Parents challenging school exclusion policies for unvaccinated

While vaccinations are required in every state in the U.S. as a condition of public school or day-care attendance, all allow for exemptions in certain circumstances, namely medical, religious, or philosophical reasons (or a combination thereof, depending on the state). However, most states warn that those exempted from vaccinations may be prohibited from attending school in the event of an outbreak. With the current mumps epidemic in the Midwest, this policy is being tested, with mixed results...

• In Kansas, 15-year old David Brockway was not permitted to attend school for 12 days after another student contracted mumps. Brockway's father, who had acquired a religious exemption for his son and signed a form acknowledging suspensions such as this were possible, protested the action to the school board and won, according to the Wichita Eagle. The compromise: Brockway's father had to sign a 'waiver' specific to mumps, calling into question whether the motivation for the school board's actions is a concern over public health and limiting the transmission of the virus or merely insulating itself against potential liability. Since it's acknowledged that those vaccinated are not 100% protected against mumps, the school board may have actually put themselves at greater legal risk, if other students get mumps as a result of Brockway being an ideal vector for transmission.

• In Edwardsville, MO, two students were escorted from school by police when they attempted to attend classes despite being prohibited from school because of not being vaccinated for mumps, the St. Louis Post-Dispatch reports. One parent is reportedly meeting with a lawyer over the matter.

CDC update on global polio eradication efforts

The latest MMWR reports on progress made over the past 15 months in the quest to eradicate polio worldwide. Among the details included:

• The number of polio-endemic countries now stands at 4 (Afghanistan, India, Nigeria, and Pakistan), down from 6 as recently as February 2006 (Egypt and Niger have been dropped from the list.)
• India and Pakistan are moving closer to eradication, with a 50% decrease in cases over the past year.
• Nigeria remains the primary nation of concern (as we've written about previously). 41% of cases worldwide (799 of 1,948) occurred in Nigeria, and 94% of global cases were caused by viruses originating in northern Nigeria.
• Worldwide infant vaccination levels are estimated at 80%, but are much lower (as expected) in polio-endemic countries. The number is only 39% in Nigeria overall, and lower still in provinces with higher rates of polio transmission.

Today's report comes a month after an extended feature in the New York Times on polio eradication efforts, which we previously discussed here.

At least 5 years of protection from Merck HPV vaccine

A few weeks ago, we discussed the news from GSK that their cervical cancer vaccine, Cervarix, appears to provide at least 4.5 years of protection against the pre-cancerous lesions caused by HPV types included in the vaccine. Today, news from a conference in Paris that Merck's vaccine, Gardasil, offers at least 5 years of such protection. Reuters has the story.

We should expect these back-and-forth announcements every few months from each manufacturer as long-term follow-up data continues to trickle in. The question needing an answer is how long immune protection lasts following the initial HPV vaccination series. These results will help determine whether booster doses are needed, and if so, how often.

Among the advantages of these follow-up studies led by the vaccines' manufacturers is the head start it provides in advance of the vaccines' public debut. If immunity does wane at some point, we know (a) that it appears that it won't for at least 5 years and (b) there will be ample time to implement recommendations for booster doses well before the initial public vaccine recipients near the point at which immune protection would otherwise begin to fall.

Strategies for distributing limited supplies of avian flu vaccine

One of the most difficult public health and ethical questions a potential flu pandemic raises is how best to allocate limited supplies of vaccine (which will only be of limited effectiveness at first, as we've written previously). There's general consensus that first responders or other 'essential personnel' (the definition of which varies widely) should be a top priority, including hospital staff, police, firefighters, top government leaders, etc.

Eventually, though, the focus shifts to larger segments of the population, and the key question becomes how to equitably distribute vaccine supplies while most effectively combating the virus' spread. According to this story in today's Seattle Times, flu researches Ira Longini and Elizabeth Halloran have an answer: school-aged children...

"At school, kids are close together, they don't practice the best hygiene, and they help germs spread like pollen in spring. At home, they do the same with their families.

Giving them the best available vaccine at the earliest sign of a major epidemic might fend off a deadly pandemic, say two of the nation's most prominent influenza researchers, newly arrived at the Fred Hutchinson Cancer Research Center.

'A lot of people believe kids are the best transmitters of the virus, and with a limited supply of vaccine, this might work,' said Elizabeth Halloran, who has studied epidemics for decades.

Halloran and her colleague, Ira Longini, believe using available vaccine would buy time for manufacturers to create a vaccine that matches the pandemic flu virus exactly and would protect millions of people worldwide."

Ask any teacher and they (and their immune system) will agree that school-age children are highly effective vectors of bacteria and viruses. This public health strategy is not new in itself and has implications reaching well beyond avian flu. As in most discussions of vaccines, the challenge is weighing individual benefits versus societal good. Children may be a common vector of transmission, but their immune systems are (generally) better equipped to fight off infections. Thus, alternative strategies suggest vaccinating the elderly, the immunocompromised, pregnant women, and other groups that individually are more susceptible to the effects of infections.

The story in today's Seattle Times actually references a Science paper published by Halloran and Longini back in February. (Science, 3 February 2006, 311:615-616 -- subscription required). In the paper, the authors call for increased research of vaccinating schoolchildren against seasonal flu in order to better understand the impact of such a strategy in limiting transmission.

Speaking of Science, the current (April 21) issue is devoted entirely to influenza and is available free (with registration). In an introduction to the issue titled "Influenza: The State of Our Ignorance," Caroline Ash and Leslie Roberts write,

"An energetic response to H5N1 does not have to be alarmist. We can marshal existing concern about this particular strain of avian influenza to build a long-lasting international infrastructure to monitor and thwart threats from such emerging infections."

Agreed.

Editorial pages weigh in on mumps epidemic

The New York Times offers its take on the mumps epidemic in the Midwest, stressing the continued importance of vaccination efforts and suggesting a closer look should be taken as to whether the vaccine's effectiveness may wane over time. As to the latter, there's no evidence at this point to suggest a booster dose might be necessary, but there is presumably little harm in exploring that possibility. From the editorial...

"Even so, federal and state health officials will need to look hard for any signs that the mumps vaccine is less effective than we previously thought or that its effectiveness diminishes over time. Health officials are wisely urging students and others who are at high risk of exposure and are not fully immunized to get their shots. The current outbreaks would no doubt be much larger — hitting thousands or tens of thousands of people — without the high levels of vaccination already prevalent."

Meanwhile, The Courier News (a suburban Chicago newspaper), published this editorial credited to the St. Louis Post Dispatch (though it appears nowhere on their site). Titled "Halt diseases before they reach the U.S.," the piece relies on a tenuous connection between mumps, avian flu, and 9/11, yet still makes interesting observations about the design of public health efforts and the potential adverse effects of vaccination exemption laws. They write,

"Doctors at the U.S. Centers for Disease Control and Prevention believe the first mumps case was carried to this country by someone traveling from overseas late last year. Two infected airline travelers are believed to have spread it through the Midwest on a total of nine flights.

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It's likely that at least some of the 75 people who have contracted mumps in Missouri and Illinois this year would not be infected if they had received the so-called MMR (measles, mumps and rubella) vaccine. But in recent years, lawmakers in Missouri and several other Midwestern states have expanded options for parents who object to vaccination on religious or philosophical grounds. That policy carries significant public health risks. Many parents probably don't understand the great stakes.

Since the 9/11 attacks, national spending on public health has soared. But much of that has been for work aimed at combating bioterrorism. The greater threat, unfortunately, seems to be from diseases that are far more mundane and easily overlooked."

Provisional rotavirus recommendations expected within a month

This afternoon, the National Immunization Program hosted a live netconference titled "Current Issues in Immunization". Among the topics covered in the one-hour session were revisions to the General Recommendations on Immunization, the document updated every few years that provides general guidance of immunization practices in the U.S. The revisions, addressing particulars of simultaneous administration of multiple vaccines and the impact of altered immunocompetence on vaccination recommendations, were discussed in detail at the February ACIP meeting.

Also presented was an update on the recently licensed and recommended rotavirus vaccine, Merck's RotaTeq. CDC's Dr. Umesh Parashar gave an overview of rotavirus epidemiology worldwide and in the U.S., contrasted RotaTeq with RotaShield (Wyeth's failed vaccine of 1998-99), and offered an update on the current status of the ACIP recommendation approved in February that all infants receive the vaccine at 2, 4, and 6 months.

According to Dr. Parashar, the ACIP recommendation is currently undergoing final clearance from the CDC and HHS. These required approvals are expected within the next month, at which point provisional recommendations will be posted online here. Recommendations do not become official until printed in the Morbidity and Mortality Weekly Report (MMWR), a step expected to occur sometime in fall 2006.

Still, federal government vaccination recommendations remain only recommendations unless individual states act to require the vaccine as a condition of school or day care attendance. These mandates are widely expected for RotaTeq, but require actions by state departments of health or (in some cases) legislatures. Mandates for rotavirus vaccination are not expected to be nearly as contentious as those for HPV vaccines in the months and years ahead.

Latest on Midwest mumps epidemic

We haven't written here yet about the mumps outbreak affecting Iowa and neighboring states in the Midwest, but stories in today's Washington Post and New York Times address the role of the mumps vaccine in the epidemic and also provide good overviews for those who haven't been following the story over the past several weeks. On the vaccine, from the Times...

"(CDC Director Dr. Julie) Gerberding said the disease had spread quickly because of the dense concentration of students in affected cities and because the vaccine is not perfect. It has about an 80 percent efficacy rate for people who have been inoculated with one dose, and a rate of about 90 percent for people who have received the recommended two doses.

'We have absolutely no information to suggest that there's a problem with the vaccine,' Dr. Gerberding said. 'What's going on here is basically a number of people who haven't received both doses, coupled together with people who have received the vaccine but are susceptible anyway, living in crowded conditions like college dormitories or mixing up with other students at spring break or during holidays, and setting up a cascade of transmission that's going to take a while to curtail.'"

The vaccine in question is Merck's M-M-R II, the only licensed mumps vaccine available in the United States. The stories report that CDC will be shipping 25,000 doses of the vaccine from its stockpile to affected areas and Merck will donate another 25,000.

For mumps, there are no specific risk behaviors that increase the likelihood of contracting it (other than not following standard hygiene recommendations -- although people should wash their hands, etc., for many more health reasons than the very slim chance of coming down with mumps). However, the quotes from the general public in both stories reflect near-amazement that it's even possible to get mumps in 2006. While a testament to the effectiveness of decades of vaccination, these views underscore the challenge of stressing the continued necessity of high vaccination rates and the importance of reminding the public that no vaccine guarantees 100% protection against an infection. This second point becomes particularly important when vaccines provide partial protection, as is the case with HPV (which targets viral strains accounting for only 70% of cervical cancers).

Fauci on improving seasonal flu vaccines for elderly

From CNN.com...

"Put aside hypothetical worries about bird flu: Regular flu already kills elderly Americans in droves every winter because the vaccine simply doesn't work as well inside aging bodies as young ones.

The National Institutes of Health wants to strengthen flu shots destined for the elderly, part of a push to get the nation to start treating influenza's yearly attack as seriously as the threat of some super-flu striking in the future.

The message: Why wait for a pandemic to benefit from better flu vaccines and treatments?"

Among the strategies being studied to boost flu vaccine effectiveness in the elderly: higher doses, adjuvants, and the administration of two vaccines (e.g., an injection + FluMist).

"Bird flu threat not so grave, CDC chief says" (or did she?)

This is another topic in which vaccines are only one component of a much broader issue (though a very important component, as we've written about previously), but this story in the Tacoma News Tribune warrants a mention (thanks to our friends at blog.bioethics.net). Here's what the News Tribune reports about a pandemic flu planning summit held in Washington state on Friday...

"'There is no evidence it will be the next pandemic,' Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention in Atlanta, said of avian flu. There is 'no evidence it is evolving in a direction that is becoming more transmissible to people.'

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She did not say what had changed the thinking of health care officials about bird flu, but said that, at this point, there is 'no reason to think it ever will' pass easily between people. Given those facts, bird flu, like SARS, swine flu and other once widely publicized health threats, might never become a significant human illness."

It's dangerous to assume there's been a major shift in government thinking based on a few isolated quotes presented in a single news story. In fact, another report of the same event, this one in The Olympian (Olympia, WA), quotes Dr. Gerberding in a way that drastically alters how her comments could be taken...

"'Pandemics do happen, and we would be foolish not to prepare for one,' said Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention. There's no evidence that the so-called Asian bird flu will become the next global scourge — and there's no evidence it won't, she said." (emphasis added)

All of a sudden, her statements seem much more in line with what we've been hearing for months. It should be noted that there's no evidence of any shift in thinking at CDC.gov or pandemicflu.gov, the government's one-stop clearinghouse of information on the topic. In fact, today's Washington Post reports that a final pandemic flu response plan is nearing completion, one that includes 300 contingencies ranging from latex glove stockpiles to printing U.S. currency overseas if necessary.

The impact of biobanking on vaccine development

After a slow week of vaccine news -- attributable, at least in part, to the holidays -- today's New York Times Magazine has a lengthy feature on biobanking, the gathering of vast repositories of tissue samples that is becoming an increasingly significant part of clinical research. The story, titled "Taking the least of you," estimates that 307 million tissue samples are currently stored in the U.S., collected primarily from blood and tissue samples taken as part of clinical treatment. Samples can be stored for years, and many wonder whether patients fully understand that their tissues may be used for research long after their medical care is completed. It's a topic with scientific and ethical dimensions that extend far beyond vaccines, although, as the story notes, vaccination has benefited from the practice...

"Scientists and surgeons use these tissues to develop everything from flu vaccines to penis-enlargement products. They put cells in culture dishes and expose them to radiation, drugs, cosmetics, viruses, household chemicals and biological weapons and then study their responses. They remove DNA to examine it — and therefore the person it came from — gene by gene. Without those tissues, we would have no tests for diseases like hepatitis and H.I.V.; no vaccines for polio, smallpox, measles; none of the new promising drugs for leukemia, breast cancer, colon cancer. And without tissue samples, the developers of those products would be out billions of dollars."

Evaluating the adequacy of pediatric vaccine stockpiles

While the Chiron-induced flu vaccine shortage in 2004 received far more public attention, there have been a number of shortages of universally-recommended pediatric vaccines since 2001. Among the vaccines in limited supply at some point in the past five years are measles/mumps/rubella, varicella, and diphtheria/tetanus/pertussis, among others. There's little doubt that the likelihood of temporary shortages is increased by the presence of only a single manufacturer of many recommended pediatric vaccines. Ensuring an adequate supply of those vaccines recommended to be administered to all children is very much an ethical issue.

The reasons for the current shape of the U.S. vaccine marketplace are many and well documented elsewhere. While some may hope for a wholesale redesign of the vaccine production marketplace, a more immediate response implemented by the CDC has been the creation of a 6-month stockpile of many recommended pediatric vaccines. The stockpile is intended to provide a buffer against short-term disruptions.

The current issue of Vaccine has an interesting paper that examines the adequacy of current stockpile levels to respond to shortages. The paper is titled "Stockpile levels for pediatric vaccines: How much is enough?" (free abstract, subscription required for full text). Using mathematical modeling, the authors' data validate the belief that current levels are adequate for a 6-month shortage of the vaccines included in the stockpile. Not surprisingly, the current stockpiles are very likely too small for a shortage of 8 months or longer, depending on how severe the shortage is. It should be noted that most recent pediatric vaccine shortages have lasted over one year.

CDC update on possible link between meningitis vaccine and Guillain-Barre Syndrome

Today's issue of the Morbidity and Mortality Weekly Report (MMWR -- the widely-read CDC infectious disease publication) includes an update on a series of cases of Guillain-Barre Syndrome among college-age students shortly after receiving meningococcal vaccine. Below are excerpts from the CDC summary of the report. The bottom line: It's unclear whether the vaccine is responsible for the GBS cases, further study is needed, and no changes for the time being regarding the recommendation status of the vaccine.

"In October 2005, a possible association between Guillain-Barré Syndrome (GBS) and receipt of meningococcal conjugate vaccine (MCV4)...was reported. GBS is a serious neurologic disorder involving inflammatory demyelination of the peripheral nerves. At the time of the first report, five confirmed cases of GBS after receipt of MCV4 had been reported to the Vaccine Adverse Events Reporting System (VAERS). During the 4 months since, three additional confirmed cases of GBS have been reported...

Because available evidence neither proves nor disproves a causal relation between MCV4 and GBS, further monitoring and studies are ongoing within VAERS and the Vaccine Safety Datalink (VSD). CDC continues to recommend use of MCV4 for persons for whom vaccination is indicated; the additional reported cases have not resulted in any change to that recommendation."

"Prospects for Universal Influenza Virus Vaccine"

The current issue of Emerging Infectious Diseases (a CDC publication) includes a paper by Walter Gerhard and colleagues outlining the potential for developing a universal flu vaccine. Such a vaccine would target common areas of the virus, theoretically eliminating the need for annual vaccination, which can target only three specific flu strains each year. The choice of strains to include in the vaccine must be made months in advance of flu season, leading to decreased effectiveness if the virus mutates differently than anticipated in the intervening months.

As the paper describes, animal data on such a vaccination strategy is favorable, though a human vaccine is many, many years away.

"Autism controversy eats at credibility of CDC"

Thursday's Atlanta Journal-Constitution (registration required) has a very good story detailing some of the recent developments in the continuing vaccines and autism controversy. As to the validity of such a link, there's no news and still no evidence to support it, according to the American Academy of Pediatrics and the CDC, among many others. But renewed interest and support from members have Congress have redirected attention to the topic, which by itself has an impact on vaccination, as the story explains...

"As the debate and controversy increasingly finds its way into pediatricians' offices, average parents of healthy children are questioning whether vaccines are safe, sometimes even refusing inoculations.

The CDC and other public health officials insist such questions lack a basis in fact or science. Their greatest concern is that the broadening debate holds the potential to put a new generation of children at certain risk of deadly diseases if confidence in the safety of vaccines is lost and they don't receive recommended shots.

'I think it's huge,' said Dr. Julia McMillan, a member of the American Academy of Pediatrics committee that makes vaccine recommendations. 'There's no pediatrician in practice that doesn't confront this on a weekly basis: families who are questioning the need for – and in some cases refusing — vaccines for their children.'"

Yesterday's USA Today featured a full page ad paid for by several autism advocacy groups which cites Robert F. Kennedy's comments on the CDC last month (which we wrote about here) and links to the website www.putchildrenfirst.org. That site, which includes links to numerous CDC documents, memoranda, and e-mails, describes its mission as follows...

"In our efforts to share the truth with other parents, we have been frustrated by the amount of misinformation in the press stating that the connection between mercury and autism has been disproven. This website was constructed to share the truth about what 'proof' actually means.

The National Immunization program (sic) is at risk. The CDC through the choices made, has eroded public trust. Autism is a national emergency and a national shame. We need independent journalists and members of Congress to take action now and put our children first."

In the AJC, the CDC responds... "CDC spokesman Glen Nowak said many of the documents on the site have been in the public domain for years, and are presented out of context and in ways that may 'look quite ominous' – when they're not." Regarding the USA Today advertisement, the CDC released this response, expressing 'disappointment' at how their (and others') efforts were characterized.

Finally, the Vaccine Education Center at the Children's Hospital of Philadelphia recently updated its page on "Thimerosal and Autism."

Pharma sparring over which HPV vaccine is better

Aside from the controversy that likely will shadow HPV vaccines' introduction, Merck and GSK are fully engaged in a not-so-friendly debate over whose vaccine is superior. Those in attendance at the last ACIP meeting in February caught a glimpse of this jockeying, and a piece in today's Philadelphia Inquirer covers the latest round of salvos.

First, the news. A paper was published today on the website of The Lancet (subscription required) reporting new trial data of the GSK vaccine, Cervarix. It is titled "Sustained efficacy up to 4·5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial." Here's the GSK press release.

Two newsworthy items: (1) The follow-up study showed 100% efficacy over 4.5 years against the precancerous lesions caused by HPV. The data was gathered from a sample of 776 women who participated in an earlier vaccine trial, according to Forbes. For both vaccines, long-term efficacy data is not yet available, so it's unclear whether booster doses may be needed. 4.5 years of protection is a start, but ultimately, life-long protection is necessary.

(2) The paper also suggests broader protection against more subtypes of HPV than the two specifically included in the vaccine. From the press release:

"The study provided evidence that GSK’s candidate vaccine demonstrated substantial protection against infection with the third and fourth most prevalent cancer-causing types of HPV, namely types 45 and 31. This protection also extends over 4.5 years. GSK is conducting further large studies to determine the potential mechanism and extent of the demonstrated broader oncogenic protection."

If this finding holds up, it would mean that GSK's vaccine provides protection against up to 80% of cervical cancers in the U.S. (up from the 70% figure originally believed).

As the Inquirer reports, Merck scientists were skeptical of the GSK announcement:

"Merck...immediately questioned GlaxoSmithKline's study. One of its HPV researchers, Eliav Barr, called Dubin's analysis 'unorthodox' and emphasized that Merck also was testing for additional virus protections. Merck's vaccine already has been shown to help prevent HPV infections that cause genital warts.

Reacting to Merck's criticism, Dubin defended the study results as highly reliable and suggested that a reporter 'ignore' Merck's comment."

We've discussed the differences between each company's HPV vaccine and other recent developments previously (here, here, here, and here). While Merck's inclusion of additional HPV subtypes responsible for genital warts in their vaccine gave it the early competitive advantage (as males could also benefit from it), today's news signals that the battle for superiority is far from over.

Society for Adolescent Medicine position on HPV and other teen vaccines

This is a few weeks old, but the March issue of the Journal of Adolescent Health included this position paper on adolescent immunization from the Society for Adolescent Medicine. (free PDF).

The paper addresses several vaccines administered to teenagers and outlines some of the general challenges that adolescent immunization programs face. HPV vaccines receive significant attention, with respect to the science, cost-effectiveness, and behavioral concerns the vaccine raises among many. On the latter, here's what they write...

"Data indicate that parents will support the use of a vaccine to prevent sexually transmitted infections (STIs) including HPV, especially after receiving education and an understanding of the potential outcomes of the disease. In addition, provider acceptability is important to parents and their adolescent children. Thus, health care professionals need to educate themselves, parents and patients with the goal of promoting the health and well-being of patients regardless of the transmission routes of infection and disease. Vaccination does not preclude the use of other methods to prevent disease, including significant educational initiatives. Even with significant educational efforts aimed at behavioral change, adolescents still engage in health-risk behaviors. Just as with any other health prevention strategy, it makes the most sense to protect all youth--including our most vulnerable youth--with all prevention strategies available, including education and vaccination."

Mediocre avian flu vaccine still better than Tamiflu?

(Our friends at blog.bioethics.net noted a paper in the latest issue of BMJ titled "An iatrogenic pandemic of panic." It's a fact vs. fiction piece that's as provocative as the title suggests. About 20% of our posts have been about avian flu vaccines, which doesn't seem excessive, but we're mindful that ample attention should be given to the many other vaccine issues that are real, present, and affect populations around the world every day. That said, avian flu vaccines are making a lot of news lately, and traffic to this site from search engines suggests that many are looking for info on the topic. We're striving to find the right balance...)

A paper published online at the website of the Proceedings of the National Academy of Sciences (PNAS -- subscription required) reports that a moderately effective avian flu vaccine (meaning one that is not a close match to the viral strain circulating) would be a more effective way to limit the spread of avian flu in its early stages than the widespread use of antiviral drugs such as Tamiflu. The paper is titled "Mitigation strategy for pandemic influenza in the United States" (Germann, TC, et al.). Here's the Bloomberg story about it.

Ultimately, the question this paper (and all stockpiling efforts) address is how best to buy time in the early weeks of a pandemic until a perfect-match vaccine is produced. The results in this paper are based on statistical modeling, the limitations of which are many. Nevertheless, it suggests that a vaccine about as effective as the Sanofi product in the news last week (our post here), coupled with school closings and voluntary social distancing, offers the best strategy for limiting the virus' spread in its early stages

$75 Million from Gates to PATH for pneumonia vaccine

The Seattle Post-Intelligencer reports this morning...

"Pneumonia is the leading killer of children worldwide, taking a life every 30 seconds, so the Bill & Melinda Gates Foundation has awarded Seattle-based PATH $75 million to create inexpensive vaccines tailored specifically to the disease strains prevalent in poor countries."

The award will be announced today at the 5th International Symposium on Pneumococci and Pneumococcal Diseases in Australia. PATH, a non-profit that frequently receives support from Gates, describes its mission as "improv[ing] the health of people around the world by advancing technologies, strengthening systems, and encouraging healthy behaviors."

The Seattle P-I continues...

"Children in the United States and Europe are routinely vaccinated against the leading strain of the bacteria, Streptococcus pneumoniae. But the Western vaccine does not protect well against varying strains found in developing countries -- where 90 percent of pneumococcal deaths occur.

Also, the current vaccine costs from $40 to $60 a dose -- a price that is completely unaffordable for most people in poor countries living on perhaps a dollar a day or less."

The vaccine referred to is Wyeth's Prevnar. Much like HPV, there are dozens of strains of pneumococcus, and Prevnar only provides protection against the 7 most common in the U.S. and elsewhere in the developed world. The stated goal of this project is to bring down dramatically the cost of a pneumonia vaccine (the story suggests $5/dose as a target) while developing candidate vaccines that are not specific to individual strains of the bacteria.

This news is only the most recent example of the leading role played by the Gates Foundation in steering vaccine research in new directions. Last week, we wrote about their commitment to a new tuberculosis vaccine for the developing world, and a few weeks earlier, we noted a Financial Times profile on Bill and Melinda Gates and their philanthropic efforts.