As we continue our coverage of World Immunisation Week, we give the floor to Alice Carter, who works with the Sabin Vaccine Institute, an organisation involved in NTDs research. Read the other articles here!
The Sabin Vaccine Institute (Sabin) is a U.S.-based non-profit organization, made up of scientists, researchers and advocates dedicated to reducing needless human suffering from vaccine preventable and neglected tropical diseases (NTDs). Since its founding in 1993 in honor of the oral polio vaccine developer, Dr. Albert B. Sabin, the Institute has been at the forefront of efforts to control, treat and eliminate vaccine preventable and neglected tropical diseases by developing new vaccines, advocating use of existing vaccines and promoting increased access to affordable medical treatments. Our job is to educate, eliminate barriers, and lead scientific discovery, delivering on the promise of a healthier future for nearly two billion people still plagued by NTDs and vaccine preventable diseases.
The Impact of NTDs
NTDs are a diverse group of infectious diseases that are prevalent in tropical conditions in 149 countries, and disproportionately affect populations living in poverty. The 17 NTDs together constitute the fourth largest disease burden of all communicable diseases, affecting 1 in 6 people worldwide.
NTDs plague not only the poorest countries, but are found increasingly in middle income countries (52 percent of NTD cases now occur in middle income countries). These diseases often strike in childhood and cause a cascade of debilitating consequences throughout the life of people living with the disease; effects that limit their educational opportunities, decrease their quality of life and labour productivity, and as a consequence affect future wage earning potential by as much as 43 percent, according to recent studies. These diseases are vastly underfunded considering their global scope and disabling impact in endemic communities.
Vaccines for NTDs – a global health priority
Currently, there are no licensed vaccines for any of the NTDs. The current model for their control is mass drug administration (MDA), in which drugs designed to prevent and treat these diseases are distributed to entire communities at one time. While this approach has been very successful for some diseases, for others it has proven to be inadequate. The Global Burden of Disease study estimates that since 1990, although MDA has resulted in substantial reductions in the prevalence of NTDs such as lymphatic filariasis, blinding trachoma, onchocerciasis and ascariasis, the prevalence of hookworm infection has not changed and the prevalence of schistosomiasis has actually increased despite significant expansion of MDA programs for these diseases. In fact, a recent survey of almost 400 NTD experts concluded that elimination of hookworm and schistosomiasis will not be feasible by MDA alone.
Therefore, development of vaccines for hookworm and schistosomiasis are global priorities for NTD disease control and elimination, as leading NTDs in terms of disease burden, infecting an estimated 600 million and 252 million people respectively. The Sabin PDP currently has a human hookworm vaccine and a schistosomiasis vaccine in Phase 1 clinical trials, and is also advancing vaccines against leishmaniasis, Chagas disease, trichuriasis, ascariasis, West Nile, SARS/MERS and onchocerciasis.
The PDP model – leveraging networks for vaccine research
Dr. Peter Hotez, President of the Sabin Vaccine Institute, leads the Sabin Product Development Partnership’s (Sabin PDP) efforts to develop vaccines for diseases of the world’s poorest people. The Sabin PDP brings together a diverse group of global partners with NTD expertise in the academic, public and private sectors, accelerating the development of NTD vaccines. Our unique approach leverages industry best practices, expert scientists, and cutting-edge laboratories to make significant progress in developing viable and safe vaccine candidates. We work in partnership with leading scientists and institutions throughout Europe, including the University of Tubingen in Germany, the Amsterdam Institute for Global Health and Development, and a Belgian Small Medium Enterprise Q-Biologicals NV, to utilize the best science to develop vaccine candidates.
Fast-tracking NTD vaccine research – innovation and investment support needed
Despite the pressing need for NTD vaccines, they have been largely overlooked by traditional vaccine developers. NTDs overwhelmingly impact the world’s poorest people, and as diseases of poverty, receive a paucity of global health resources relative to their impact. This also means there is no market to pay for these essential products. The traditional vaccine development pathway is long and expensive, with bottlenecks at every stage of development, including early discovery, manufacturing and formulation, preclinical testing and clinical trials. If these bottlenecks remain unaddressed, they will continue to present significant barriers to NTD vaccines reaching the market.
Because of limited funding, vaccine development for NTDs must be as direct and efficient as possible. To mitigate risk, shorten development timelines and lower costs, we need innovative and cost-effective discovery, development and testing criteria early in the vaccine development pathway. The Sabin PDP is working on developing a platform that will allow global partners to collaborate in parallel to advance vaccine candidates instead of relying on the traditional sequential development paradigm, rooting out non-viable candidates earlier in the process and shortening the timeline for an effective vaccine to reach the people who need it.
Ultimately, however, we lack the financial means to advance vaccine candidates through expensive Phase 3 clinical trials. Recent Policy Cures G-Finder reports show decreasing investments from government institutions and donors in supporting vaccine development. We are already witnessing drug resistance for some NTD treatments, even with the limited reach of only 40% of people requiring treatment receiving it. Ensuring that we have a full arsenal of tools to combat NTDs, including vaccines, to complement treatment regimens will be vital if we are to see an end to many of these diseases by the WHO’s 2030 goal.
If each UN member state were to commit 0.05% of GDP to R&D in line with recommendations, this alone would serve to hugely increase global resources for global health R&D and help us to achieve an end to these devastating diseases. As the world looks towards setting in motion the UN member state agreed Sustainable Development Goals, overseeing progress for the next 15 years, we need to see more global commitment towards research and development of new and improved global health tools.
Alice Carter is the Resource Development Coordinator at the Sabin Vaccine Institute