This special issue of the journal Philosophical Transactions of the Royal Society B: Biological Science explores how vaccines can fulfil their full potential for addressing global health challenges. It charts the progress to date, reviewing successes as well as challenges in the development and distribution of both human and veterinary vaccines.

The articles describe how vaccines can help mitigate and treat the world's major infectious diseases such as malaria, tuberculosis and HIV/AIDS, as well as chronic diseases, such as cancer. They explore vaccine policy and financing, ways to accelerate the development of new vaccines, issues surrounding public acceptance, and the logistics of getting vaccines to where they are needed. Also discussed is the use of vaccines to treat diseases in livestock — making an important link between health interventions, agricultural output and economic consequences.

The papers in this issue were presented at the meeting, 'New vaccines for global health', held at the Royal Society in London, United Kingdom, in November 2010.

According to the author of this review, only 7.4 per cent of complementary and alternative medicine (CAM) — which includes homeopathy and acupuncture — is evidence-based. The author evaluates research evidence from clinical trials and systematic reviews to reach this conclusion. By contrast, he says, more than half of all interventions in general internal medicine, and more than 65 per cent in psychiatry are based on sound evidence, including results from randomised controlled trials.

This article from The Lancet provides useful background information on Chagas disease including its transmission, epidemiology, pathogenisis, diagnosis and treatment. The disease affects eight million people in Latin America and poses a growing health problem in non-endemic areas due to increased trade and travel.

This report gives an overview of progress in developing an HIV/AIDS vaccine, including new adjuvant strategies, novel vectors for antigen delivery and presentation, and alternative ways of eliciting antibody responses. The authors call for continued commitment to basic research to identify an effective and affordable HIV vaccine.

This Nanomedicine paper reviews a range of strategies based on nanotechnology that are currently being used or tested to improve HIV/AIDS treatment and prevention. The authors review nanomedical advances in antiretroviral therapy, gene therapy, immunotherapy, vaccines and microbicides.

They conclude that nanotechnology promises great improvements in all of these areas but they warn that the field still faces many challenges including the toxicity of nanomaterials, their stability in physiological settings and the question of how to mass-produce them.

This article, written by scientists from Canada, China, Egypt and India, examines the spread of alliances in health biotechnology and the extent of collaboration in this sector between the South and the North.

The authors surveyed 288 firms on South–North health biotech collaborations and use the results to map the extent and geography of partnerships. They analyse the international collaborations of firms in Brazil, China, Cuba, Egypt, India and South Africa and compare them to South–South collaborations.

The authors conclude that developing countries' firms are closely tied to northern health biotech networks and that South–North collaborations are common practice in health biotech. More than half the firms surveyed actively collaborate with countries in the North — compared to just a quarter working with other developing countries. Egypt is the only country where South–South collaborations outnumber South–North ones.

This paper proposes a model to provide better access to fairly priced antiretroviral (ARV) drugs for HIV-infected people in poor countries, while also safeguarding the interests of ARV manufacturers.

The authors explain what governments and brand and generic companies are doing to increase the availability of ARVs in developing countries, taking examples from Brazil, Canada, China, India, the United States and Thailand. They also discuss the implications of creating more South–South partnerships to produce and market ARVs; and the impact that the UNTAID–Clinton Foundation coalition has had on lowering ARV prices in developing countries.

The authors recommend an incentive-based strategy that includes international donors bulk-purchasing generic ARVs, individual governments providing financial relief packages for generic companies, and the WHO brokering negotiations between brand and generic companies.

This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

In this commentary article, HIV vaccine researcher Ron Desrosiers presents his view that the main reason we do not yet have a vaccine for HIV is due to unsolved scientific questions rather than a bottleneck in conducting clinical trials. Accordingly, he advocates a "renewed, coordinated and focused effort" on basic research rather than clinical trials for "feeble" candidates that "stand little chance of being effective".

Desrosiers is well known and respected in the HIV research field for his contribution to the scientific debate, and presents five lines of evidence for his contentions. These include the failure of immune responses elicited by current vaccines in HIV-infected individuals to control the virus; the failure of the animal models much favoured by researchers to fully represent HIV infection in humans; and the ability of new strains of HIV to 'super-infect' individuals already infected with another strain, even if their immune system appears to be controlling the first infection. He also disagrees with the aim of the recently formed "Global Vaccine Research Enterprise" of placing more candidates in clinical trials more quickly. 

The article is written for general readers with a scientific background, and assumes knowledge of how the immune system works and relevant technical terms. Nonetheless, it is a well-argued piece that provides much food for thought for the vaccine community and policymakers alike.

In this article, leading vaccine researchers and advocates join forces to call for a global strategy for developing an effective HIV vaccine. The goal, they say, would be to unite teams of researchers in a series of coordinated global HIV vaccine centres, each with the critical mass, focus and scientific expertise for a more rapid and systematic approach to vaccine development.

The authors point to the recent success of the Human Genome Project in achieving the full sequencing of the human genome within a shorter than predicted timeframe. They say this provides an encouraging model, which highlights the need for a common vision among funders and major stakeholders, including those from developing countries.

The so-called 10/90 gap in health research — which refers to the fact that only about 10 per cent of funding is targeted to diseases which account for 90 per cent of the global disease burden — is a well recognised phenomenon which is being targeted by a number of initiatives. This article, by members of the Drugs for Neglected Diseases Working Group at Médicines Sans Frontières, analysed the outcomes of pharmaceutical research and development over the past 25 years and reviewed current public and private initiatives aimed at addressing the lack of research into controlling important infectious diseases in developing countries.

The authors found that of nearly 1400 new drugs marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis (all of which had been developed with public-sector involvement). There is a 13-fold greater chance of a drug being brought to market for central nervous system disorders or cancer than for a neglected disease.

The authors conclude that there is no indication that drug development for "non profitable" infectious diseases will significantly improve in the near future and that new strategies are required to stimulate such development. They argue that a sustainable solution will require the establishment of an international pharmaceutical policy for all neglected diseases. Private sector research obligations should be explored further, and public sector not-for-profit research capacity promoted, particularly for the most neglected diseases.

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