Wednesday, 27 November 2013

Addressing emotional negative perceptions of vaccines. Part 1

Vaccines are good for society. Apart from sanitation, vaccines have been the most effective healthcare measure that has ever been introduced. However, when I mention this, there is always someone who starts to attack vaccines, using shock phrases such as "corpse formaldehyde", "scandalous use of aborted embryos", "allergenic egg proteins and gelatins", "use of autism-inducing thimerosal", etc. Being neither a biologist nor a medical doctor, I am not able to answer such attacks easily. In the end, the discussion just turns into an exchange of opinion, which is useless and unproductive in this case. 

Therefore, I decided to dig into the subject of vaccines and vaccine production, for any future such confrontations. I am not going to present in this post the review of the history of vaccine scares - the 19th century smallpox fear, the Lancet autism publication, etc. - all them are well documented by now, and can be found on Wikipedia. Rather, the purpose of this post is to provide an overview of vaccines and vaccine production types.

First of all, the diseases that are currently preventable by vaccines, are very different in nature. If we look at the 26 diseases that are present in the WHO routine vaccination list, I think they can be roughly classified into three classes, according to the nature of their harmful mechanisms (how the disease is causing harm to the organism): 
1) bacteria - the bacteria itself attacks the body and lives there at the body's expense; 
2) bacterial toxins - toxins that are produced by bacteria and that harm the human body;  
3) viruses - viruses use human cells to live and reproduce, and thereby harm the body by corrupting the normal function of human cells. 

These three completely different mechanisms require completely different types of vaccines. It is therefore not possible to generalize about vaccines.

Secondly, depending on the nature of the disease, vaccines have very different mechanisms of action. In the case of diseases caused by bacteria, the role of the vaccine is to help the organism identify the "disguise," to use a lay term, that the bacteria uses. The body can be fooled; bacteria are complex organisms, they consist of several types of cells, and the coating cells can be sometimes very "pleasant" for our body, like in the case of streptococcus pneumoniae that causes pneumococcus. In the case of diseases caused by bacterial toxins, it is critical to incite the body (of the child usually, in this case) to start producing antibodies against these toxins before contamination. The reason for this is that these toxins spread so quickly that harm can take place before the organism even figures out how to fight them. 

Thirdly, the production process of vaccines is radically different for different vaccines. For bacterial vaccines, one needs to grow the bacteria in a bioreactor, and (if required) weaken them by growing them in harsh living conditions. Since this process does not always lead to the desired result, once a particular colony of bacteria has been selected, it should be kept alive (for almost 100 years already, like in the case of BCG, against TB). Vaccines against bacterial toxins use toxoids which are the isolated and deactivated toxins produced by these bacteria (like for tetanus). Viruses, on the other hand, need cells to live on and spread. For some viruses it is possible to use animal cells to make vaccines (like for polio), but some live only in human cells (like for herpes). In this latter case, vaccines are produced using cell lines from two fetuses (aborted in the 1960s).

It is therefore not really possible to generalize about vaccines or about vaccine production processes, since they vary enormously with each type of disease. When vaccines are discussed, it is important to keep this in mind, and focus on a particular vaccine or disease. 

In a few days I will post a detailed table which will summarize this information for all of the 26 diseases in the WTO routine vaccination list.



Sources:

Polio Vaccine Deactivated, Sanofi Pasteur http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm133479.pdf

Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals? http://pediatrics.aappublications.org/content/112/6/1394.full

Human Fetal Links with Some Vaccines http://www.immunizationinfo.org/issues/vaccine-components/human-fetal-links-some-vaccines

Human Cell Strains in Vaccine Development http://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development

Growth of Rotaviruses in Primary Pancreatic Cells http://jvi.asm.org/content/76/18/9537.full

The Story of WI-38, the Other Famous Cell Line http://www.ascb.org/activationenergy/index.php/component/k2/search?searchword=vaccine&categories=&format=html&t=1385567833883&tpl=search

Tuesday, 12 November 2013

Breakthrough of Social Impact Bonds?

On the 3rd of November 2013, the Financial Times published an article announcing that Goldman Sachs is going to launch a $250m Social Investment Bond (SIB). The return of this bond is linked to the success of different social projects (affordable housing, pre-school education, etc.) in the USA. This news did not get much attention in the social media. 

However, for all those looking at new ways of financing social improvement this is one of the most significant news of the year. Goldman Sachs had only invested very modest amounts in SIBs before. Also, they were investing their own cash into SIB projects before; but now for the first time its clients will have the opportunity to put money into the new structure. Such backing from one of the world's most well-known financial institutions could signal a shift in the general  perception of SIBs. From being a witty topic of conversation at Davos soirĂ©es, the SIB has become a real financial instrument.

So what might made Goldman Sachs open up its wallet to SIBs? One might have noticed that the news of this Goldman Sachs investment came after a series of other news on the subject. First, in September the state of Illinois became the third regional government in the US to announce the introduction of SIBs. Second, in the last week of October, the UK Ministry of Justice issued interim results claiming "success" on its Peterborough Social Impact Bond, which was the world first ever SIB. 

"Me and My Net" , RCS
Third, in same month, Sir Ronald Cohen from Big Society Capital, one the biggest advocates of SIBs, announced that Nandos, a UK based fast food company, in collaboration with African mining giant Anglo-America and Coca-Cola, will create a Mozambique Malaria Performance Bond, to fund malaria reduction efforts. Just a week ago, Nandos confirmed this news from its twitter account. So much buzz so close together regarding SIBs are uncommon outside of academic circles.

And to top it off, the New York Times have just published an article about the idea advocated by Lindsay Beck of creating a non-profit NASDAQ; a market place where NGOs performance can be traded through their related SIBs.

So what is going on? Is this just a temporary trend of social responsibility used by private corporations to create positive publicity? Or it is a real financial innovation that will make it possible practically to put the private profit interest in line with social improvement? Why are SIBs being spun only now when the idea has been circulating since the late 80s? One thing is certain: these developments are thought provoking. To be continued...