50 years of vaccines
The eradication of smallpox uniquely combined product innovation, process innovation and policy innovation – with an unprecedented level of stakeholder collaboration.
Research and development is, and always has been, at the heart of immunization success.
In the last 50 years smallpox has been eradicated, polio nearly so and strides have been made in reducing measles infections. Vaccines have been developed to prevent 26 diseases.
Scientific innovations in the second half of the 20th century led to the creation of vaccines for measles, mumps, rubella, hepatitis A and B, chicken pox, pneumonia, and influenza. Notable is the work of Maurice Hilleman, who developed over 40 vaccines and eight of the 14 routinely recommended today and is credited with saving more lives than any other medical scientist in the 20th century.
Innovation also improved vaccine delivery technologies such as thermostability to reduce the need for refrigeration and techniques such as microneedles or intradermal devices to enhance vaccine effectiveness and make it easier for health workers to immunize. Combination vaccines such as MMR reduce the number of shots a child needs while maintaining the same level of protection.
Achieving eradication of polio
In the pre-vaccine era, when poliovirus was the leading cause of permanent disability in children, almost all children became infected by poliovirus, with one in 200 susceptible individuals developing the paralyzing poliomyelitis.
With effective vaccines available, partnerships moved towards eradicating polio. Programs such as Rotary International’s PolioPlus and The Global Polio Eradication Initiative along with industry contributions such as Sanofi Pasteur providing OPV doses have bought polio to the brink of eradication. In 1994, the Americas were certified polio-free, followed by the WHO Western Pacific Region in 2000, the WHO European Region in 2002, and the WHO South-East Asia region in 2014. Poliovirus transmission levels are currently at the lowest point in history and eradication is a realistic expectation.
The infrastructure introduced to enable mass immunization has broader impacts in strengthening delivery of health services. For example, in Nigeria medicines for malaria are being delivered on a mass scale as part of the infrastructure for delivering the polio vaccine.
A shift to life course vaccination – Human Papilloma Virus vaccine
The perception that vaccines are a solution for infectious disease in children can be damaging: In the US, more adults die of vaccine preventable illnesses than children. Innovation in the industry is shifting to life-course vaccines to target people’s needs throughout their life as and when they need them.
The HPV vaccine provides the first great example of a shift towards life-course vaccines. It is estimated that cervical cancer affects more than 500,000 women each year, 80% of whom live in the developing world. The HPV vaccine is ideally given at a young age to prevent cancer. To date, a variety of HPV vaccines have been licensed: a quadrivalent (four-strain), a bivalent (two-strain) for girls and a nine-strain version. The impact of immunization on cervical and other HPV-related cancers will be evident in the next decades. A marked decrease in HPV infections, precancerous lesions and genital warts is already dramatic in vaccinated populations.
Immunization for all
Vaccines are a key part of the ambition for UHC and the UN SDGs. Immunization not only saves lives and improves health, it also unlocks the potential of the community. Vaccination not only protects vaccinated individuals, but indirectly protects unvaccinated individuals through community protection or ‘herd protection’.
The resurgence of measles in some parts of the world today serves as a reminder of the potential impacts of infectious diseases, which are easily preventable with vaccines.
Without successful immunization programs, the benefits of vaccine innovation will not be fully realized. The collaborative approach to developing recent dengue and malaria vaccines shows that industry needs to work hand-in-hand with governments, civil society, and global health policymakers to enable the benefits of vaccination to extend to all. Landmark initiatives include:
- WHO’s Expanded Programme on Immunization with the goal of making vaccines available to all children
- Gavi, founded by the BMGF, the World Bank, WHO, UNICEF and vaccine manufacturers
- The Developing Countries Vaccine Manufacturers Network aiming to increase the quality and affordability of vaccines for all
- The Global Vaccine Action Plan’s Decade of Vaccines, endorsed by 194 member states with the aim of delivering universal access to immunization regardless of where children were born
- The Humanitarian Mechanism, launched by WHO, UNICEF, Médecins Sans Frontières and Save the Children, to enhance access to vaccinations for traditionally ‘left behind’ populations.
Future innovation
Investment in vaccines is critical to address AMR. Vaccines can prevent illness and death and eliminate the need for the use of antimicrobials in the first place.
The next phase of innovation will be driven by a greater understanding of pathogens and immune responses as well as data and technology-led developments in research. Today there are 264 vaccines in the pipeline in the US alone, including a mix of life-course and infectious disease vaccines.
Smarter technologies will play a big role in the development of vaccines in the future. For example, vaccines that utilize messenger RNA (mRNA) provide instructions to our cells to make whatever we need to prevent disease, including antibodies. mRNA vaccines offer prompt and flexible design, cost-optimized production, and safer administration. Other projects aim to bring vaccine adjuvants – which can improve vaccine efficacy by aiding its effect on the immune system – to market.
Vaccines can also play a vital role in the fight against AMR, reducing infections and limiting their transition, enabling less reliance on antibiotics as well as reducing the inappropriate use of antibiotics for viral infections.
Vaccines remain the safest, most effective, and cost-effective medical technology ever developed and deployed globally to all, regardless of gender or location.