Pneumococcal vaccine

Pneumococcal vaccines are subunit vaccines against the bacterium Streptococcus pneumoniae. Their use can prevent some cases of pneumonia, meningitis, and sepsis. There are two types of pneumococcal vaccines: conjugate vaccines and polysaccharide vaccines. They are given by injection either into a muscle or just under the skin. The World Health Organization (WHO) recommends the use of the conjugate vaccine in the routine immunizations given to children. This includes those with HIV/AIDS. The recommended three or four doses are between 71 and 93% effective at preventing severe pneumococcal disease. The polysaccharide vaccines, while effective in healthy adults, are not effective in children less than two years old or those with poor immune function. These vaccines are generally safe. With the conjugate vaccine, about 10% of babies develop redness at the site of injection, fever, or change in sleep. Severe allergies are very rare. Whole-cell vaccinations were developed alongside the characterisation of the subtypes of pneumococcus from the early 1900s. The first polysaccharide vaccine (tetravalent) was developed in 1945. The current 23-valent polysaccharide vaccine was developed in the 1980s. The first conjugate vaccine (heptavalent) reached market in 2000. It is on the World Health Organization's List of Essential Medicines.

Medical uses

Different pneumococcal vaccines protect against different serotypes. In particular, their coverage of antibiotic‐resistant serotypes varies. Early vaccines did not cover certain serotypes, which later became a major contributor to antibiotic‐resistant infections. Subsequent vaccines are designed to address this gap.

Recommendations

Worldwide Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP) is a program to accelerate the evaluation and access to new pneumococcal vaccines in the developing world. PneumoADIP is funded by the Global Alliance for Vaccines and Immunization (GAVI). Thirty GAVI countries have expressed interest in participating by 2010. PneumoADIP aims to save 5.4 million children by 2030. A pilot Advance Market Commitment (AMC) to develop a vaccine against pneumococcus was launched by GAVI in June 2009 as a strategy to address two of the major policy challenges to vaccine introduction: a lack of affordable vaccines on the market and insufficient commercial incentives to develop vaccines for diseases concentrated in developing countries. Under the terms of an AMC, donors make a legally binding guarantee that, if a future vaccine is developed against a particular disease, they will purchase a predetermined amount at an agreed-upon price. The guarantee is linked to safety and efficacy standards that the vaccine must meet and is structured to allow several firms to compete to develop and produce the best possible new product. AMCs reduce risk to donor governments by eliminating the need to fund individual research and development projects that may never produce a vaccine. If no company produces a vaccine that meets the predetermined standards, governments (and thus their taxpayers) spend nothing. For the bio-pharmaceutical industry, AMCs create a guaranteed market, with a promise of returns that would not normally exist. For developing countries, AMCs provide funding to ensure that those vaccines will be affordable once they have been developed. It is estimated that the pneumococcal AMC could prevent more than 1.5 million childhood deaths by 2020. Doctors Without Borders has criticized GAVI's pneumococcal AMC for not encouraging innovation, discouraging competition from new market entrants, and raising vaccine costs. They said that it had allowed Pfizer and GlaxoSmithKline to maintain a duopoly while making it more difficult for the Serum Institute of India to sell their cheaper vaccine. The duopoly allowed price discrimination; somewhat higher prices for GAVI, and unaffordable prices (about ten time the GAVI price) for middle-income countries too rich for GAVI aid. The pneumococcal program (unlike previous market-shaping programs from GAVI) did not include any mechanism for increasing competition. The Humanitarian Mechanism makes the pneumococcal vaccine available to humanitarian actors (but not governments) at a lower-than-normal price during humanitarian emergencies.

Belgium The national vaccination program started vaccinating newborns in 2004 with the 7-valent pneumococcal conjugate vaccine (PCV 7). This was changed into the 13-valent conjugate (PCV 13) in 2011. The switch to the 10-valent conjugate (PCV 10) was made in July 2015 in Flanders and May 2016 in Wallonia. In late 2020 a start was made with the vaccination of care home residents with the 23-valant pneumococcal polysaccharide vaccine (PPV 23).

Canada The Public Health Agency of Canada's general recommendations are the 13-valent pneumococcal conjugate vaccine (PCV 13) vaccine for children aged 2 months to 18 years and the 23-valent pneumococcal polysaccharide vaccine (PPV 23) vaccine for adults.

India In May 2017, the Government of India decided to include the pneumococcal conjugate vaccine in its Universal Immunization Programme.

The Netherlands The national vaccination program started including the pneumococcal vaccine for newborns in April 2006. The Health Council advised in 2018 that those who are over the age of 60 should also be vaccinated on a 5-year recurring schedule. The resulting program, NPPV, started at the end of 2020. Health authorities reported in December 2020 that former COVID-19 patients also have an indication for this vaccine because of the damage their lungs incurred. Vaccinating this group is not part of the NPPV program.

New Zealand The National Immunisation Schedule first introduced pneumococcal vaccination in 2006, starting with PCV7 for high-risk individuals. As of December 2022, the schedule now includes three doses of PCV13 for all infants, given at 6 weeks, 5 months and 12 months of age. A high-risk schedule including a fourth dose is offered for infants with an eligible medical condition, with the additional dose given at 3 months of age. PPV23 is not included in the routine immunisation schedule, but is funded for adults and children over 2 years of age at increased risk of invasive pneumococcal disease.

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