A World Health Organisation (WHO) study published this week in The Lancet’s eBioMedicine names 17 pathogens – that regularly cause diseases in communities – as top priorities for new vaccine development.
The study is the first global effort to systematically prioritise endemic pathogens based on criteria that included regional disease burden, antimicrobial resistance risk and socioeconomic impact.
The research reconfirms longstanding priorities for vaccine research and development (R&D), including for HIV, malaria, and TB, three diseases that collectively take nearly 2.5m lives each year.
The study also identifies pathogens like Group A streptococcus and Klebsiella pneumoniae as top disease control priorities in all regions, highlighting the urgency to develop new vaccines for pathogens increasingly resistant to antimicrobials.
The WHO asked international and regional experts to identify factors most important to them when deciding which vaccines to introduce and use. The analysis of those preferences, combined with regional data for each pathogen, resulted in top 10 priority pathogens for each region.
The regional lists were then consolidated to form the global list, resulting in 17 priority endemic pathogens for which new vaccines need to be researched, developed and used.
The list provides an equitable and transparent evidence base to set regional and global agendas for new vaccine R&D and manufacturing, and provide a clear direction for where vaccine R&D could have the most impact.
This global prioritisation exercise for endemic pathogens complements the WHO R&D blueprint for epidemics, which identified priority pathogens that could cause future epidemics or pandemics like Covid-19 or severe acute respiratory syndrome (SARS).
Priority endemic pathogens list
Vaccines for these pathogens are at different stages of development.
Pathogens where vaccine research is needed
• Group A streptococcus
• Hepatitis C virus
• HIV-1
• Klebsiella pneumoniae
Pathogens where vaccines need to be further developed
• Cytomegalovirus
• Influenza virus (broadly protective vaccine)
• Leishmania species
• Non-typhoidal Salmonella
• Norovirus
• Plasmodium falciparum (malaria)
• Shigella species
• Staphylococcus aureus
Pathogens where vaccines are approaching regulatory approval, policy recommendation or introduction
• Dengue virus
• Group B streptococcus
• Extra-intestinal pathogenic E. coli
• Mycobacterium tuberculosis
• Respiratory syncytial virus (RSV)
Study details
Identifying WHO global priority endemic pathogens for vaccine research and development (R&D) using multi-criteria decision analysis (MCDA): an objective of the Immunisation Agenda 2030
Mateusz Hasso-Agopsowicza, Angela Hwangb, Maria-Graciela Hollm-Delgadoa et al.
Published in The Lancet eBioMedicine on 4 November 2024
Summary
Background
To date, global priorities for new vaccine R&D have not been systematically identified for endemic pathogens. As part of Immunisation Agenda 2030 (IA2030), we have systematically identified priority endemic pathogens for new vaccine R&D based on country and regional stakeholder values to address this need.
Methods
MCDA surveys targeting policy makers and immunisation stakeholders in each World Health Organisation (WHO) region were used to weight eight criteria for prioritisation. Applying those weights to regional pathogen data yielded regional top 10 pathogen lists, which are intended to inform regional deliberations on R&D priorities. The regional top 10 lists were combined into an IA2030 global priority list. To inform R&D, use cases for new vaccines and monoclonal antibodies were identified, then categorised in terms of the activities needed to accelerate progress.
Findings
In five out of six WHO regions, Annual deaths in children under five and Contribution to antimicrobial resistance were the most heavily weighted criteria. How participants weighted the criteria was not associated with their region, biographical characteristics, or areas of expertise. Five pathogens were common priorities across all regions: M tuberculosis, HIV-1, K pneumoniae, S aureus, and Extra-intestinal pathogenic E coli. Six pathogens were priorities in single regions. Combining regional top ten lists provided a global list of 17 priority pathogens for new vaccine R&D. Thirty-four distinct use cases were identified for new products targeting these pathogens. While most are in the “Advance product development” category, ten are in the “Research” category and seven are in the “Prepare to implement” category.
Interpretation
These priorities for new vaccine R&D will help stakeholders better respond to regional and country needs. The use cases will inform R&D and enable monitoring of R&D under IA2030.
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