The recent outbreaks of measles in Canada and the United States came as a shock to many public health experts but they wouldn't have to Dr. Gregory Poland, one of the world's most admired, most advanced thinkers in the field of vaccinology.
The measles vaccine has failed, he explained two years ago in a prescient paper, "The re-emergence of measles in developed countries." In that paper, he warned that due to factors that most haven't noticed, measles has come back to be a serious public health threat. Thankfully, in that paper and elsewhere he also spelled out in no-nonsense fashion what now needs to be done.
Dr. Poland is no vaccine denier. Not only is he among the harshest and most outspoken critics of the "irrationality of the antivaccinationists," he is also one of the strongest proponents for vaccines and the good that they can do. As Professor of Medicine and founder and leader of Mayo Clinic's Vaccine Research Group, one of the world's largest vaccine research organizations; as editor-in-chief of the peer-reviewed scientific journal, Vaccine; as recipient of numerous awards; as chair of vaccine data monitoring committees for pharmaceutical giant Merck; as patent holder in various vaccines processes; as someone who enjoys special employee status with the Centers for Disease Control and the U.S. Department of Defense and as someone who has sat on every federal committee that has dealt with vaccines, no one can accuse him of seeing vaccines from a narrow perspective.
And he sees the need for a major rethink, after concluding that the current measles vaccine is unlikely to ever live up to the job expected of it: "outbreaks are occurring even in highly developed countries where vaccine access, public health infrastructure, and health literacy are not significant issues. This is unexpected and a worrisome harbinger -- measles outbreaks are occurring where they are least expected," he wrote in his 2012 paper, listing the "surprising numbers of cases occurring in persons who previously received one or even two documented doses of measles-containing vaccine." During the 1989-1991 U.S. outbreaks, 20 per cent to 40 per cent of those affected had received one to two doses. In a 2011 outbreak in Canada, "over 50 per cent of the 98 individuals had received two doses of measles vaccine."
Dr. Poland noted 15 U.S. outbreaks between 2005 and 2011 and 33 in Europe in 2011 alone, involving more than 30,000 known cases. Meanwhile, the "UK has declared measles once again endemic.... such outbreaks result from both failure to vaccinate, and vaccine failure."
People's failure to get vaccinated is deplorable, Dr. Poland often stresses. But the more fundamental problem stems from the vaccine being less effective in real life than predicted, with a too-high failure rate -- between 2 per cent and 10 per cent don't develop expected antibodies after receiving the recommended two shots. Because different people have different genetic makeups, the vaccine is simply a dud in many, failing to provide the protection they think they've acquired.
To make matters worse, even when the vaccine takes, the protection quickly wanes, making it unrealistic to achieve the 95 per cent-plus level of immunity in the general population thought necessary to protect public health. For example, 9 per cent of children having two doses of the vaccine, as public health authorities now recommend, will have lost their immunity after just seven and a half years. As more time passes, more lose their immunity. "This leads to a paradoxical situation whereby measles in highly immunized societies occurs primarily among those previously immunized," Dr. Poland stated.
The measles vaccine's inadequacy doesn't end there, however. It "cannot be administered to those who are immunocompromised, who have allergies to vaccine components, or who are pregnant [among other limitations, leaving] a large enough segment of the population susceptible and unprotected from measles such that cases will continue to occur."
The answer, according to Dr. Poland, lies in our genes. Because of their genetic predisposition, some people will not respond to the current measles vaccine, even with additional boosters. By the same token, the genetic predisposition of others makes them susceptible to harm from the measles vaccine, leading to public wariness, including among the well educated. What is needed, suggests Dr. Poland, is for the public health establishment to accept that the current measles vaccine has so many drawbacks as to make it unworkable, and get on with the job of developing next-generation vaccines.
This next generation vaccine technology, which his Mayo Clinic group is helping pioneer, marries vaccinology with genomics to create personalized, rather than one-size-fits-all, vaccines. Through this new medical discipline of "vaccinomics," a term he dubbed, medical science will not only have the wherewithal to finally achieve the decades-long dream of eradicating measles and other diseases, he believes, but will also do so at lower cost while addressing the concerns of the educated public.
As I will discuss in part two of this series, vaccinomics is no pie-in-the-sky fantasy but possibly the next big coming thing, well worth pursuing, and well worth the investment in its development that will be required.
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