Saturday, 18 January 2014

Global Vaccine R&D pipeline and potential challengers to current market

The current vaccine market is dominated by Big Pharma (see my post). However, the dynamic development in vaccine R&D could change this landscape in the near future. The following table provides an overview of the potential challengers to the current market leaders, in six main categories of vaccines:
Overview of Global R&D pipeline

Pediatric vaccines account for more than 40% of all disclosed vaccine R&D, and for the majority of all vaccine projects conducted by manufacturers in emerging countries. Such attention is caused by both the market size of this category, which according to the projections will reach $100Bln globally by 2025, and by the aggressive vaccination efforts of GAVI alliance, who drives demand and buys more than 50% of pediatric vaccines worldwide. GAVI global vaccination targets gives a guaranteed long-term demand with a preference for developing countries' manufacturers and new vaccines. This leads to a situation in which main developing countries manufacturers are trying to enter the main pediatric disease areas, and existing Big Pharma tries to maintain its market share by proposing improved vaccines in the same disease categories. Competition is even fiercer with the new "technology transfer" initiative from Big Pharma to developing countries. 
Three UN Millennium Goal diseases - HIV, Malaria and Tuberculosis - remain scientific challenges with promises of glory and wealth. They attract both Big Pharma, small start-ups and research institutions from all countries. With most of the projects in these areas still in the proof-of-concept stage, we are seeing more and more players progressing to more advanced stages, with even one HIV project at Phase III from Finnish FIT Biotechnologies.

With the growth of purchasing power in Asian and Latin American countries, more companies are turning their heads towards tropical diseases. It is particularly exciting to see progress for diseases with no current vaccines at all. For instance, Sanofi is expecting to launch the first ever Dengue fever vaccine, and Crucell is aiming at the Ebola virus.

The market success of HPV, although mostly driven by cancer concerns, has probably contributed to the explosion of interest in the area of sexually transmitted diseases (STD), with Genoceas aiming to become a pioneer in chlamydia and herpes simplex vaccines. 

Finally, it is interesting to observe the R&D effort coming from emerging countries: Chinese companies (Chengdu Institute, 3SBion, Sinovac) and Indian companies (Serum Institute and Bharat) are focusing on replacing Big Pharma vaccines in their local markets. And Instituto Finlay from Cuba wants to break-through in the most scientifically challenging areas (malaria, tuberculosis, hepatitis), while Brazilian, Indonesian and Mexican players prefer to rely on technology transfer programmes.

ps: the table above does not mention therapeutical cancer and influenza vaccines because there are an important and particular areas which should be treated separately.

Sunday, 8 December 2013

Addressing emotional negative perceptions of vaccines. Part 2

In part 1 of this post, I tried to demonstrate that a categorical rejection of vaccines in general is not only socially irresponsible, but does not make sense from a medical point of view. The reason for this is that vaccines (and the diseases that they prevent) are very different in nature. However, if one goes beyond this general argument, certain details of a particular vaccine can still provoke two sorts of individual concerns: medical and ethical. And while most rational people will probably agree that immunization is good for society, one still has to admit that individual freedom of choice based on informed consent remains an issue in vaccination practices in most countries.

I am not going to go into the details of the scientific studies of the impact of certain substances that can cause concern (such as formaldehyde, embryo cells, egg protein, gelatin, thimerosal) for human health. This subject is widely covered elsewhere and is easily accessible. Rather, I would like to focus here on the lack of any routine procedures that could help medical professionals inform in an accessible way about any potential concerns to patients and their parents. Doctors still posses an aura of "sacred knowledge" that is considered inaccessible to patients. This practice perhaps goes back to the times when medical community was closed, and doctors for thousands of years swore the Hippocratic Oath to "not share knowledge outside of the guild". Whatever the origins of this practice are, in modern times the individual should get information about what is happening in his own organism. Such secretive practices are also contra-productive because they can feed conspiracy theories and give arguments to the general anti-vaccine sentiment.

The information given by the medical community should be simple. Personally, as a user of the pediatric services in France, I would generally be satisfied with the following table that I have put together: 

Example of Immunisation Information for Patient Consent (France)
Represents vaccines approve in EU and USA, for other countries information might be different.

Whatever my concerns will be after seeing this table, I would want to be able to openly discuss all of them with my doctor. In the absence of real scientific evidence of any harmful nature of the substances that could be of concern, I and probably most parents and patients could accept these vaccines.

As for the ethical concern about the use of human embryos in the production of certain vaccines, most religious leaders (for example the Pope, The Supreme leader of Iran, etc.) have approved the use of vaccines produced using stem cells. Doctors should also be trained to talk about such subjects with patients.

To summarise, the search for balance between individual freedom and the social good should enter also the realm of medical practice, and informed consent about immunisation should become the part of the routine medical process. Such measure could help not only to reduce the conspiratorial hipe around immunisation, but also indirectly lead to a more responsible individual attitude towards health, as well as the changing the nature of doctor/patient relationships for good.


European Centre for Diseases Prevention and Control

Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals?