SciDev.Net

Cardiovascular disease accounts for 30% of deaths worldwide and 10% of all years of healthy life lost to disease, and the figures are nearly as high in developing countries — 27 per cent and 9 per cent respectively. This compares with 10% of lives lost worldwide from HIV/AIDS, TB and malaria put together (12% in developing countries). So why have donors not invested as heavily into tackling non-communicable chronic diseases as they have with infectious ones? The authors of this article suggest several reasons: infectious diseases are in some ways easier to solve by a vaccine or drugs so it might seem sensible to use precious funding this way; Western donors may want to see epidemics contained quickly to avoid global spread; pictures of small African children dying of AIDS are more heartrending than a middle-aged man with hypertension, even if that man is supporting a large family; there is a myth that chronic diseases are more costly to prevent than infectious ones. This last issue is one that should be tackled strongly to spread awareness that low-cost methods can have an enormous effect on chronic diseases.

Vaccination for infectious diseases is a vital method of prophylaxis, and has transformed modern medicine. By contrast, research into vaccines against chronic diseases has been less successful, in part because of the increased complexity involved.

In this opinion piece, the authors outline the prospects for the development of chronic disease vaccines. These might not need to rely on the traditional method of inducing the body to produce antibodies, but rather on introducing monoclonal antibodies against specific proteins — this has so far worked well against Crohn's disease and rheumatoid arthritis.

The authors outline key hurdles in developing a successful therapeutic vaccine. Safety and efficacy are two obvious ones, but there is a third that is unique to vaccines for chronic diseases. Because these vaccines would block bodily chemicals — such as cytokines or hormones — it would not be acceptable for a vaccine to induce a life-long block (unlike a malaria vaccine, for example, where a lifelong block would be ideal).

These might be particularly useful in developing countries, say the authors. Because prophylaxis with vaccines is already a familiar concept, there should be no problem with patients' compliance, and judicious partnerships between public and private organisations could mean the vaccines are produced cheaply.