Previous generations were fearful of diseases that, today, don’t even fall on our radar: Smallpox. Polio. Whooping cough. Thanks to vaccines, those diseases are either preventable or eradicated completely in some areas. But are we failing to recognize current vaccine needs, namely those for the elderly? What should modern vaccine development look like?
During a PRA-sponsored program held at the 2017 European World Vaccine Congress in Barcelona, Gregory A. Poland, MD, FISDA, MACP presented “12 Things Vaccine Developers Often Get (Terribly) Wrong” with an audience of vaccine leaders.
Our Darin Seehafer, BSC, PRA Vaccine Solutions, attended and he shares his thoughts from Dr. Poland’s presentation:
While at times Dr. Poland’s talk was tongue-in-cheek and provocative, it addressed a very serious topic. He examined the current state of vaccine research and development, highlighting many of the current issues the industry is facing. He then outlined a potential future.
Dr. Poland started by sharing his seven “Ps,” four of which struck a particular chord with the attendees. “Payers are short-term focused,” he said. “The Public is suspicious and mistrustful; Politicians are ignorant of public health needs; and finally, Pharma has insufficient innovation and courage.”
These were bold words delivered to a room full of industry leaders – and yet there were still nodding heads of agreement.
Dr. Poland went on to share a quote from Blaise Pascal. “The majority opinion is the best way because it can be seen and is strong enough to command obedience,” he said. “But it is the opinion of the least clever.”
Poland explained his Pascalian Agenda by indicating that we must expose ourselves to different viewpoints, including those that differ from the majority opinion. It is from this rigor, this scientific debate, that we learn and grow, which ultimately helps us to “become more clever in our approach.”
Cryptically, he also added, “The main thing is to keep the main thing, the main thing!”
Targeting specific demographics
Dr. Poland applied this philosophy of constantly growing and challenging ourselves scientifically to modern vaccine development. He noted that we are failing to see the real societal need for future vaccine development.
He correctly pointed out that our society is rapidly aging, and the demand for future vaccines will not be driven by pediatrics but rather geriatrics. This is a phenomenon Dr. Poland referred to as the “Silver Tsunami.” He warned that in order to deal with this rapidly growing and aging population, we had better focus our priorities, time and resources on understanding immunosenescence, designing vaccines against diseases which primarily afflict the elderly, improving vaccine immunogenicity and efficacy in the elderly, funding vaccine delivery for all elderly, and developing a global adult immunization schedule. Currently, only a few vaccines specifically designed for older adults exist, such as pneumococcal, zoster, and high-dose influenza.
...the demand for future vaccines will not be driven by pediatrics but rather geriatrics.
However, Dr. Poland was not finished. He raised the question about obesity and its effects on the human immune system, asking, “Do we fully understand and appreciate the impact obesity has on lowering immunologic responses to current vaccines? If so, what are we doing about it?”
He continued, “The demographics and evidence demonstrates that we are becoming a world of obese, immunocompromised, elderly persons, but the current vaccine development priorities have failed to accept and address this important truth.”
Dr. Poland then launched into one possible, maybe not-so-distant future of vaccine development, one which includes the advent of personalized/individualized vaccines – vaccines designed to maximize efficacy and safety while minimizing harm or uselessness in particular subgroups of people, or in those who carry specific genetic alterations.
This created quite a buzz in the audience, as we wondered, how we could possibly even entertain the idea of such a far-fetched idea? After all, we can hardly create enough vaccines now (cost-effectively) under the current model; how would we ever design such an R&D pipeline for vaccine development?
The questions prompted significant debate and discussion and Dr. Poland was challenged on several fronts. But he simply smiled and calmly explained, “True, today this seems far off but the idea is there. In fact, we are working on this very concept right now in my own lab. So while I understand your hesitation or even rejection of this idea, the need is there and the technology exists, so all that is needed is for us to be more clever in our approach on how we currently think about vaccine development and manufacturing.”
He also pointed out that the biotech industry, governmental regulators, and the National Institutes of Health have expressed significant interest, and the NIH has funded studies to investigate the basic science aspect of this idea of personalized vaccines.
Like most everything else in life, it is apparent that the vaccine research and development front will look very different from today over the coming decades.
And, so, what was the “main thing” Dr. Poland advised us to ultimately keep in mind? He finally shared his answer: to design and deliver life-saving and disability-preventing vaccines to everyone who can receive them, in a manner that is safe, cost-effective, and capable.