Breakthroughs Blog: Child health

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Sanofi Pasteur’s announcement that it will cease work on its Zika vaccine candidate has raised concerns about the future of Zika vaccine development. While the World Health Organization has reported 40 Zika vaccine candidates in development, with six candidates in phase 1 clinical trials, Sanofi was the only major pharmaceutical company working on a vaccine against the virus. Its exit from this space raises questions about who will fund clinical development if these candidates show further promise. Additionally, many unanswered questions remain about the virus’s epidemiology and the target population for a vaccine. While the number of Zika cases is now falling, Zika epidemics will likely reoccur in the future. Because of this risk, developing an effective and low-cost Zika vaccine must remain a priority. Johnson & Johnson and the Biomedical Advanced Research and Development Authority (BARDA) have formed a partnership to develop vaccines and drugs to protect against pandemic influenza. Among its projects, the partnership is seeking to develop a “universal” flu vaccine that protects against all or most influenza strains. This collaborative effort highlights a larger trend in partnerships between the private sector, the US government, and nonprofits to develop vaccines and technologies against emerging health threats for which there is currently limited commercial market. Pakistan has launched its first nationwide vaccination drive for polio, aiming to immunize over 37 million children. Pakistan is one of just three countries where polio cases remain, so this nationwide drive is an important step toward eradication. While polio still remains endemic in Pakistan, the number of cases has reduced dramatically in recent years from 306 cases in 2014 to just 4 today. Pakistan has experienced obstacles in its attempts to eradicate the virus, which include efforts by extremists to target immunization campaigns.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week.  Researchers at MIT are working to create an all-inclusive vaccine for infants that can protect against diphtheria, whooping cough, polio, measles, meningitis A, B, and C, and more. The researchers have designed a promising micro-particle that could combine all of these vaccines into one single shot. The shot has not yet been tested on humans, though results were promising in a trial on mice. If this micro-particle proves effective and safe in human trials, this all-inclusive vaccine will be useful for infants in developing countries—as reducing the  number of vaccines necessary for infants in low-resource settings means fewer clinic visits. Mobile technology has the potential to help save the lives of newborns and their mothers in Tanzania. Researchers and phone developers are hoping to reduce rates of maternal mortality by launching a new service called “Text to Treatment” that uses toll-free texting to provide women with information that facilitates access to treatment centers. For instance, this service allows users to send money for travel to free clinics. Similarly, the “Mobilising Maternal Health” program also aims to provide better access to health care services by connecting women to transportation services, such as ambulance taxis and other travel to free clinics. Both of these programs have saved lives, with a 40 percent increase in female patients visiting treatment centers due to the “Text to Treatment” service and 30 percent reduction in maternal deaths due to the “Mobilising Maternal Health” program. These services have the potential to help bridge the rural-urban divide that impacts access to timely, high-quality health care for new mothers. Researchers at the University of Alberta, Canada have discovered the malaria parasite uses tagged carbohydrates to avoid detection and continue the spread of the disease in humans—especially in the liver. The researchers believe if treatments can be improved to account for the tagged carbohydrates, then these solutions may weaken the parasite to the point where it cannot survive within the host. They also believe these findings may help improve malaria vaccine design. Malaria remains one of the leading killers in the developing world, with about 650,000 annual deaths due to the disease.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Novartis has launched patient testing of a new anti-malaria compound with the hopes of staving off the development of further drug-resistance. The experimental compound—KAF156—will be tested in combination with another medicine in children and adults across nine countries in Africa and Asia over the next few months. In recent years, there have been increasing reports of malaria parasites that have become resistant to the standard treatment regimens against malaria, spurring the need for new treatment options from different classes of antimalarial compounds. Novartis expects to complete phase 2b studies of the compound by late 2019. It remains too early to tell whether the product will eventually reach market. A strain of gut bacteria taken from the diaper of a baby could hold promise in saving the lives of thousands of newborns in poor regions. Scientists conducting a large clinical trial in India found that babies who were fed a probiotic strain of Lactobacillus bacteria for a week were 40 percent less likely to develop a deadly infection called sepsis, which kills 600,000 newborns per year in India and other nearby nations. Babies who took the probiotic also had fewer cases of pneumonia, diarrhea, and ear infections. Researchers believe this probiotic—which costs only US$1—could be a “game changer” in advancing the health of infants in poor nations. Scientists at Harvard University are genetically engineering relatives of Mycobacterium tuberculosis (TB) in the hopes if speeding development and clinical trials to develop a better TB vaccine. The only currently available TB vaccine is partially effective in children and performs poorly in adults, so scientists are working to develop other vaccine candidates. However, performing clinical trials on vaccines is challenging because a typical clinical trial involves observing large numbers of people over long periods of time to monitor results in a small subset of people that naturally come into contact with the microbe. Alternatively, “challenge studies” infect people on purpose, so are faster and less expensive, but these studies are only possible if the disease can be detected and treated easily. TB can take time to detect and many months to treat, so is not appropriate for this type of study. The team at Harvard is working to genetically modify TB so it can be safely given to people as part of challenge trials, and thus help speed vaccine development. 

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers in Brazil have discovered the structure of the protein responsible for replicating the Zika virus thousands of times in cells, causing the virus to break through the cell wall and infect the body. Through many months of collecting data and studying the origins of the virus, the researchers put together a three-dimensional model of the protein and published their findings in Nature Communications. Zika is a flavivirus and in the same genus as diseases like yellow fever, dengue, and hepatitis C. Because of the genetic similarity, researchers and scientists have found that sofosbovir, a commonly used drug to treat hepatitis C, is a good therapeutic option for those suffering from Zika. The unlocking of Zika’s genetic code will lead to the development of new solutions to the virus. It recently became global news that RTS,S (trade name Mosquirix™), the candidate malaria vaccine furthest along in development, is beginning vaccine pilot programs in three chosen countries: Ghana, Kenya, and Malawi. The vaccine, created through a partnership with PATH’s Malaria Vaccine Initiative and GlaxoSmithKline, is given in four doses over a specific period of time. It is not yet known if tracking of these vaccine doses will be 100 percent. Any vaccine administered in multiple doses, whether for malaria or HPV, requires a lot more work in educating individuals about the need to return for all treatments necessary to ensure the vaccine’s success. UNICEF and members of the vaccine community will work with government authorities to ensure the supply chain delivers vaccines to children in need. If successful, the burden of malaria could decrease drastically. While this vaccine is promising to many individuals in these three countries, the search for a more perfect vaccine is high on the priority list for health researchers around the globe. In order to increase global access to immunization, successful and smooth-moving supply chains are necessary. The problem? Immunization supply chains are complex and every part of the chain needs to be working perfectly to ensure access to the vaccines. Many members of the immunization community have neglected the supply chain facet of vaccine delivery, and as a result, these supply chains have suffered and grown obsolete. With these chains being out-of-date, many children remain unvaccinated from even the most common diseases. A special issue published in Vaccine highlights these issues and brings the need for supply chain renewal to the forefront of the conversation. But even after this publication, more has to be done to ensure all members of the vaccine community work together to guarantee access to vaccines is in reach for all. Despite vaccine initiatives being stronger than ever, there is still a glaring gap in the number of children receiving basic vaccines. Currently, there are over 19 million children who are unvaccinated, leaving them susceptible to diseases that can be protected against. The American Academy of Pediatrics and the Centers for Disease Control worked together to establish the Global Vaccine Action Plan (GVAP) aimed at closing the gap of vaccine inequality around the globe. GVAP has already seen many successes, including fostering a working relationship with government institutions to implement surveillance techniques to figure out what vaccines children need most in each country. Kenya and Nepal, for example, have initiatives through pediatricians to educate families about the importance of vaccines for children’s development and longevity of life. GVAP is in the forefront of bridging the gap of health inequity and bringing immunization to all.