99% effective, lasts a lifetime, costs <$1, and can save > 70,000 lives - What is it?

The Answer: A vaccine that for over 70 years has protected 99% of vaccinees against yellow fever, a deadly hemorrhagic viral infection spread by Aedes aegypti and Aedes albopictus female mosquitoes (males do not seek a bloodmeal, unlike females which need the blood protein for egg production).

Aedes aegypti female. Photo credit: James Gathany, CDC.

The Problem:  In case you are not aware, there is a yellow fever (YF) vaccine shortage problem in the DRC and Angola (and likely expanding elsewhere), and the on-going YF outbreak in the Africa region (see below).

Aedes albopictus female.
Photo credit: James Gathany, CDC.

One key objective in “implementation science” is to “…investigate and address major bottlenecks (e.g., social, behavioral, economic, management) that impede effective implementation, test new approaches to improve health programming, as well as determine a causal relationship between the intervention and its impact.”

The YF vaccine shortage offers a prime example of an intervention that is ~99% percent effective, likely producing lifelong immunity, fairly cheap at < $1 per dose in Africa, yet is not accessible to populations that need it, resulting in >70,000 unnecessary deaths annually.  

I recently spoke with Institute Pasteur of Dakar leadership a few weeks ago during my visit to Dakar.  

They are at max YF vaccine production capacity (10 million doses per year) with their current facility (one of 4 in the world) which will need to shut down for several months for renovations to build a newer production unit.

Meantime, the YF shortage continues which Jack Woodall, retired virologist formerly with CDC and WHO, says, “I hate being alarmist, but this is something I’m really panicking about.”

The Solution: This implementation problem should give one pause when an Ebola or Zika vaccine is a “proposed solution” to prevent these devastating diseases, and yet the YF “known solution” cannot meet current demand, even with a diluted 1/5 dose in the interim. 

Considered as an opportunity, this YF implementation science issue would make for a really interesting and usesful thesis or dissertation topic for a UNC student!

Any takers?

Jim