Executive Summary
As part of a revolution that began before Covid-19 emerged, vaccine technology had been advancing at speed, with new programmable platforms, including RNA and viral vectors, making it easier to create new vaccines. Meanwhile, the ongoing evolution of adjuvants – ingredients added to vaccines to trigger a stronger immune response – and lipid nanoparticles means the next generation of products will soon be available to tackle many of the world’s major pathogens and chronic diseases. Together, these advances will enable us to prevent many high-burden diseases, including the non-communicable ones that account for 74 per cent of deaths around the world.
Currently, adult-vaccination efforts are focused on addressing the urgent need for Covid-19 immunisation, particularly among at-risk groups. But in the longer term, this framework should be adapted and evolved to increase access to other vaccines for preventable diseases and to support the rollout of promising new candidates. In a previous paper, the Global Health Security Consortium (GHSC) estimated that at least 10 million deaths per year are attributable to diseases with existing or forthcoming adult vaccines and preventative injectable therapies.
Potential candidates include new vaccines for flu, respiratory syncytial virus (RSV), pneumococcal, malaria, human papillomavirus (HPV) in adolescents, tuberculosis (TB) and dengue, as well as long-acting injectables to prevent heart disease through better control of cholesterol and blood pressure, and pre-exposure prophylaxis for HIV. In addition, vaccines against causes of hospital-acquired infections and other bacteria considered to be antimicrobial resistant will be exceedingly important in countries with large numbers of chronically ill patients.
Emerging technologies and established vaccines are an integral part of the infrastructure for the One Shot programme proposed by the GHSC. To facilitate the development of such a global disease-prevention programme for adults, a number of steps will be needed.
How Do We Take Action?
Develop a global oversight model led by the World Health Organisation (WHO): Scientific advisory groups will issue recommendations for the use of adult vaccines and long-acting injectable therapies, based on clinical-trial outcomes and real-world evidence studies.
Ensure that such a global oversight model can take timely and efficient decisions. This is especially crucial in urgent scenarios such as outbreaks and public-health emergencies of international concern.
Collect timely, consistent and representative data: Disease surveillance, which tracks regional disease burden and at-risk groups, will be imperative to efforts by individual countries.
Use surveillance data to make evidence-based decisions: Regional scientific advisory or expert groups will interpret this data and advise policymakers on which of the WHO recommendations are relevant and should be adopted. Cost-benefit analyses can then be carried out for specific vaccines and injectable therapeutics.
Adopt a “bundle” approach to adult vaccination: By viewing adult vaccination in a systematic way and accounting for the needs of particular groups – for example, pregnant women, the elderly and health-care workers – processes and deployment infrastructure can be streamlined and efficient.