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in an allergy desensitization trial that has contributed to keeping it off the market here. There’s a strong suspicion at the agency toward adjuvants, that are made to boost the effectiveness of vaccines, that Reed says he thinks is unwarranted. “Perhaps the issue hasn’t been presented rationally to them,” he said.
On new technologies: “Intradermal deliver hasn’t really caught on, but now the skin is becoming a much more viable way to deliver vaccines. A lot of viable innate immune cells are just under the skin, and when you stick a needle in, you pass them by,” Reed says. Some microneedle technologies are not only less painful, but might work better at sparking immune defenses just under the skin, he said.
Denise Galloway, head of the Program in Cancer Biology in the Human Biology and Public Health Sciences Divisions of the Fred Hutchinson Cancer Research Center
On federal support for basic science in vaccines: “The NIH funding is at an all-time low, with just about 10 percent of grants getting funded. Everything is being hurt.”
There is actually some more support for vaccine work at the NIH’s in-house laboratories, just not as much available for grants to external researchers, Galloway said. She added there’s still support for therapeutic vaccines, like for cancer, that don’t prevent people from getting a disease but stimulate the immune system to fight it.
On lessons learned from working on the human papillomavirus vaccine: “With HPV, it’s a genital infection, and you’d think you’d need to stimulate secretory immunity. That’s not the case.” Instead, researchers found that boosting the immune response in the general bloodstream was good enough, and that might be applicable to other vaccine work, she said. “That was a surprise.”
On whether there’s hope for an HIV vaccine: “I don’t know. I think it’s important that we go back to the basic biology and try to get some new ideas.”
Chris Elias, CEO of PATH
On market failures: “A report from Mercer consulting a few years ago said that 80 percent of the vaccines are used in poor countries, and 80 percent of the revenue comes from rich countries.”
The GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunization) has significantly improved that model, Elias says, by putting up billions of dollars to buy vaccines in poor countries and providing certainty to manufacturers with longer-term contracts than historically used by UNICEF. “About 10 years ago, it was UNICEF doing one-year contracts. Now you have people doing three- and five-year contracts. It’s taken some of the uncertainty out of the market. They’ve made a market where there wasn’t one.”
On logistics of vaccine delivery: “We have what I call the innovation pile-up.” By that he meant that innovative new vaccines like Merck’s Gardasil, which can prevent most forms of cervical cancer, “pile-up” in storage because they are difficult to deliver in poor countries that lack a system for immunizing pre-adolescent girls. Then there’s the traditional challenge of proper storage and distribution, and keeping vaccines cold in hot, humid environments. “There’s no comparable investment” in solving these problems, Elias said.
On the market forces driving innovation in the developing world: “Pricing is not driving it in the developing world. What drives it in the developing world is increased volume of vaccination, and greater certainty,” from longer-term contracts, Elias said.
On whether there’s hope for an HIV vaccine: “We’re in a much better place than two years ago. The failure of the Merck trial caused a re-focusing of effort. We had all our eggs in one basket for a while and everybody thought it would work. Now people are trying new approaches.” He closed with a joke about his own sunny attitude. “Ben Franklin once said, ‘If you can’t find a bright side, polish a dull one.”
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