Vaccine Takeaways from the 2019 BIO Convention and National Adult Immunization and Influenza Summit

After spending several days in Philadelphia at the BIO International Convention last week and Atlanta a few weeks ago at the National Adult immunization and Influenza Summit, I came away excited about the current and future state of vaccine innovation. In addition to listening to the excellent sessions, I spent time with thought leaders, my clients in industry and leaders from many smaller biotechs with innovative vaccination platforms. Here are a few takeaways –

1. The vaccines pipeline is exciting.

Seniors face life-threatening and debilitating illnesses, sometimes simply by interacting with our modern healthcare system. Novel candidates for C. difficile as well as newer and more protective shingles and pneumococcal candidates hold great promise for healthier, more comfortable aging. While development of a Staph aeurus vaccine candidate has struggled, we see promising candidates for C. difficile and others that targeting infections in chronic and vulnerable older populations.

Several new technologies could radically disrupt vaccines. Research and development of technologies such as micro-needle patches and early stage nanobased-gel nasal vaccines stand to make vaccines more accessible to patients, especially those who fear needle-stick, over the long-term.

There is also a robust pipeline of candidates to prevent seasonal respiratory illness, including flu vaccines based on technology that will also enable faster pandemic response, as well as multiple long-awaited, candidates for RSV in younger and older populations alike. While egg-based flu vaccines have saved countless lives and continue to play an important role in lowering overall flu disease burden, cell-based and plant-based technologies lower the risk of strain mutation and allow for faster production to meet pandemic needs.

2. Vaccines must be deployed alongside other interventions.

HIV candidates hold the promise of stemming the epidemic by preventing novel incidence. With several HIV candidates in the pipeline, we are truly closer than ever to the promise of ending HIV transmissions. Ending the HIV epidemic will require multiple interventions on multiple levels. Antiviral PrEP/PEP regimens are essential to preventing the spread of HIV, but so are vaccines. A comprehensive public health approach with stakeholders working together and breaking down silos and barriers to access to all interventions is essential.

New, non-vaccine preventive products will also need an appropriate future pathway. Our current system of evaluating and recommending immunizations is built around vaccines. With several interesting antibody and inhibitor candidates in the pipeline, non-vaccine interventions will play an important role in routine immunization. Giving them due consideration will require the adaptation of our current system.

Balancing investments between preventing and treating infectious diseases is a persistent theme. Increasingly resistant infections in healthcare settings requires innovative antibiotics, but current hospital reimbursement mechanisms do not incentivize uptake of these products, therefore disincentivizing manufacturer research and development in the antibiotics space. Vaccines will play an important future role in preventing these infection diseases, but these candidates will face their own share of systemic barriers (see below).

3. Despite innovation, systemic barriers must be addressed.

Our current system of vaccine coverage in Medicare – which covers new vaccines under the prescription drug benefit with potential for patient out of pocket costs and no recognition of physicians – poses barriers to access for many new candidates. Likewise, Medicaid vaccine coverage and reimbursement adequacy is highly variable (states are not required to cover all vaccines without cost sharing in traditional Medicaid as they must in expansion programs). FQHC reimbursement, an important safety net setting for immunization, involves a patchwork of payers and reimbursement mechanisms. Little of this makes sense to those on the ground simply trying to get vaccines in the arms of patients.

Many in industry are focusing strategies on Integrated Delivery Networks (IDNs) given the higher degree of integration and coordination and absence of many traditional hassles between settings of care and payer and provider. While approximately 30 million lives can be reached through these models, ensuring optimal vaccination and protection will require addressing many underlying challenges that inconvenience patients in the rest of the system and impede vaccine access.