Join Date: Dec 2002
Location: the Seacoast of Bohemia
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Sometimes they know what to "suspect", sometimes not.
Deborah mentioned (was it in this thread?) the "insane optimism" with which new vaccines are introduced. Having that zeal is sort of a prerequisite for work in the upper teirs of public health, it seems.
The Immunization program is the child of a "public-private partnership". The "private" end of things, of course, is not going to have a motive to talk about how their product might not actually work out so great. In fact, the people who call the shots there have an obligation to promote their product and make money for their companies, more or less at all costs. So you will never, ever see Wyeth talking about how staph replaces pneumococcus until they have a staph vax, for example.
So we're left relying on the "public" side of things for any hope of an objective evaluation of the possibilities, but in addition to their problem with "insane optimism", those individuals spend quite a lot of time being...very very friendly...with their "private" partners.
I don't think it's corruption, but I do think there's an amazingly powerful groupthink and phenomenal amount of bias that sets in in these circles.
|Also, I think you'd be surprised how much planning goes into vaccines. I work on Hepatitis C - there's not even a promising vaccine candidate yet. But there are probably about a hundred papers out there talking about what risk groups should be in the clinical trials, how big these trials are going to need to be if the vaccine is genotype-specific, is this vaccine going to need to be subsidized given how it's transmitted (mostly intravenous drug users in industrialized countries), should it be prophylactic or preventative or preventative only among high-risk groups, etc.|
|And a bias does creep in, but I don't think that it's necessarily all profit-driven. You'd have to be inhuman if you worked in a hospital in San Francisco in the 90s and didn't cheer on AZT, the first antiretroviral, even if the confidence turned out to be a bit misplaced. Because you knew how bad HIV/AIDS was back then.|
|But given that vaccines actually make relatively little money for pharma companies, I would be more worried about how much drugs like Ambien and Singulair are being pushed.|
I know there's a lot of planning, but the manufacturers have a lot of say in that, too. For one thing, once they're at phase II or beyond, they can tell the ACIP that they're not even going to make the product at all without a universal recommendation (which morphs into state mandates over time).
This has happened before. (I'll find a link if you want).
Another motive to vaccinate "everyone" is price tiering. Mass vaccination in the US brings the manufacturing costs down, then Europe can afford them, then developing nations...and the vision of being able to save MILLIONS of lives REALLY fuels the "insane optimism".
|I doubt that HCV is ever going to really be a universal vaccine, mostly because the virus is so variant. There are 13 genotypes out there now (well, probably more than that actually) and they are incredibly different from one another. Whatever vaccine does come out (if it comes out) is probably going to be genotype-restricted. Meaning that it will be more useful therapeutically to treat people who are already infected. And the transmission probabilities are even lower than HepB for low-risk populations (non-IDU, non-healthcare).|