an­timi­cro­bial re­sis­tance.

Vac­cine de­vel­op­ment takes a long time, of­ten more than ten years. It is a high-risk en­deav­our, with the vast ma­jor­ity of po­ten­tial vac­cines fail­ing to reach the mar­ket. Con­se­quently, many vac­cines are not com­mer­cially vi­able, even if they would be use­ful for so­ci­ety.

In­deed, there is no vac­cine avail­able for any of the three re­sis­tance threats that the US Cen­ters for Dis­ease Con­trol and Preven­tion con­sid­ers “ur­gent”: Clostrid­ium dif­fi­cile, car­bapenem-re­sis­tant en­ter­obac­te­ri­aceae, and drug-re­sis­tant Neis­se­ria gon­or­rhoeae. Nor are there enough can­di­date vac­cines against th­ese pathogens un­der­go­ing clin­i­cal tri­als.

There have also been prob­lems de­vel­op­ing vac­cines to com­bat tu­ber­cu­lo­sis or – more wor­ry­ing still – mul­tidrug-re­sis­tant TB. The World Health Or­gan­i­sa­tion has warned that the Sus­tain­able De­vel­op­ment Goal of erad­i­cat­ing TB by 2035 will not be achieved un­less new drugs, bet­ter di­ag­nos­tics, and im­proved vac­cines are de­vel­oped. And yet a new vac­cine re­mains many years away, es­pe­cially given that fund­ing for TB vac­cine re­search has de­clined in re­cent years.

Even vac­cines that are al­ready avail­able are not be­ing used widely enough to have a large im­pact on an­tibi­otic use and re­sis­tance. Ev­ery year, in­fec­tions caused by the Strep­to­coc­cus pneu­mo­niae bac­te­ria kill more than 800,000 chil­dren un­der the age of five.

Th­ese deaths are com­pletely pre­ventable – by a jab that is al­ready avail­able in many parts of the world, the pneu­mo­coc­cal con­ju­gate vac­cine. Uni­ver­sal vac­ci­na­tion would save mil­lions of lives and pre­vent 11.4 mil­lion days of an­tibi­otic use per year in chil­dren younger than five. Sim­i­larly, the ro­tavirus vac­cine could be used to pre­vent out­breaks of di­ar­rheal dis­eases, a chief cause of child mor­tal­ity in de­vel­op­ing coun­tries and a ma­jor driver of an­tibi­otic use.

Vac­cines also have an im­por­tant role to play in pro­tect­ing live­stock and fish from in­fec­tions, op­ti­miz­ing the ap­pli­ca­tion of an­tibi­otics in agri­cul­ture – where their overuse is an im­por­tant cause of grow­ing re­sis­tance.

Max­imis­ing the po­ten­tial of vac­cines to fight an­timi­cro­bial re­sis­tance thus re­quires the wider ap­pli­ca­tion of ex­ist­ing vac­cines in hu­mans and an­i­mals. But it also en­tails de­vel­op­ing new vac­cines, which, in the short-term, could be kick-started by a $2 bil­lion Global In­no­va­tion Fund for earlystage re­search in vac­cines and other vi­able al­ter­na­tives to an­tibi­otics.

And in ar­eas where re­search and de­vel­op­ment is not an at­trac­tive propo­si­tion, de­vel­op­ers must be pro­vided an op­por­tu­nity to make a re­turn from use­ful prod­ucts. De­pend­ing on the char­ac­ter­is­tics of dif­fer­ent prod­ucts, pos­si­ble in­ter­ven­tions would in­clude ad­vance mar­ket com­mit­ments and mar­ket-en­try re­wards.

Vac­cines hold the po­ten­tial to have a huge im­pact on drug re­sis­tance, if they are in­cluded as part of a broad se­ries of in­ter­ven­tions to com­bat the prob­lem. For­tu­nately, aware­ness of this chal­lenge is start­ing to take root.

At the World Eco­nomic Fo­rum’s an­nual gath­er­ing in Davos last month, 85 com­pa­nies, in­clud­ing vac­cine de­vel­op­ers, large phar­ma­ceu­ti­cal com­pa­nies, di­ag­nos­tic de­vel­op­ers, and biotech firms, com­mit­ted to fur­ther ac­tion to re­duce drug re­sis­tance. And later this year, the World Health As­sem­bly, the G-7 and G-20 sum­mits, and the UN Gen­eral As­sem­bly will all ad­dress the topic. The mo­men­tum now gath­er­ing in the pub­lic and pri­vate sec­tors is cre­at­ing an op­por­tu­nity that must not be missed.

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