SABIN VACCINE REPORT the newsletter of the Albert B. Sabin Vaccine Institute at Georgetown University Volume II, Number 1, March 1999 IN THIS ISSUE Gates donates $100 million for childrens vaccines Rotavirus vaccine developed The newly developed vaccine for BY JOHN CLYMER AND DIANE MYERS Decreasing the lag time intestinal disease could improve the health of over 500 million children Microsoft billionaires Bill and Melinda Gates have Why is the Gates Foundation program of such importance? made a $100 million gift to establish a program to acceler- New, life-saving vaccines generally are in broad use in in- worldwide. ate access to new vaccines for children in developing na- dustrialized countries several years before they become widely 1 tions. The goal of the Bill and Melinda Gates Children’s used in developing countries where the need is greatest. This Vaccine Program’s is to significantly reduce the time it cur- time lag in vaccine “uptake” is due to economic, logistical rently takes for vaccines to reach children living in poor coun- and other challenges. tries. “We have a social imperative to work together to The initiative is a program of the William H. Gates SPECIAL REPORT: MALARIA address this basic inequity,” said Bill Gates, trustee of the A report on the impact of malaria on Foundation and will Fiset photo by PATH/J. William H. Gates Foundation. global health, the search for a vaccine, be administered by Sabin Vaccine Institute chairman and the risks travelers face when the Program for H. R. “Shep” Shepherd ap- visiting malaria-endemic areas. Appropriate plauded Gates’ vision and the es- 2-5 Technology in tablishment of the Children’s Vac- Health (PATH). cine Program. “Vaccines are the Headquartered in most powerful tool available to Seattle, PATH will equalize the health of human be- work with the World ings in every corner of the Profile: Herbert Herscowitz Health world,” he said. “Enlightened Institute scientist combines career in Organization, leaders understand the power of research and teaching. UNICEF, the vaccines to help bring peace and 6 World Bank, the Phillip Russell (l), Suryanarayan Ramachandran, and James Maynard. opportunity to the most troubled Children’s Vaccine places in our world. Vaccines are Initiative, vaccine the microchip that will revolution- manufacturers, ize healthcare,” Shepherd de- governments and clared. Aerosol measles workshop nongovernmental organizations. The Children’s Vaccine Program will specifically support Researchers meet to dicuss PATH plans to focus on four recently developed ways to make the vaccines widely available to children in alternerative vaccine delivery systems. or about-to-be-marketed vaccines against respiratory, in- developing countries. It will not be used to buy the vac- 6 testinal and liver diseases. Global use of the vaccines could cines. reduce childhood deaths by 33%, representing 2.5 million The program will be managed by a Secretariat lives, and reduce liver cancer deaths by 75%. Two of the based at PATH, under the guidance of a Strategic Advisory vaccines prevent respiratory ailments caused by the bacte- Council that is composed of seven international experts in ria Haemophilus influenzae type b, or Hib, and strepto- vaccinology and vaccine introduction. Philip K. Russell, coccus pneumoniae; a third prevents rotavirus infection, founding president of the Albert B. Sabin Vaccine Institute, which causes severe diarrhea;, and the fourth vaccine be- is a member of the Strategic Advisory Council. He lauds the ing considered prevents hepatitis B, a viral liver disease. Gates’ program as a “very exciting development in the field In the United States, vaccines for Hib and hepati- of international health.” tis B are part of the recommended childhood immuniza- tion schedule, and vaccines for rotavirus and streptococ- An entreprenurial approach cus pneumonia are expected to become part of the recom- mended immunization schedule soon. According to Russell, who has years of experience continued on page 7 Rotavirus vaccine could benefit 500 million children BY RACHEL LIBERATORE veloped by Albert Z. Kapikian of the Laboratory of Infectious Diseases (LID) at the National Institute of Allergy and Infectious Although rotavirus infections affect 300-500 million Diseases (NIAID) along with other colleagues at the National children every year, this disease has only recently provoked the Institutes of Health. The vaccine is manufactured by Wyeth- kind of intense research investment one might expect for such Ayerst Laboratories at a cost of approximately $38 per dose. a ubiquitous affliction. Unfortunately, the reason for this is Ideally, a vaccine is supposed to save society money the same for many diseases whose primary because the price of the vaccine is less than the cost of treating the targets are nations in which the average per disease. From the perspective of the health care capita health expenditure hovers just around system, however, the cost of the vaccine should $10. In the case of rotaviruses, this trend of be high enough that the system does not lose apathy toward diseases in developing nations money due to the decreased need for treatment. was turned around following studies demon- A study headed by Roger I. Glass, chief of the strating that this disease actually leads to a sig- Viral Gastroenteritis Section at the Centers for nificant amount of health care expenditure in Disease Control and Prevention (CDC), deter- developed countries, where the ability to pay mined that a rotavirus vaccine would be cost- for preventive and prophylactic treatments is effective to both society and the health care sys- much greater. Once a lucrative market was es- tem in the United States if the cost fell within a tablished, a vaccine for rotavirus was soon de- range of $9-$51 per dose. Glass’s pivotal study veloped and has been recently licensed. is widely credited with providing the impetus Rotaviruses are the infectious agents photo by Erica Seiguer for the pharmaceutical industry to devote re- sources to rotavirus vaccine development, which responsible for most cases of childhood diar- Roger Glass rhea. Ninety-five percent of children worldwide ultimately led to the approval of Rotashield™. are exposed to rotaviruses between the ages of three and five, According to Glass, although “there is a clear need for though in developing nations initial exposure is usually within rotavirus vaccine for all children, without the demand and money the first year of life. Such intestinal infections are particularly of the developed countries, it is unlikely that any country would dangerous in children because they are more likely than adults to be interested.” As evidence, he points to the failures of new chol- suffer from dehydration, especially if they have previously com- era and typhoid vaccines, needed in developing countries but promised health. now priced and sold for travelers—a tiny and nonviable market. In August 1998, the Food and Drug Administration (FDA) approved the first rotavirus vaccine since the discovery of continued on page 7 Sabin Vaccine Report Vaccine Sabin Institute Vaccine Sabin Albert B. at Georgetown University NW Road, Suite 154, 4000 Reservoir Building D, Washington, DC 20007-2145 rotaviruses in 1973. The vaccine, called RotaShield™, was de- Malaria Report Malaria Report Malaria Report Malaria Report Malaria Report Mala SABIN VACCINE REPORT March 1999 ALBERT B. SABIN VACCINE INSTITUTE Controlling Malaria Will Require an International Effort AT GEORGETOWN UNIVERSITY BY HOWARD ENGERS, PHD CHAIRMAN Malaria alone accounts for over 2% of the total global disease burden and five times this figure in Africa, H.R. Shepherd ranking third among major infectious disease threats. There are an estimated 300-500 million cases of malaria each year, resulting in over 1 million deaths, mainly of children under five years old in Africa. Augmented by the more recent EXECUTIVE VICE PRESIDENT impact of globalization, the disease is often linked to poverty, the movement of refugees or populations seeking work Edward Neiss MD PhD and to environmental change, including forestry, mining and water development projects. We can conquer malaria. But to do so, will require a concerted global effort, involving Private and Public SENIOR VICE PRESIDENT sector participation and that of civil society. All manner of resources will need to be brought to bear. Better ways must Joseph A. Bellanti MD be found to apply existing control methods. Improved tools must be developed and solutions need to be identified to circumvent and combat emerging problems including social/political unrest, the widespread resistance of the malaria BOARD OF DIRECTORS parasite to existing drugs and the potential change in the distribution and incidence of malaria due to anthropogenic Jason S. Berman climate change. Zev Braun Reflecting its prominent status as a global killer, malaria has been a priority for World Health Organization Kenneth L. Dretchen PhD (WHO) since its founding in 1948. A revised WHO Global Malaria Control Strategy was adopted at the Amsterdam Robert E. Fuisz MD Summit of 1992, based on a renewed global commitment to malaria control. Recognizing the widespread political E. Andrews Grinstead III desire that has been building over this decade, the new Director General of WHO, Dr G.H. Brundtland, declared upon Jerome Jacobson taking office in July 1998 that there should be a deeper commitment to win the fight against malaria. Greater financial David J. Meiselman Esq resources and a higher visibility for malaria control activities would be necessary. This declaration led four UN-System Lewis A. Miller agencies (UNDP, UNICEF, WHO and the World Bank) to launch Roll Back Malaria (RBM) on 30 October 1998. Louis Padovano SJ MD The RBM project, co-ordinated by WHO, aims to: 1) support governments and partners; 2) improve technical effi- Maj. Gen. Philip K. Russell MD ciency and capacity, including the development of new methods, new tools and capacity strengthening in the malaria Heloisa Sabin endemic countries; 3) to improve resource allocation, utilization and mobilization.