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Tortorice D, Rappuoli R, Bloom DE. The economic case for scaling up health research and development: Lessons from the COVID-19 pandemic. Proc Natl Acad Sci U S A 2024; 121:e2321978121. [PMID: 38885387 PMCID: PMC11214072 DOI: 10.1073/pnas.2321978121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/26/2024] [Indexed: 06/20/2024] Open
Abstract
In response to the COVID-19 pandemic, governments directly funded vaccine research and development (R&D), quickly leading to multiple effective vaccines and resulting in enormous health and economic benefits to society. We develop a simple economic model showing this feat could potentially be repeated for other health challenges. Based on inputs from the economic and medical literatures, the model yields estimates of optimal R&D spending on treatments and vaccines for known diseases. Taking a global and societal perspective, we estimate the social benefits of such spending and a corresponding rate of return. Applications to Streptococcus A vaccines and Alzheimer's disease treatments demonstrate the potential of enhanced research and development funding to unlock massive global health and health-related benefits. We estimate that these benefits range from 2 to 60 trillion (2020 US$) and that the corresponding rates of return on R&D spending range from 12% to 23% per year for 30 y. We discuss the current shortfall in R&D spending and public policies that can move current funding closer to the optimal level.
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Affiliation(s)
- Daniel Tortorice
- Department of Economics and Accounting, College of the Holy Cross, Worcester, MA01610
| | | | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA02115
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Warkentin L, Werner F, Zeschick N, Kühlein T, Steininger P, Überla K, Kaiser I, Sebastião M, Hueber S. Reactogenicity and safety of COVID-19 primary immunisation and booster vaccination regimens: a comparative observational cohort study. BMC Med 2023; 21:218. [PMID: 37340463 DOI: 10.1186/s12916-023-02924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Since the beginning of the COVID-19 vaccination campaigns, recommendations regarding the vaccination have been very dynamic. Although the safety and efficacy of different vaccines have been analysed, data were scarce for vaccine regimens combining different vaccines. We therefore aimed to evaluate and compare the perceived reactogenicity and need for medical consultation after the most frequently applied homologous and heterologous COVID-19 vaccination regimens. METHODS In an observational cohort study, reactogenicity and safety were assessed within a maximum follow-up time of 124 days using web-based surveys. Reactogenicity was assessed for different vaccination regimens 2 weeks after a vaccination (short-term survey). The following surveys, long-term and follow-up surveys, focused on the utilisation of medical services, including those that were not suspected to be vaccine-related. RESULTS Data of 17,269 participants were analysed. The least local reactions were seen after a ChAdOx1 - ChAdOx1 regimen (32.6%, 95% CI [28.2, 37.2]) and the most after the first dose with mRNA-1273 (73.9%, 95% CI [70.5, 77.2]). Systemic reactions were least frequent in participants with a BNT162b2 booster after a homologous primary immunisation with ChAdOx1 (42.9%, 95% CI [32.1, 54.1]) and most frequent after a ChAdOx1 - mRNA-1273 (85.5%, 95% CI [82.9, 87.8]) and mRNA-1273/mRNA-1273 regimen (85.1%, 95% CI [83.2, 87.0]). In the short-term survey, the most common consequences were medication intake and sick leave (after local reactions 0% to 9.9%; after systemic reactions 4.5% to 37.9%). In the long-term and follow-up surveys, between 8.2 and 30.9% of participants reported consulting a doctor and between 0% and 5.4% seeking hospital care. The regression analyses 124 days after the first and after the third dose showed that the odds for reporting medical consultation were comparable between the vaccination regimens. CONCLUSIONS Our analysis revealed differences in reactogenicity between the COVID-19 vaccines and vaccination regimens in Germany. The lowest reactogenicity as reported by participants was seen with BNT162b2, especially in homologous vaccination regimens. However, in all vaccination regimens reactogenicity rarely led to medical consultations. Small differences in seeking any medical consultation after 6 weeks diminished during the follow-up period. In the end, none of the vaccination regimens was associated with a higher risk for medical consultation. TRIAL REGISTRATION DRKS DRKS00025881 ( https://drks.de/search/de/trial/DRKS00025373 ). Registered on 14 October 2021. DRKS DRKS00025373 ( https://drks.de/search/de/trial/DRKS00025881 ). Registered on 21 May 2021. Registered retrospectively.
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Affiliation(s)
- Lisette Warkentin
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany.
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany
| | - Nikoletta Zeschick
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Schloßgarten 4, Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Schloßgarten 4, Erlangen, Germany
| | - Isabelle Kaiser
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 6, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, Germany
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Tortorice D, Ferranna M, Bloom DE. Optimal global spending for group A Streptococcus vaccine research and development. NPJ Vaccines 2023; 8:62. [PMID: 37185380 PMCID: PMC10125865 DOI: 10.1038/s41541-023-00646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/13/2023] [Indexed: 05/17/2023] Open
Abstract
Group A Streptococcus (Strep A) leads to 600,000 deaths and 600 million cases of pharyngitis annually. Although long a promising target for vaccine development, how much funding should be allocated to develop a Strep A vaccine is unclear. We aim to calculate the optimal amount of global spending for Strep A vaccine development, the resulting benefits, and the social rate of return on this spending. We develop a model of optimal spending, from a global societal perspective, on research and development (R&D) for vaccines and treatments. The model takes as inputs total harm from the disease, the probability an R&D project succeeds, the cost of a project, and the fraction of total harm a success alleviates. Based on these inputs the model outputs an optimal amount of spending and a rate of return. We calibrate the model for Strep A. Optimal spending is estimated to be 2020 USD33 billion. This spending leads to 2020 USD1.63 trillion in benefits and a real return of 22.3% per year for thirty years. Sensitivity shows an optimal spending range of 15.9 billion to 58.5 billion, a benefits range of 1.6 trillion to 37.9 trillion, and a return range of 18.0-48.2%. Investment in a Strep A vaccine could create enormous benefits for comparatively little cost. It represents one of the highest return uses of public spending. Policy can promote Strep A vaccine development through direct funding of projects and by promoting financial mechanisms that allow the private sector to diversify its R&D investment.
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Affiliation(s)
- Daniel Tortorice
- Department of Economics and Accounting, College of the Holy Cross, Worcester, MA, USA.
| | - Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Yao Z, Lum Y, Johnston A, Mejia-Mendoza LM, Zhou X, Wen Y, Aspuru-Guzik A, Sargent EH, Seh ZW. Machine learning for a sustainable energy future. NATURE REVIEWS. MATERIALS 2022; 8:202-215. [PMID: 36277083 PMCID: PMC9579620 DOI: 10.1038/s41578-022-00490-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 05/28/2023]
Abstract
Transitioning from fossil fuels to renewable energy sources is a critical global challenge; it demands advances - at the materials, devices and systems levels - for the efficient harvesting, storage, conversion and management of renewable energy. Energy researchers have begun to incorporate machine learning (ML) techniques to accelerate these advances. In this Perspective, we highlight recent advances in ML-driven energy research, outline current and future challenges, and describe what is required to make the best use of ML techniques. We introduce a set of key performance indicators with which to compare the benefits of different ML-accelerated workflows for energy research. We discuss and evaluate the latest advances in applying ML to the development of energy harvesting (photovoltaics), storage (batteries), conversion (electrocatalysis) and management (smart grids). Finally, we offer an overview of potential research areas in the energy field that stand to benefit further from the application of ML.
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Affiliation(s)
- Zhenpeng Yao
- Shanghai Key Laboratory of Hydrogen Science & Center of Hydrogen Science, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
- Chemical Physics Theory Group, Department of Chemistry and Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Innovation Center for Future Materials, Zhangjiang Institute for Advanced Study, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yanwei Lum
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Innovis, Singapore, Singapore
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario Canada
| | - Andrew Johnston
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario Canada
| | - Luis Martin Mejia-Mendoza
- Chemical Physics Theory Group, Department of Chemistry and Department of Computer Science, University of Toronto, Toronto, Ontario Canada
| | - Xin Zhou
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yonggang Wen
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Alán Aspuru-Guzik
- Chemical Physics Theory Group, Department of Chemistry and Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario Canada
| | - Edward H. Sargent
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario Canada
| | - Zhi Wei Seh
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Innovis, Singapore, Singapore
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Kumar V, Kumar S, Sharma PC. Recent advances in the vaccine development for the prophylaxis of SARS Covid-19. Int Immunopharmacol 2022; 111:109175. [PMID: 35994853 PMCID: PMC9381430 DOI: 10.1016/j.intimp.2022.109175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-caused Coronavirus Disease 2019 (COVID-19) is currently a global pandemic that has wreaked havoc on public health, lives, and the global economy. The present COVID-19 outbreak has put pressure on the scientific community to develop medications and vaccinations to combat COVID-19. However, according to highly optimistic forecasts, we could not have a COVID-19 vaccine until September 2020. This is due to the fact that a successful COVID-19 vaccine will necessitate a careful validation of effectiveness and adverse reactivity given that the target vaccine population includes high-risk people over 60, particularly those with severe co-morbid conditions, frontline healthcare professionals, and those involved in essential industrial sectors. For passive immunization, which is being considered for Covid-19, there are several platforms for vaccine development, each with its own advantages and disadvantages. The COVID-19 pandemic, which is arguably the deadliest in the last 100 years after the Spanish flu, necessitates a swift assessment of the various approaches for their ability to incite protective immunity and safety to prevent unintended immune potentiation, which is crucial to the pathogenesis of this virus. Considering the pandemic's high fatality rate and rapid spread, an efficient vaccination is critical for its management. As a result, academia, industry, and government are collaborating in unprecedented ways to create and test a wide range of vaccinations. In this review, we summarize the Covid-19 vaccine development initiatives, recent trends, difficulties, comparison between traditional vaccines development and Covid-19 vaccines development also listed the approved/authorized, phase-3 and pre-clinical trials Covid-19 vaccines in different countries.
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Affiliation(s)
- Vipul Kumar
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Sahil Kumar
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India.
| | - Prabodh Chander Sharma
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
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Rapid In-Process Measurement of Live Virus Vaccine Potency Using Laser Force Cytology: Paving the Way for Rapid Vaccine Development. Vaccines (Basel) 2022; 10:vaccines10101589. [PMID: 36298454 PMCID: PMC9608199 DOI: 10.3390/vaccines10101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccinations to prevent infectious diseases are given to target the body’s innate and adaptive immune systems. In most cases, the potency of a live virus vaccine (LVV) is the most critical measurement of efficacy, though in some cases the quantity of surface antigen on the virus is an equally critical quality attribute. Existing methods to measure the potency of viruses include plaque and TCID50 assays, both of which have very long lead times and cannot provide real time information on the quality of the vaccine during large-scale manufacturing. Here, we report the evaluation of LumaCyte’s Radiance Laser Force Cytology platform as a new way to measure the potency of LVVs in upstream biomanufacturing process in real time and compare this to traditional TCID50 potency. We also assess this new platform as a way to detect adventitious agents, which is a regulatory expectation for the release of commercial vaccines. In both applications, we report the ability to obtain expedited and relevant potency information with strong correlation to release potency methods. Together, our data propose the application of Laser Force Cytology as a valuable process analytical technology (PAT) for the timely measurement of critical quality attributes of LVVs.
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Balkrishna A, Arya V, Rohela A, Kumar A, Verma R, Kumar D, Nepovimova E, Kuca K, Thakur N, Thakur N, Kumar P. Nanotechnology Interventions in the Management of COVID-19: Prevention, Diagnosis and Virus-Like Particle Vaccines. Vaccines (Basel) 2021; 9:1129. [PMID: 34696237 PMCID: PMC8537718 DOI: 10.3390/vaccines9101129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 claimed numerous lives and put nations on high alert. The lack of antiviral medications and the small number of approved vaccines, as well as the recurrence of adverse effects, necessitates the development of novel treatment ways to combat COVID-19. In this context, using databases such as PubMed, Google Scholar, and Science Direct, we gathered information about nanotechnology's involvement in the prevention, diagnosis and virus-like particle vaccine development. This review revealed that various nanomaterials like gold, polymeric, graphene and poly amino ester with carboxyl group coated magnetic nanoparticles have been explored for the fast detection of SARS-CoV-2. Personal protective equipment fabricated with nanoparticles, such as gloves, masks, clothes, surfactants, and Ag, TiO2 based disinfectants played an essential role in halting COVID-19 transmission. Nanoparticles are used not only in vaccine delivery, such as lipid nanoparticles mediated transport of mRNA-based Pfizer and Moderna vaccines, but also in the development of vaccine as the virus-like particles elicit an immune response. There are now 18 virus-like particle vaccines in pre-clinical development, with one of them, developed by Novavax, reported being in phase 3 trials. Due to the probability of upcoming COVID-19 waves, and the rise of new diseases, the future relevance of virus-like particles is imperative. Furthermore, psychosocial variables linked to vaccine reluctance constitute a critical problem that must be addressed immediately to avert pandemic.
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Affiliation(s)
- Acharya Balkrishna
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar 249405, India; (A.B.); (V.A.); (A.R.)
- Department of Allied Sciences, University of Patanjali, Haridwar 249405, India
| | - Vedpriya Arya
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar 249405, India; (A.B.); (V.A.); (A.R.)
- Department of Allied Sciences, University of Patanjali, Haridwar 249405, India
| | - Akansha Rohela
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar 249405, India; (A.B.); (V.A.); (A.R.)
| | - Ashwani Kumar
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar 249405, India; (A.B.); (V.A.); (A.R.)
| | - Rachna Verma
- School of Biological and Environmental Sciences, Shoolini University of Biotechnology and Management Sciences, Solan 173229, India
| | - Dinesh Kumar
- School of Bioengineering and Food Technology, Shoolini University of Biotechnology and Management Sciences, Solan 173229, India;
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic;
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic;
- Biomedical Research Center, University Hospital in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Naveen Thakur
- Department of Physics, Career Point University, Hamirpur 177001, India; (N.T.); (N.T.); (P.K.)
| | - Nikesh Thakur
- Department of Physics, Career Point University, Hamirpur 177001, India; (N.T.); (N.T.); (P.K.)
| | - Pankaj Kumar
- Department of Physics, Career Point University, Hamirpur 177001, India; (N.T.); (N.T.); (P.K.)
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Janse M, Brouwers T, Claassen E, Hermans P, van de Burgwal L. Barriers Influencing Vaccine Development Timelines, Identification, Causal Analysis, and Prioritization of Key Barriers by KOLs in General and Covid-19 Vaccine R&D. Front Public Health 2021; 9:612541. [PMID: 33959579 PMCID: PMC8096063 DOI: 10.3389/fpubh.2021.612541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
A frequently mentioned factor holding back the introduction of new vaccines on the market are their prohibitively long development timelines. These hamper their potential societal benefit and impairs the ability to quickly respond to emerging new pathogens. This is especially worrisome since new pathogens are emerging at all-time high rates of over one per year, and many age-old pathogens are still not vaccine preventable.Through interviews with 20 key-opinion-leaders (KOLs), this study identified innovation barriers that increase vaccine development timelines. These innovation barriers were visualized, and their underlying causes revealed by means of qualitative root cause analysis. Based on a survey the innovation barriers were quantitatively ranked based on their relative impact on both regular, and Covid-19 vaccine development timelines. KOLs identified 20 key innovation barriers, and mapping these barriers onto the Vaccine Innovation Cycle model revealed that all phases of vaccine development were affected. Affected by most barriers is the area between the preclinical studies and the market entry. Difficult hand-off between academia and industry, lack of funding, and lack of knowledge of pathogen targets were often mentioned as causes. Quantitative survey responses from 93 KOLs showed that general vaccine development and Covid-19 vaccine development are impacted by distinct sets of innovation barriers. For the general vaccine development three barriers were perceived of the highest impact; limited ROI for vaccines addressing disease with limited market size, limited ROI for vaccines compared to non-vaccine projects, and academia not being able to progress beyond proof of principle. Of highest impact on Covid-19 vaccine development, are lack of knowledge concerning pathogen target, high risk of upscaling unlicensed vaccines, and proof of principle not meeting late-stage requirements. In conclusion, the current study demonstrates that barriers hampering timelines in vaccine development are present across the Vaccine Innovation Cycle. Prioritizing the impact of barriers in general, and in Covid-19 vaccine development, shows clear differences that can be used to inform policies to speed up development in both war and peace time.
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Affiliation(s)
- Marga Janse
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Thomas Brouwers
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Eric Claassen
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Peter Hermans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, Netherlands
| | - Linda van de Burgwal
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
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Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y, Jit M. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet 2021; 397:1023-1034. [PMID: 33587887 PMCID: PMC7906643 DOI: 10.1016/s0140-6736(21)00306-8] [Citation(s) in RCA: 657] [Impact Index Per Article: 219.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic is unlikely to end until there is global roll-out of vaccines that protect against severe disease and preferably drive herd immunity. Regulators in numerous countries have authorised or approved COVID-19 vaccines for human use, with more expected to be licensed in 2021. Yet having licensed vaccines is not enough to achieve global control of COVID-19: they also need to be produced at scale, priced affordably, allocated globally so that they are available where needed, and widely deployed in local communities. In this Health Policy paper, we review potential challenges to success in each of these dimensions and discuss policy implications. To guide our review, we developed a dashboard to highlight key characteristics of 26 leading vaccine candidates, including efficacy levels, dosing regimens, storage requirements, prices, production capacities in 2021, and stocks reserved for low-income and middle-income countries. We use a traffic-light system to signal the potential contributions of each candidate to achieving global vaccine immunity, highlighting important trade-offs that policy makers need to consider when developing and implementing vaccination programmes. Although specific datapoints are subject to change as the pandemic response progresses, the dashboard will continue to provide a useful lens through which to analyse the key issues affecting the use of COVID-19 vaccines. We also present original data from a 32-country survey (n=26 758) on potential acceptance of COVID-19 vaccines, conducted from October to December, 2020. Vaccine acceptance was highest in Vietnam (98%), India (91%), China (91%), Denmark (87%), and South Korea (87%), and lowest in Serbia (38%), Croatia (41%), France (44%), Lebanon (44%), and Paraguay (51%).
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Affiliation(s)
- Olivier J Wouters
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Kenneth C Shadlen
- Department of International Development, London School of Economics and Political Science, London, UK
| | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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10
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MacPherson A, Hutchinson N, Schneider O, Oliviero E, Feldhake E, Ouimet C, Sheng J, Awan F, Wang C, Papenburg J, Basta NE, Kimmelman J. Probability of Success and Timelines for the Development of Vaccines for Emerging and Reemerged Viral Infectious Diseases. Ann Intern Med 2021; 174:326-334. [PMID: 33226855 PMCID: PMC7707230 DOI: 10.7326/m20-5350] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anticipated success rates and timelines for COVID-19 vaccine development vary. Recent experience with developing and testing viral vaccine candidates can inform expectations regarding the development of safe and effective vaccines. OBJECTIVE To estimate timelines and probabilities of success for recent vaccine candidates. DESIGN ClinicalTrials.gov was searched to identify trials testing viral vaccines that had not advanced to phase 2 before 2005, and the progress of each vaccine from phase 1 through to U.S. Food and Drug Administration (FDA) licensure was tracked. Trial characteristics were double-coded. (Registration: Open Science Framework [https://osf.io/dmuzx/]). SETTING Trials launched between January 2005 and March 2020. PARTICIPANTS Preventive viral vaccine candidates for 23 emerging or reemerged viral infectious diseases. MEASUREMENTS The primary end point was the probability of vaccines advancing from launch of phase 2 to FDA licensure within 10 years. RESULTS In total, 606 clinical trials forming 220 distinct development trajectories (267 343 enrolled participants) were identified. The probability of vaccines progressing from phase 2 to licensure within 10 years was 10.0% (95% CI, 2.6% to 16.9%), with most approvals representing H1N1 or H5N1 vaccines. The average timeline from phase 2 to approval was 4.4 years (range, 6.4 weeks to 13.9 years). The probabilities of advancing from phase 1 to 2, phase 2 to 3, and phase 3 to licensure within the total available follow-up time were 38.2% (CI, 30.7% to 45.0%), 38.3% (CI, 23.1% to 50.5%), and 61.1% (CI, 3.7% to 84.3%), respectively. LIMITATIONS The study did not account for preclinical development and relied primarily on ClinicalTrials.gov and FDA resources. Success probabilities do not capture the varied reasons why vaccines fail to advance to regulatory approval. CONCLUSION Success probabilities and timelines varied widely across different vaccine types and diseases. If a SARS-CoV-2 vaccine is licensed within 18 months of the start of the pandemic, it will mark an unprecedented achievement for noninfluenza viral vaccine development. PRIMARY FUNDING SOURCE McGill Interdisciplinary Initiative in Infection and Immunity (MI4) Emergency COVID-19 Research Funding program.
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Affiliation(s)
- Amanda MacPherson
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Nora Hutchinson
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Oliver Schneider
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Elisabeth Oliviero
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Emma Feldhake
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Charlotte Ouimet
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Jacky Sheng
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Fareed Awan
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | - Catherine Wang
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
| | | | - Nicole E Basta
- McGill University, Montreal, Quebec, Canada (J.P., N.E.B.)
| | - Jonathan Kimmelman
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada (A.M., N.H., O.S., E.O., E.F., C.O., J.S., F.A., C.W., J.K.)
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11
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Nguyen LC, Bakerlee CW, McKelvey TG, Rose SM, Norman AJ, Joseph N, Manheim D, McLaren MR, Jiang S, Barnes CF, Kinniment M, Foster D, Darton TC, Morrison J. Evaluating Use Cases for Human Challenge Trials in Accelerating SARS-CoV-2 Vaccine Development. Clin Infect Dis 2021; 72:710-715. [PMID: 32628748 PMCID: PMC7454474 DOI: 10.1093/cid/ciaa935] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/02/2020] [Indexed: 01/07/2023] Open
Abstract
Human challenge trials (HCTs) have been proposed as a means to accelerate SARS-CoV-2 vaccine development. We identify and discuss three potential use cases of HCTs in the current pandemic: evaluating efficacy, converging on correlates of protection, and improving understanding of pathogenesis and the human immune response. We outline the limitations of HCTs and find that HCTs are likely to be most useful for vaccine candidates currently in preclinical stages of development. We conclude that, while currently limited in their application, there are scenarios in which HCTs would be extremely beneficial. Therefore, the option of conducting HCTs to accelerate SARS-CoV-2 vaccine development should be preserved. As HCTs require many months of preparation, we recommend an immediate effort to (1) establish guidelines for HCTs for COVID-19; (2) take the first steps toward HCTs, including preparing challenge virus and making preliminary logistical arrangements; and (3) commit to periodically re-evaluating the utility of HCTs.
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Affiliation(s)
- Linh Chi Nguyen
- Department of Politics and International Relations, University of Oxford, Oxford, United Kingdom
| | - Christopher W Bakerlee
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Sophie M Rose
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David Manheim
- Health and Risk Communication Research Center, School of Public Health, University of Haifa, Haifa, Israel
| | - Michael R McLaren
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
| | - Steven Jiang
- Harvard Law School, Cambridge, Massachusetts, USA
| | | | - Megan Kinniment
- Department of Physics, University of Oxford, Oxford, United Kingdom
| | - Derek Foster
- Rethink Priorities, Redwood City, California, USA
| | - Thomas C Darton
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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12
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Calina D, Sarkar C, Arsene AL, Salehi B, Docea AO, Mondal M, Islam MT, Zali A, Sharifi-Rad J. Recent advances, approaches and challenges in targeting pathways for potential COVID-19 vaccines development. Immunol Res 2020; 68:315-324. [PMID: 33006053 PMCID: PMC7529090 DOI: 10.1007/s12026-020-09154-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022]
Abstract
During the COVID-19 pandemic in a modern era, there is a global consensus on the need for the rapid development of a vaccine against SARS-CoV-2 for effective and sustainable control. Developing these vaccines is fundamental to public health. This urgent need is supported by the scientific explosion in structural and genomic biology that facilitates the urgent development of an ideal COVID-19 vaccine, using new pathways to facilitate its large-scale development, testing, and manufacture. Here, we summarize the types of COVID-19 candidate vaccines, their current stage in early testing in human clinical trials, and the challenges for their implementation.
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Affiliation(s)
- Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Chandan Sarkar
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh
| | - Andreea Letitia Arsene
- Department of Department of Microbiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bahare Salehi
- Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran.,Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Milon Mondal
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh
| | - Muhammad Torequl Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, 02125719, Iran
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Munira SL, Hendriks JT, Atmosukarto II, Friede MH, Carter LM, Butler JRG, Clements ACA. A cost analysis of producing vaccines in developing countries. Vaccine 2019; 37:1245-1251. [PMID: 30651198 DOI: 10.1016/j.vaccine.2018.11.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
Developing country vaccine manufacturers (DCVMs) supply over half of the vaccines used in developing country immunisation programs. Decisions by developing countries to establish vaccine manufacturing should be based on economic viability, however reliable assessments of vaccine production costs are lacking. This study aimed to quantify the cost of establishing vaccine manufacturing facilities and producing vaccines in developing countries. This study estimates vaccine production costs in developing countries based on twelve vaccines produced by eight DCVMs. The results were based on estimates of the capital and operating costs required to establish vaccine manufacturing facilities under three hypothetical scenarios of production scale and scope. Cost patterns were then compared to vaccine prices paid by countries in both industrialized and developing country markets. The cost of producing vaccines in developing countries was estimated to be on average US$ 2.18 per dose, ranging between US$ 0.98 and US$ 4.85 for different vaccine types and formulations. Vaccine costs-per-dose decrease as production scale and scope increase. Cost-per-dose is mainly driven by fixed costs, but at a scale of production over 20 million doses per year it becomes driven by variable costs. Under the three hypothetical scenarios used, costs-per-dose of vaccines produced by developing countries were around 47% lower than vaccine prices in developing-country markets and 84% lower than prices in industrialized-country markets. This study has found that local production of vaccines in developing countries exhibits both economies of scale and economies of scope. The lower costs relative to prices suggests that a producer surplus and potential profits may be attainable in both developing and developed country markets, supporting sustainable production.
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Affiliation(s)
| | - Jan T Hendriks
- Institute for Translational Vaccinology (Intravacc), the Netherlands
| | | | - Martin H Friede
- Initiative for Vaccine Research, World Health Organization, Switzerland
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14
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Gouglas D, Thanh Le T, Henderson K, Kaloudis A, Danielsen T, Hammersland NC, Robinson JM, Heaton PM, Røttingen JA. Estimating the cost of vaccine development against epidemic infectious diseases: a cost minimisation study. Lancet Glob Health 2018; 6:e1386-e1396. [PMID: 30342925 PMCID: PMC7164811 DOI: 10.1016/s2214-109x(18)30346-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Coalition for Epidemic Preparedness Innovations was established in 2016, to develop vaccines that can contribute to preparedness for outbreaks of epidemic infectious diseases. Evidence on vaccine development costs for such diseases is scarce. Our goal was to estimate the minimum cost for achieving vaccine research and development preparedness targets in a portfolio of 11 epidemic infectious diseases, accounting for vaccine pipeline constraints and uncertainty in research and development preparedness outcomes. METHODS We assembled a pipeline of 224 vaccine candidates from preclinical through to phase 2 for 11 priority epidemic infectious diseases. We used a linear regression model to identify drivers of development costs from preclinical through to end of phase 2a. Drawing from published estimates of vaccine research and development probabilities of success, we simulated costs for advancing these 224 vaccine candidates through to the end of phase 2a. We combined these findings to determine minimum costs for progressing at least one vaccine through to the end of phase 2a per epidemic infectious disease by means of a stochastic optimisation model. FINDINGS The cost of developing a single epidemic infectious disease vaccine from preclinical trials through to end of phase 2a is US$31-68 million (US$14-159 million range), assuming no risk of failure. We found that previous licensure experience and indirect costs are upward drivers of research and development costs. Accounting for probability of success, the average cost of successfully advancing at least one epidemic infectious disease vaccine through to the end of phase 2a can vary from US$84-112 million ($23 million-$295 million range) starting from phase 2 to $319-469 million ($137 million-$1·1 billion range) starting from preclinical. This cost includes the cumulative cost of failed vaccine candidates through the research and development process. Assuming these candidates and funding were made available, progressing at least one vaccine through to the end of phase 2a for each of the 11 epidemic infectious diseases would cost a minimum of $2·8-3·7 billion ($1·2 billion-$8·4 billion range). INTERPRETATION Our analysis provides new evidence on vaccine research and development pipelines and associated costs for 11 epidemic infectious diseases, highlighting both funding needs and research and development gaps for achieving vaccine research and development preparedness targets. FUNDING This work was partly supported by the Research Council of Norway through the Global Health and Vaccination Programme GLOBVAC.
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Affiliation(s)
- Dimitrios Gouglas
- Norwegian Institute of Public Health, Oslo, Norway; CEPI-Coalition for Epidemic Preparedness Innovations, Oslo, Norway.
| | - Tung Thanh Le
- CEPI-Coalition for Epidemic Preparedness Innovations, Oslo, Norway
| | - Klara Henderson
- CEPI-Coalition for Epidemic Preparedness Innovations, Oslo, Norway; Independent consultant, North Balgowlah, NSW, Australia
| | - Aristidis Kaloudis
- Norwegian University of Science and Technology, Faculty of Economics, Department of Industrial Economics and Technology Management, Gjøvik, Norway
| | - Trygve Danielsen
- CEPI-Coalition for Epidemic Preparedness Innovations, Oslo, Norway
| | | | | | - Penny M Heaton
- Bill & Melinda Gates Medical Research Institute, Cambridge, MA, USA
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15
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Hebert CG, DiNardo N, Evans ZL, Hart SJ, Hachmann AB. Rapid quantification of vesicular stomatitis virus in Vero cells using Laser Force Cytology. Vaccine 2018; 36:6061-6069. [PMID: 30219365 DOI: 10.1016/j.vaccine.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 09/01/2018] [Indexed: 01/06/2023]
Abstract
The ability to rapidly and accurately determine viral infectivity can help improve the speed of vaccine product development and manufacturing. Current methods to determine infectious viral titers, such as the end-point dilution (50% tissue culture infective dose, TCID50) and plaque assays are slow, labor intensive, and often subjective. In order to accelerate virus quantification, Laser Force Cytology (LFC) was used to monitor vesicular stomatitis virus (VSV) infection in Vero (African green monkey kidney) cells. LFC uses a combination of optical and fluidic forces to interrogate single cells without the use of labels or antibodies. Using a combination of variables measured by the Radiance™ LFC instrument (LumaCyte), an infection metric was developed that correlates well with the viral titer as measured by TCID50 and shortens the timeframe from infection to titer determination from 3 days to 16 h (a 4.5 fold reduction). A correlation was also developed between in-process cellular measurements and the viral titer of collected supernatant, demonstrating the potential for real-time infectivity measurements. Overall, these results demonstrate the utility of LFC as a tool for rapid infectivity measurements throughout the vaccine development process.
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Affiliation(s)
- Colin G Hebert
- LumaCyte, LLC, 1145 River Road, Suite 16, Charlottesville, VA 22901, USA
| | - Nicole DiNardo
- Thermo Fisher Scientific, Inc., 3175 Staley Road, Grand Island, NY 14072, USA
| | - Zachary L Evans
- LumaCyte, LLC, 1145 River Road, Suite 16, Charlottesville, VA 22901, USA
| | - Sean J Hart
- LumaCyte, LLC, 1145 River Road, Suite 16, Charlottesville, VA 22901, USA
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16
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Riese P, Trittel S, Schulze K, Guzmán CA. Rodents as pre-clinical models for predicting vaccine performance in humans. Expert Rev Vaccines 2015. [DOI: 10.1586/14760584.2015.1074043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Stephanie Trittel
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Kai Schulze
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Carlos A Guzmán
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany
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17
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Gannavaram S, Dey R, Avishek K, Selvapandiyan A, Salotra P, Nakhasi HL. Biomarkers of safety and immune protection for genetically modified live attenuated leishmania vaccines against visceral leishmaniasis - discovery and implications. Front Immunol 2014; 5:241. [PMID: 24904589 PMCID: PMC4033241 DOI: 10.3389/fimmu.2014.00241] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/09/2014] [Indexed: 12/16/2022] Open
Abstract
Despite intense efforts there is no safe and efficacious vaccine against visceral leishmaniasis, which is fatal and endemic in many tropical countries. A major shortcoming in the vaccine development against blood-borne parasitic agents such as Leishmania is the inadequate predictive power of the early immune responses mounted in the host against the experimental vaccines. Often immune correlates derived from in-bred animal models do not yield immune markers of protection that can be readily extrapolated to humans. The limited efficacy of vaccines based on DNA, subunit, heat killed parasites has led to the realization that acquisition of durable immunity against the protozoan parasites requires a controlled infection with a live attenuated organism. Recent success of irradiated malaria parasites as a vaccine candidate further strengthens this approach to vaccination. We developed several gene deletion mutants in Leishmania donovani as potential live attenuated vaccines and reported extensively on the immunogenicity of LdCentrin1 deleted mutant in mice, hamsters, and dogs. Additional limited studies using genetically modified live attenuated Leishmania parasites as vaccine candidates have been reported. However, for the live attenuated parasite vaccines, the primary barrier against widespread use remains the absence of clear biomarkers associated with protection and safety. Recent studies in evaluation of vaccines, e.g., influenza and yellow fever vaccines, using systems biology tools demonstrated the power of such strategies in understanding the immunological mechanisms that underpin a protective phenotype. Applying similar tools in isolated human tissues such as PBMCs from healthy individuals infected with live attenuated parasites such as LdCen(-/-) in vitro followed by human microarray hybridization experiments will enable us to understand how early vaccine-induced gene expression profiles and the associated immune responses are coordinately regulated in normal individuals. In addition, comparative analysis of biomarkers in PBMCs from asymptomatic or healed visceral leishmaniasis individuals in response to vaccine candidates including live attenuated parasites may provide clues about determinants of protective immunity and be helpful in shaping the final Leishmania vaccine formulation in the clinical trials.
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Affiliation(s)
- Sreenivas Gannavaram
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration , Bethesda, MD , USA
| | - Ranadhir Dey
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration , Bethesda, MD , USA
| | - Kumar Avishek
- National Institute of Pathology, Indian Council of Medical Research , New Delhi , India
| | | | - Poonam Salotra
- National Institute of Pathology, Indian Council of Medical Research , New Delhi , India
| | - Hira L Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration , Bethesda, MD , USA
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18
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Keith JA, Agostini Bigger L, Arthur PA, Maes E, Daems R. Delivering the promise of the Decade of Vaccines: opportunities and challenges in the development of high quality new vaccines. Vaccine 2014; 31 Suppl 2:B184-93. [PMID: 23598480 DOI: 10.1016/j.vaccine.2012.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/05/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022]
Abstract
The Decade of Vaccines (DoV) initiative, launched in 2010, has as its mission "to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live". Through their life-saving vaccines, the research-based vaccine companies represented by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) and the Biotechnology Industry Organization (BIO) make a major contribution toward this vision. In this article, we begin by summarizing progress made over the past three decades in research and development (R&D) of new and future vaccines, and identify the opportunities and challenges faced by the research-based vaccine industry. We then review the Global Vaccine Action Plan (GVAP) and provide IFPMA and BIO consensus perspectives on its six strategic objectives. Finally, we identify policy measures to support R&D of, and access to, high-quality, innovative vaccines.
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19
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Stephens P. Vaccine R&D: past performance is no guide to the future. Vaccine 2014; 32:2139-42. [PMID: 24613519 DOI: 10.1016/j.vaccine.2014.02.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/06/2013] [Accepted: 02/12/2014] [Indexed: 12/14/2022]
Abstract
Vaccines offer the most cost-effective solution to prevent both communicable and non-communicable disease in poor countries. Published studies suggest that vaccine research is seeing declining success. This study updates the latest analyses on success rates in vaccine research, and examines the potential causes of decline and their ongoing impact. Success rates are shown to decline, the observed probability of market entry being just 1.8%, almost a fourfold decline over 5 years, but in the context of a very different product portfolio from that seen in earlier studies. DNA vaccines see high Phase I failures as expected, and therapeutic vaccines have lower success rates than prophylactic vaccines. The changing scientific challenge, lack of investment and lack of co-operation are highlighted as potential causes of the decline. Many issues have now been resolved, but co-operation between academia, regulators and industry remains a significant challenge, requiring links across new disciplines and technologies.
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Affiliation(s)
- Peter Stephens
- IMS HEALTH, 210 Pentonville Road, London N1 9JY, United Kingdom; WHO Collaborating Centre for Pharmacoepidemiology and Pharmaceutical Policy Analysis, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands.
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20
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Koff WC, Burton DR, Johnson PR, Walker BD, King CR, Nabel GJ, Ahmed R, Bhan MK, Plotkin SA. Accelerating next-generation vaccine development for global disease prevention. Science 2013; 340:1232910. [PMID: 23723240 DOI: 10.1126/science.1232910] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vaccines are among the greatest successes in the history of public health. However, past strategies for vaccine development are unlikely to succeed in the future against major global diseases such as AIDS, tuberculosis, and malaria. For such diseases, the correlates of protection are poorly defined and the pathogens evade immune detection and/or exhibit extensive genetic variability. Recent advances have heralded in a new era of vaccine discovery. However, translation of these advances into vaccines remains impeded by lack of understanding of key vaccinology principles in humans. We review these advances toward vaccine discovery and suggest that for accelerating successful vaccine development, new human immunology-based clinical research initiatives be implemented with the goal of elucidating and more effectively generating vaccine-induced protective immune responses.
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Affiliation(s)
- Wayne C Koff
- International AIDS Vaccine Initiative (IAVI), New York, NY 10004, USA.
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21
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Pronker ES, Weenen TC, Commandeur H, Claassen EHJHM, Osterhaus ADME. Risk in vaccine research and development quantified. PLoS One 2013; 8:e57755. [PMID: 23526951 PMCID: PMC3603987 DOI: 10.1371/journal.pone.0057755] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/29/2013] [Indexed: 11/19/2022] Open
Abstract
To date, vaccination is the most cost-effective strategy to combat infectious diseases. Recently, a productivity gap affects the pharmaceutical industry. The productivity gap describes the situation whereby the invested resources within an industry do not match the expected product turn-over. While risk profiles (combining research and development timelines and transition rates) have been published for new chemical entities (NCE), little is documented on vaccine development. The objective is to calculate risk profiles for vaccines targeting human infectious diseases. A database was actively compiled to include all vaccine projects in development from 1998 to 2009 in the pre-clinical development phase, clinical trials phase I, II and III up to Market Registration. The average vaccine, taken from the preclinical phase, requires a development timeline of 10.71 years and has a market entry probability of 6%. Stratification by disease area reveals pandemic influenza vaccine targets as lucrative. Furthermore, vaccines targeting acute infectious diseases and prophylactic vaccines have shown to have a lower risk profile when compared to vaccines targeting chronic infections and therapeutic applications. In conclusion; these statistics apply to vaccines targeting human infectious diseases. Vaccines targeting cancer, allergy and autoimmune diseases require further analysis. Additionally, this paper does not address orphan vaccines targeting unmet medical needs, whether projects are in-licensed or self-originated and firm size and experience. Therefore, it remains to be investigated how these - and other - variables influence the vaccine risk profile. Although we find huge differences between the risk profiles for vaccine and NCE; vaccines outperform NCE when it comes to development timelines.
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22
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Stefanakis R, Robertson AS, Ponder EL, Moree M. Analysis of neglected tropical disease drug and vaccine development pipelines to predict issuance of FDA priority review vouchers over the next decade. PLoS Negl Trop Dis 2012; 6:e1803. [PMID: 23145186 PMCID: PMC3493373 DOI: 10.1371/journal.pntd.0001803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rianna Stefanakis
- BIO Ventures for Global Health, San Francisco, California, United States of America.
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23
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Pronker ES, Claassen E, Osterhaus ADME. Development of new generation influenza vaccines: recipes for success? Vaccine 2012; 30:7344-7. [PMID: 23044407 DOI: 10.1016/j.vaccine.2012.09.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 12/26/2022]
Abstract
As infectious diseases cause approximately 25% of the annual global mortality, vaccines are found to be a time proven and promising response to infectious disease need. However, like for pharmaceutical small molecules, vaccine development is lengthy, risky and resource demanding. Faced with an attrition rate estimated around 80%, key opinion leaders were interviewed with the question: is there a recipe for success?
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Affiliation(s)
- E S Pronker
- Vacceleron, Jenalaan 18c, 3584 CK Utrecht, The Netherlands.
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24
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The gold industry standard for risk and cost of drug and vaccine development revisited. Vaccine 2011; 29:5846-9. [DOI: 10.1016/j.vaccine.2011.06.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/30/2011] [Accepted: 06/14/2011] [Indexed: 11/19/2022]
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25
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Barrett ADT, Beasley DWC. Development pathway for biodefense vaccines. Vaccine 2009; 27 Suppl 4:D2-7. [PMID: 19837280 DOI: 10.1016/j.vaccine.2009.07.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 07/24/2009] [Indexed: 10/20/2022]
Abstract
At the present time it is estimated that the process of development of a vaccine from discovery to licensure takes approximately 18-20 years and costs in excess of US$500 million. For "routine" vaccines, the case for developing a vaccine is straightforward in terms of economics and large scale public health utilization each year. For vaccines used for biodefense and emerging diseases, the considerations are somewhat different as the vaccine may not be needed every year to control outbreaks and may be stockpiled only as a countermeasure that hopefully may never be needed. Furthermore, efficacy trials are often difficult as the natural disease may be rare or not present. Consequently, animal models will play a critical role in demonstrating efficacy. Nonetheless, the vaccine pathway still requires the same fundamental components of basic science/discovery, preclinical development, clinical trials, registration/licensure, and a plan for implementation.
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Affiliation(s)
- Alan D T Barrett
- Sealy Center for Vaccine Development, Center for Biodefense and Emerging Infectious Diseases, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555-0436, USA.
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Infectious diseases know no borders: a plea for more collaboration between researchers in human and veterinary vaccines. Vet J 2008; 178:1-2. [PMID: 18406639 PMCID: PMC7128901 DOI: 10.1016/j.tvjl.2008.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 02/23/2008] [Accepted: 02/26/2008] [Indexed: 11/22/2022]
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27
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Development of a travelers' diarrhea vaccine for the military: how much is an ounce of prevention really worth? Vaccine 2008; 26:2490-502. [PMID: 18417259 DOI: 10.1016/j.vaccine.2008.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 02/10/2008] [Accepted: 03/11/2008] [Indexed: 11/21/2022]
Abstract
Infectious diarrhea is one of the many threats to the deployed military, and given limited resources, a decision to pursue a vaccine acquisition strategy should be based on best evidence that weighs costs and benefits compared to alternatives. An economic model was developed to estimate the marginal cost to avert a duty day lost due to diarrhea for a vaccine acquisition strategy compared to current clinical management, for both multiplex and pathogen-specific vaccines. Vaccines against Campylobacter and enterotoxigenic Escherichia coli appeared to be more favorable than a Shigella vaccine. This model provides an evidence-based decision tool to support prioritization in vaccine development.
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28
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Matheny J, Mair M, Mulcahy A, Smith BT. Incentives for Biodefense Countermeasure Development. Biosecur Bioterror 2007; 5:228-38. [PMID: 17903091 DOI: 10.1089/bsp.2007.0030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Therapeutics and vaccines are available for only a fraction of biological threats, leaving populations vulnerable to attacks involving biological weapons. Existing U.S. policies to accelerate commercial development of biodefense products have thus far induced insufficient investment by the biopharmaceutical industry. In this article, we examine the technical, regulatory, and market risks associated with countermeasure development and review existing and proposed federal incentives to increase industrial investment. We conclude with several recommendations. To increase industry's engagement in biodefense countermeasure development, Congress should expand BioShield funding, giving HHS the flexibility to fund a portfolio of biodefense countermeasures whose revenues are comparable to those of commercial drugs. Congress should establish tradable priority review vouchers for developers of new countermeasures. A National Academy of Sciences or National Biodefense Science Board should formally evaluate incentive programs and a government-managed "Virtual Pharma," in which HHS contracts separate stages of research, development, and production to individual firms.
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Gillim-Ross L, Subbarao K. Emerging respiratory viruses: challenges and vaccine strategies. Clin Microbiol Rev 2006; 19:614-36. [PMID: 17041137 PMCID: PMC1592697 DOI: 10.1128/cmr.00005-06] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The current threat of avian influenza to the human population, the potential for the reemergence of severe acute respiratory syndrome (SARS)-associated coronavirus, and the identification of multiple novel respiratory viruses underline the necessity for the development of therapeutic and preventive strategies to combat viral infection. Vaccine development is a key component in the prevention of widespread viral infection and in the reduction of morbidity and mortality associated with many viral infections. In this review we describe the different approaches currently being evaluated in the development of vaccines against SARS-associated coronavirus and avian influenza viruses and also highlight the many obstacles encountered in the development of these vaccines. Lessons learned from current vaccine studies, coupled with our increasing knowledge of the host and viral factors involved in viral pathogenesis, will help to increase the speed with which efficacious vaccines targeting newly emerging viral pathogens can be developed.
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Affiliation(s)
- Laura Gillim-Ross
- Laboratory of Infectious Diseases, National Insitute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
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30
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Serdobova I, Kieny MP. Assembling a global vaccine development pipeline for infectious diseases in the developing world. Am J Public Health 2006; 96:1554-9. [PMID: 16873743 PMCID: PMC1551949 DOI: 10.2105/ajph.2005.074583] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Commercial realities have drastically reduced private investment in the development of new public health tools, but increased awareness of this situation has resulted in the emergence of a variety of research-based, nonprofit organizations. We reviewed current vaccine developments and developed a framework for efficient research and development investments in this area. We have identified several key "push" and "pull" forces within the vaccine research and product development environment and have examined their impacts on the process. These forces affect the global vaccine pipeline, which is composed of all individual vaccine initiatives and global partnerships (i.e., stakeholders), All of these research and development stakeholders must work together to establish and promote a global, sustainable research and development pipeline that delivers optimal vaccines and immunization technologies.
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31
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Brogan D, Mossialos E. Applying the concepts of financial options to stimulate vaccine development. Nat Rev Drug Discov 2006; 5:641-7. [PMID: 16883302 DOI: 10.1038/nrd2035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Stimulating research and development for neglected diseases (such as tuberculosis, malaria and AIDS) has proven difficult. We offer an alternative approach to stimulating research into neglected diseases based on the concept of a financial call option. Our Call Options for Vaccines (COV) model allows the purchaser to make payments during the early stages of development in exchange for reduced future prices. We conclude with a discussion of possible risks and benefits.
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Affiliation(s)
- David Brogan
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
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32
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Milstien JB, Kaddar M, Kieny MP. The Impact Of Globalization On Vaccine Development And Availability. Health Aff (Millwood) 2006; 25:1061-9. [PMID: 16835187 DOI: 10.1377/hlthaff.25.4.1061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globalization is likely to affect many aspects of public health, one of which is vaccine-preventable communicable diseases. Important forces include increased funding initiatives supporting immunization at the global level; regulatory harmonization; widespread intellectual property rights provisions through the World Trade Organization agreements; the emergence of developing-country manufacturers as major players in vaccine supply; and the appearance of new communicable disease threats, including those potentially linked to bioterrorism. All of these forces can affect, either positively and negatively, the development and availability of vaccines. Harnessing these will be a challenge for policymakers and immunization stakeholders.
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Affiliation(s)
- Julie B Milstien
- Center for Vaccine Development, Department of Geographic Medicine, University of Maryland School of Medicine, USA.
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33
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Kieny MP, Excler JL, Girard M. Research and development of new vaccines against infectious diseases. Am J Public Health 2004; 94:1931-5. [PMID: 15514230 PMCID: PMC1448562 DOI: 10.2105/ajph.94.11.1931] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infectious diseases are responsible for approximately 25% of global mortality, especially in children aged younger than 5 years. Much of the burden of infectious diseases could be alleviated if appropriate mechanisms could be put in place to ensure access for all children to basic vaccines, regardless of geographical location or economic status. In addition, new safe and effective vaccines should be developed for a variety of infections against which no effective preventive intervention measure is either available or practical. The public, private, and philanthropic sectors need to join forces to ensure that these new or improved vaccines are fully developed and become accessible to the populations in need as quickly as possible.
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Affiliation(s)
- Marie Paule Kieny
- Initiative for Vaccine Research, World Health Organization, Avenue Appia 20, CH1211-Genève 27, Switzerland.
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34
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Development and application of PROVAX adjuvant formulation for subunit cancer vaccines. Adv Drug Deliv Rev 1998; 32:187-197. [PMID: 10837644 DOI: 10.1016/s0169-409x(98)00010-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A major challenge facing the development of subunit vaccines comprised of well-defined recombinant antigens is their weak immunogenicity and inability to induce effective cytotoxic T cell (CTL) responses. Adjuvants aimed at increasing the immunogenicity of recombinant antigens remain a focus in vaccine development. The potency of an adjuvant is linked to specific stimulation of T cell responses, involving TH1 and TH2 subsets of CD4(+) T helper cells and CD8(+) CTL and B cell-mediated antibody responses. As a result of the existence of two distinct intra-cellular pathways for antigen processing, immunization with exogenous antigens often shows a greater propensity for T helper and antibody responses, but not CD8(+) CTL responses. However, existing experimental evidence suggests that CD8(+) CTLs, which are critical in the elimination of viral-infected and neoplastic cells, can be elicited with soluble antigens when delivered in appropriate formulations or adjuvants. This review focuses on the properties of PROVAX adjuvant in inducing antigen-specific CTL responses, antibody responses and tumor regression in experimental models and its potential application for the development of recombinant cancer vaccines.
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Abstract
The approach to the development of a Leishmania vaccine has undergone a revolution since its early beginnings with the ancient practice of leishmazation: the inoculation of infectious parasites from an active lesion in order to produce a self-healing lesion in a healthy individual. Controlled infection has been followed by injection of killed parasites and has now progressed to subunit and naked DNA vaccines. Emanuela Handman here discusses the current studies and the future prospects for a Leishmania vaccine with a focus on cutaneous leishmaniasis. Unfortunately, what J.F. Williams said about antiparasite vaccines in 1987 (Ref. 1) is still true in 1997: 'the reasons for optimism are less evident than the reasons for enthusiasm'.
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Affiliation(s)
- E Handman
- The Walter and Eliza Hall Institute of Medical Research, Victoria 3050, Australia.
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