Never-ending war on disease (From The Oxford Times)

Never-ending war on disease

6:20am Thursday 18th February 2010 in

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Friends of Professor Andrew Pollard suggested he did not look an altogether welcoming figure the last time he appeared in The Oxford Times, holding up a syringe in his surgically gloved right hand.

The photograph had been taken to help promote the Oxford professor’s appeal to find 250 children, including babies, to take part in a swine flu vaccine trial. As it turned out the image only helped encourage parents of children aged between six months and 12 years to enrol their youngsters for the trials of two different swine flu vaccines.

“The parents were fantastic,” Prof Pollard, told me when we met at the Oxford vaccine centre, where he is a director. “There was an unprecedented response. It was unparalleled for any clinical trial in children that I am aware of. There was a huge amount of interest in the science as well as in the potential benefits.”

But then the parents had good reason to place faith in the Oxford Vaccine Group, which is now a world leader in developing vaccines and running trials to combat many of the world’s most lethal diseases, such as malaria, meningitis, typhoid and TB.

Prof Pollard began leading the vaccine group, initially on level four at the John Radcliffe Hospital in 2002, long before we had come to know and fear such global afflictions as bird and swine flu.

While some ongoing projects to develop Hib and meningococcal vaccines may run over years, if not decades, the swine flu children’s trials showed just how rapidly Prof Pollard and his 40-strong team can respond in the face of a potential pandemic.

Cast your mind back to last September, when outbreaks of swine flu were resulting in school closures, amid fears that the winter would see as many 65,000 elderly and young people carried off by a new virus.

When, in March, residents of La Gloria, Mexico, began complaining of peculiar fevers, aches and sore throats, no one had initially taken much notice, with governments and researchers still focused on the threat of bird flu.

But as reports from Mexico pointed to unusual mortality patterns among young people, scientists began to talk of swine flu being potentially as deadly as the 1918 Spanish influenza, another strain of H1N1 that killed an estimated 50m people worldwide.

The manufacture of vaccines was fast-tracked but the Government was uncertain last autumn which one of the two vaccines that it had bought would offer the nation’s children the best protection and cause the least side effects.

Within weeks the data provided by Prof Pollard resulted in the Government deciding to give both the vaccines to children — Pandemrix made by GlaxoSmithKline and Celvapan made by Baxter. The trials took place in September, and by November the Government was giving the go-ahead to immunise the under-fives.

But in a few weeks’ time Prof Pollard’s more detailed findings are set to be published in a medical journal.

“Our findings showed that they were both acceptable. But there are some differences between the vaccines. And I think our data will have important implications and will have an impact in determining future vaccination policy.”

The swine flu scare made billions of pounds for vaccine manufacturers, with millions of unwanted doses of vaccine now having to be thrown away.

But Prof Pollard has little time for the conspiracy theorists who have claimed the panic was fake, with the World Health Organization under the influence of the vaccine manufacturers.

He said: “I think what happened in the UK showed that the system worked with remarkable efficiency. Whether it was ultimately needed is a different question. It is easy to say these things in retrospect.

“If things had become really terrible during winter, with a rising death count, and the vaccines had not been available, people would have bitterly criticised the system.

“But the pandemic was not as bad as expected and more vaccine was bought than was needed.”

Surprisingly, it turned out that swine flu tended to target people aged from 15 to 45, with older people having immunity as a result of being around in the 1950s and before, when similar viruses were around.

New flu viruses, however, behave in true Darwinian fashion, displacing other existing flu viruses. And Prof Pollard points out that the swine flu virus could easily become the seasonal flu virus next winter. If the virus were to change its complex make-up even a tiny amount, millions of older people would no longer be immune and be highly vulnerable to the next phase of swine flu.

The vaccine group is now based in modern offices in the Centre for Clinical Vaccinology and Tropical Medicine, on the Churchill Hospital site. It is also part of Oxford University.

“We are unique, in that we develop our own vaccines and get them to the point where they are tested in humans. The normal place for this work is in industry, not the world of academia.

“I can’t imagine anywhere in the UK where there are so many vaccines at the point of trials on humans. We carry out research studies of new and improved vaccines for babies, young children, teenagers and adults, but also teach doctors and nurses about vaccines and immunisations.”

Over the past five years alone, more than 7,000 people in Oxfordshire and across the Thames Valley region have taken part in research studies, which have included studies of a vaccine against avian influenza (bird flu) and against pneumonia.

Prof Pollard’s colleague Prof Adrian Hill has, for more than a decade, been leading work to develop a new vaccine to combat the most deadly form of malaria, which kills over a million people each year, mainly women and young children.

A vaccine to defeat the strain P.flaciparum, responsible for 90 per cent of deaths, has proved hugely difficult to develop because the parasites responsible for infection live inside cells, where they cannot be reached by antibodies. Prof Hill was responsible for bringing to trials for the first time a virus found in chimpanzees to boost the efficacy of the vaccine.

Since 2005, the Oxford Vaccine Group has been working on a series of collaborative projects with the paediatric department of Patan Hospital in Nepal, where they have studied more than 4,000 children admitted to the hospital with febrile illnesses and cases of typhoid, Hib and pneumonia.

Meningitis is Prof Pollard’s own specialism, and in recent weeks he has been sending out letters to hundreds of people in Oxfordshire, appealing for volunteers to take part in a study of a new vaccine designed to broaden protection against the disease, caused by infection around the surface of the brain.

Prof Pollard said: “A new vaccine has been developed to protect against four different types of bacteria that cause meningitis: meningococcus A, C, W-135 and Y. It has been adapted from the existing meningitis C vaccine which has been safely given to millions of children.”

Those taking part will all receive a dose of the new vaccine, and either a further dose of the new vaccine or a dose of the licensed meningitis ACWY vaccine. The group is trying to recruit 150 healthy adults for the study, being funded by Oxford University, and approved by the Oxfordshire Research Ethics Committee.

With both vaccines, the most common side effects are local pain, redness, fever, headache and tiredness, with a rare risk of allergic infection. So any advantages?

“As it is an investigational vaccine we cannot guarantee this will provide direct benefits. However, this immunisation may provide a long-term protection against the strains A,C, W-135 and Y.”

But not, alas, against B, one of the most common causes of meningitis in the UK. There is, as yet, no vaccine available against it, although a new vaccine is to be developed funded by the Wellcome Trust. For the time being, that strain is set to remain on a lengthening list of ‘killer bugs’ being fought at Oxford’s vaccine centre.

Their ability to change more rapidly than scientific advances, means some viruses are unlikely to be ever overcome. While the rest of us are wondering whether swine fllu was such a terrible threat, Prof Pollard is already thinking about next winter. For his team, what came out of the town of La Gloria in Mexico last March was only a surprise assault in a never-ending war.

lAnyone wishing to take part in the meningitis trial should ring 01865 857420 or email ovg@paediatrics.ox.ac.uk