saved more Canadian lives over the past 50 years than any other
medical intervention.” That’s the bold headline
on an advertisement for BIOTECanada and the 16 members of its
Vaccine Industry Committee, made up of “global leaders
in vaccine research and innovation,” from the country’s
biggest pharmaceutical companies.
are vaccine marketers so they have a stake in keeping aloft
the notion that investments in vaccine research are important
so we can continue to get needed vaccines to improve the health
of Canadians. They tell us “Canadian innovation is driving
the discovery of new vaccines that will transform the future
of public health in Canada.”
it true that vaccines have “saved more lives” than
any medical intervention? How vital are they in allowing us
to live longer and healthier lives? When describing advances
in vaccine research BIOTECanada singles out two particular vaccines:
One to reduce the risk of cervical cancer (the HPV vaccine)
and the other to reduce the risk of gastroenteritis (the rotavirus
vaccine), which is responsible for a lot of diarrhea and death
in the developing world.
years ago, the British Medical Journal ran a contest asking
readers to vote for what they thought was the most important
public health advance in the last 150 years. Vaccines appeared
on the ‘top 15 list’ and the editorial proposing
its inclusion cited polio, whooping cough and measles as three
major diseases that have all been tamed by vaccine programs.
Yet the advance people voted as #1, however, was not a medical
innovation at all: it was toilets. Which is to say, advances
in sanitation and the role of clean water in human health topped
biotech industry is not alone in claiming vaccines have been
a major tool in the prevention of many deadly illnesses. Public
health officials seem eternally eager to urge all parents to
get onboard with the full suite of recommended childhood vaccines
for all our children, as well as carrying out somewhat unsavoury
mandatory flu programs for health workers.
his book, Fooling Ourselves on the Fundamental Value of Vaccines,
Australian author Greg Beattie lays out a very interesting case,
mostly using graphs, which will make many people wonder if the
value of vaccine programs has been exaggerated. His book closely
examines the timing of vaccine programs, compared to changes
in death rates due to a range of vaccine-preventable diseases
such as measles, mumps and rubella. He says that the major drops
in those deaths predated vaccine programs, sometimes by a lot.
So something else was happening that caused a dramatic drop
in deaths due to these diseases 40 to 50 years ago, before these
vaccines were routinely given to children. What could it have
been? You guessed it – improvements in sanitation, nutrition
and general medical improvements (better diagnosis, etc). Did
vaccines help? Maybe. But if they did, Beattie would argue it
wasn’t by much.
is still considered a major killer of children under five in
the developing world and vaccines tackling the rotavirus that
sometimes causes it have been developed. Diarrheal deaths have
been reduced markedly over the last 20 years, but there are
still about half a million children every year around the world
who die from dehydration and diarrhea, mostly in the developing
world. Yet the US Centre for Disease Control estimates only
about 20 to 60 children die in the US each year from complications
due to rotavirus.
when you try to tease out the effects of vaccines like that
for rotavirus, they are hard to find. Why? Because the major
reductions in diarrhea are due to better sanitation, use of
oral-rehydration therapies (we have much better knowledge now
on treating severe diarrhea) as well as growing knowledge around
keeping potable water free from contaminants. Again, we come
back to the major lifesaving actions of basic public health
(and mostly sanitation-related) interventions.
to the National Vaccine Information Centre in the US, by age
three, most kids have had a case of rotavirus and by getting
it the child will develop immunity for life. Many people don’t
know that the vaccines that work against rotavirus also come
with a somewhat checkered past; one was withdrawn back in 1999
after the CDC found the vaccine was linked to an increase in
cases of intussusception (a type of bowel obstruction that can
be fatal). In 2007, the US FDA issued a public health alert
on a different rotavirus vaccine (intussusception again) and
in 2010 the FDA issued another warning about a rotavirus vaccine
that had become infected with a lethal strain of pig virus.
Remember; this vaccine is for a ‘disease’ that is
largely treatable, has very few deaths associated with it and
involves huge costs in trying to immunize entire generations
brilliant Canadian research might be trying to develop better
types of vaccines against the rotavirus, it seems to me you’d
get a lot more public health impact if you made sure people
washed their hands and tried to keep their drinking water clean
and allowed natural immunity to develop. This vaccine seems
a bit of a stretch in trying to be the poster-child for more
investments in vaccine research.
brings me to the second example of stunning medical innovation,
mentioned by BIOTECanada, which concerns the very controversial
HPV vaccine. There are currently two vaccines on the market
to immunize against the virus linked to cervical cancer. We
have relatively low rates of cervical cancer deaths in Canada
and an already effective screening program (the Pap smear) to
prevent that disease, but what about in developing countries?
For several years now, a large HPV vaccine trial has been the
subject of headlines in India, cited by one activist as a “clear
case of child abuse” and a “violation of fundamental
was referring to a trial in 2010 where more than 23,000 girls
aged 10 to14 were given the HPV vaccine in a manner that activists
asserted was “tantamount to using Indians as guinea pigs.”
The main issues were the misleading information given to parents
about the vaccine and the lack of proper monitoring of adverse
effects and vaccine effectiveness.
might put all that aside and ask, “But isn’t it
important to study the vaccine in India and help prevent so
many women dying every year of cervical cancer?” One of
the big problems is, of course, the cost and whether or not
there are even proper ways to measure the effectiveness of a
vaccine program. Allyson Pollock, a researcher from the UK,
told the British Medical Journal that an HPV vaccine program
in India “seems totally irrational,” citing statistics
showing that cervical cancer in India has already dropped dramatically,
going from 42.3 per 100,000 women in 1983 to 22.3 per 100,000
women in 2005. That’s still a huge death rate, but something
good must have been happening which predated the HPV vaccine,
to have created such a huge reduction in cervical cancer deaths.
low-cost surveillance methods (such as the Pap smear) are effective
and probably need to be more widely available in India. And
given the many unknowns around the effectiveness and duration
of protection offered by the HPV vaccine, it doesn’t seem
to make much sense to be pushing poor women into HPV vaccine
back to the glowing promotional material put out by groups like
BIOTECanada extolling the virtues of vaccine research. Do we
need better vaccines? Maybe we do, but if the rotavirus and
HPV vaccines are the best they can come up with, I would hope
the investors are asking some hard questions about whether those
companies are being somewhat disingenuous in wrapping up their
research with so much hype.
who want to invest in improving the lives of people in this
world might want to rethink the value of their investments.
They might want to invest in toilets.