Vaccines in the Pipeline
Vaccines are hailed as one of the most important public health achievements of the 20th century.
It’s an exciting time in the field of vaccine research and development. There are many new innovations in vaccine technology. There is also new information about how the immune system works to protect us.
There are currently around 200 vaccines in development. Around half are for infectious diseases. The rest are to prevent and treat other diseases and health conditions, like cancer, Alzheimer’s disease, allergies, and autoimmune disorders.
We have new vaccines to protect against deadly viruses.
The development of a vaccine for respiratory syncytial virus (RSV) has been a global health priority for some time. RSV can be dangerous and even deadly for babies, toddlers, and older adults. Researchers have been studying RSV and working on a vaccine for 60 years! Recently progress was made in understanding the structure of RSV and the human immune response to it. In 2020 there were 39 vaccines and monoclonal antibodies under development to treat RSV. Of those, 19 were in clinical trials and 3 ended up being successful. They were approved in 2023. The immunization for young babies, called nirsevimab, reduces the risk of hospitalization from RSV by 80 – 90%. The two available vaccines for adults, Arexvy and Abrysvo, are more than 80% effective at preventing RSV-related lung infections. Abrysvo is also available to pregnant people between 32 and 36 weeks of pregnancy and provides protection to their babies after they are born.
The process to develop the COVID-19 vaccine was years faster than the typical vaccine because of research already in progress. Scientists knew about coronaviruses and were studying a prototype vaccine. When the COVID-19 pandemic started, they adapted their prototype to create COVID-19 vaccines in less than a year. This process showed how important it is to continue vaccine research. It showed the impact research can have on scientists' ability to respond quickly to new disease outbreaks.
We know that everyone should get an influenza (flu) vaccine each year. Scientists are working hard to figure out if an annual COVID-19 vaccine will also be needed. Each year, a new flu vaccine is produced to more accurately target the flu virus as it evolves. Much like the flu virus, SARS-CoV-2, the virus that causes COVID-19, has evolved. Scientists and government officials monitor emerging variants. They study how variants could impact the effectiveness of existing vaccines. Vaccine recommendations are updated as researchers learn more.
Vaccines against the “big three” – HIV, malaria, and tuberculosis (TB) – are within reach.
Human immunodeficiency virus, or HIV, is a virus that attacks the body’s immune system. It can lead to AIDS (acquired immunodeficiency syndrome) if not treated. There is currently no vaccine to prevent HIV or way to cure it. HIV can be managed with medical treatments and people with HIV can live long, healthy lives. HIV and AIDS can be very serious. As of 2019, more than 75 million people worldwide have been infected with HIV and over 32.7 million people have died from HIV.
More than 40 years ago, scientists started studying HIV and trying to understand the virus and the disease it caused. They thought they would have a vaccine within 5 years, but it proved much more complicated. Dedicated volunteers, community members, and researchers have been working to develop a vaccine ever since. Some of the strategies they discovered were used in the COVID-19 vaccine! A safe, effective HIV vaccine could build on existing treatment and prevention strategies. This would help reach the goal of ending the HIV epidemic.
Malaria is a serious disease spread to people by certain types of mosquitoes. It is mostly found in tropical regions of the world. Symptoms may start mild and can become deadly. The infection is caused by a parasite. Malaria does not spread directly from person to person. A mosquito must bite someone who is infected with malaria to then spread it to another person when it bites them. 80% of deaths from malaria are in children under the age of 5.
Malaria vaccines have been in development since the 1960’s. The first malaria vaccine was recommended by the World Health Organization (WHO) in 2021. It is for use in children living in areas with moderate to high malaria transmission, including Sub-Saharan Africa. This vaccine reduces cases of malaria in young children by 30%. There are more than a dozen other malaria vaccines in the development and testing process. The goal is to develop and license a vaccine with at least 75% efficacy to prevent malaria in areas with ongoing transmission.
Tuberculosis, or TB, is caused by bacteria that infect the lungs. It can also attack the brain, spine, kidney, or other parts of the body. It spreads when bacteria travel through the air from a person coughing, sneezing, or speaking and are inhaled by another individual. In 2022, 1.3 million people died from TB worldwide and an estimated 10.6 million people fell ill with TB. The U.S. had 8,331 reported cases of TB disease in 2022. Up to 13 million people in the U.S. are estimated to be living with latent TB infection. There is also a rise in drug-resistant TB which can make the disease harder to treat.
There is a TB vaccine available called Bacille Calmette-Guérin (BCG). It is given to infants and young children in countries outside the U.S. The vaccine can prevent severe forms of TB like TB meningitis in very young children. It does not prevent TB disease in the lungs, which is the most common form, and does not prevent TB disease later in life. Some people in the U.S. may be eligible to get the vaccine in specific circumstances if they consult with a TB expert.
Researchers are making improvements to existing vaccines.
Respiratory infections like influenza and pneumonia are particularly dangerous for children and the elderly. During the 2022-2023 flu season there were 21,000 deaths from flu in the U.S. Scientists and researchers are working on how to improve the flu vaccine to reduce illnesses and deaths caused by the flu. The Center for Disease Control and Prevention (CDC) is working to identify a better candidate vaccine virus. This would allow them to make flu vaccines that create the best possible immune response. Eventually, researchers hope to develop a universal flu vaccine. It would last for multiple years and offer better, broader protection against the flu, even as the virus changes year to year.
There have been many improvements in flu vaccines in the past few years. These include a high dose vaccine and a vaccine made with an adjuvant. These vaccines can help create a stronger immune response in people 65 and older. A flu vaccine that does not require egg for production has also recently been approved. The quadrivalent flu vaccine now gives you protection against 4 different flu strains in one vaccine! Researchers have also developed a recombinant influenza vaccine which can be manufactured more quickly.
Doctors and researchers are working to develop new vaccines to prevent and treat other diseases.
Alzheimer’s
There have been great strides in creating vaccines to prevent cancer, autoimmune diseases, and Alzheimer’s. These conditions impact millions of people. As many as 50 million Americans have an autoimmune disease and 6 million Americans are living with Alzheimer’s disease.
Progress is being made towards a vaccine for Alzheimer’s. There are currently over 10 vaccines in clinical trials for Alzheimer’s. They will target inflammation and various proteins in the brain related to Alzheimer’s.
Autoimmune Diseases
Autoimmune diseases occur when immune cells that are designed to protect us get confused. They see our own cells as intruders. There are more than 80 known autoimmune diseases. These include type 1 diabetes, multiple sclerosis, rheumatoid arthritis, and lupus. Researchers hope to create therapeutic vaccines. These vaccines would treat rather than prevent. They will reestablish a balance in the immune system for people with autoimmune disorders.
Cancer
Already, we have 2 vaccines that prevent cancer. The HPV vaccine prevents cervical, genital, anal, and oral cancers. The hepatitis B vaccine helps prevent liver cancer. Researchers are working to develop more vaccines to prevent more types of cancer. There are over 100 vaccines for cancer currently in development, including one for breast cancer. The outlook for more cancer-preventing vaccines is positive.
Tropical Diseases
As global temperatures and travel increase, diseases that were previously only seen in the tropics, such as malaria, West Nile virus, and dengue are appearing in the U.S. In 2012, there were over 5,000 cases of West Nile in the U.S. In 2023 there were 2,400 cases. Mosquitos spread many of these diseases and they are now able to move north due to warmer year-round temperatures. In recent years there have been a small number of cases of dengue and malaria in the U.S. There is a dengue vaccine that is approved in the U.S. for people living in places where dengue is circulating. There are not any malaria or West Nile virus vaccines approved for use in the U.S. Development of more vaccines that prevent tropical diseases is an important goal for researchers.
Researchers are working to develop new vaccine ingredients and delivery methods.
Adjuvants are vaccine additives that stimulate the immune system to create a strong response. They serve a very important purpose. New adjuvants will make current vaccines more effective and are key components for future vaccines. Current and future adjuvant safety is thoroughly investigated. The right adjuvant can enhance the immune system’s response to the vaccine.
While vaccines are very effective preventive care, shots can be painful. There are already needle- and pain-free vaccines that can be given as a nasal spray and taken orally. Researchers are coming close to releasing a new form of vaccine delivery called vaccine patches. These patches could be self-administered and distributed to many people quickly. They would be helpful for kids (and adults!) who have a fear of needles.
It’s important to consider vulnerable populations in vaccine research.
Pregnant people, infants, individuals with certain allergies, and people with weakened immune systems cannot receive some vaccines. Developing vaccines for vulnerable populations is a main goal for public health officials and researchers. As researchers learn more about the immune system and we see advances in vaccine technology, new vaccines may be possible.
Prevention is the most effective and affordable way to stop the spread of disease. Just imagine the variety of illnesses and diseases your children will be able to protect their children against one day!