The Future of Vaccines

In this new blog, author Stuart Blume takes a look at the future of vaccines, in the light of the COVID-19 pandemic.

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Have vaccines ever been as much in the news as they are today? They crop up on the front page of every newspaper, in every newscast, in almost every conversation. The most dedicated historian would be hard-pressed to find anything comparable. April 1955, perhaps? That’s when in the United States church bells greeted the announcement that Salk’s polio vaccine had been proven effective. Parents would no longer have to fear their children being stricken by that terrifying summer plague. Perhaps. Since that time public health has become more and more dependent on vaccination. It’s much the simplest way of protecting communities against infectious diseases. In the past twelve months we have all become horribly familiar with other public health measures. Resentfully and impatiently, we spent 2020 awaiting an announcement like that of April 1955. We soaked up reassurances that vaccines would give us back our freedoms, our lives! Stop for a moment! Who or what is, or was, this hopeful ‘we’? It obviously excludes all the vaccine sceptics: the people who say they don’t trust the vaccines and would rather not… It also excludes the millions of people – refugees, displaced persons, illegal immigrants, the homeless – who live day-to-day and almost without hope. And there’s the millions more living in remote areas of the poorest countries, which Covid vaccines might, at best, reach by late 2022. When thinking about the future of vaccines, what exactly ought we to be focusing on? Is a question of science and technology?

Committees of experts tried it years ago. Virologists, microbiologists, epidemiologists. A few paediatricians and experts in public health. Committees with access to all the relevant scientific, medical, and technical knowledge. They drew up lists of diseases for which, according to mortality and hospitalization rates, effective vaccines were most needed. There was one list for poor countries ravaged by infectious diseases, exacerbated by environmental insult and malnutrition. Rich countries suffered from diseases of affluence: chronic diseases associated with over-consumption of unhealthy food and sedentary lifestyles. Infectious diseases, other than HIV/AIDS, weren’t the priority they were in poor countries. They needed a separate list. Did the science needed for development of each of these vaccines actually exist? There was a clear need for vaccines against HIV/AIDS, and against parasitic diseases, including malaria, but these were scientifically challenging. Some of the vaccines on those lists have since been developed. Some have not. It gradually became clear that scientific obstacles weren’t all that stood in the way. Scientists need funding for their research whilst pharmaceutical companies seek profitable markets. There were few incentive to invest in developing and producing vaccines against diseases which only afflict poor countries. The economics were inauspicious. It made more sense to focus on conditions prevalent in wealthy countries. Admittedly most infectious diseases are – or were – seen as innocuous in the wealthy north. But perceptions aren’t immutable. People are risk-averse and panic-prone. Remember the H1N1 flu epidemic of ten years ago. Markets can be grown. At the same time advances in immunology were leading scientists to explore possibilities of immunizing against conditions other than infectious diseases. It’s not common knowledge, but attempts to develop vaccines against breast cancer, Alzheimer’s disease, obesity, and various addictions, have been underway for years.

If we think of the future in these terms, then what might it hold? More research in virology and immunology, for sure. Everything that has taken place since the middle of 2020 must have added to vaccines’ scientific and commercial appeal. Awareness of the multitude of viruses which could potentially jump from wild animals to humans has grown. At some point in the future another pandemic is probable. Nor are those non-infectious diseases going away. Far from it.

But is this the way to think about the future? Ought we to focus on the vaccines that might appear scientifically feasible or commercially appealing? Surely it’s vaccination which saves lives rather than vaccines? For the past twenty or thirty years there’s been so much talk of ‘global health’. Almost every self- respecting university, in the global north at least, now has its Centre for Global Health. The concept seems to suggest that everyone’s health counts, or should count, equally irrespective of nationality or status. The last few months have shown how far from any reality this is. Perhaps we should think of the future of vaccines in relation to the supposed goals of global health. How and by whom should the vaccines of the future be developed and produced if their contribution to global health is to be optimised? Is some reconsideration needed: some re-equilibration between the roles and responsibilities of states and markets?

– Stuart Blume

To read more about vaccines and our relationship with them, you can order Immunization: How Vaccines Became Controversial by Stuart Blume from our online shop now.

Stuart Blume is Emeritus Professor of Science and Technology Studies at the University of Amsterdam. Educated at Oxford University, he has previously worked at the University of Sussex, the London School of Economics and in Whitehall.