From a global public-health standpoint, vaccines are considered some of the most important inventions in human history. Some notable achievements of vaccines include the eradication of smallpox and the near eradication of poliovirus. Approximately 300 million people died of smallpox between 1900 and 1980, and millions more were disfigured; however, by 1979, vaccination programs had completely wiped out the disease. In 1988, at the onset of a global campaign to end polio, there were 350,000 new cases per year; nearly 30 years later, only 22 cases were reported, and those were in war-stricken areas where immunization was not possible.
Approximately 300 million people died of smallpox between 1900 and 1980, and millions more were disfigured; however, by 1979, vaccination programs had completely wiped out the disease.
The past 20 years have seen a rejuvenation of innovation in vaccines, including vaccines for pneumococcus, rotavirus, human papillomavirus (HPV), and varicella. Indeed, in the 2017 annual letter, the Bill & Melinda Gates Foundation reported that 122 million children’s lives had been saved since 1990—and that vaccines were the biggest reason for this decline in childhood deaths.
These statistics are in line with the historically high growth rate of the vaccine industry—12 to 15 percent year on year over the past two decades—which is double the rate of the rest of the pharmaceutical industry. In the past ten years, the number of vaccines in the pipeline has also doubled, to 336 vaccines in 2017. And while vaccines have mostly focused on disease prevention to date, we expect them to play an increasing role in treatment (for example, treatment vaccines for HPV and hepatitis B) and thus have even greater impact in the future.
However, we have seen four signs of slowing innovation over the past five years:
1. Revenue growth has slowed to below 5 percent in the past five years (Exhibit 1, click through the interactive).
2. We are now seeing a flattening development pipeline (Exhibit 2, click through the interactive), with the share of growth from new vaccines launched down from almost 50 percent in 2011 to less than 15 percent in 2017—the lowest level in 20 years (Exhibit 3, click through the interactive).
3. We are recording higher attrition rates for vaccine-development programs relative to other biologics, with “fewer shots on goal,” meaning fewer vaccine candidates are advancing to clinical studies (Exhibit 4, click through the interactive).
4. There are remaining unmet needs cutting across multiple categories of vaccines, including diseases endemic to high-income regions (such as HIV and norovirus) and those endemic to low-income regions (for instance, tuberculosis and malaria).
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