September’s historic dialogue between President Obama and Iran’s President Rouhani together with calls to seek constructive engagement opens the door to a little known but powerful foreign policy instrument, which could simultaneously create new life-saving vaccines.
The cornerstone of vaccine diplomacy is two or more countries putting aside their ideological differences to engage in an intense and focused scientific collaboration and produce an urgently needed technology that serves humanity.
In modern times, the first triumph of vaccine diplomacy occurred in the decade that began following the death of Stalin in 1953. Together, Dr. Albert B. Sabin in the U.S. and his Soviet virology counterpart each received back channel permission to jointly develop and then test a prototype oral polio vaccine on more than 10 million children in the USSR. The successful results led to the licensure of the oral polio vaccine in 1962, the elimination of polio in the U.S. in 1979, and ultimately the eradication of polio in all but three countries. Similar international cooperation with the Soviets to improve the vaccine was a key step resulting in the global eradication of smallpox.
Both the U.S. and Iran are under serious threat from several neglected tropical diseases that have emerged in our countries because of a variety of factors, including extreme poverty, urbanization, population growth, and possibly climate change.
Today, both the U.S. and Iran are under serious threat from several neglected tropical diseases that have emerged in our countries because of a variety of factors, including extreme poverty, urbanization, population growth, and possibly climate change. They include dengue fever, a mosquito-transmitted viral infection that results in hemorrhage, shock, and death. Dengue has recently emerged on the U.S. Gulf Coast and in southeastern Iran neighboring Pakistan. Kinetoplastid infections such as Chagas disease, a cause of severe heart disease, are now widespread among the poor in Texas and the southern U.S. where over 300,000 cases occur, while leishmaniasis, a severely disfiguring skin disease, affects 100,000 or more Iranians, and has also emerged in Texas and Oklahoma. Worm infections are still commonly found in impoverished areas in both countries, and where infections overall account for a significant amount of the health care burdens.
Both the U.S. and Iran would benefit enormously from research leading to the development and joint testing of vaccines against these neglected tropical diseases. Our recent investigations reveal that the extreme poor living in middle income and wealthy countries suffer as much from these conditions as those in the poorest countries in Africa, so that all of the world’s people living in poverty would benefit from new vaccines. Unfortunately because there is no major commercial market for neglected tropical disease vaccines (with the exception of dengue) the multinational pharmaceutical companies are not attempting to produce them.
In Iran, both fundamental and epidemiological research is conducted on a number of neglected tropical diseases including Crimean-Congo hemorrhagic fever, West Nile virus infection, brucellosis, leptospirosis, echinococcosis, fascioliasis, and intestinal worms. Iranian scientists have made several attempts at vaccines for some of their tropical infections, including prototype leishmaniasis vaccines made from live or killed whole parasites. However the efficacy and safety of such vaccines has thwarted further development along those lines. Nascent efforts to develop a safer and more effective vaccine through advanced genetic engineering—so called recombinant vaccines—are beginning, but a U.S. collaboration to accelerate their development will be needed. In addition, in order to enhance the efficacy of a recombinant leishmaniasis vaccine there may be requirements to add novel substances that increase the body’s immune response, but the best of these immunostimulants are currently only available in the West and can’t easily (or possibly legally) be shipped to Iran. Ultimately such steps would help to ensure future success in terms of producing a vaccine that would be widely used in the Middle East and adjoining regions of North Africa and Central Asia.
Indeed, such vaccines could be developed in the non-profit sector through joint activities of U.S.-based product development partnerships through support of the Gates Foundation, the National Institutes of Health, and other sources, together with Iranian institutions, such as the Tehran University and the Razi Serum and Vaccine Institute. However, meaningful scientific collaboration to actually produce such products is not currently practical given both financial and political constraints, including the need to overcome fears of potentially producing so-called “dual use” technologies. Therefore, high-level discussions need to first take place between the U.S. Department of State and its Iranian counterpart to actively encourage and support joint vaccine development, and then implement steps to effectively shape policy and launch the first stages of vaccine product development, including antigen discovery, process development, pilot manufacture, regulatory filing, and initial clinical testing.
Vaccine diplomacy’s modern day track record is impressive, having led to the global eradication of smallpox and the near-elimination of polio. It occurred because the U.S. and USSR put aside their differences during the Cold War. We now have an opening and potential path to do the same between the U.S. and Iran.