Vaccine Confidence Project

About Us

What is the Vaccine Confidence Project™?

Vaccine confidence concerns the belief that vaccination – and by extension the providers and range of private sector and political entities behind it – serves the best health interests of the public and its constituents. The Oxford English Dictionary defines confidence as “the mental attitude of trusting in or relying on a person or thing”. In light of that, we are not examining the well-studied domain of supply and access barriers to vaccination, but rather what is typically called the “demand” side of immunisation.

However, our focus on confidence takes the “demand” rubric a step further than the more traditional notion of building demand through increasing knowledge and awareness of vaccines and immunisation to understanding what else drives confidence in vaccines, and the willingness to accept a vaccine, when supply, access and information are available. In other words, understanding vaccine confidence means understanding the more difficult belief-based, emotional, ideological and contextual factors whose influences often live outside an immunisation or even health programme but affect both confidence in and acceptance of vaccines.

VCP Mission

The purpose of the project is to monitor public confidence in immunisation programmes by building an information surveillance system for early detection of public concerns around vaccines; by applying a diagnostic tool to data collected to determine the risk level of public concerns in terms of their potential to disrupt vaccine programmes; and, finally, to provide analysis and guidance for early response and engagement with the public to ensure sustained confidence in vaccines and immunisation. This initiative also defines a Vaccine Confidence Index™ (VCI) as a tool for mapping confidence globally. 1)

Vaccine Confidence Project™ Research Team

The Vaccine Confidence Project™ Team is an interdisciplinary and international group of researchers with expertise in anthropology, digital analytics, epidemiology, policy, psychology and more. Vaccine confidence is not a one-dimensional issue, and so the VCP™ cuts across disciplines to produce innovative research and policy recommendations.

Prof. Heidi J. Larson, PhD, is an anthropologist and Director of The Vaccine Confidence Project (VCP); Professor of Anthropology, Risk and Decision Science, Dept. Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM); Clinical Professor, Institute of Health Metrics & Evaluation, University of Washington; and Chatham House Centre on Global Health Security Fellow. Dr. Larson previously headed Global Immunisation Communication at UNICEF, chaired GAVI’s Advocacy Task Force, and served on the WHO SAGE Working Group on vaccine hesitancy. The VCP is a WHO Centre of Excellence on addressing Vaccine Hesitancy.

Prof. Larson’s research focuses on the analysis of social and political factors that can affect uptake of health interventions and influence policies. Her particular interest is on risk and rumour management from clinical trials to delivery – and building public trust. She served on the FDA Medical Countermeasure (MCM) Emergency Communication Expert Working Group, and is Principle Investigator of the EU-funded (EBODAC) project on the deployment, acceptance and compliance of an Ebola vaccine trial in Sierra Leone.

Prof. Heidi Larson has recently joined the Centre for the Evaluation of Vaccination (CEV) (University of Antwerp) as associate professor, as the CEV at the Antwerp University will host the European regional Office of the Vaccine Confidence Project as of May 15, 2019, and will closely collaborate with VCP partners at European level on implementing the Vaccine Confidence Index and developing and evaluating interventions to address vaccine hesitancy.

Dr. Pauline Paterson is an Assistant Professor and co-director of the VCP. Dr. Paterson, together with Dr. Larson, established a global, internet-based information surveillance system on public concerns around vaccines and vaccination programmes. The Vaccine Confidence research group has been conducting qualitative research on specific vaccine confidence issues and risk perceptions globally since 2010.

Dr. Leesa Lin is an Assistant Professor at LSHTM and leads the VCP’s work in the Asia region. She specialises in decision and behavioral sciences, social epidemiology, and implementation science in the context of public health emergency preparedness and response. Since 2008, Leesa's work has centered around the assessment of public health system performance, emergency risk communications, and social determinants of health in the response to large-scale public health emergencies including earthquakes, water crises, and acute infectious disease outbreaks (e.g. H1N1, MERS, and COVID-19). Dr. Lin conducted knowledge synthesis in support of the WHO guideline development on emergency risk communication.

Dr. Lin's current research focuses on social science response to epidemic outbreaks, community and vaccine preparedness, and antibiotic resistance. Knowledge generated from her research has been translated into guidelines and programmes. She is currently a member of the Social Science Research Working Group for the WHO Blueprint for 2019 novel Coronavirus Global R&D Preparedness.

Sarah Malycha is Communications and Partnerships Lead at the VCP. She brings to the role twenty years’ experience in developing and implementing high profile political, corporate and social impact campaigns. An expert in strategy, message development and implementation, content development, digital, social and traditional media, Sarah is experienced in designing communications systems founded upon research and measuring effectiveness by the campaign’s attitudinal and behavioural effect on target audiences. Prior to joining the VCP, Sarah worked as Head of Brand at the Conservative Party during the 2015 General Election, and Head of Digital and Creative at C|T|F Partners.

Robert Kanwagi is a Research Fellow for the VCP and leads projects in the Africa region, including the Africa Centres for Disease Control Working Group. He has a professional background as a social worker and public health professional and holds a master’s degree in Public Health. Robert is currently working with the international COVID-19 vaccine acceleration program COVAX, as well as being a member of GAVI's Health Systems and Immunization Strengthening Team. He formerly worked with World Vision International as program coordinator of their Ebola vaccine project and with several of their other public health programs in Africa.

Alex de Figueiredo conducts mathematical and statistical analyses for the Vaccine Confidence Projec. Alex’s background lies in physics (MSci, Imperial College) and mathematical and statistical modelling (PhD, Imperial College; MSc, University of Oxford) and harnessing tools from these fields to model vaccine confidence data. Alex’s research interests lie in probing ties between socioeconomic data and national coverage rates and vaccine confidence levels; on forecasting national and sub-national immunisation rates; and on the large-scale inference of vaccine attitudes in the absence of survey data. Alex holds a doctorate from Imperial College London with the PhD thesis: “A mathematical assessment of the global state of vaccine coverage and confidence.”

Emilie Karafillakis is a Research Fellow for the VCP. She has a background in public health, infectious disease control, and health systems and policies and holds a Master’s degree in the Control of Infectious Diseases from LSHTM. Her work focuses on understanding determinants of vaccine hesitancy in European populations, including healthcare workers, and strategies to effectively address concerns about vaccination. Emilie is also a PhD Candidate at the school – her research focuses on adolescent girls’ decision-making processes with regards to HPV vaccination in France. (Merk's Gardasil vaccine)

Ed Pertwee conducts media monitoring and analysis for the VCP. He joined the team as a Research Fellow in 2020, having previously been an ESRC Postdoctoral Fellow at the London School of Economics. A sociologist by training, his research explores contemporary forms of reactionary politics and anti-science, with a particular focus on conspiracy theories. Ed works at the intersection of political sociology and digital sociology, combining qualitative research methods with new techniques of digital data analysis to investigate how reactionary political movements mobilise online and offline. His current research investigates organised opposition to vaccination and its relationship to populist, far right and conspiracist political cultures. Previous research projects have covered areas such as networked racism and misogyny, right-wing digital ecosystems and alternative media platforms. He holds a PhD in Sociology from the London School of Economics.

Simon Piatek is a Digital Media Researcher and an experienced strategic digital practitioner, with 10+ years’ experience of working in the commercial media and higher education industry. Simon joined LSHTM as a Research Fellow (Digital Lead) for the VCP in 2020. Simon has extensive experience of managing digital and social media projects with a particular focus on social listening, audience engagement and digital content production. Simon has led global communications teams and has experience of project-managing complex campaigns and initiatives. Simon’s other interests include Social Network Analysis, Fake News and Disinformation narratives, OSINT and SOCMINT. Simon has expertise in understanding and working with social media platforms relevant for ECA region, as well as proven experience in monitoring and the analysis of social media interactions in the local languages. He has a Masters in Social Research (Goldsmiths University) and PhD in Digital Media, Digital Methods, Social Listening, and Twitter Trends (University of Warwick).

Izzy Goldstein is a strategic communications manager and digital campaigner. She has a professional background in creating and coordinating integrated policy and behaviour change campaigns with a focus on politics, social issues and counter polarisation. In her role at the VCP, she works with the team and external partners to help develop, amplify and optimise creative and academic content across media channels, as well as managing ongoing projects and the production of new grant proposals. Before joining the VCP Izzy helped lead The Zero Carbon Campaign, supporting development across all aspects of the campaign, including political and public engagement strategy, creative, digital and design.

Fiona Sun is a Research Fellow for the VCP. She received an Honours Bachelor’s degree in Global Health and Biology from the University of Toronto and a Master’s Degree in Epidemiology from LSHTM. Prior to joining the VCP, Fiona has worked with the World Health Organisation, UNAIDS, the Ministry of Health of China, China National Centre for Cardiovascular Diseases, and the Department of Public Health at Beijing University. Her previous work involved evaluating multiple vaccination programs and health insurance schemes in China; developing maternal and child nutrition profiles of Central and Western China; implementing a Chinese- African Health Cooperation Programme affiliated malaria eradication project in Malawi; as well as contributing as a writing group member for a Lancet Commission report on China’s Primary Health Care. Fiona’s work at VCP aims to monitor vaccine confidence in China and assess the capacity of the Chinese public health system to deliver current and planned vaccines.

Clarissa Simas is a Psychologist and Research Fellow for the VCP. She has a professional background in Global Health and Development and holds an MSc in Medical Anthropology from University College London (UCL) and a BSc in Psychology from University of Brasília. She is currently investigating social impacts of the Zika epidemic in Brazil, the Ebola vaccine trial deployment, acceptance and compliance, impact of new digital technology in health communication, public acceptance of health interventions, with a particular focus on vaccine confidence in South America, outbreak preparedness, risk perception and its impact in decision making, psychogenic adverse reactions to vaccines globally, and have investigated acceptance of HIV/STI prevention interventions amongst European youth. Her research interests include risk perception, rumours, trust and mistrust dynamics, health psychology, vaccines, Medical Anthropology, Postcolonialism, structural violence, digital epidemiology, community engagement, health communication, and new social media.

(Don't miss Clarissa Simas role in BBC special Unvaccinated - Naked Emperor watched it twice and did a review so we don't have to.

Professor Fry says the vaccine has received some extreme responses around the UK. Cue comedy British “extreme” responses of people shouting “Shame on you!” and an old man knocking over a sign. Hannah first discusses her challenge (of the upcoming week) with Clarissa Simas, a psychologist from the Vaccine Confidence Project. Strangely she didn’t interview Clarissa’s colleague from the Vaccine Confidence Project! That would have made more interesting TV. In this conversation, triple jabbed Hannah shows how unbiased this show is going to be. “What did we get so wrong that millions of people still don’t want to take the vaccine?” she asks.)2)

Many more staff and PhD students 3)

Current Projects

The Vaccine Confidence Project™ conducts research all around the world on a range of vaccines. Below, you can find more information about current and past projects.4)

Facebook research award on misinformation and polarization

The Vaccine Confidence Project has been selected as one of the winners of Facebook’s research awards on misinformation and polarization

The 2019/2020 Covid-19 pandemic is not just a health problem – it is also fuelling an infodemic on an unprecedented scale. Since the beginning of the outbreak, the digital media ecosystem has been flooded with “alternative explanations” and conspiracy theories.

The current attention to misinformation is still very focused on public social media such as Facebook and Twitter. There is however a growing body of evidence that private messaging services such as Telegram, WhatsApp or Link are just as likely to spread misinformation as publicly available social networks.

Rumours can start on a private social network, go viral in minutes, and only then spread to public social networks. The closed nature of private social networks makes it impossible to identify the origin of rumours as not even the service’s employees can read the content of messages that were not intended for them. The only window of opportunity to see how misinformation spreads on private social networks is to ask their users to share it with researchers when they see it.

Heidi Larson, the director of the VCP said: “We are thrilled to learn that we are one of the winners in this highly competitive call. I am confident that our proposed innovative approach to investigating misinformation networks has the potential to create a truly transformative tool to inform misinformation intervention.” And added “our vision is to become a world leader in methodological innovation in the space of health misinformation and we will continue to working on innovative projects, such as this, that aim to push the methodological boundaries and address pressing social and policy issues.”

The aim of “The contagion of misinformation” project is to understand how health misinformation around Covid-19 spreads in the context of private social media and to develop strategies to identify misinformation that is most likely to transition from Private Social Messaging into the Public Social Media/domain. Simon Piatek, digital lead at the VCP said: “This study draws on traditional social science methods of surveys and content analysis to develop an innovative methodological approach, capturing misinformation and tracking its spread on private social networks using crowdsourcing tool with the aim to see how/if it then migrates to public social media. The entire VCP team is thrilled to be able to start working on this innovative project.”

For this project, the VCP will be working with Premise – a global leader in crowdsourcing that combines the power of a global network of two million on-the-ground contributors with industry-leading data science and machine learning. Maury Blackman, CEO of Premise Data said: “Misinformation surrounding healthcare, particularly in the context of the global COVID-19 pandemic, can lead to serious harm. Premise is delighted to partner with the LSHTM on this innovative and important project.” 5)

Issues in ensuring COVID-19 vaccine compliance

16 September 2020 - An effective COVID-19 vaccine could help us emerge from isolation and end the social distancing required during this pandemic; but it will only work if people are willing to be vaccinated.

We conducted a survey in June of 2020 that addressed whether people’s willingness to use a COVID-19 vaccine and adopt other preventive healthcare measures was associated with trust. The survey was conducted in nine countries: China, India, Indonesia, Italy, Japan, South Africa, Sweden, the United Kingdom, and the United States. A thousand individuals were surveyed in each country, and the responses were weighted to the most recent census data.

While an average of 86% of the respondents had increased the number of times they washed their hands in April and May of 2020, an average of 21% said that they would not get vaccinated. These figures were highest in Sweden (31%) and South Africa (30.6%), but were not much better in the United States (28%) and Italy (23%) (Figure A). Unfortunately, many of these levels barely reach the cusp of vaccine coverage needed to achieve population-wide herd immunity against COVID-19.3,4,5

Sources show that the public is most concerned with vaccine effectiveness and the risk of vaccine side effects.5,6,7,8 Worry about side effects has historically had a big influence on vaccine acceptance. In the UK, concern about reported neurological complications from common childhood vaccines lowered the vaccination rate from 81% in 1974 to 31% in 1980, leading to a resurgence of pertussis that resulted in over 100,000 cases.6 In 2018, 20% of respondents to the Wellcome Global Monitor survey in the UK said they believed that the risk of vaccine side effects was fairly high or very high.7

Interestingly, our survey showed that respondents who said they would get vaccinated had more education than those who said they would not get vaccinated. These results were highest in the U.S. and Sweden (Figure B). This may mean that people with more education have more information, but this correlation will need to be further explored before it can be explained.

A recent piece in the Journal of the American Medical Association on flu vaccination during the COVID-19 pandemic stated that strong, unified messaging is essential to vaccine compliance. The article cites the CDC’s call to action that urges physicians to make every effort to get their patients vaccinated and acknowledges that physicians and healthcare professionals are the most trusted source for accurate information on vaccine risks. The role of medical professions in preventing larger public health crises that could overwhelm the world’s healthcare resources cannot be overestimated.

We suggest that healthcare professionals partner with their national governments and international healthcare experts, such as the World Health Organization, to create consistent, accurate messages about the benefits of vaccination for COVID-19. These messages should use simple language that people with no more than an elementary education can understand; acknowledge peoples’ fears about vaccine side effects and cite accurate, verifiable data on side effect risks; and state whatever data is available on vaccine effectiveness. This will ensure that the greatest number of people will get vaccinated as soon as a vaccine is ready leading to a potential end to the current COVID-19 pandemic. 6)


By listening for early signals of public distrust and questioning and providing risk analysis and guidance, we aim to engage the public early and pre-empt potential programme disruptions.

The Vaccine Confidence Project™ European Regional Office Announced

The CEV at the Antwerp University will host the European Regional Office of the Vaccine Confidence Project™ as of May 15, 2019, and will closely collaborate with VCP™ partners at European level on implementing the Vaccine Confidence Index™ and developing and evaluating interventions to address vaccine hesitancy.

Stuck: How Vaccine Rumours Start — and Why They Don’t Go Away

Authored by VCP™ Director, Prof Heidi J. Larson, Stuck examines the state of vaccine confidence globally and what it means for the future. This book considers the beginnings of the vaccine resistance movement, messages of medical authorities, the growing role of social media platforms and individual choice.

New Short Course: Building trust, managing risk around vaccines: from trials to delivery

This 3.5-day course, developed by the Vaccine Confidence Project at London School of Hygiene & Tropical Medicine, will highlight the importance of maintaining and improving vaccine confidence and explore the diversity of concerns and perceptions about vaccines and how they have impacted vaccine uptake across multiple global settings. 7)

Journal Articles

(note the research for VCP is not named in these artocless it must be buried in hyperlinks)

The Atlantic

Get Ready for a Wave of Missed Infections

At last, rapid COVID tests are everywhere—and that means a surge of false-negative results. By Benjamin Mazer - March 23, 2022

Early-treatment options for COVID—antiviral pills such as Paxlovid and Molnupiravir, infusions such as Remdesivir and monoclonal antibodies, and hopefully other options soon—promise to blunt some of the remaining risk from the virus among unvaccinated and high-risk vaccinated people. As these treatments must be started within five to seven days of symptom onset (depending on the therapy), eligibility requires the timely receipt of a positive result—and rapid tests will be essential. 8)


Lessons from the COVID data wizards Data dashboards have been an important part of pandemic response and planning. What have their developers learnt about communicating science in a crisis? 23 March 2022 - by Lynne Peeples

Ideally, data that are this important for public health should be freely available, machine-readable and standardized. From the start, the team realized that they were not. Compiling complete and consistent COVID-19 data was “very manual and very messy”, says Gardner. “We were scrambling, collecting and validating reported data as fast as we could.” Because COVID-19 data were not yet provided on any public-health agency’s website, they looked elsewhere, including on Facebook and Twitter posts and in one-off news and media announcements. Even after agencies launched official data pages, both sourcing and formatting remained an issue. Gardner says that some of the data the team collects are still not machine-readable. “There should be a standardized way in which the data is provided and shared publicly, as well as what is shared,” says Gardner. “That would’ve made our job a lot easier.”

Social media has also given data scientists a chance to draw back the curtain around what they do, answer questions, correct misunderstandings and provide context for their data — promoting transparency and trust. But social media can rapidly spread inaccurate messages and potentially degrade trust in dashboards.

Take, for example, the wave of misinformation that rippled worldwide after a guest of US podcaster Joe Rogan said that COVID-19 case rates were higher among vaccinated people. Brazilian President Jair Bolsonaro reported the same thing on social media and included baseless claims that vaccinated people also had a higher risk of contracting AIDS. They each referenced data published by the UK Health Security Agency, which did show that SARS-CoV-2 infection rates among fully vaccinated people aged 40 years and older were higher compared with unvaccinated people in the same age group.

The numbers, however, were based on an inaccurate estimate of the pool of unvaccinated people. When a more appropriate estimate was used, case rates among unvaccinated individuals were shown to be higher than for vaccinated people in nearly all age groups.9)


Delta and omicron met up inside 1 person and made the Frankenstein hybrid 'deltacron'

March 23, 2022 - Michaeleen Doucleff

Health officials, including those at the World Health Organization, are watching these hybrid variants closely. Because they demonstrate how the virus can take its most successful parts and combine them quickly into a supervirus. This process is called recombination, and it's how dangerous strains of flu are made.

“So very often recombination is the way in which we get pandemics of influenza. ,” Dr. Mike Ryan with the World Health Organization said on Friday. “So we have to be very cautious … we have to watch these recombinant events very, very closely.”

For instance, omicron's spike protein is especially apt at hiding the virus from our immune system, especially our antibodies. And so the XD variant is essentially the delta variant wearing omicron's invisibility cloak.

“From the variant's perspective, it has the best of worlds,” Nguyen says. ““It's surprising that the virus can really do this, and do it very well, as well. How a Frankenstein hybrid is born

So how does the virus do this? How does it create these Frankenstein hybrids?

For starters, a person has to catch both omicron and delta at the same time, says Shishi Luo, a bioinformatician at the genomics company Helix. “So a person has to be exposed to both variants in a short enough time frame so that they have both of them in this system.”

Luo and her colleagues recently analyzed samples from nearly 30,000 Americans infected with SARS-CoV-2 during the rise of omicron in this country, from November until February. They found 20 people co-infected with both delta and omicron. In other words, they were infected twice.

“Omicron happened around Christmas and New Year, when there were many social gatherings,” Luo explains. “So you can imagine, you go to one social gathering and got exposed to delta, and then you go to a different social gathering, and you catch omicron.”

If both variants manage to infect the same cell, at the same time, then the virus can end up doing recombination, Luo says. In essence, during replication, one variant steals a chunk of genes from another variant. So the delta variant, in way, plagiarized part of omicron's genetic code.

“If you're writing a document, you can have typos where you change a single letter,” Luo says. “But you can also copy and paste and move big chunks of text. That's recombination, where one variant, in this case delta, takes a big chunk of text from omicron.”

Grabbing chunks of code instead of just single letters makes the virus more malleable or flexible, Luo says, so it can quickly evolve new variants, including ones that can evade our immune protection. “It just shows how SARS-CoV-2 has many tools in its kit for changing itself.” Recombination could key to the past and future of SARS-CoV-2

Scientists are just starting to understand how important recombination is for SARS-CoV-2 evolution. “It's been known that coronaviruses, in general, have a lot of recombination. For SARS-CoV-2, this is the first time we've seen so much evidence that it's happening,” she adds.

In fact, recombination may be the reason SARS-CoV-2 exists in the first place. Last month, scientists at the University of Glasgow published a study in which they speculate about the origins of SARS-CoV-2. Their analysis suggests an animal in the Wuhan seafood market could have been co-infected with two coronaviruses at the same time – and that these two viruses recombined, just like omicron and delta are doing right now, to generate the initial version. 10)

New York Times

Covid Test Misinformation Spikes Along With Spread of Omicron By Davey Alba - Jan. 10, 2022 (wench who did NYT smear of Dr Robert Malone)

The added demand for testing and the higher prevalence of breakthrough cases have created an “opportune moment” to exploit.

On Dec. 29, The Gateway Pundit, a far-right website that often spreads conspiracy theories, published an article falsely implying that the Centers for Disease Control and Prevention had withdrawn authorization of all P.C.R. tests for detecting Covid-19. The article collected 22,000 likes, comments and shares on Facebook and Twitter.

Researchers say that the falsehoods are rising despite efforts by social media companies to crack down, and that many contain lies that had surfaced in the past.

The surge “fits with the misinformation industry’s pattern during the pandemic,” said John Gregory, deputy health editor at NewsGuard, which rates the credibility of news sites and has tracked the prevalence of Covid-19 and vaccine misinformation. “Whatever the current mainstream story is, they seek their own narrative to undermine it.”11)

Pharmaceutical Technology

How vaccine science could help tackle antimicrobial resistance

Successful vaccine technologies, such as mRNA and reverse vaccinology, could give researchers new approaches to fighting AMR.

February 17, 2022 - By Darcy Jimenez

In their ability to provide substantial protection against the worst effects of the novel coronavirus, vaccines are our ticket out of the Covid-19 pandemic – but research suggests they could also help us tackle another urgent threat to public health: antimicrobial resistance.

Antimicrobial resistance (AMR), which occurs when pathogens such as bacteria and viruses no longer respond to treatment, is one of the World Health Organization’s (WHO) top 10 global threats to humanity. The United Nations has warned that drug-resistant infections, driven largely by antibiotic misuse and overuse, could kill 10 million people a year by 2050 – threatening a future where once easily cured infections become untreatable.

The need to act on AMR is clear – but the solution is not as simple as making new medicines. No new antibiotic classes have been discovered since the 1980s, and a WHO report last year found that the current antibacterial clinical pipeline and recently approved antibiotics are “insufficient to tackle the challenge” of growing AMR.

According to a recent report, more than 38% of the 72 antibiotic drug programmes currently underway in the US target C. difficile and tuberculosis, leaving just 44 drugs that address other disease-causing bacteria.

While available antibiotics grow increasingly inadequate, there’s a serious lack of financial incentive for drug companies to try and produce new ones, which can cost as much as $1.5bn. High failure rates and the restricted use of novel antimicrobials further make antibiotics an unattractive market.

UK-based GlaxoSmithKline (GSK), for one, is developing vaccines that target the common respiratory virus RSV, and the bacterial infections caused by Shigella, Staph aureus, and Mycobacterium tuberculosis, in an effort to further reduce global reliance on antibiotics. The drugmaker is also exploring the possibility of repurposing its meningitis vaccine Bexsero to protect against gonorrhoea, a sexually transmitted bacterial infection that is growing increasingly resistant to antibiotics.

Across the pond, Johnson & Johnson (J&J) is developing a vaccine for a dangerous and increasingly resistant strain of E. coli. Extraintestinal Pathogenic Escherichia coli (ExPEC) can cause severe and even fatal infections that are particularly dangerous for older adults, and existing treatments are becoming ineffective. J&J’s vaccine candidate, ExPEC9V, is currently being investigated in Phase III studies in adults aged 60 years and older with a history of urinary tract infection in the past two years.

Urinary tract infections (UTIs), usually caused by E. coli bacteria, are one of the most common infections typically treated with antibiotics. But the infection-causing bacteria are showing increased resistance to drugs – meaning the prevalence of UTIs must be reduced, and fast.

Uromune, developed by Spanish pharma company Inmunotek, is a sublingual vaccine designed to prevent recurrent or chronic UTIs. The vaccine, administered as a spray, contains the whole inactivated versions of the four most common pathogens behind UTIs: E. coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. Uromune is currently in Phase III studies and only available in certain countries under patient programmes, but clinical research indicates that the vaccine significantly reduces the recurrence of infections.

Another approach is to utilise reverse vaccinology, which involves computationally screening whole genomes of pathogens to identify protein antigens that can serve as potential vaccine candidates. By beginning with the pathogen’s genomic information, researchers are able to select antigens demonstrating the most desirable traits to test in preclinical models.

This reverse method of vaccine discovery has seen success in the highly effective Meningitis B jab Bexsero, and vaccine candidates for ExPEC and Pseudomonas aeruginosa have also been explored using this approach.

Harnessing mRNA

Messenger RNA (mRNA) vaccines were thrust into the limelight during the Covid-19 pandemic when Pfizer along with BioNTech, and Moderna developed mRNA-based jabs against the virus, but researchers have been exploring this technology for decades. In these vaccines, mRNA encoding pathogen-specific antigens are introduced into host cells to produce proteins that trigger an immune response against the pathogen.

“To develop an AMR vaccine, theoretically, all we needed is the mRNA sequence of the antigen from the AMR pathogen of interest,” Chen says.

Along with its success in Covid-19 vaccines, mRNA-based platforms could be ideal for jabs targeting resistant pathogens. For example, early research into an mRNA vaccine against human malaria – two parasite species of which have confirmed resistance to antimalarial drugs – has recently yielded encouraging results.

Chen also said alternative mRNA vaccine platforms like that use self-amplifying or trans-amplifying RNA, which will be developed in the next few years, could provide novel strategies to address existing challenges. Researchers have investigated self-amplifying mRNA vaccines against group A and group B Streptococci. Mice immunised in the study generated significant amounts of antibodies and the immune response was found to offer consistent protection against bacterial infection.

“In addition to excellent protection, efficacy and good safety profiles, the speed to design and produce mRNA vaccines with the premade constructs, the potential low R&D cost, and fast regulatory approvals are specifically attractive for AMR vaccine development,” Chen says.

The speedy rollout of mRNA vaccines during the pandemic indicates that mRNA-based jabs could be developed safely and quickly in response to emerging resistant pathogens and outbreaks of drug-resistant disease. But specific biomanufacturing facilities and expertise are needed to make this a reality, Chen says.

GSK’s Giordano says Covid-19 has highlighted the invaluable role of vaccines in tackling urgent public health threats. “We have all seen [during the pandemic] that vaccines are important, and learned that a vaccine can be developed and produced in record time, without taking any shortcuts on safety,” she says. “Having [the] technology ready in case there is a need – everywhere in the world, in low- or high-income countries – is of paramount importance.” 12)

Partners & Funders