By Dr Andrea Collins, Senior Clinical Lecturer in Respiratory Medicine at LSTM
We all remember the all-important contribution of vaccines to ending the worst of the COVID pandemic, not least here in Liverpool as one of the main recruiting sites for the trials that culminated in one of the first jabs to be approved in the UK.
The overwhelmingly positive response from the scientific, medical and local community enabled this to happen. We had over 50 volunteer doctors working in the Liverpool Vaccine Group on the trials, huge efforts from all staff, and hundreds of volunteer trial participants who enabled us to gather crucial efficacy data. These efforts combined meant that we were able to get the vaccine out to protect the most vulnerable as quickly as we did.
The COVID vaccine success story is now a familiar one, and the regular boosters to protect vulnerable populations continue to be extremely important.
But that isn’t the end of the story – either for COVID, or for the enormous potential of vaccine technology generally as a tool to prevent the devastating effects of other disease outbreaks.
For example, we’re all familiar with jabs that go into our arms. They provide what we call systemic immunity. Vaccines that provide systemic immunity provide us with lots of antibodies in our blood, which prevents us from getting severe disease, but not necessarily from mild or moderate infection. Or, crucially, from spreading the disease to others.
But what about one that goes up your nose in a spray? Could an effective mucosal vaccine, which would provide mucosal immunity for respiratory viruses like COVID, give us what we need? Studies for vaccines such as these are now underway to see if, in the future, we can produce better vaccines more quickly that could stop transmission during a pandemic and could prevent people getting disease, other than perhaps extremely mild or asymptomatic.
These sorts of vaccine trials will be an early focus of LSTM’s new Human Challenge Facility (HCF) when it opens later this year. This £8m inpatient facility, the biggest academic facility of its type in the country, is a specialist clinical trials unit that will accelerate the development of new treatments and vaccines for infectious diseases. This builds on our strong history in Controlled Human Challenge Models – a type of clinical trial where healthy volunteers are intentionally infected in a safe, controlled environment – which offer huge benefits in the time and cost of bringing potentially life-saving vaccines to people across the world.
HCF puts Liverpool as part of an international network of sites working together on types of vaccines that could play a huge role in any future pandemic or important infectious diseases. Improved vaccine platforms that allow us to ‘plug and play’ for any number of different antigens in years to come would be game-changing.
At the Liverpool Vaccine Group, our ethos is to deliver safe, effective vaccines for the world.
We aim to use the additional capacity of HCF to tackle global health challenges, and in particular those diseases that are endemic in low- and middle-income countries. Human challenge models work well where other vaccine trials cannot, for example, for diseases that currently have low prevalence like Zika or where field trials are very difficult or even impossible to run.
LVG’s ethos means that we want to produce vaccines that are affordable and effective in different populations globally. That is why we were so focused on transferring the TB and pneumococcal vaccine models developed in Liverpool to our colleagues at the Malawi-Liverpool-Wellcome Programme.
Vaccines are increasingly important weapon in our arsenal against future pandemics – and infection in general. It’s a cliché, but it’s true – prevention is better than cure. We can’t treat viruses with antibiotics, and multiple drug resistance is becoming an increasing challenge to bacterial infection too. The World Health Organization estimate that by utilising existing vaccines against 23 pathogens, we could reduce antibiotic use by 2.5 billion doses per year.
We’re learning more about the relationships between infections and other diseases, not to mention the increased likelihood of, for example, an elderly person dying of another condition such as heart failure because of their recent respiratory infection. And of course, COVID also reminded us of the very many immunocompromised people who rely on others being vaccinated to protect them.
That is why the continued generosity of our volunteers – some 4000 involved in human challenge and vaccine trials at the Liverpool School of Tropical Medicine over the years, as well as the expertise of researchers and clinicians, can help us fight back against future pandemics – and maybe even prevent them.