Vaccines: Investing for Life

Vaccines help to protect millions of people from disease, yet the search continues for vaccines that will halt the spread of cancer and diseases such as malaria and AIDS.

Approximately 900 of these staff work in the Province of Quebec, engaged in manufacturing, clinical development, R&D and regulatory functions. Canadian commercial development and marketing of vaccines is managed by GSK Canada-Pharmaceuticals in Mississagua, Ontario.

Vaccine pioneer

Edward Jenner must have felt a breakthrough was near. James Phipps, however, the eight-year-old boy on whom Jenner was about to experiment, may have been more apprehensive.

After all, medicine at the time - 1796 - could be a hit-and-miss affair and this was the English countryside, not the centre of science that was London.

But Jenner was sure he was on the right path and started the experiment. He took part of a cowpox pustule on the hand of milkmaid Sarah Nelmes and inserted it into an incision on the boy's arm.

His theory was drawn from countryside folklore that milkmaids with the mild disease of cowpox did not contract smallpox. Infants and young children were particularly vulnerable.

As we know, Jenner was correct and the boy was successfully immunised against smallpox. He published the results in 1798 and coined the word 'vaccine', from the Latin vacca for cow.

It took a while, but Jenner would have been pleased to hear the World Health Organization (WHO) declare in 1980 that vaccination had finally rid the world of endemic smallpox. Since his pioneering work, and that of Louis Pasteur, mass vaccination programmes have prevented illness or death from a number of diseases for millions of people every year. A world without vaccines is unimaginable.

Immunisation against infectious disease

Immunisation is one of the most cost-effective and successful of public health interventions. It has been used to tackle diseases such as rabies, diphtheria, tetanus, yellow fever and, more recently, polio, measles, mumps, and rubella and hepatitis B.

Smallpox has been eradicated, and WHO says measles and polio have been eliminated regionally, and that diphtheria, tetanus and pertussis have been substantially reduced in terms of rate of incidence and deaths.

Jenner started all this two centuries ago, but the work continues. New vaccines with potential for controlling infectious diseases are at advanced stages of development, targeting illnesses such as cervical cancer.

"Immunisation is one of the best values for public health investment today - adequate resources and the right strategies lead to concrete results" says Lee Jong-wook, late WHO director general.

Vaccine innovations

  • Infants and children: eg measles, mumps, rubella, rotavirus (causes diahorrea)
  • Adults: eg human papillomavirus infection (causes cervical cancer), hepatitis, typhoid
  • Elderly: eg influenza

One major innovation was the development of combination vaccines that can protect against several diseases with one simple injection. An example is the MMR (measles, mumps, rubella) vaccine that is used to protect children around the world.

GSK vaccines

This innovation is now 'business as usual' at GSK Biologicals, the vaccines business of GlaxoSmithKline, which has about 30 marketed vaccines, of which more than half are combination vaccines to protect children, adolescents and/or adults against up to six diseases at the same time.

GSK's portfolio of potential vaccines is one of the best in the industry, with 25 vaccines in clinical development at the end of last year. Five major vaccine launches are anticipated in the next five years. The company is proud to note that its vaccine development portfolio contains vaccines to protect people of all ages, in most parts of the world.

This unique position is the direct result of key decisions taken in the past, specifically one taken around 15 years ago when the company decided to invest in so-called 'adjuvant' technologies.

Vaccine adjuvants

Adjuvants are essentially additives designed to improve the effectiveness of a vaccine. For example, adjuvanted vaccines may be used in the future to:

  • Protect for longer - for example against cervical cancer, a condition caused by a virus
  • Potentially provide protection against previously unpreventable infections
  • Reduce the dose needed to gain protection - for example, this would be an advantage if a large number of doses were required to protect a population against pandemic influenza
  • Offer cross protection against similar strains of a virus

Therapeutic vaccination

Another innovation that GSK is pioneering is 'therapeutic vaccination', a form of therapy that can induce an immune response against cancer cells. The aim of the vaccination is to stimulate the production of an immune response that is capable of destroying the cancer cells very specifically. This work is at an early stage but results look promising.

However, like pharmaceuticals, vaccines take time and their development is a complicated process that requires significant investment. One new way of meeting this considerable commitment is through private-public partnerships.

These partnerships allow companies such as GSK and the public sector to work together - GSK can provide the R&D, technology, manufacturing and distribution expertise, while other partners and governments help fund other costs such as delivery.

"We are in an explosive stage of growth in the field of vaccine research due to the progress of science, especially immunology. It's our hope to protect against even more infectious diseases than ever as well as prevent some forms of cancer", says Philippe Monteyne, head of global vaccine development at GSK Biologicals.

Clinical studies

GSK is currently conducting clinical studies with candidate vaccines against malaria, HIV and tuberculosis, three diseases that WHO has named for priority eradication. Other candidate vaccines for diseases such as dengue are in early stages of development.

Influenza vaccines

With the threat of a possible influenza pandemic, GSK is developing pre-pandemic and pandemic vaccines with the hope of offering the best possible options in the face of a pandemic.

Why two? Why not focus development resources on one, given the urgency? Jean Stéphenne, president of GSK Biologicals, says: "While the first vaccine candidate aims at mounting a strong defence against a pandemic outbreak, the second vaccine may offer governments a preferred option to proactively stockpile and begin vaccination before the onset of a pandemic, significantly increasing the speed of a public health response in the event of an outbreak."

HIV vaccines

Various avenues are also being explored for developing an HIV vaccine. One is in collaboration with the International Aids Vaccine Initiative (IAVI) and the other in collaboration with the Institut Pasteur of France. In addition to these avenues, GSK is developing its own candidate vaccines.

GSK's candidate vaccine

A collaboration has also been established with the Aeras Foundation, a participant in the fight against tuberculosis, for the continued development of GSK's candidate vaccine. A new agreement has also been signed with the Malaria Vaccine Initiative (MVI) for the continued development of GSK's candidate vaccine against malaria, with a possible application for licensure in about 2010-11.

In 2005, GSK distributed over one billion doses of vaccines in developing countries, often through organisations such as UNICEF and the GAVI Alliance (Global Alliance for Vaccines and Immunisation).

Edward Jenner would have approved of how his work has developed. Even young James Phipps might have felt differently about his discomfort in that famous experiment if he could have foreseen the greater outcome.

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