WEBVTT

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It is hard to overstate
the beneficial effects of immunization.

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According to the US
Centers for Disease Control,

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US children born over the last 20 years --

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for those children, vaccines will prevent
greater than 322 million illnesses,

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greater than 21 million hospitalizations

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and greater than 730,000 deaths,

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with the societal cost savings
of nearly 1.4 trillion dollars.

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Those are big numbers.

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But let's zoom in
and look at a particular example.

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Vaccines have nearly eliminated

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a bacterial infection
called Haemophilus influenzae.

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This bacterium
used to infect young infants

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causing bloodstream infections,

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pneumonia, meningitis, death

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or permanent disability.

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As a young pediatrician,
I saw a few cases.

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You folks probably have never
heard of this disease,

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because vaccines have been so effective.

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You could see in the graph on the right

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that since the introduction of vaccines,

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the incidence of Haemophilus
bacterial infections

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has plummeted like a rock,
and it's nearly vanished.

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So vaccines are generally a success story.

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But we also face challenges.

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For one, for most vaccines,
we need to give multiple doses

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to achieve or maintain protection.

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The scientific community is working
on developing single-shot vaccines.

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Imagine being able to get only one
influenza shot your whole life

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and not having to get
a seasonal flu vaccine.

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Certain microbes
are difficult to immunize against.

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A classic example is human
immunodeficiency virus, or HIV.

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The need is urgent,
progress is being made;

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we're not there yet.

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Another critical element
in vaccine research right now

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is optimizing vaccines
for the most vulnerable among us,

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the very young and the elderly.

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And this is an active area of research.

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Finally, one of the biggest challenges
we unfortunately face right now

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are anti-vax attitudes.

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In fact, it's alarming that over 100,000
infants and children in the United States

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have not received any vaccines,

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and that number is growing.

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In fact, the World Health
Organization, or WHO,

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has declared anti-vax attitudes

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as one of the 10 most important
threats to human health

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in the world today.

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This graphic illustrates
the spread of anti-vax sentiment

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in the state of California,

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from the year 2000 to 2013,

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by looking at the percentage
of public kindergarten students

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who claim the personal exemption
against immunization.

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Anti-vax sentiment is on the rise,

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and it has very real consequences.

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Many of you may be aware of the fact

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that we're seeing infections
that we thought we conquered long ago

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coming back.

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Measles outbreaks have been reported
in multiple US states.

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And many have forgotten,

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but measles is very
infectious and dangerous.

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Just a few viral particles
can infect an individual.

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And there have been even reports

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at sporting events
and at an Olympic stadium

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where the virus, through the air,
travels long distances

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and infects a vulnerable
person in the crowd.

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In fact, if I had
a measles cough right now,

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(Coughs)

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somebody in the back
of this auditorium could get infected.

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And this has had
very real-world consequences.

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Just a few months ago,

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an airline stewardess
contracted measles on a flight,

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the virus entered her brain
and caused encephalitis,

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and she died.

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So people are now dying
due to this anti-vax sentiment.

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I do want to take a few minutes

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to address those
who don't believe in vaccines

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and who resist vaccines.

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As a pediatrician who receives
my yearly flu vaccination,

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as a parent of three children

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who have been vaccinated according
to the recommended schedule,

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and as a pediatric infectious
disease consultant

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who has taken care
of young children with meningitis

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that would have been preventable
had their parents accepted immunization,

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this is a personal matter to me.

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Let's take a look
at who is going to pay the price

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if we start dialing back the amount
of vaccination in our society.

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This graph depicts, on the Y axis,

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the number of individuals
dying of infection in the world.

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And on the X axis,

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the age of the individuals who are dying.

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And as you can see,
it's very much a U-shaped distribution,

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and it's particularly stark
in the very young ages.

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So vaccines shield
the very young from infection.

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And if we want to talk, my friends,
about what vaccines cause,

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because there's a lot of speculation,

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unfounded speculation on the internet,
of what vaccines cause,

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vaccines cause adults, OK?

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That's what they cause.

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And the other thing that they cause
is for elderly individuals to live longer.

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Because they are shielded
against influenza

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and other killers of the elderly.

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Now, let's talk a little bit

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about how we can improve
vaccines even further.

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We can create vaccines that can immunize
the most vulnerable among us

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and perhaps even vaccines
that protect with single shots.

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Let me go over a little bit
of the immunology.

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In the top panel, what you see
is a simple vaccine.

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All vaccines contain
something called an antigen.

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The antigen is like a piece
of a germ, of a microbe,

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that your body remembers, right?

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It forms antibodies
and those antibodies can protect you.

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So those kind of vaccines
can induce an immune response,

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but as you see here,

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that immune response
tends to go up and back down,

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and you need to get another dose
and another dose

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to maintain protection.

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What can we do?

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We and other scientists around the world

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are finding molecules
that can boost a vaccine response.

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Those are called adjuvants,

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from the Latin "adjuvare," to help or aid.

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Adjuvants are molecules
we might add to a vaccine

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to get a stronger response.

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And in the presence of the adjuvant,
depicted here in red,

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you have a much more profound
activation of the white blood cells

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of your immune system,

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and generate a much more
profound immune response,

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with much higher antibody
levels, more rapidly,

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and that lasts a long time
for durable immunity.

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Interestingly, these adjuvants
have different effects

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depending on the age or other demographic
factors of the individual.

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Which brings me to the notion
of precision vaccines.

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This is the idea that we will take
precision medicine --

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you know what precision
medicine is, right,

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that's the idea that populations may vary

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in their response
to a particular medicine --

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and apply that to vaccines.

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Right?

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And here in Boston Children's Hospital

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at the Precision Vaccines
Program I direct,

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we have five approaches,
stepwise approaches we take,

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to build precision vaccines

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that are tailored
to vulnerable populations.

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Number one,

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we need to understand
what the attitude of a given population is

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towards a vaccine.

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You could build the most
sophisticated vaccine in the world,

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but if nobody wants to take it,
you're going nowhere.

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Number two,

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we have to think
of the route of immunization.

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Most vaccines are intramuscular, or IM,

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but there are others,
intranasal, oral and others.

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Then, as I just described to you,
vaccines have components.

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All vaccines have an antigen,

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that's the part of the microbe
that your body remembers,

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that you might make antibodies
or cell-mediated immunity against.

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And we might add an adjuvant,
as we talked about,

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to boost an immune response.

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But guess what?

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There are many different
antigens to choose from

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and many different adjuvants.

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How are we going to make that decision?

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And the menu of these keeps growing.

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So on our team,

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we've developed ways
to test vaccines outside the body --

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in Latin, that's "in vitro" --

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in a tissue culture dish.

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So we use tissue engineering
with blood cells

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to immunize outside the body

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and study the effect of the vaccine

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against, for example, infants
or elderly individuals or others.

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And if you think about it,
this is critical,

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because if you look at all the infections
we want to build vaccines against,

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like Zika virus and Ebola virus
and HIV and others,

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all the candidate antigens,

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all the candidate adjuvants,

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all the different populations,

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it's going to be impossible to do
large, phase III clinical trials

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for every combination.

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This is where we think being able
to test vaccines outside the body

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can make a big difference
to accelerate vaccine development.

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And finally, this whole effort
is to drive an immune response

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that will protect against
that particular pathogen,

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getting antibodies and other cells
to defend the body.

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We are also using additional
innovative approaches

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to bring the most cutting-edge science
to vaccine development.

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We're taking a deeper dive
as to how current vaccines protect.

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We've formed an international consortium

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to study how hepatitis B vaccine
protects newborns

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from hepatitis B infection.

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And to do this,

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we've developed a technique
called small sample, big data.

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We can get a tiny little drop
of baby blood before immunization,

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and take a tiny little drop
after immunization,

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and we can measure the inventory
of all the cells,

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and all the genes and all the molecules
in that drop of blood,

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and we can compare after the vaccine

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to before the vaccine in that same baby

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and understand in a deep way

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exactly how that successful
vaccine protects.

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And those lessons we can use
to build the next vaccines in the future.

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So this diagram is really illustrating
a tiny drop of blood

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yielding huge amounts of information,

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tens of thousands of analytes,

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and that hairball is meant to depict
the gene pathways that are turned on

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and the molecular pathways
that are turned on.

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So much more to come on that,
and very exciting science.

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So we are partnering
with scientists around the world

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to bring all these new technologies
to invigorate vaccine development

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in a Precision Vaccines network.

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We are going to advance
personalized vaccines

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for vulnerable populations
around the world.

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Our team includes scientists,
technical experts and physicians.

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And we're developing vaccines
against infectious diseases

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like pertussis, which is whooping cough.

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We have a whooping cough vaccine,

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but it requires multiple doses,

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and the immunity keeps dropping.

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We want to develop a single-shot
pertussis vaccine.

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We're working on a vaccine
for respiratory syncytial virus,

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the number one cause of infant
hospitalization in the United States.

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A better vaccine against influenza,

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and, of course, HIV.

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We're also looking at vaccines
against cancer, allergy

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and, interestingly, opioid overdose.

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So, this is my final message to you.

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Vaccines protect you and your loved ones

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and the people around you.

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Not only do they protect you
against infection,

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they prevent you
from spreading it to others.

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Get immunized.

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Scientific progress is fragile
and can be lost.

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We must foster accurate
and respectful public dialogue.

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And finally, we're on the verge
of great things,

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a new era of vaccination.

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We've just scratched the surface
of what can be accomplished.

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Please advocate for this research.

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Thank you.

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(Applause)