Patrick Adams writes…
Last week, US scientists convened in San Juan, Puerto Rico to assess the recent progress in controlling dengue fever, the world’s most rapidly spreading vector-borne disease. And the general tone of the three-day summit was one of cautious optimism. Harold Margolis, director of the dengue branch of the Centers for Disease Control and Prevention, summed it up, rather fittingly, with a baseball analogy: “We’ve finally gotten into the home stretch,” he told reporters. “But the home stretch can take a while”.
Indeed it can, especially when getting to “home” hinges on the development of a vaccine targeting all four serotypes of a wily, ages-old virus, the pathogenesis of which remains only poorly understood.
“It is really folly to predict when you’re going to have a vaccine,” National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci said at a press briefing after the conference. Fauci explained that if Sanofi-Pasteur’s Chimerix vaccine, currently the only candidate in Phase III trials, does well in ongoing efficacy trials, it could be available in as few as three years. If it fails, however, all bets are off as to any timeline.
Nonetheless, he said, scientists remain “reasonably optimistic” that things are headed in the right direction.
“There are some promising leads to provide the tools, resources and services that investigators throughout the world can utilize such as some of the genomic sequences of the virus, the various serotypes of the virus, data bases, core immunological facilities as well as a variety of other services,” he said. Fauci also alluded to several of the international collaborations focused on dengue research, “particularly those in the Americas, where this meeting was held”.
Indeed, San Juan was an appropriate place for a meeting on dengue control. Home to the CDC’s dengue branch, it is the site of some of the world’s most advanced work on dengue epidemiology, diagnostics and vector ecology. According to Margolis, the CDC works very closely with the Puerto Rican Department of Health. “We’re there all the time working together on both the surveillance and helping the health department in terms of their dengue control and prevention activities.”
Sanofi-Pasteur’s Chimerix is the most advanced candidate, but it’s not the only one. And according to Fauci, that’s a reflection of the US government’s increasing commitment over the past several years. NIAID dengue research funding went from $5 million in 2000 to $45 million in 2010, he said – and this despite “a relatively flat budget at the National Institutes of Health (NIH) in general and certainly at NIAI”. Of that, he added, 62% is spent on basic research; 24% on vaccines; 12% on therapeutics; and 2% on diagnostics.