Professor Adrian Hill has been studying the immune system and malaria susceptibility in African children for years. We asked him about his latest findings in the development of vaccines against malaria.
Professor Hill develops vaccines against malaria based on inducing cellular immune responses (T lymphocytes) instead of the more commonly used stimulation of antibodies. Prophylactic vaccines developed in Oxford are now showing great promise in clinical trials.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: Hello Adrian. Why is it important to research vaccines in a University rather than in a company?
AH: Well these days developing a vaccine takes a long time, typically 15 years from the idea to actually licensing the vaccine. We don't do all of that process in the University but it's really important that the early stage of vaccine research and early clinical trials are done in a setting where we can test out lots of new ideas and find the best way to vaccinate against some of these very difficult diseases. So we would typically take the vaccine from the idea to the bench to pre-clinical and then phase I and phase II clinical trials, and it's only at that stage that one of the large vaccine companies would be interested in licensing that vaccine and developing it and taking it forward for market supply.
Q: How much progress has been made producing a vaccine for malaria?
AH: Malaria's a good example of something that's very difficult to make a vaccine for and where lots of different vaccine concepts have to be tested. That's where research and academia comes in and we can try a whole variety of different vaccine approaches to try and find out what would be best, and of course it is difficult because we have no vaccines that work against any parasitic disease of humans, but malaria is showing the most signs of progress in that we have vaccines that are now protecting a significant number of people in clinical trials, not enough, but we are rapidly improving those vaccines so in phase II trials we can see some efficacy in over half the people with two completely different types of vaccine today.
Q: Is research on malaria adequately funded considering the number of people affected compared to degenerative illnesses of the rich world?
AH: For years people have debated the big problem of how you incentivize, particularly companies, to invest in Malaria vaccine design and development. We are talking about a huge amount of money, probably close to a billion pounds, from the idea to market supply of the vaccine. And that's a big risk for a company because we know it's very difficult and we know it's going to take a long time, and crucially we know that at the end of the day the people who need that vaccine most are not able to pay even a modest price for it. So we need a different mechanism and lots of thought has gone into this, but essentially it means that governments and charities have to fund most of that vaccine development process, and it's only when the vaccine is clearly working and going to work in the real world that private companies will invest in manufacturing that vaccine and supplying it. So in a way the difficult bit has to be done before it gets taken up by a company.
Q: How is your approach to this research different to other researchers?
AH: So what we're doing in our vaccine programmes is something fundamentally different to nearly all other vaccines. We're trying to make vaccines work by inducing cellular immunity not inducing antibodies and nearly every vaccine you can buy today works by inducing antibodies. So why are we doing something different? Well, we know for Malaria that by inducing cells that can kill the parasite inside infected human liver cells, possibly blood cells, we can get better protection than through the traditional way of inducing antibodies. So those vaccines are now showing promise and we believe that's the best way of vaccinating against malaria.
Q: So happens after these trials have been completed in Oxford?
AH: With vaccines for malaria of course the people we really want to vaccinate eventually are those African children; we know about a million children a year die from malaria. So already we've taken some of these vaccines into clinical trials in both West Africa and East Africa, that's at Kilifi in Kenya. There we've seen very promising results: good safety, good immune responses and we're testing those vaccines now to see if they are effective at protecting children in Kilifi against malaria.
Q: Could your approach be used to develop vaccines against other illnesses?
AH: What we're doing in malaria is also being developed for a whole variety of other infections- hepatitis C, (which is also a liver infection) tuberculosis, HIV and even cancer has this same major challenge of getting cellular immunity to work with vaccination. People are trying all sorts of ideas but the approach that we're using in malaria does seem to be one of the most promising of those out there.
Q: Finally Adrian, how does your research fit into Translational Medicine within the department?
AH: So we think that vaccinology is a great example of Translational Medicine. You can't do vaccinology without trying to translate your findings into real products either for veterinary medicine or for humans. So what we're doing is taking vaccines that are initially designed in the University and finding the best ones to take into clinical trials, and it's only when you're really in the clinic testing this on people that you get the answers about whether a vaccine is going to be useful or not. So this is a quintessential translational activity.