Why no new vaccinations? - UK

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Why no new vaccinations?

[Published: 23 June 2005 Source: Prescriber Volume No:16, Issue No:10, 19

May 2005]

By Tim Dean - Editor

Drugs have had a major impact on the management of disease over the last 75

years. However, we are talking management rather than prevention, and

antibiotics and vaccines are notable exceptions. We know that the

development of new antibiotics and antivirals is struggling to keep pace

with resistance and new infections. But what of vaccines? Vaccination

programmes have been hugely successful in eradicating diseases such as polio

and smallpox, and targeted vaccines such as flu and hepatitis B have also

had a significant impact on disease.

Given the early success with vaccination it is perhaps surprising that we do

not have a more extensive range of vaccines. Vaccines have been described as

the Cinderella of medicines development – a reference to a perceived lack of

enthusiasm on behalf of the pharmaceutical industry to engage in vaccine

research. The truth is that vaccines are difficult to develop: the failure

to tackle the common cold and HIV are two prime examples. There are also a

range of issues around the introduction of a new vaccine, particularly a

universal childhood one, that prove major obstacles.

New vaccinations

However, vaccines look set to make an increasing contribution to health

improvement over the next few years. The BMA has recently renewed its call

for universal childhood immunisation against hepatitis B virus (HBV). The UK

is one of the few developed countries that does not routinely immunise

babies against HBV. HBV is on the increase in the UK and is a significant

cause of cirrhosis, liver cancer and death. Pressure is also increasing on

the Department of Health to introduce universal childhood pneumococcal

vaccination. Again the UK lags behind other countries, Australia beginning

its national programme at the start of this year. Both of these vaccines

have been available for a number of years and are proving safe and effective

around the world.

One of the most exciting developments is the possibility of a vaccine

against the human papilloma virus (HPV), which is linked to almost all cases

of cervical cancer. Cervical cancer is the most common cancer in women under

35 in the UK and is the cause of 1300 deaths each year. The vaccine also

protects against genital warts. Two vaccines are currently being tested in

phase III trials and efficacy looks very good. The vaccines will need to be

given to young girls before they become sexually active.

Why the hesitancy?

Given the government’s hesitancy with the HBV and pneumococcal vaccines, it

could be some time before an effective HPV vaccine is introduced in the UK.

But why is this? Why is the Department of Health so reluctant to introduce

new universal vaccination?

The MMR experience is a major factor. Public concern over vaccine safety has

always been and will remain extremely high. Parents are naturally wary of

subjecting their babies and children to vaccines when they are not ill. Even

if, and it is a big if, the MMR debate is subsiding, the main issue remains.

Parents are concerned that too many vaccines can ‘overload’ the immune

system. This will be a major hurdle to overcome when planning to introduce

two or even three new vaccines.

This leads to the second issue, the logistics of fitting in new vaccines to

the crowded childhood immunisation schedule. The organisation required to

deliver an increased schedule presents a significant challenge to primary

care. There are other issues that also require careful consideration. The

potential impact of vaccination on the wider population needs to be

considered because universal vaccination can cause unintended consequences

as a result of a sudden decrease in circulating disease in the population.

The current mumps epidemic in young adults who missed out on vaccination

with MMR is at least partly due to the fact that they were not exposed to

the disease when they were younger. The potential for an increase in

shingles in the elderly is a concern were chickenpox vaccination to be

introduced.

Overcoming the obstacles

These obstacles can be overcome, and need to be if we are to benefit from

the significant health gains that vaccines have to offer. Primary care has a

key role to play both in terms of public confidence and delivery.

Developments in IT, supplementary prescribing and closer working within the

primary care team can support delivery. Public confidence requires the whole

healthcare community to stand behind any new vaccination programmes.