Accelerating vaccines against cholera: IVI’s film for the Healthier Together series, presented by the WHO Foundation

“The people of Bangladesh begin their day with tea,” says Mohammed Mintu Mia. He would know, selling freshly brewed tea in and around his community along the outskirts of Dhaka city. Mintu is a tea seller, a devoted father to his 8-year-old daughter, and a cholera survivor. We met Mintu and his family in February of this year to learn more about his recent experience with cholera and how the illness affected his life and his family’s livelihood.

He shares that a sudden onset of symptoms like dizziness, lack of appetite, restlessness, and frequent vomiting led him to seek care at “The Cholera Hospital” in the city center, the colloquial name for the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospital. Mintu was in medical care for four days and sick for a total of one month during which he could not work. He explains that his family had to borrow a loan to support their living expenses.

BBC x IVI - Bangladesh - Final – MAIN [FOR SUBTITLING].mp4_Mintu — Mintu brews a fresh batch of tea at his home. Credit: IVI

Cholera is a severe and life-threatening condition which not only impacts one’s health, but a patient’s ability to work, attend school, and support their family members. Dr. Julia Lynch, Director of IVI’s Cholera Program, points out, “Individuals who acquire cholera can die within four hours from dehydration if left untreated. There is nothing else quite like cholera in how severe and rapidly it can kill an individual.” As a disease that particularly strikes communities in poverty, densely populated countries like Bangladesh with limited access to safe water and sanitation infrastructure are at risk of outbreaks of cholera. Additionally, with climate change spurring extreme weather events such as flooding (which can further spread the cholera bacteria) and droughts (which may cause people to turn to unsafe sources of water), and geopolitical conflicts that lead to displacement and forced migration, outbreaks of cholera and other waterborne diseases have been on an alarming rise around the world.

About the situation in her home country, Bangladesh, Dr. Firdausi Qadri, Senior Scientist at icddr,b shares, “In 2022, we had the worst epidemic of cholera that we have not seen in the last 60 years. Every minute a cholera patient was being brought in.” Cholera is, however, a preventable disease. With access to safe water, reliable sanitation infrastructure, and widespread education and facilities to practice good hygiene, the prevalence of cholera would decline dramatically. This sustainable development goal is not achievable immediately, Dr. Qadri points out. “We need a multisectoral plan,” she says. “Like vaccines.”

BBC x IVI - Bangladesh - Final – MAIN [FOR SUBTITLING].mp4_Qadri — Dr. Firdausi Qadri, Senior Scientist at icddr,b, and her colleagues in the Infectious Diseases Division. Credit: IVI

While there are several vaccines available to prevent the diarrheal disease, the current demand for those vaccines far outweighs the available supply. Moreover, vaccines against cholera and other poverty-associated infectious diseases are not necessarily at the top of the priority list for major vaccine manufacturers; the primary use of these vaccines in resource-poor settings does little to incentivize the market.

So, how did the first generation of oral cholera vaccine (OCV), which currently makes up the global stockpile of vaccines against cholera and has saved countless lives over the past 10 years, come to fruition? In partnership with collaborators, including icddr,b and several vaccine manufacturers and through the support of the Bill & Melinda Gates Foundation, IVI set out to bring forward a first-hand account of the impact of cholera and the behind-the-scenes story of the groundbreaking public-private partnerships that made OCV possible and available for use around the world.

IVI’s Cholera Program is featured in a new digital film series Healthier Together: A path to a better world, created for the World Health Organization (WHO) Foundation and produced for them by BBC StoryWorks Commercial Productions. The OCV development story is part of the “Innovating for equity” section of the series, which shines a light on breakthrough technology transforming disease prevention and cure, made available to those who need them globally.

Since 1999, IVI has been working with partners around the world to bring to market and increase the supply of low-cost OCVs. To borrow Dr. Qadri’s words again, the OCV story was “a multisectoral plan” from the outset: a philanthropic-funded, public-private partnership with a goal of accelerating safe, effective, and affordable cholera vaccines for global health. IVI helped reformulate an OCV originally developed by scientists at University of Gothenburg and produced in Vietnam to ensure that this vaccine would meet international Good Manufacturing Practice standards and WHO-approved regulatory requirements. With these qualifications, organizations like Gavi, the Vaccine Alliance and UNICEF would then be able to procure the vaccine for global distribution and use.

With government and philanthropic funding from the governments of the Republic of Korea and Sweden and the Bill & Melinda Gates Foundation, IVI approached Developing Countries Vaccine Manufacturers to further seek manufacturing partners for this new OCV. In 2010, IVI initiated the first technology transfer of OCV to a Korean company called EuBiologics. This 14-year partnership has resulted in three OCVs pre-qualified by the World Health Organization (WHO) to date, including a simplified OCV (Euvichol-S) which achieved WHO prequalification on April 12, 2024.

Technology transfer is the process of sharing the necessary materials, technical know-how, and licensing to manufacture quality vaccines at scale in addition to helping meet regulatory requirements that ensure the safety and efficacy of the vaccines. Learn more about IVI’s OCV technology transfers here.

BBC x IVI - Bangladesh - Final – MAIN [FOR SUBTITLING].mp4_Lynch — Dr. Julia Lynch, Director of IVI’s Cholera Program, at Matlab, Bangladesh, the site of the pivotal OCV clinical trial in 1995.

In the film, Dr. Lynch explains, “One of the key roles that IVI plays is to catalyze the development of vaccines by bringing together multiple stakeholders including philanthropies and governments, as well as technical experts and policymakers so that they can be widely available to the people who need them.”

Currently, EuBiologics is the sole producer of OCV for the global public market. The sharp increase in cholera outbreaks worldwide and the shortage of available vaccines signal the need for more vaccine manufacturers to join the effort to prevent cholera and eliminate this disease of poverty.

“At IVI, we are actively working on bringing additional manufactures onboard to develop and produce vaccines so that the global supply can expand. We hope that by 2025 the supply shortage we are experiencing now will be greatly reduced, if not eliminated,” says Dr. Lynch.

by Aerie Em

Last updated April 29, 2024