Mary Chris Jaklevic is a freelance health reporter and regular contributor to this blog. She tweets as @mcjaklevic.
I was in the waiting room of a medical office last week when I noticed this teaser on the cover of an old beauty magazine: “Acne vaccine?”
I flipped through the April 2016
issue of Allure to find a short blurb about a University of California, San Diego, researcher who “has been working on two different acne-targeted vaccines in partnership with the drug firm Sanofi.” It said one vaccine would immunize children against developing acne as teenagers, and the other would fight existing acne. The magazine has since ran an updated version online, which you can read here.
There was no information in that original piece about whether these vaccines had been proven safe and effective, when they might be available, and how much they might cost.
An internet search found reports that they haven’t been tested on humans, only on biopsied skin. San Diego’s NBC affiliate speculated that “if clinical trials (on actual humans) start soon, the vaccine could be available in three to five years.”
In other words, kids, don’t raise your hopes of averting a breakout before next year’s prom. Yet this unproven vaccine has drawn quite a bit of coverage, including articles in the Huffington Post, Business Insider, and the UK’s Independent.
The unblemished truth is that experimental vaccines grab our attention, and not just when they promise to improve our looks. Just in recent months, unproven vaccines for breast cancer, high cholesterol, malaria and melanoma have made headlines. None of these vaccines was vetted in a large-scale clinical trial, like the one that recently showed a vaccine to be highly effective against one strain of the Ebola virus.
Too often this coverage has a positive spin, liberally using terms such as “game changer” and “hope” without acknowledging that most trial vaccines never pan out.
Take HIV. Three decades ago, it was widely expected that a vaccine would be created to quash its deadly spread. That hasn’t happened.
You don’t have to look far to find examples of hyped vaccines that crashed and burned. In the late 2000s, NicVAX, a vaccine to help people quit smoking, garnered hopeful media attention before it failed to work in a late-stage clinical trial.
In 2008, Dr J. Leonard Lichtenfeld, deputy chief medical officer of the national office of the American Cancer Society, blogged about exuberant reaction to a kidney cancer vaccine called vitespen, which has since faded to near oblivion, though it’s approved for use in Russia.
At the time, Lichtenfeld wrote: “There is something that fascinates the public about the possibility of treating cancer with a vaccine. Perhaps that explains why so many abstracts and journal articles about the latest cancer vaccine research find their way into our newspapers, magazines and television reports.”
In an interview, Lichtenfeld said vaccines continue to draw public interest. “The concept of something that’s simple, straightforward and effective is very appealing to the consumer public,” he said. “I think the media buys into that.”
The mere announcement last year of U.S. clinical trials of a lung cancer vaccine developed in Cuba, called CimaVax, has generated a cascade of media attention that Lichtenfeld called “overstated.”
HealthNewsReview.org Managing Editor Kevin Lomangino blogged about one Fox affiliate’s coverage, which prematurely called the vaccine a “medical breakthrough that could literally save millions of lives.”
Harnessing the body’s immune system using vaccines has “been part of cancer research for decades,” Lichtenfeld said. But “when it comes to actual demonstrated clinical benefit, we don’t have much to show for that,” with vaccines for Hepatitis B and HPV being notable exceptions.
“One has to always be highly skeptical about any claims that are made about a therapeutic vaccine,” he said.
There are many reasons why vaccines fizzle. “We believe that every major disease will eventually have its vaccine,” said a 2015 editorial in the journal Frontiers in Microbiology. The journal has collected input on the topic of vaccine failure. “However, if we consider major infectious agents, such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), and malaria, despite many years of effort, billions of dollars spent and countless animal lives sacrificed, no vaccine is available to protect against these infections.”
In other words, it’s complicated science, and that’s why stories about experimental vaccines need a strong shot of caution. A 2014 story about a malaria vaccine by NPR science correspondent Richard Harris demos this beautifully:
“For the first time in decades, researchers trying to develop a vaccine for malaria have discovered a new target they can use to attack this deadly and common parasite.
Finding a target for attack is a far cry from having a vaccine. And the history of malaria vaccines is littered with hopeful ideas that didn’t pan out. Still, researchers in the field welcome this fresh approach.
Over the past four decades, researchers have developed about 100 potential vaccines for malaria. The best of the bunch is still only modestly successful in children, who are at greatest risk for the disease.”
Often there’s a publicity machine at work behind the scenes, as vaccine developers attempt to raise money to fund research or push for accelerated approval. Those dynamics need to be brought to light.
Take a study published last week suggesting that a vaccine for meningitis might be useful in fighting gonorrhea. It was widely covered despite the fact that there’s been no clinical trial. The observed data in New Zealand resulted in an estimate that the vaccine was effective just 31 percent of the time. (See our review of a STAT story on this.)
Of six mainstream stories I read, only one mentioned that the study was funded by industry or alluded to the fact that the manufacturer, GlaxoSmithKline, has been actively trying to expand the market for its vaccine, called Bexsero. STAT was the exception, and it followed up a few days later with an interview with a GSK official on the company’s intent to “move as quickly as we can” to get the vaccine approved for gonorrhea despite the lack of a clinical trial.
When vaccines make it to market, news stories should report their limitations. Vaccines may be less than 100 percent effective, require multiple doses, lack testing in children, protect against only certain strains of a bacteria or virus, or offer an uncertain length of immunity.
Public acceptance can be another hurdle, with one example being slow uptake of the HPV vaccine due in part to confusion about its utility.
Because vaccines are typically given to healthy people, there’s a high bar for safety. A Lyme disease vaccine called LYMErix was withdrawn in 2002 amid plummeting sales attributed to safety concerns, even though the FDA found no convincing evidence of harm.
While media coverage of LYMErix was initially positive–with journalists urging people in tick-prone areas to ask their doctor about it–that coverage quickly swung negative when reports of adverse reactions arose, wrote researchers at Boston Children’s Hospital. They said vaccines “require that we may need to take a small risk of potential side-effects in order to avoid the potential of more serious health outcomes associated with the disease. Given this up-front risk, vaccines generally must present exceptionally high safety profiles.”
While vaccines are a cornerstone of prevention, they shouldn’t be portrayed as a panacea, said Preeti Malani, M.D., a professor of medicine at the University of Michigan who’s a regular HealthNewsReview.org contributor.
Journalists should ask about cost-effectiveness and whether public health measures are being optimally funded, particularly for the populations most at risk, she said. If a vaccine is expensive, it may be unlikely to reach those in poverty who need it most.
“Would an expensive vaccine with low efficacy be where we want to put our public health dollars? You could buy a lot of education for that,” Malani said. The availability of a vaccine — such as for gonorrhea — might also backfire by prompting riskier behavior, she added.
“You can probably do the public more good by writing that gonorrhea is still a problem and it’s resistant to antibiotics and education is really important,” she said. “I think it’s very much a coin flip whether this (vaccine) will ever prevent gonorrhea.”