How are we developing vaccines for the future?
Bill Gates recently announced that he has teamed up with Larry Page, the co-founder of Google, to provide funding for the development of a universal flu vaccine.
Efforts are already being made to develop a universal vaccine that protects against all strains of flu but Bill Gates has challenged scientists to go one step further. He has asked them to develop a vaccine that will protect against current and emerging strains for three to five years.
He did this as we mark 100 years since the deadliest flu pandemic. Since then we have had several other flu pandemics with the latest killing at least 18,000 people in 2009, although some estimate the real death toll could be more than 284,000.
When he made the announcement at the end of April, Bill Gates said: “This should concern us all, because if history has taught us anything, it’s that there will be another deadly global pandemic.”
Although annual flu vaccinations still save lives, their success rate falls short of many other vaccines. Flu vaccines are approximately 40 to 60% effective compared to others like MMR which have success rates as high as 97%. This is partly because flu strains mutate quickly and it takes time to develop and manufacture new vaccines.
Flu is just one of several illnesses that are proving difficult to develop vaccines for. Scientists are now dealing with more complex diseases and conditions than in the past, like malaria, cancer, AIDS and Alzheimer’s. Certain pandemics, like the Zika and Ebola outbreaks, can also spread faster than we can develop new vaccines.
To tackle these challenges, some new trends in developing future vaccines are emerging.
A new type of vaccine
More productive and quicker ways of manufacturing new vaccines are already growing in popularity. This includes using more efficient methods of vaccine propagation.
For example, some cell-based vaccines have been approved in recent years as an alternative to traditional egg-based vaccines. Such vaccines are faster and easier to produce and also overcome the issue of egg allergies.
Egg-based flu vaccines have been criticised for being inefficient for a number of reasons including poor antibody-antigen binding affinity.
Live recombinant vaccines that use attenuated viruses (or bacterial strains) as vectors for immunogens are another alternative. Recombinant vaccines are quicker to produce, more effective and have fewer side effects than traditional alternatives.
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Because recombinant and cell-based vaccines can be produced more quickly, they are better suited to responding to a pandemic.
DNA vaccines are a promising new area of development too. DNA vaccines take the DNA which encodes a particular antigen and injects it directly into the muscle or skin.
DNA vaccines are relatively easy to produce and provide long-lasting immunity with few side effects. They are also cheaper than other vaccines and easier to transport which is particularly useful when they are needed in developing countries.
However, DNA vaccines have not yet been found to produce a strong enough immune response, so further development needs to be done in this area. Adjuvants that assist DNA to enter cells or target it towards specific cells could be one way to improve the efficacy of such vaccines.
Exploring new delivery methods
Future vaccines are also likely to be delivered in a variety of ways.
Nasal sprays are already being used as a pain-free way to deliver the flu vaccine to children and in the future we may see other pain-free vaccines.
Patches which deliver vaccines through a matrix of extremely tiny needles are one alternative in development. They don’t need to be delivered by a health professional which makes them ideal for use in remote areas.
Vaccines which overcome the cold-chain problem are also needed. Many vaccines need to be stored at cold temperatures to remain viable which can create a problem when transporting them. When the Icelandic volcano Eyjafjallajokull erupted in 2010, it grounded planes carrying 15 million doses of polio vaccine, which caused concerns that the disease would spread.
We must understand the immune system more
Undoubtedly, if new vaccines are to be developed, a better understanding of the immune system is also necessary. Advances in areas like genomics, bioinformatics and artificial intelligence can help scientists unravel the complexities of the immune system and develop more innovative vaccines.
Although developing new vaccines is challenging, their potential to save millions of lives throughout the world makes the effort and costs involved worthwhile.
A new app is providing vital palliative care in Ethiopia
A new mobile phone app has been developed to support patients needing end of life care in Ethiopia.
The Ayzot app has been created in collaboration between the UK's University Surrey, the University of Strathclyde, Hospice Ethiopia, the Federal Ministry of Health and Hello Doctor Ethiopia, an Ethiopian-based software company.
The app is named after a common Ethiopian expression roughly translated to mean "to soothe a sick person". The app is aimed at supporting patients with life-limiting illnesses such as cancer and HIV/AIDS, by helping them manage pain along with other symptoms.
A self-assessment management system leads the patient or carer through a common set of symptoms such as pain, nausea, drowsiness, breathlessness, tiredness, and loss of appetite.
Successful symptom management
Both patients and carers are encouraged to use the Ayzot app to assess the severity of each symptom using a combination of measures, including a pain assessment scale. The app contains both pharmacological and non-pharmacological medication information, and where appropriate it directs the user to get help and further information on things like wound care, spiritual care and diet.
During beta user-testing, carers reported positive changes in how they treated their loved one’s wounds because of the advice found on the app. Healthcare professionals commented on the app's potential to support them in delivering targeted care with limited resources. The patients testing the app reported that it helped them feel more reassured and supported with their pain management and symptom control.
Accessing palliative care
The majority of Ethiopia's 114 million people live in rural locations where access to palliative care is difficult, and there is only one hospice in the entire country. The pandemic has made accessing care even more difficult. "During the COVID-19 pandemic, access to essential palliative care in Ethiopia has been reduced" Dr Nicola Carey, from the School of Health Sciences at the University of Surrey said.
"I believe the app will help prevent disease and treat patients. We hope that Ayzot will be embedded into the national palliative care clinical provision to support healthcare professionals and provide enhanced palliative coverage in Ethiopia.”
The team behind Ayzot are now planning to test the app in other African countries.