The right vaccine stories: a panel discussion with Samir Saha

Pneumonia, a preventable and treatable disease, kills one child every 2 min.

In the November 2017 issue of the National Geographic Magazine, Cynthia Gorney and William Dianiels painted a vivid picture of why and how vaccines play pivotal roles in our societies. The article revolves around pneumonia, pneumococcus (bacteria that cause pneumonia), and pneumococcal conjugate vaccine. It does not cover

“..the best-known vaccine stories, but the right vaccine stories” – Cynthia Gorney

And in the center of the illustration lies Dr Samir Saha and his lifelong dedication to beating pneumonia and other pneumococcal infections in Bangladesh.

Read the article here.

In continuation to this article, the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, National Geographic, and the Bill and Melinda Gates Foundation co-hosted a panel discussion during the American Society of Tropical Medicine and Hygeine Conference, 2017, in Baltimore.

Cynthia Gorney (University of California, Berkeley, National Geographic), the writer of the NatGeo article, led a vibrant discussion on different aspects of pneumococcal vaccine and vaccines in general. Like in the article, Dr. Samir (Head of Microbiology Department at the Dhaka Shishu Hospital, Bangladesh and Executive Director of the Child Health Research Foundation, Bangladesh), was the crux of the affair, but right with him were Dr. Cynthia Whitney, (Chief of Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control) Dr. Keith Klugman (Director for Pneumonia, The Bill & Melinda Gates Foundation) Dr. Chizoba Wonodi, (Nigeria Director, International Vaccine Access Center of Johns Hopkins University) Martha Rebour, (Executive Director, Shot@Life, United Nations Foundation)

There were sparking discussions about the present and the future of pneumococcal vaccines, demonstrating time and again that the most disadvantaged populations at the highest risk of disease still remain the least covered by vaccines – and the reasons vary from lack of data from low-resource populations, lack of notice during vaccine formulations or just low vaccine coverage in remote areas.

“The system is upside down. The system designs for return of invest, profit, and in this particular case, the people who need this product the most, are the ones not only who cannot afford it but the ones who suffer individually most dramatically once the infectious diseases hit them.” – Cynthia Gorney.

In the last 40 years, we have come a long way – from one death every 6-8 s due to pneumonia, we have come to one every 2 min. However, Dr Saha does not shy away from drawing attention to the fact there is a long way to go still. Pneumococcus has more than 94 different types, called serotypes. While not all cause disease, a large number do. The current vaccine introduced in Bangladesh, PCV10, covers 10 serotypes. It’s true that the vaccine is working very well on the vaccine-types, however, we will not get rid of all pneumonia with this vaccine.

Cynthia Gorney and Samir Saha take questions from the audience.

We need to start thinking right now about the next steps to save more lives. – Samir Saha.

He talked about the importance of surveillance and generating data for further evidence-based interventions to ensure that impact of pneumococcal vaccines are not undermined/misunderstood. Non-vaccine serotype 2, which has been the predominant cause of invasive pneumococcal disease since early 2000 in Bangladesh, is yet to be included in a vaccine formulation. Dr. Wonodi also pointed out that we need to ensure that all kids get the vaccine when it is available, even within the country; in Nigeria coverage of pneumococcal vaccine ranged from 3% in the north west of the country to 80% in the south west.

Conversations on pneumonia engage Cynthia Whitney of the CDC and Samir Saha of CHRF – two old friends fighting pneumonia together.

In addition to directly protecting a disease, vaccines can have remarkable indirect impacts. Data suggest that pneumococcal vaccine protects children and adults who are not vaccinated. In addition, protection of bacterial disease decreases the use of antibiotic to cure diseases, leading to decrease in rise of antimicrobial resistance. Finally, prevention of vaccine preventable-diseases can free up beds for non-vaccine preventable diseases in hospitals of resource poor countries, where neonates and children seeking urgent care are frequently refused admission due to unavailability of beds. Take the example of what rotavirus vaccine can potentially do in addition to preventing rotaviral diarrhea.

Vaccines are arguably the most powerful public health tools ever created. When a child is ill, it is not only the child who suffers, but the whole family, the whole society, the whole humankind suffers.