Reportedly, the world’s first vaccine was developed in 1774 by a farmer, Benjamin Jesty, who intentionally infected his wife and children with pus from cow udders. Apparently, in the local community, they had discovered that dairymaids who had been infected with the cowpox virus from udders didn’t develop the more serious human variant of smallpox. The result must have been satisfactory, because 22 years later, the English doctor Edward Jenner described the method which subsequently became known all over the world.
Today, the principle behind every vaccine, i.e. exposing the immune system to a mild or modified version of a bacterium or virus so that it develops antibodies that prevent infection with a more dangerous variant, is well documented and under constant development. Vaccines are produced in many different ways. One method uses large amounts of hens’ eggs for the cultivation of vaccines, but over time, a number of different, more advanced methods have been developed.
Vaccines have been an invaluable help in the fight against serious and life-threatening diseases which have now either been totally eradicated or pushed back to such a level that a large proportion of the world’s population no longer need fear them. Right up to the second half of the twentieth century, polio infected and disabled hundreds of thousands of people every year. The first polio vaccine was given in 1950, and today polio has been strongly reduced. To this day, smallpox is the only, but very important, example of a fatal infectious disease that has been totally eliminated. Smallpox is estimated to have killed between 300 and 500 million during the twentieth century, and as recently as 1967, two million people died from the disease. In 1979, WHO was able to declare smallpox eradicated.
In Africa, vaccination is associated with a number of challenges that appear trivial in industrialised countries. The price of a vaccine alone can be a limiting factor in countries where incomes are extremely low, and besides the actual vaccine, a safe syringe is also required. Even if the money for the vaccine and syringe is available, common logistics can limit the availability of a safe vaccination. For example, keeping the vaccines cool can be problematic. The lack of syringes and, consequently, the re-use of syringes combined with scant knowledge about the risk of infection has accelerated the spread of fatal diseases, such as HIV.
Since cheaper vaccines would have a positive effect on the number of vaccinations in Africa, a new concept from NNE Pharmaplan has the potential to improve the situation. Normally, facilities for the production of vaccines are complex and expensive, but by recategorising the facilities in order to make modular standard products and producing them in Asia, construction can become quicker and cheaper. The modules can then be shipped to, for instance, Africa, where they can be assembled as vaccineproducing facilities. According to Klaus Hermansen, Senior Biotechnology Specialist with NNE Pharmaplan, this method has several advantages. Since the factories are standardised, employees can be trained at a factory in a completely different location while the modules are transported and assembled. This reduces the elapsed time between when the decision is made until the factory is ready to start production. It is even conceivable to store the modules in a warehouse so that they can be dispatched immediately and be available 6 to 8 weeks after they are ordered. In this way, a new factory would be ready to start production in six to twelve months. Construction work is simple since, in principle, the modules only require a stable foundation. This could also solve some of the logistics problems. NNE Pharmaplan’s standardisation idea has the backing of WHO. Dr. Marie-Paule Kieny, who is the Director of the WHO Initiative for Vaccine Research, says that after a trend of great concentration in vaccine production, local production is now coming back. WHO is trying to find a good location south of Sahara, but it must be acompanied by upgrades of national regulations, she says.
New technology is beginning to address the problem of the dangerous re-use of syringes. Various companies have developed auto-disable syringes that can only be used once. Since 2003, the World Health Organisation has recommended that all vaccinations are carried out with auto-disable syringes. This would effectively put a stop to the spread of HIV and other dangerous diseases caused by the re-use of syringes for vaccination. The ongoing development of syringes and production facilities are important initiatives in the efforts to supply sufficient numbers of syringes of the best quality possible at an affordable price in order to implement this recommendation. NNE Pharmaplan has developed an autodisable syringe that has been approved by WHO and, as a supplier to UNICEF, the company already has extensive experience in the production of syringes.
Unfortunately, however, there are still a number of infectious diseases against which no vaccination is available, such as malaria and HIV, which are the two diseases with the highest mortality in Africa. On a global scale, one child dies every 30 seconds as a result of malaria. Malaria is both preventable and treatable, but nevertheless around a million people die of the disease every year. Why has Africa been hit much harder than most other places in the world? Again, the economic situation and knowledge play crucial roles. Since no vaccine is available, the prevention of infection by other means is necessary. Besides the climate being favourable to the malaria-carrying mosquito, the spread of malaria in Africa is largely due to the lack of protection against mosquitoes in the form of mosquito nets and insecticides. In the case of HIV and AIDS, both the lack of condoms, the lack of knowledge and the lack of willingness to use condoms are crucial factors in the problem being much greater than it is in the rest of the world.
It is, of course, important to try and limit infection by improving conditions so that Africans can also use the same preventive measures as the wealthier parts of the world. However, the biggest hope lies in potential vaccines. Effective vaccines against malaria and HIV will make a huge difference to Africa, because the link between the diseases and the rest of Africa’s problems works both ways. Many diseases are worse in Africa because of poverty but, at the same time, Africa is also poor because of these diseases. If Africa could escape the clutches of HIV and malaria, many resources would be freed up to help in the construction of a hopefully richer and better functioning continent.
The work on developing vaccines is already underway. After twenty years of tests, researchers have announced that a malaria vaccine could be on the way. The Bill & Melinda Gates Foundation has donated large amounts of funds for this purpose, and according to Dr. Kieny a vaccine has been tested and could be ready in 2015. The vaccine is not perfect, but valuable in combination with known methods of minimizing the risk. Similar pronouncements are regularly made regarding HIV but, unfortunately, development of a vaccine against HIV is proving much more difficult. A new and much improved vaccine against tuberculosis is also on the way. No-one knows if we actually can develop perfect vaccines against HIV and malaria. But, as long as the research and development continue, there is hope for Africa.
Read more on the challenges that Africa is facing in our company magazine Angle, March 2010 issue