7 ms·

Strep A kills half a million per year; why don't we have a vaccine?

54 points by apsec112 2y ago

jimbob45 2y ago
Drug companies have been unwilling to take financial risks when they can’t be sure there’ll be a market for a strep A vaccine in wealthy countries Did they not poll anyone on this? I struggle greatly to believe the greater public wouldn’t sprint to their nearest pharmacy for such a vaccine. I wanted to fund it before the article was over - I simply never knew such a thing was on the table.
- Molitor5901 2y ago
  Vaccine makers could lobby the government to make the vaccine mandatory, thereby guaranteeing a revenue stream for the vaccine to reduce the financial risk.
  - K0balt 2y ago
    [flagged]
  - fshbbdssbbgdd 2y ago
    I wonder if people downvoted this because they took it as some kind of political point about COVID-19. Maybe it was, but I agree with it as a serious proposal. Even if the government is not confident in its ability to get people to accept vaccinations, it should commit to pay for the doses either way, to incentivize the development of the vaccine. In general, a contest or prize is a smart way to fund a public good. Among left and right economists, this is one thing most would agree on.
    - fooker 2y ago
      Okay suppose the government commits to pay for it and keeps coercing people to take it. What happens when: (1) TotallyGenuine drug company realizes that they can still get paid giving out fake shots. (2) NotEvil drug company buys up it's smaller competitors and stops improving vaccines. (3) KeyboardScientist makes a viral post that the government is sterilizing people of a particular ethnicity. With a bit of googling, you can find events very close to all these three.
      - kelnos 2y ago
        And yet we still have many successful mandatory vaccination campaigns. Certainly they've been hurt by all the antivax garbage going around since the pandemic, but that doesn't make them not worthwhile.
        fooker 2y ago
        We have also had many successful wars. Doesn't mean wars are the best way to solve issues.
    - Molitor5901 2y ago
      I was actually thinking of Gardasil but yes, it could be applied to anything. It was not meant to be political.
- pfdietz 2y ago
  The concern with any Strep vaccine is stimulating autoimmune reactions. Rheumatic fever is just such a reaction associated with strep infection, and it can be very damaging, even deadly.
- fny 2y ago
  First, there are cheap alternatives (antibiotics) which limit the total market size. Second, it’s almost tautological. If there was enough profit to justify the development time and cost, drug companies would pursue a vaccine. Since they’re not pursuing a vaccine, you can assume there’s not enough estimated profit compared to other research ventures. The second point includes considerations of difficulty. There are many strep strains. Strep can trigger autoimmune diseases. Will the costs of surmounting these challenges be rewarded above other pursuits?
  - log_e 2y ago
    You realize tautology is a logical fallacy, right?
    - pdonis 2y ago
      Huh? A tautology is a statement that is automatically true by the laws of logic.
      - maxbond 2y ago
        GP is correct that the argument contains an informal fallacy[1], and people often express this criticism by saying "your argument is tautological," and you are correct that a tautology is a statement which is always true [2]. [1] https://en.wikipedia.org/wiki/Begging_the_question https://en.wikipedia.org/wiki/Begging_the_question [2] https://en.wikipedia.org/wiki/Tautology_(logic) https://en.wikipedia.org/wiki/Tautology_(logic)
        pdonis 2y ago
        > GP is correct that the argument contains an informal fallacy The GP didn't say that. As for which informal fallacy the GGP's argument contained, I would say it was more like a false dilemma. And the GGP did say "almost tautological", which implicitly recognizes that there might be other possibilities. > people often express this criticism by saying "your argument is tautological," I have never seen this (nonsensical) way of expressing the criticism that an argument is false by saying that it is tautological (and therefore true).
- toast0 2y ago
  It would depend on the efficacy and the length of time its effective. One dose and very little strep for the rest of your life is different than an annual regimine. But you can't know how it will do before a lot of spending.
- deleted 2y ago
  [deleted]
- YetAnotherNick 2y ago
  And the wealthy country here just means United States. It is the only country where pharmaceutical companies could sell their products at any price.
- tim333 2y ago
  It sounds somewhat comparable to the Hepatitis A vaccine and I'm not sure many are sprinting to the pharmacies although it is moderately successful.
deleted 2y ago
[deleted]
slillibri 2y ago
Probably because a half million a year is a rounding error in global mortality. It sounds like a lot but the daily global mortality rate, when last I checked, was something like 170,000 per day.
- vladmk 2y ago
  That's easy to say, but not productive. What are the diseases that kill the most people we should be working on?
  - Traubenfuchs 2y ago
    Cardiovascular diseases, cancers, respiratory infects. Strep A is technically solved due to being easily treatable with common antibiotics.
    - kelnos 2y ago
      And yet a half million people still get it and die. Doesn't sound "solved" to me ("technically" or otherwise). I'm not sure if mass vaccination campaigns would be more effective than hoping people see a doctor when they get sick (seems like a lot don't) and hoping they are able to pay for a full course of antibiotics (seems like a lot can't), and hoping they actually stick with it and take the full course (many people in general don't). At least with vaccinations, it's usually one shot every $DECENTLY_NOT_SHORT_INTERVAL, and that's it. Granted, crazy stupid antivax sentiment is on the rise...
  - slillibri 2y ago
    Cancer kills over 9 million people per year, or 18x strep A. Tuberculosis kills nearly 1.5 million people per year, or 3x. Over 9 million people die from hunger related causes, which while not a disease is 18x strep A. It's not to demean the people who die from strep A, because to each of their families it's a tragedy, but the scale and the fact that it can be treated with common antibiotics means that we can put the effort and resources that would be spent on a vaccine to better use elsewhere.
lqstuart 2y ago
> Although the penicillin family of antibiotics is highly effective against strep A, many Ugandan families instead visit traditional healers, whose treatments include scraping tonsils with a spoon or a sharp piece of wood until they bleed. If parents do seek out antibiotics, they might just buy two pills of penicillin, not the full course necessary to clear an infection. Think this is the problem they should be solving before trying to immunize people against bacteria that lives literally everywhere
- bjelkeman-again 2y ago
  In other words, poverty is the real problem.
  - Spooky23 2y ago
    Ignorance is the problem. Plenty of wealthy people are taking horse deworming medicine for political purposes.
    - throawayonthe 2y ago
      [dead]
    - carlmr 2y ago
      A mix of both, the poverty creates some of this ignorance by lack of access to education. That people in the US choose to be ignorant despite having an education happens, but it's rarer than where there is no education.
      - more_corn 2y ago
        My mother was educated. She bought into some misinformation and fear-mongering about modern medicine and rejected it entirely. No vaccines no doctors. Mostly it was fine till it wasn’t. I took myself to a doctor as a teen with bad strep. Not our doctor we didn’t have one. just a doctor. No insurance. They could see I was in rough shape. They just diagnosed me with strep (although I already knew that’s what it was) and sent me away with a prescription. I didn’t even realize how weird that was till much later. (That they saw me with no insurance and no previous relationship and no payment) My sister was in town once years later and my younger brother was in such bad shape she took him to a doctor. She swears to this day he would have died. Again strep. Misinformation is a big problem. People who buy into it put their kids at risk. When we allow purveyors of nonsense to thrive because “freedoms” we do everyone a disservice.
hypercube33 2y ago
What about bacteria phages for strep? If I'm not mistaken and I really could be but I thought we use them to keep some meats fresh? I didn't dig into this further many years ago but I also haven't seen anything new either beyond a paper suggesting their research. Antibiotics come up here a lot and other places in discussion due to their (possibly) bad side effects or immunity with excessive use. I think someone else here pointed out that it's tricky to make an immune response have the desired outcome and no undesired ones so a vaccine may not be the right hammer for this nail.
- Fomite 2y ago
  HN tends to love phage, but for this application, it's not a great one, because the infrastructure required to safely do phage prep greatly exceeds what you need even for complex vaccines.
  - cenamus 2y ago
    Especially for diseases that can be cured with regular antibiotics, but aren't due to different reasons
- OutOfHere 2y ago
  The development of phages has thus far made more sense for resistant infections. Perhaps phages could also help patients with chronic lung infections. For strep there isn't much motivation even if it's theoretically desirable.
karim79 2y ago
I had this, in 2011. I was in another country, attending job interviews I had been invited to. It was the single worst experience of my life. I was in a hotel, a fever crept in. Then my throat was so swollen I could barely talk. I was sweating so much that my delirious brain decided it would be a good idea to lay out all the clothes in my suitcase onto the bed. I had a fever dream that my brother had called an ambulance to save me. I then woke up to realise I was still actually in hell. I managed to muster up the strength to go down to the hotel lobby and ask the hotel receptionist to direct me to the nearest pharmacy. I almost couldn't speak because my throat was almost swollen shut. Sweat was literally pouring down my face and I sounded, let's say, incompetent. I eventually arrived at the pharmacy and I honestly credit the lovely lady there for saving my life. She gave me fever reducers and a concentrated iodine-based throat gargle. It took around five days to recover from this, I had missed my flight and had to book a new one back. When I arrived back home, the first comment I received was "there is no colour in your face, you're white as a sheet". I've had many of the nasty viruses several times (covid, you-name-it flu, measles even, please do not ask). This was by far the worst illness I can remember.
- MathMonkeyMan 2y ago
  Strep is a bacterial infection, and I'm glad you recovered without antibiotics.
  - karim79 2y ago
    Thank you. Had I been smarter I would have just called an ambulance, like what my brother did in my fever dream.
    - OutOfHere 2y ago
      This is why I never travel abroad without antibiotics and more.
- carlmr 2y ago
  >I had a fever dream that my brother had called an ambulance to save me. Reminds me of this, people imagining a helping person or spirit in a dire situation: https://en.wikipedia.org/wiki/Third_man_factor https://en.wikipedia.org/wiki/Third_man_factor

54 points by apsec112 2y ago

Drug companies have been unwilling to take financial risks when they can’t be sure there’ll be a market for a strep A vaccine in wealthy countries Did they not poll anyone on this? I struggle greatly to believe the greater public wouldn’t sprint to their nearest pharmacy for such a vaccine. I wanted to fund it before the article was over - I simply never knew such a thing was on the table.

Molitor5901 2y ago
Vaccine makers could lobby the government to make the vaccine mandatory, thereby guaranteeing a revenue stream for the vaccine to reduce the financial risk.
- K0balt 2y ago
  [flagged]
- fshbbdssbbgdd 2y ago
  I wonder if people downvoted this because they took it as some kind of political point about COVID-19. Maybe it was, but I agree with it as a serious proposal. Even if the government is not confident in its ability to get people to accept vaccinations, it should commit to pay for the doses either way, to incentivize the development of the vaccine. In general, a contest or prize is a smart way to fund a public good. Among left and right economists, this is one thing most would agree on.
  - fooker 2y ago
    Okay suppose the government commits to pay for it and keeps coercing people to take it. What happens when: (1) TotallyGenuine drug company realizes that they can still get paid giving out fake shots. (2) NotEvil drug company buys up it's smaller competitors and stops improving vaccines. (3) KeyboardScientist makes a viral post that the government is sterilizing people of a particular ethnicity. With a bit of googling, you can find events very close to all these three.
    - kelnos 2y ago
      And yet we still have many successful mandatory vaccination campaigns. Certainly they've been hurt by all the antivax garbage going around since the pandemic, but that doesn't make them not worthwhile.
      - fooker 2y ago
        We have also had many successful wars. Doesn't mean wars are the best way to solve issues.
  - Molitor5901 2y ago
    I was actually thinking of Gardasil but yes, it could be applied to anything. It was not meant to be political.
pfdietz 2y ago
The concern with any Strep vaccine is stimulating autoimmune reactions. Rheumatic fever is just such a reaction associated with strep infection, and it can be very damaging, even deadly.
fny 2y ago
First, there are cheap alternatives (antibiotics) which limit the total market size. Second, it’s almost tautological. If there was enough profit to justify the development time and cost, drug companies would pursue a vaccine. Since they’re not pursuing a vaccine, you can assume there’s not enough estimated profit compared to other research ventures. The second point includes considerations of difficulty. There are many strep strains. Strep can trigger autoimmune diseases. Will the costs of surmounting these challenges be rewarded above other pursuits?
- log_e 2y ago
  You realize tautology is a logical fallacy, right?
  - pdonis 2y ago
    Huh? A tautology is a statement that is automatically true by the laws of logic.
    - maxbond 2y ago
      GP is correct that the argument contains an informal fallacy[1], and people often express this criticism by saying "your argument is tautological," and you are correct that a tautology is a statement which is always true [2]. [1] https://en.wikipedia.org/wiki/Begging_the_question https://en.wikipedia.org/wiki/Begging_the_question [2] https://en.wikipedia.org/wiki/Tautology_(logic) https://en.wikipedia.org/wiki/Tautology_(logic)
      - pdonis 2y ago
        > GP is correct that the argument contains an informal fallacy The GP didn't say that. As for which informal fallacy the GGP's argument contained, I would say it was more like a false dilemma. And the GGP did say "almost tautological", which implicitly recognizes that there might be other possibilities. > people often express this criticism by saying "your argument is tautological," I have never seen this (nonsensical) way of expressing the criticism that an argument is false by saying that it is tautological (and therefore true).
toast0 2y ago
It would depend on the efficacy and the length of time its effective. One dose and very little strep for the rest of your life is different than an annual regimine. But you can't know how it will do before a lot of spending.
deleted 2y ago
[deleted]
YetAnotherNick 2y ago
And the wealthy country here just means United States. It is the only country where pharmaceutical companies could sell their products at any price.
tim333 2y ago
It sounds somewhat comparable to the Hepatitis A vaccine and I'm not sure many are sprinting to the pharmacies although it is moderately successful.

deleted 2y ago

[deleted]

slillibri 2y ago

Probably because a half million a year is a rounding error in global mortality. It sounds like a lot but the daily global mortality rate, when last I checked, was something like 170,000 per day.

vladmk 2y ago
That's easy to say, but not productive. What are the diseases that kill the most people we should be working on?
- Traubenfuchs 2y ago
  Cardiovascular diseases, cancers, respiratory infects. Strep A is technically solved due to being easily treatable with common antibiotics.
  - kelnos 2y ago
    And yet a half million people still get it and die. Doesn't sound "solved" to me ("technically" or otherwise). I'm not sure if mass vaccination campaigns would be more effective than hoping people see a doctor when they get sick (seems like a lot don't) and hoping they are able to pay for a full course of antibiotics (seems like a lot can't), and hoping they actually stick with it and take the full course (many people in general don't). At least with vaccinations, it's usually one shot every $DECENTLY_NOT_SHORT_INTERVAL, and that's it. Granted, crazy stupid antivax sentiment is on the rise...
- slillibri 2y ago
  Cancer kills over 9 million people per year, or 18x strep A. Tuberculosis kills nearly 1.5 million people per year, or 3x. Over 9 million people die from hunger related causes, which while not a disease is 18x strep A. It's not to demean the people who die from strep A, because to each of their families it's a tragedy, but the scale and the fact that it can be treated with common antibiotics means that we can put the effort and resources that would be spent on a vaccine to better use elsewhere.

lqstuart 2y ago

> Although the penicillin family of antibiotics is highly effective against strep A, many Ugandan families instead visit traditional healers, whose treatments include scraping tonsils with a spoon or a sharp piece of wood until they bleed. If parents do seek out antibiotics, they might just buy two pills of penicillin, not the full course necessary to clear an infection. Think this is the problem they should be solving before trying to immunize people against bacteria that lives literally everywhere

bjelkeman-again 2y ago
In other words, poverty is the real problem.
- Spooky23 2y ago
  Ignorance is the problem. Plenty of wealthy people are taking horse deworming medicine for political purposes.
  - throawayonthe 2y ago
    [dead]
  - carlmr 2y ago
    A mix of both, the poverty creates some of this ignorance by lack of access to education. That people in the US choose to be ignorant despite having an education happens, but it's rarer than where there is no education.
    - more_corn 2y ago
      My mother was educated. She bought into some misinformation and fear-mongering about modern medicine and rejected it entirely. No vaccines no doctors. Mostly it was fine till it wasn’t. I took myself to a doctor as a teen with bad strep. Not our doctor we didn’t have one. just a doctor. No insurance. They could see I was in rough shape. They just diagnosed me with strep (although I already knew that’s what it was) and sent me away with a prescription. I didn’t even realize how weird that was till much later. (That they saw me with no insurance and no previous relationship and no payment) My sister was in town once years later and my younger brother was in such bad shape she took him to a doctor. She swears to this day he would have died. Again strep. Misinformation is a big problem. People who buy into it put their kids at risk. When we allow purveyors of nonsense to thrive because “freedoms” we do everyone a disservice.

hypercube33 2y ago

What about bacteria phages for strep? If I'm not mistaken and I really could be but I thought we use them to keep some meats fresh? I didn't dig into this further many years ago but I also haven't seen anything new either beyond a paper suggesting their research. Antibiotics come up here a lot and other places in discussion due to their (possibly) bad side effects or immunity with excessive use. I think someone else here pointed out that it's tricky to make an immune response have the desired outcome and no undesired ones so a vaccine may not be the right hammer for this nail.

Fomite 2y ago
HN tends to love phage, but for this application, it's not a great one, because the infrastructure required to safely do phage prep greatly exceeds what you need even for complex vaccines.
- cenamus 2y ago
  Especially for diseases that can be cured with regular antibiotics, but aren't due to different reasons
OutOfHere 2y ago
The development of phages has thus far made more sense for resistant infections. Perhaps phages could also help patients with chronic lung infections. For strep there isn't much motivation even if it's theoretically desirable.

karim79 2y ago

I had this, in 2011. I was in another country, attending job interviews I had been invited to. It was the single worst experience of my life. I was in a hotel, a fever crept in. Then my throat was so swollen I could barely talk. I was sweating so much that my delirious brain decided it would be a good idea to lay out all the clothes in my suitcase onto the bed. I had a fever dream that my brother had called an ambulance to save me. I then woke up to realise I was still actually in hell. I managed to muster up the strength to go down to the hotel lobby and ask the hotel receptionist to direct me to the nearest pharmacy. I almost couldn't speak because my throat was almost swollen shut. Sweat was literally pouring down my face and I sounded, let's say, incompetent. I eventually arrived at the pharmacy and I honestly credit the lovely lady there for saving my life. She gave me fever reducers and a concentrated iodine-based throat gargle. It took around five days to recover from this, I had missed my flight and had to book a new one back. When I arrived back home, the first comment I received was "there is no colour in your face, you're white as a sheet". I've had many of the nasty viruses several times (covid, you-name-it flu, measles even, please do not ask). This was by far the worst illness I can remember.

MathMonkeyMan 2y ago
Strep is a bacterial infection, and I'm glad you recovered without antibiotics.
- karim79 2y ago
  Thank you. Had I been smarter I would have just called an ambulance, like what my brother did in my fever dream.
  - OutOfHere 2y ago
    This is why I never travel abroad without antibiotics and more.
carlmr 2y ago
>I had a fever dream that my brother had called an ambulance to save me. Reminds me of this, people imagining a helping person or spirit in a dire situation: https://en.wikipedia.org/wiki/Third_man_factor https://en.wikipedia.org/wiki/Third_man_factor