At Issue

What are the world’s top vaccine priorities?

Experts are developing and testing numerous vaccine candidates against norovirus, which causes hundreds of millions of infections each year worldwide and is seen as a top target for vaccine research. Infectious Disease News asked C. Buddy Creech, MD, MPH, and Leigh M. Howard, MD, MPH, of the Vanderbilt Vaccine Research Program and division of pediatric infectious diseases at Vanderbilt University Medical Center, what the world’s top vaccine priorities are.

C. Buddy Creech, MD, MPH
C. Buddy Creech
Leigh M. Howard, MD, MPH
Leigh M. Howard

Identifying the world’s top vaccine priorities requires a great deal of scientific, regulatory, financial and ethical insight. Clearly there are a number of commonly encountered pathogens that lead to substantial morbidity and mortality — pathogens such as respiratory syncytial virus, Staphylococcus aureus, cytomegalovirus, malaria and group B Streptococcus, to name only a few, as well as periodic threats that are potentially catastrophic should widespread outbreaks occur, such as pandemic influenza, Ebola and other emerging high-threat pathogens. Development of vaccines that protect against certain bacterial pathogens, such as S. aureus or Streptococcus pyogenes, may have an important role in reducing the development of antimicrobial resistance, a critical global health threat. Investing in new vaccine technologies that apply active or passive immunization approaches and may provide cross-reactive protection against multiple pathogens is a compelling priority. In the last few decades, recombinant antigen and adjuvant development, as well as conjugate polysaccharide-protein approaches, resulted in remarkable growth in the number of available vaccines, and this growth is anticipated to continue to occur precipitously with the advent of novel adjuvant systems, use of virus-like particles, mRNA vaccines, novel production methods and additional live-attenuated vaccine candidates.

It is important to note that priorities in vaccine science are not limited to infectious diseases. Hepatitis B and HPV vaccines have demonstrated that vaccines can be effective in preventing cancer. Additional vaccines aimed at treating cancer are an emerging resource for treating primary or chemotherapy-resistant malignancies or preventing relapse. In addition, vaccines that target cells, proteins or other molecules associated with certain noncommunicable diseases, such as Alzheimer’s dementia, obesity and atherosclerosis, are steadily moving through preclinical evaluation and may represent a critical future strategy in preventing these and other important illnesses.

Recent technological advances in immunology and cell and molecular biology have opened new avenues for vaccine development. Prioritizing discovery and cross-disciplinary application may be the first step toward ensuring that we can address current threats and be prepared for future ones.

Disclosures: Creech reports no relevant financial disclosures. Howard reports receiving grant funding from Pfizer.

Experts are developing and testing numerous vaccine candidates against norovirus, which causes hundreds of millions of infections each year worldwide and is seen as a top target for vaccine research. Infectious Disease News asked Editorial Board Member William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, what the world’s top vaccine priorities are.

The big four are without a doubt influenza, HIV, tuberculosis and malaria. Other than influenza, which I think almost everybody would put at the top, the other three are in nonspecific order. They have all provided sustained scientific challenges, so there is not an ideal vaccine against any of these infectious agents right around the corner.

For influenza, to justify putting it at the top of the list, we recognize that the vaccine is imperfect. It is good but not great. What everyone would like is a universal vaccine, one that would protect against a whole variety of different strains of influenza. One of the vexing things about influenza, of course, is that it has the capacity to mutate. If we had a universal vaccine, it would protect against these strains.

William Schaffner, MD
William
Schaffner

The other three — HIV, tuberculosis and malaria — provide scientific challenges in figuring out how the human immune system can optimally protect against these infectious agents. All of them produce major illnesses that affect large populations around the world. And in terms of the extent of illness, the morbidity, all of them have major population effects in terms of economics and the ability of populations to function effectively. They continue to present major challenges and should be at the top of everyone’s lists for effective vaccines we wish we had.

The first thing having these vaccines would do is oblige us as a global community to get together to create the means to manufacture and deliver them to the populations that need them — and these are very large populations, such as the whole world for influenza and then more limited populations for malaria, for example. Nonetheless, there would be challenges to create a sufficient vaccine, to be able to purchase it and to create and put structures in place to deliver these vaccines. These are the sorts of things we can do in the 21st century. The question, though, is “Will we do it?”

Disclosure: Schaffner reports being a member of the data safety monitoring board for Pfizer and consulting for Roche Diagnostics.

Experts are developing and testing numerous vaccine candidates against norovirus, which causes hundreds of millions of infections each year worldwide and is seen as a top target for vaccine research. Infectious Disease News asked C. Buddy Creech, MD, MPH, and Leigh M. Howard, MD, MPH, of the Vanderbilt Vaccine Research Program and division of pediatric infectious diseases at Vanderbilt University Medical Center, what the world’s top vaccine priorities are.

C. Buddy Creech, MD, MPH
C. Buddy Creech
Leigh M. Howard, MD, MPH
Leigh M. Howard

Identifying the world’s top vaccine priorities requires a great deal of scientific, regulatory, financial and ethical insight. Clearly there are a number of commonly encountered pathogens that lead to substantial morbidity and mortality — pathogens such as respiratory syncytial virus, Staphylococcus aureus, cytomegalovirus, malaria and group B Streptococcus, to name only a few, as well as periodic threats that are potentially catastrophic should widespread outbreaks occur, such as pandemic influenza, Ebola and other emerging high-threat pathogens. Development of vaccines that protect against certain bacterial pathogens, such as S. aureus or Streptococcus pyogenes, may have an important role in reducing the development of antimicrobial resistance, a critical global health threat. Investing in new vaccine technologies that apply active or passive immunization approaches and may provide cross-reactive protection against multiple pathogens is a compelling priority. In the last few decades, recombinant antigen and adjuvant development, as well as conjugate polysaccharide-protein approaches, resulted in remarkable growth in the number of available vaccines, and this growth is anticipated to continue to occur precipitously with the advent of novel adjuvant systems, use of virus-like particles, mRNA vaccines, novel production methods and additional live-attenuated vaccine candidates.

It is important to note that priorities in vaccine science are not limited to infectious diseases. Hepatitis B and HPV vaccines have demonstrated that vaccines can be effective in preventing cancer. Additional vaccines aimed at treating cancer are an emerging resource for treating primary or chemotherapy-resistant malignancies or preventing relapse. In addition, vaccines that target cells, proteins or other molecules associated with certain noncommunicable diseases, such as Alzheimer’s dementia, obesity and atherosclerosis, are steadily moving through preclinical evaluation and may represent a critical future strategy in preventing these and other important illnesses.

Recent technological advances in immunology and cell and molecular biology have opened new avenues for vaccine development. Prioritizing discovery and cross-disciplinary application may be the first step toward ensuring that we can address current threats and be prepared for future ones.

Disclosures: Creech reports no relevant financial disclosures. Howard reports receiving grant funding from Pfizer.

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Experts are developing and testing numerous vaccine candidates against norovirus, which causes hundreds of millions of infections each year worldwide and is seen as a top target for vaccine research. Infectious Disease News asked Editorial Board Member William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, what the world’s top vaccine priorities are.

The big four are without a doubt influenza, HIV, tuberculosis and malaria. Other than influenza, which I think almost everybody would put at the top, the other three are in nonspecific order. They have all provided sustained scientific challenges, so there is not an ideal vaccine against any of these infectious agents right around the corner.

For influenza, to justify putting it at the top of the list, we recognize that the vaccine is imperfect. It is good but not great. What everyone would like is a universal vaccine, one that would protect against a whole variety of different strains of influenza. One of the vexing things about influenza, of course, is that it has the capacity to mutate. If we had a universal vaccine, it would protect against these strains.

William Schaffner, MD
William
Schaffner

The other three — HIV, tuberculosis and malaria — provide scientific challenges in figuring out how the human immune system can optimally protect against these infectious agents. All of them produce major illnesses that affect large populations around the world. And in terms of the extent of illness, the morbidity, all of them have major population effects in terms of economics and the ability of populations to function effectively. They continue to present major challenges and should be at the top of everyone’s lists for effective vaccines we wish we had.

The first thing having these vaccines would do is oblige us as a global community to get together to create the means to manufacture and deliver them to the populations that need them — and these are very large populations, such as the whole world for influenza and then more limited populations for malaria, for example. Nonetheless, there would be challenges to create a sufficient vaccine, to be able to purchase it and to create and put structures in place to deliver these vaccines. These are the sorts of things we can do in the 21st century. The question, though, is “Will we do it?”

Disclosure: Schaffner reports being a member of the data safety monitoring board for Pfizer and consulting for Roche Diagnostics.