Last week, we finished our Ask the Expert discussion with Dr. Paul Offit. The result was an excellent overview of vaccine technology past, present and future. The discussion included information about vaccine manufacturing, new vaccine technologies, past and present vaccines, upcoming vaccine breakthroughs and concerns about non-vaccination.

The session was hosted by Dr. Paul Offit. Paul A. Offit, MD is the Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. In addition, Dr. Offit is the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the University of Pennsylvania School of Medicine. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, and a Research Career Development Award from the National Institutes of Health. Dr. Offit has published more than 150 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC; for this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases; and was honored by Bill and Melinda Gates during the launch of their Foundation’s Living Proof Project for global health.

He is also the author of five medical narratives: The Cutter Incident: How America’s First Polio Vaccine Led to Today’s Growing Vaccine Crisis (Yale University Press, 2005), Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases (HarperCollins, 2007), for which he won an award from the American Medical Writers Association, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure (Columbia University Press, 2008), Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (Basic Books, 2011), and Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine (HarperCollins, 2013).

Below is a sneak peek of the discussion. For a full transcript of the discussion, please see – Ask the Expert with Author Dr. Paul Offit.

Question:

What do you think the next big vaccine breakthrough will be?

The Answer:

I think the next big breakthrough will be a meningococcal vaccine that contains cross-reactive proteins that protect against all 5 prevalent serogroups; specifically, serogroups , A, C, Y, W, and B. Although the incidence of meningococcal disease in infants and adolescents has declined in the last 10 years, this is still an important disease to prevent. The current meningococcal vaccine doesn’t contain a polysaccharide that protects against serogroup B, the most important cause of disease in infants and young children, and an important cause of disease in adolescents.

Question:

Which up and coming vaccine technologies do you think show the most promise?

The Answer:

My fantasy vaccine technology would be microencapsulation. There is no reason why all vaccines couldn’t be given by mouth. This would address the most common concern parents have: painful injections. Microcapsules could be constructed to survive the acid-protease environment of the mouth and stomach and be made in such a way that antigen release could occur in the small intestine, which is a rich source of B cells, T cells, and antigen presenting cells. Also, microcapsules could be targeted to specific antigen-presenting cells depending on the type of immune response desired.

Question:

Do you believe that vaccine manufacturing will eventually move to an entirely cell-based manufacturing? If so, what do you think will be the hurdles that must be overcome to make this happen?

The Answer:

Probably the best example is the influenza vaccine, which for decades was made in hen’s eggs. Now we have a mammalian-cell-based vaccine, which in many ways is an easier and more reliable way to make the vaccine. The challenge, however, was that this is an entirely new product. Therefore, both the product, the manufacturing protocol, and the building in which the product is made have to be licensed as a new product, which is an enormously expensive thing to do for what is not a big-ticket item. Vaccine profits will always pale in comparison to drugs as vaccines are given just once or at most a few times during one’s lifetime, whereas some drugs are given every day.

Question:

What do you think were the biggest factors that led to the anti-vaccine movement and what can we do to change public perception and assure safety.

The Answer:

Regarding the first part of your question, I think that the single greatest factor that led to an anti-vaccine backlash (which began in the early 1800s in response to the smallpox vaccine) was vaccine mandates. I think if you ask the professional anti-vaccine groups what would cause them to stop their activities they would say to make vaccines optional. This, of course, would be a disaster for society as it would no doubt lead to an erosion of vaccine rates and an increase in vaccine-preventable diseases.

Regarding the second part of your question, I would argue that vaccines are the safest, best tested medical products that we put into our bodies. So the issue isn’t one of data (plenty of data are available to address these concerns). The issue is one of making those data compelling. And that is where I think we have fallen short. We have to be able to grab the attention of the media and the public with the data that can exonerate vaccine fears.

Question:

Do you think polio will ever be eradicated?

The Answer:

Yes. Although it is apparently going to take much longer than originally hoped.

The reasons for optimism are that it has been eradicated from developing nations and that there are now only three countries (Pakistan, Afghanistan, and Nigeria) that have continued to suffer endemic disease. But the disease has now been eradicated from India, a hopeful sign.

The problem at this point isn’t money or availability of vaccines; it’s political will in the countries that continue to have a problem. The other problem is that the oral polio vaccine viruses can rarely revert to neurovirulent type and can survive in sewage.