Value of Vaccines Q2 - Jun 2019 by Mediaplanet UK&IE

Q2 / 2019 AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET WHO TAKE SOLE RESPONSIBILITY FOR ITS CONTENTS CDC Spotlight on monkeypox and the need to develop a new vaccine. » p4

ROYAL PHARMACEUTICAL SOCIETY & IFPMA Dispelling common myths around inﬂuenza. » p6

NaTHNaC Make sure your vaccinations are up to date before you travel internationally. » p8

Value of Vaccines Vaccination is the most effective public health intervention available, ranking second only to clean water for disease prevention.” - p10 Dr Tonia Thomas DPhil

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The global value of vaccination DR PHILIPPA WHITFORD MP, Central Ayrshire and Chair, APPG Vaccinations for All Every child, no matter where they are born, deserves a life free from preventable diseases. Without prioritising vaccinations, we risk losing hard won health improvements and seeing the return of deadly infectious diseases.

his is not only a moral responsibility, but also a case of global health security as, with increased global travel, the risk of epidemics is on the increase. Disease outbreaks, such as the recurrent Ebola outbreaks, cause vast human and economic costs - it is estimated that the cost of severe pandemics could reach up to £450 billion a year1. Vaccination saves up to three million lives every year, and millions more from disability; cutting polio cases from 350,000 in 1988 to just 33 in 2017, thanks to successful global vaccination projects. Vaccines also have wider lifetime benefits, from improving a child’s physical, mental and educational development, to strengthening a country’s health system and economy. They are also central for tackling the growing threat of antibiotic resistant infections, as they prevent diseases and the need to use antibiotics in the first place. Despite the known value of vaccines, one in 10 children globally still receives no vaccines at all2. This is why it is imperative that the UK Government prioritises vaccinations in domestic and international policy, and encourages other governments to do the same. At the same time, we must continue to support organisations such as Gavi, the Vaccine Alliance3, who support access to affordable vaccines for lower-income countries, to give every child an equal shot at a disease and disability-free life. Complacency about the threat of life changing infectious diseases is leading to reduced uptake of many crucial vaccines, as shown by the recent outbreaks of measles across the world. With 82,000 cases of measles across Europe last year, leading to 72 deaths, we are complacent at our own peril. 1: worldbank.org/en/topic/pandemics 2: who.int/immunization/ newsroom/2018_infants_worldwide_vaccinations/en/ 3: gavi.org/

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Delivering a miracle: the power of vaccines INTERVIEW WITH: VIOLAINE MITCHELL Interim Director, Vaccine Delivery, Bill & Melinda Gates Foundation

This is an exciting time to be working in the field of immunisation says Violaine Mitchell, Interim Director, Vaccine Delivery, Bill & Melinda Gates Foundation. Why are vaccination programmes important? Vaccines are the miracle of science and technology, making commonplace diseases a distant memory. Take smallpox, the fi rst disease to ever be eradicated, and polio, which is close to becoming the second – thanks to vaccines. We've also reduced the number of children killed by measles every year. That's the power of vaccines. Immunisation is the foundation of every country's public health programme and important in fighting antimicrobial resistance. What are the trends in vaccine uptake? The World Health Organization has identified vaccine hesitancy as one of the top ten threats to global health and this is threating to reverse the amazing progress we've made in tackling vaccine-preventable diseases. We have to understand what's driving these issues. I travel a lot and do come back to this: the majority of the world seeks vaccination. For instance, I've seen women in northern Nigeria walking miles and miles to ensure their children are vaccinated.

How can we get vaccines to children in remote areas? One of the most exciting developments is the use of drones, which is opening up a whole new delivery system. Let's say you're in an underserved area of Rwanda or Ghana - it can be a real challenge for some healthcare centres to make sure they have enough vaccines for every child. Now, a healthcare worker can text a message and the vaccine arrives in 20 minutes. Are you optimistic for the future? Yes, because there are lots of exciting innovations happening, such as micro-needle patches to do away with injections. I'm excited about where the future is heading. We're going to get sharper, smarter and more effective in delivering vaccines. Written by: Tony Greenway Read more at healthawareness.co.uk MEDIAPLANET

Designing vaccines for the developing world

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Producing safe, low-cost and effective vaccines for developing countries is essential for public health. Getting vaccines out of the lab and to the people who need them is a real challenge, however. “Vaccines save lives,” says Dr Jerome H. K im, “-millions of them. If all the vaccines we currently have were fully deployed, we would save 2.5 million lives per year,” he says. “In a decade, we would save 25 million people. That’s incredible.” Yet, the fact is that more vaccines need to reach more people in developing countries. That’s a challenge — and for many reasons. Dr Kim is the Director General of the International Vaccine Institute (IVI). He presses the importance of partnerships across countries, between companies and with the support of philanthropies. “This partnership model fi lls an important niche,” insists Dr Kim, “because big pharma doesn’t have much interest in R&D or bulk manufacturing of vaccines for diseases that only exist in low-income countries. The R&D costs can be too large and the failure rates too high.” Dealing with the challenges of vaccine delivery Of course, developing vaccines that are effective against deadly diseases is one challenge. Delivering them to hundreds of thousands of people in remote

INTERVIEW WITH: DR JEROME H. KIM Director General, The International Vaccine Institute

areas, disaster locations, refugee camps, or countries experiencing civil unrest and violence is an equally daunting one. As a result, more inventive vaccine design is needed. “Vaccines that need to be stored at a certain temperature can’t be stockpiled in, say, a refugee camp or in a cyclone-hit location where there is no refrigeration,” says Dr Kim. “So, we have to design vaccines that are more robust and can deal with those types of delivery issues.” “We also have to think of the end user. It’s no use producing vaccines that must be kept at -20°C and have to be reconstituted with cold, clean water.” “Thankfully,” says Dr Kim, “many low-income countries are developing, or have developed, their vaccination infrastructure, which helps with delivery and increases immunisation coverage.” For example, 85% of infants globally receive a DPT vaccine to protect them against diphtheria, pertussis and tetanus. “We now need to find new funders, build on the success we have achieved in cholera, and extend it to other vaccines and diseases that are a substantial burden in low- and middle-income countries,” explains Dr Kim. “With the right partnerships and

funding, I think we can do it: improve delivery of existing vaccines and develop and deploy vaccines against the next set of neglected disease targets – HIV, TB, Strep A and others.” Written by: Tony Greenway IVI is the only non-profit international organisation that discovers, develops and delivers its vaccines for developing countries; and has brought to market the world’s first low-cost, oral cholera vaccine.

Read more at healthawareness.co.uk

www.gov.uk/guidance/monkeypox | www.gov.uk/government/news/monkeypox-case-in-england | www.gov.uk/guidance/ high-consequence-infectious-diseases-hcid

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Monkeypox in Central and West Africa also found in UK BRETT W PETERSEN MD, MPH Medical Epidemiologist, Poxvirus and Rabies Branch, CDC

Monkeypox is a serious viral disease that causes a pustular rash illness similar to smallpox. The disease can be fatal in up to 11% of cases, and even those that survive can be left with significant complications including disfiguring scars and blindness.

ases occur regularly in parts of Central and West Africa, and there has been an increase in the number of reported cases in recent years. Many countries are detecting cases for the first time in decades. For example, Nigeria experienced the largest ever outbreak of monkeypox in West Africa in 2017 and 2018 after not having reported a case since 1978. Cases linked to Nigeria have also been found in the United Kingdom, Israel, and Singapore in 2018 and 2019. Monkeypox cases are on the rise following smallpox eradication It’s not totally clear why we are seeing this increase of cases of monkeypox. One factor is likely the waning immunity among the human population due to the eradication of smallpox. The vaccine for smallpox also provides protection against monkeypox because they are related viruses. Since smallpox was eradicated in 1980, there has been

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no routine smallpox vaccinations given to the general public, making anyone under the age of 39 more susceptible to contracting the disease. Most people get monkeypox through contact with animal reservoirs of the virus (e.g. activities such as hunting, trapping, or preparing meat from rodent species such as Gambian rats, rope squirrels, or dormice, which are suspected of harbouring the virus). Monkeypox can be airborne; good hygiene is paramount However, the disease can also be spread person-to-person through large respiratory droplets or contact with lesion secretions. Monkeypox can be prevented by avoiding exposures to infected animals or people, isolating infected patients, practicing good hand hygiene after contact with infected animals or people, and using appropriate personal protective equipment when caring for patients.

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Using smallpox vaccine with improved safety profile to tackle monkeypox Recently, there has been renewed interest in considering the use of smallpox vaccines for the prevention of monkeypox. Many advances have been made in developing smallpox vaccines and other medical countermeasures to be used in an emergency involving smallpox. However, these same technologies can potentially be used for monkeypox as well. CDC has collaborated with the Ministry of Health of the Democratic Republic of the Congo (DRC) and the Kinshasa School of Public Health to evaluate one such newly developed sma l lpox vacci ne. This vaccine has been created specifically for persons at high risk of complications from traditional smallpox vaccines and has shown an improved safety profile. 1,000 participants in trial study The goal of the vaccine study is to demonstrate that it

can be administered safely to healthcare workers in areas at high risk of monkeypox and that those vaccinated develop a protective immune response. To date, 1,000 participants have been enrolled in the study and vaccinated and are currently being monitored for monkeypox virus exposures and infections. Continued efforts to repurpose medical countermeasures for the benefit of populations afflicted with monkeypox holds great potential for reducing the suffering due to this neglected disease as well as increasing preparedness for outbreaks of monkeypox and similar diseases.

Read more at healthawareness.co.uk

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Flu can cause up to 650,000 deaths a year globally Influenza is a highly infectious disease that usually strikes during the winter season. Globally, it causes an estimated one billion cases of influenza, resulting in 290,000 to 650,000 deaths per year. A person can get the virus simply by being near an infected person that coughs, sneezes or talks, or by touching something with the virus on it.

he intensity and severity of influenza season varies between years, fluctuating between mild to very serious episodes in some years. For instance, the Spanish influenza pandemic of 1918 is estimated to have killed up to 50 million people over two years, after having infected one-third (around 500 million people) of the global population. In comparison, the 2014-2016 Ebola outbreak killed, in the same time span, around 11,000 people. Some people are more at risk than others Although everyone can be affected, some people are more at risk than others, such as the elderly, people with chronic diseases (such as heart disease and diabetes), young children, pregnant women and healthcare professionals. The most effective way to

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ABRAHAM PALACHE Founding Member, Influenza Vaccine Supply International Task Force, IFPMA

prevent the disease is vaccination, which is especially important for people at high risk of influenza, as mentioned above. Studies show that influenza vaccination in patients with heart conditions can reduce the chance of a secondary heart attack by up to 67%. Annual vaccine is key to combat virus mutations Safe and effective vaccines are available and have been used for more than 60 years. Immunity from influenza vaccination wanes over time and the virus mutates continuously. Therefore, annual vaccination is recommended to protect against influenza. Regardless of the natural variation of the vaccine benefits, influenza vaccination always reduces severity of disease, complications (such as pneumonia) and death.

Yet, in spite of its known safety and benefits, influenza vaccination rates are unfortunately low, even among those most at risk. There is a perception that the disease is not that serious, or that the vaccine is not particularly effective. Other misconceptions, combined with a growing mistrust of vaccination can cause hesitance to be vaccinated at all. If you want to learn more about inf luenza, visit reliable sources such as the World Health Organization, or ask your doctor or pharmacist.

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Dispelling the myths – the importance of the flu vaccine The flu vaccine is readily available; people are encouraged to get the flu vaccine every year, but some people are still hesitant. Flu affects people of all ages and outbreaks occur almost every year, which is why we must get the message across that it’s important to get the vaccine. Why should we get the flu vaccination? There is a presumption that coming down with the flu won’t be any worse than a bad cold but in actual fact, it can be very dangerous. The flu can cause hospitalisation and even cause death. The flu vaccine is the best defence we have against such an unpredictable virus. It not only protects people who have received the vaccine but also those around them, including those who are more vulnerable (babies and young children, older people and people with chronic health conditions). Healthy people can have flu without any obvious symptoms and while it may not cause them any harm, they can pass it on to somebody more susceptible. Why and when do we need to get vaccinated? The f lu virus evolves and there can be different

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strains of the flu virus each year. New and updated flu vaccines are released every year to keep up with evolving strains of the virus - last year’s vaccine may not protect against this year’s virus. The vaccination season in the UK starts from September and if there are any changes, vaccination providers and the public are notified. High uptake of the f lu vaccination is vitally important for the health of our population. If we vaccinate enough people, the risk of the flu spreading decreases significantly, particularly among those most vulnerable. Will the flu vaccine give you the flu? A common question that pharmacists encounter is: “Will the vaccine give me a dose of the f lu?” The f lu vaccine contains inactivated f lu viruses or ‘dead viruses’ so it can’t give you the flu. It can

ASH SONI President, Royal Pharmaceutical Society

tr igger an im mune response w it h some m ild symptoms including achy muscles or a low-grade fever and some tenderness where the flu shot was given. Get your vaccine at the pharmacy Anyone who has questions about the flu vaccine can be advised by their nurse, doctor or pharmacist. Getting the vaccination at a pharmacy can be convenient for people as an appointment isn’t necessary and it can be done outside of work hours and during the weekend. Most pharmacists can administer the vaccine and answer any questions people may have.

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Protein expression and next generation vaccines INTERVIEW WITH: BENT U. FRANDSEN Chief Business Officer, ExpreS2ion Biotechnologies

There is a new frontline in the fight against tropical diseases, like malaria, which kills hundreds of thousands of people every year, namely protein antigen expression.

ew, effective techniques to produce protein antigens hold the key to changing the tropical disease vaccine landscape. Protein antigens used in vaccinations to initiate an immune response, however, are not easy to reproduce. Bent U. Frandsen, Chief Business Officer at ExpreS2ion Biotechnologies, says: “Our clients and collaborators are working on many different protein antigens for vaccines, therapeutics and diagnostics.” “Often, expressing them can be challenging, though, because they have a structure that makes them very difficult to produce using conventional protein expression systems.” Microbiological understanding is expanding all the time, offering glimpses of new ways to fight disease. But without adequate supplies of stable cell lines, research can stall. Frandsen says: “Quite simply, if you can’t produce the active ingredient in a vaccination, you can’t make the vaccine.” At the end of last year, an article in Nature provided the first proof that the malaria virus uses a molecular ‘key’ of three parasite proteins, Rh5, CyRPA and Ripr, to unlock and enter human blood cells. The study represented a “huge step forward” by uncovering a new potential target for future vaccines, but successful development, says Frandsen, relies on the ability to produce complex proteins such as Rh5 or Ripr. The company can do this, thanks to its unique, non-viral fruit fly Drosophila S2 cellbased system, ExpreS2. “ExpreS2 is a very successful platform for the production of protein antigens, and we are happy to be able to contribute to the future of vaccinations.” “When you work in life sciences, you want to improve the wellbeing of people who are affected by disease, and malaria continues to be a major threat to human health,” says Frandsen. Written by: Amanda Barrell

Read more at expres2ionbio.com

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If you’re travelling, book a pre-travel health appointment HILARY SIMONS Senior Nurse, National Travel Health Network and Centre

With changing disease patterns, emerging diseases, drug resistance and an online world that allows dissemination of misinformation, preparing for healthy international travel may be challenging.

nowing how to prepare for healthy international travel can be daunting. Research the health risks at your destination. Many travel-related health problems are preventable by taking sensible precautionary measures, which may include vaccinations. Vaccinations can protect against many infectious diseases Vaccines are generally well-tolerated, safe, and an effective way to prevent infectious disease. Administered as a single dose or a course of several doses, sometimes with booster doses, immunity can last many years, depending on the vaccine given. The benefits of vaccination extend beyond the person vaccinated to the wider community. For some vaccine-preventable diseases, vaccinating the majority ensures that those who cannot be vaccinated, but who may be very vulnerable to infection (e.g. the very young and those with a poorly functioning immune system), are protected through herd immunity. Travel vaccinations are important in our connected world While vaccines prevent few travel-related infections, the recent fatal cases of rabies and yellow fever in unvaccinated European travellers, together with the regularly reported cases of measles and typhoid imported from abroad, highlight the crucial role that vaccines have. Current best practice requires clinicians to balance the need for vaccination against the realistic risk of infection; considering many factors, including traveller perception of risk and concerns about potential side effects of vaccines. Book a travel health appointment six weeks before you travel The pre-travel health appointment will help determine (among other things) the vaccinations needed, as a requirement of entry into a country (e.g. yellow fever vaccine for certain countries in Africa and Latin America, or meningitis ACWY vaccine for Hajj pilgrims), recommended to counter common infections at the destination (e.g. hepatitis A or typhoid vaccinations), or recommended based on planned activities (e.g. tickborne encephalitis vaccine if hiking in parts of Europe). The pre-travel health appointment is also an

opportunity to ensure that you are up-to-date with your routine vaccines such as MMR; increasingly important given the UK’s elimination status. Arrange your pre-travel appointment at least four to six weeks before travel (earlier if you have health problems). This allows time for completion of vaccine courses, monitoring for adverse reactions, and time to mount an adequate immune response to vaccines given. For example, a full rabies course is usually given over four weeks, and it can take ten days for yellow fever vaccine to be effective (and for the accompanying certificate to be valid). However, an appointment is still worthwhile if you have limited time. Although vaccination provides good protection against certain infections, you should always take additional precautions when travelling such as scrupulous food and water hygiene and insect bite precautions. Regardless of your destination, ensure you have adequate travel health insurance. Vaccination provides – often long-lasting – protection against certain infectious diseases, and for travel, it is never too late to visit a health professional for advice. Few travel-related health hazards are vaccine-preventable, so if you are planning to travel, carefully research your destination health risks and take appropriate preventive measures.

TravelHealthPro TravelHealthPro is the website of the UK National Travel Health Network and Centre; a public health body with the broad goal of protecting the health of British travellers. An essential resource for both travellers and clinicians, it provides up-to-date, evidence-based information on travel health risks. In addition to informing malaria prevention choices and providing guidance on numerous travel-related health hazards, our Country Information Pages help determine vaccination recommendations.

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100 years of vaccination – How did we get here? Despite the remarkable impact of UK and global vaccination programmes, we are seeing the return of vaccine-preventable diseases. Here, we take a historical perspective to see how far we’ve come.

accination is the most effective public health intervention available, ranking second only to clean water for disease prevention. Despite the availability and affordability of vaccines, immunisation rates are falling in some countries. In the digital age of information sharing, alternative views and an emphasis on individual choice are high on the agenda, and we must recall how far we’ve come in the prevention of infectious disease, before we slide backwards. Infectious diseases In 2019, the biggest threats to the life of someone aged 20-34 in the UK are external factors (suicide, transport accidents, substance poisoning), and the average life expectancy is 81. If we look back to 1919, just 100 years ago, the biggest threat to someone aged 20-34 was infection. In fact, infectious diseases were the leading cause of death for all age categories up to age 70, and the average life expectancy was 51 years.

DR TONIA THOMAS DPHIL Vaccine Knowledge Project Manager, Oxford Vaccine Group

The disease caused 400,000 deaths per year in Europe in the 18th century, with the risk of mortality as high as 80% in infants in London. Edward Jenner first discovered ‘vaccination’ by introducing cowpox material under the skin to protect children from smallpox in 1796, and in 1853 a Parliamentary Act was passed making vaccination with cowpox compulsory for infants. By the end of the 19th Century, up to 85% of children were vaccinated against smallpox, and with the continued efforts to protect infants against the disease, we achieved global eradication in 1980.

Spanish flu wiped out 3% of the population in 1918 In 1918, a devastating global outbreak of influenza, known as the ‘Spanish Flu’, spread across the world. 500 million people were infected, and between 50 and 100 million people died – 3% of the world’s population. 100 years on, we should reflect on how we’ve achieved this impressive transformation to protect our people, and how we would tackle an outbreak of influenza today.

Health security We also have the technology to develop vaccines in response to disease epidemics, like the Ebola crisis experienced in recent years. Epidemiologists, molecular biologists and genomics experts examined a sample of Ebola virus during the outbreak in 2013, and by the end of 2014 they had developed a safe and effective Ebola vaccine. This vaccine has been used in the Democratic Republic of Congo since 2015 to protect people in the area from those already infected. These research developments allow us to protect children and families around the world, preventing the wider spread of disease. With our society becoming more global through increased travel, infectious diseases have the potential to threaten the whole planet, affecting people from many countries and cultures.

The first vaccine saw smallpox eradicated by 1980 Smallpox is an infectious disease with symptoms such as vomiting, fever and a skin rash leaving scars.

Vaccine complacency is perpetuating the spread of measles in Europe Moving back to 2019, the problem we currently face is multi-fold. While the eradication of smallpox and the

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near eradication of polio are incredible achievements in medical history, the result of such overwhelming success is that we often consider these ‘issues of the past’. The threat of severe, highly contagious diseases is perceived to be low in developed countries, in part due to our limited experience of the devastating impact infectious diseases like smallpox and polio can have. For others, this is not a main motivating reason not to vaccinate. However, vaccine complacency poses a serious risk, and we are beginning to see the return of diseases like measles in Europe, despite the incredible impact of the measles vaccination programme, which is estimated to have prevented 21 million deaths. This is a disease that is becoming increasingly prevalent around the world, with 110,000 deaths globally in 2017, mostly in children under five years of age. This resurgence is particularly concerning, given that we can protect our children using a safe and effective vaccine. Vaccines have the potential to protect our people from the serious threat of infectious diseases, but this will only be achieved if we uphold the value of this remarkable health intervention.

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What is the role of vaccines in the battle against rising antimicrobial resistance? Increasing antimicrobial resistance (AMR) has resulted in our inability to prevent or treat some infections caused by viruses, bacteria, fungi and parasites. AMR has become a major health threat around the globe. Some estimate that AMR may result in an additional 10 million deaths per year by 2050.1

DR THOMAS DARTON Florey Advanced Clinical Fellow and Honorary Consultant in Infectious Diseases, Florey Institute for Host-Pathogen Interactions, University of Sheffield

ntimicrobial substances are frequently encountered in nature and it was their chance discovery by Fleming in 1928 that led to the modern era of life-saving treatment. Microorganisms have evolved multiple mechanisms to escape the effect of these substances and it is therefore unsurprising that they have so quickly evaded newer treatments. In contrast, vaccination primes an individual’s immune system, enabling defence against pathogens through multiple synergistic pathways. Resistance to these vaccine-primed defence mechanisms is very rare and vaccination is therefore a more durable intervention for preventing AMR emergence and combating infections with resistant organisms. The development and use of effective, safe vaccines have therefore become vital for reducing and delaying the effects of AMR in human infection. Here we discuss the key roles which vaccines have in our increasing battle against the tide of antimicrobial resistance. Direct prevention of AMR infection Vaccines can protect against AMR by directly preventing infections caused by pathogens associated with resistance. Pneumococcal vaccines, for example, prevent Streptococcus pneumoniae infection, the most common cause of bacterial community-acquired pneumonia. Pneumococcal infection is becoming increasingly resistant to penicillin-type antibiotics, which makes infection more difficult to treat. Use of the vaccine reduces the risk of infection and the incidence of AMR strains. Vaccines reduce the total burden of infection rather than only those caused by AMR strains. This raises two important questions: firstly, is it possible to develop vaccines that generate protection against the mechanisms of resistance rather than the pathogen itself?

DR THUSHAN DE SILVA Wellcome Trust Intermediate Clinical Fellow and Honorary Consultant in Infectious Diseases, Florey Institute for Host-Pathogen Interactions, University of Sheffield

Almost half of the antibiotics prescribed for acute respiratory conditions in the United States, for example, are inappropriate.” 4 Secondly, can we produce vaccines for pathogens in which antimicrobial resistance is commonplace, as this is likely to have the greatest impact in preventing the transmission of AMR. While little progress has been made in specific AMR-vaccines, the WHO global priority list for antimicrobial resistant bacteria and a recent Vaccines for AMR report provides some direction for future research efforts.2,3 Indirectly reducing the drivers of AMR Antibiotics are not effective against viruses such as influenza. Nevertheless, they are frequently prescribed for respiratory infections likely to be caused by viruses, which leads to alterations in the resident microbiome and drives resistance acquisition and selection in ‘bystander’ bacteria. This is a widespread problem: almost half of the antibiotics prescribed for acute respiratory conditions in the United States, for example, are inappropriate.4 By reducing the number of respiratory infections through increased uptake of vaccines against common viruses such as influenza, we could have a significant impact in reducing this antibiotic use and removing this selection pressure. 5-7 Furthermore, a minority of influenza cases are complicated by secondary bacterial pneumonia requiring antibiotics. Preventing the initial infection by vaccinat ion wou ld a lso reduce t he r isk of pneumonia, which would be especially important in the widespread AMR era.

PROFESSOR SARAH ROWLAND-JONES Florey Chair of Infection and Immunity, Florey Institute for Host-Pathogen Interactions, University of Sheffield

Other population benefits from vaccination There is accumulating evidence that some vaccines, particularly live vaccines such as measles vaccine, oral polio vaccine and Bacillus Calmette-Guerin (BCG), offer health benefits beyond providing protection against a specific pathogen.8 These off-target or non-specific effects (NSE) were first described after vaccine use for a measles outbreak in Guinea-Bissau. Although measles had largely disappeared after the epidemic, there was a striking fall in childhood mortality.9 Subsequently, similar observations of reduced all-cause mortality and fewer hospital admissions due to infection have been made in both low- and high-income settings. While the mechanisms underlying vaccine NSE are not fully understood, these observations offer the prospect of tailoring the use of live vaccines to provide non-specific protection against AMR pathogens. Until new treatment approaches can be developed, methods to prevent infection is vital to reducing transmission and spread of AMR. In addition to clean food, water and adequate sanitation, vaccination is a proven method for preventing infectious diseases. To maximise the benefit of vaccines in the battle against AMR, further development of vaccines for priority AMR pathogens, utilisation of existing vaccines for preventing inappropriate antimicrobial prescribing, and researching the additional non-specific benefits which vaccination may offer are vital parts of the strategy for tackling AMR.

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1: O’Neill et al. Tackling Drug-Resistant Infections Globally. Review on Antimicrobial Resistance, May 2016. 2: World Health Organisation. Global Priority List of Antibiotic-resistant Bacteria to guide Research, Discovery, and Development of New Antibiotics, Feb 2017. 3: Wellcome Trust and the Boston Consulting Group. The Role of Vaccines in Combating Antimicrobial Resistance (AMR), 2019. 4: Fleming-Dutra et al. JAMA (2016). 3;315(17):1864-73. 5: Kwong et al. Clin Infect Dis (2009) 1;49(5):750-6 6: Hardelid et al. J Antimicrob Chemother. 2018 1;73(3):779-786. 7: Maltezou et al, Clin Infect Dise (2013) 57(11):1520-6. 8: de Bree et al, Semin Immunol (2018) 39:35-43. 9: Aaby et al, J Infect (1984) 8(1):13-21.

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