November 01, 2023
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Scientists have successfully developed the first vaccines against malaria and respiratory syncytial virus, but other vaccine targets remain.
We asked Robin C. Colgrove, MD, FIDSA, attending physician in infectious diseases at Mount Auburn Hospital in Cambridge, Massachusetts, and assistant professor of medicine at Harvard Medical School, what tops his list.
Colgrove: If you had asked the same question 10 years ago, a malaria vaccine might well have been the consensus answer. Now that there are two WHO-endorsed malaria vaccines, the answer depends on what you are trying to accomplish.
I go back with HIV to the beginning when I was a medical student in the early 1980s in San Francisco, when the virus was isolated. HHS Secretary Margaret Heckler made a famous comment that we would have an HIV vaccine in 2 years. Now, we are 40 years in, and there is still not a successful HIV vaccine, although we do have very good testing and very good treatment. With testing, treatment and PrEP, epidemiological models suggest that we could eliminate HIV even without a vaccine, although it would be very helpful and it is extremely disappointing that after so many trials, we still do not have one. I would put that at the top of the list in a qualified way because we have tried so hard and failed.
If you ask, in a global sense, what would make the biggest difference, though, it still would be a tuberculosis vaccine. The bacille Calmette-Guérin vaccine for TB was first administered in 1921 and is moderately effective, but it certainly has not been effective enough to drive rates of TB down. A really effective TB vaccine would make an enormous difference, but it is a very difficult task because of the biology of TB and the difficulty of getting a good immune response. Also, testing and public health-related issues make it very challenging. If you could wave a magic wand, though, and get a 100% effective vaccine against any pathogen, numerically, a TB vaccine would probably make the biggest difference.
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