PHNOM PENH, Sep 13 2012 (IPS) - Public health experts in Cambodia are
unenthused by reports of trials for a dengue vaccine conducted in neighbouring
Thailand, saying it will be too costly for those who need it most – children in
the least developed and developing countries.
“Of course, they cannot come out
with a vaccine that costs 20 cents,” Dr. Philip Buchy, head of the virology
unit at the Pasteur Institute of Cambodia, told IPS.
Buchy was referring to the
Paris-based pharmaceutical company Sanofi SA’s dengue vaccine efficacy trials,
the results of which were published in the British medical journal Lancet, this
month.
Dr. Stephen Bjorges, leader of
the vector-borne disease team at the World Health Organisation (WHO) in
Cambodia, agrees. Even if Sanofi succeeds “funds would need to be mobilised” to
cover the cost of inoculating children in Cambodia, he said.
A dengue epidemic that raged
through Cambodia during the first eight months of the year landed more than
30,000 people in hospital, the majority of them children.
According to the Lancet report,
Sanofi’s vaccine offers some protection against three of the four serotypes of
the dengue virus – about 30 percent against serotype one and from 80 to 90
percent against serotypes three and four.
However, Sanofi’s vaccine does
not protect against serotype two, which was circulating in the study area
during the trial, giving the vaccine an overall efficacy rate of 30.2 percent,
the report said.
Large-scale phase-3 trials are
underway on 31,000 children and adolescents in Latin America and Southeast
Asia, Sanofi said in a press statement timed with the release of the Lancet
report.
According to the Reuters news
agency, the company has already invested more than 430 million dollars in a new
factory in France to produce the vaccine.
WHO’s Bjorges said that if the
phase 3 trials proved the vaccine was effective, its initial market likley
would be tourists from wealthy nations and the military, a view Buchy agrees
with.
Buchy doubted, however, that an
effective vaccine was around the corner. “The vaccine is not for tomorrow,” he
said. “Dengue epidemics still have good days ahead of them.”
Still, both doctors expect
increasing investment in vaccines and vaccine-related research as global
warming expands the range of the mosquito that transmits dengue into southern
Europe and the United States.
Developed countries are beginning
to factor the costs of dengue treatment into their long-range healthcare
budgets, while pharmaceutical companies have identified a potentially
lucrative, emerging market, Buchy said. “Global warming is providing a shortcut
for vaccine research.”
“Interest in vaccines is going to
grow exponentially now that there is some success with a vaccine,” Bjorges said
The European Union provided more
than 10 million dollars for three dengue-related research projects in Southeast
Asia earlier this year – including one in Cambodia – to investigate the role
that asymptomatic carriers play in transmission, Buchy said.
“If we can identify a gene that
is protective this may allow us to develop drugs for treatment and
vaccination,” he added.
Funding for prevention and
control of epidemics in poor countries remains scant, however. The budget for
Cambodia’s national dengue control programme is about 500,000 dollars, most of
it provided by the Asian Development Bank.
Bjorges say one reason for the
lack of funding for prevention and control is that it has shown little success.
“Dengue control is 50 years old and everything that has been thought of has
been tried,” they said.
Breeding sites have to be
eradicated weekly in order to prevent the mosquito that transmits the virus
from emerging from its larvae, and this requires changes in human behaviour
that have proven difficult to sustain on a weekly basis, Bjorges explained.
Another problem may be that those
who allocate global health funds rely on short-term cost-benefit models,
Bjorges said. They are under pressure to produce quick, quantifiable results
for the funds they allocate, and dengue prevention and control projects do not
fit these models, he explained.
Buchy was less pessimistic about
the possibility of changing human behaviour. “Behaviour change is possible, but
it requires more investment in education.”
Buxhy’s view is echoed by Prof.
Duch Moniboth of Cambodia’s National Pediatric Hospital that treated 1,673
children for dengue in the first seven months of this year. “There is not
enough education about dengue – how to prevent infection and how to eradicate
breeding sites.”
New research, however, suggests
that dengue is far more prevalent in Cambodia than previously calculated,
underscoring the need for increased investment in prevention.
The disease is underreported
partly because Cambodia’s dengue surveillance system relies on data from
state-run hospitals and charitable children’s hospitals. Cases treated at
private hospitals and clinics are not reported to the health ministry.
Charitable hospitals treating
dengue patients in Cambodia have been pleading for donations after being
inundated with patients in May. The National Paediatric Hospital has been
relying on nursing students to treat children who spill into the hallways and
the foyer around the main stairwell.
The hospital receives a mere 20
dollars per patient, regardless of how long the child stays, Moniboth said. On
average, doctors receive monthly salaries of about 125 dollars, while nurses
are paid about 75 dollars, he said.
With such meager funding for
healthcare what is needed is a cheap vaccine, Moniboth said.
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