The Next Vaccine For Pregnant Women

In case you hadn’t heard, there’s a new vaccine that will likely be marketed toward pregnant women within the next couple of years. It’s for Respiratory Syncytial Virus (RSV) in the newborn – a common cold-like illness that is usually mild in healthy people. Nearly all children will have had an infection by their second birthday – according to the CDC, and of those who have an infection before 6mths of age, around 1-2% will be hospitalised, due to complications such as bronchiolitis or pneumonia [1].

The quest for an RSV vaccine actually began decades ago, and it had disastrous beginnings.

In the early 1960’s, an RSV vaccine, propagated on human embryonic kidney cells, and passaged through monkey cells, before being inactivated with formalin, and adjuvanted with aluminium, was trialled on infants, with disastrous results. Up to 80% of vaccinated infants were hospitalized with severe lower-respiratory infections, and two babies died [2].

It took scientists nearly four decades to figure out why the vaccine had such tragic results – which just goes to show how little is understood about the very system they seek to tamper with. It was due to “Lack of antibody affinity maturation followed poor Toll-like receptor stimulation”, according to the paper, published in Nature journal, in 2009 [3].

The quest for an RSV vaccine resumed with gusto.

At the forefront of the charge for an RSV vaccine, is Novavax, a biotechnology company with several products currently in the clinical testing stages. Following the announcement of positive results of Phase 2 clinical trials in older adults, in 2015, CEO of Novavax, Stanley Erck declared their RSV vaccine could be “the largest selling vaccine in the history of vaccines in terms of revenue”[4].

Unfortunately, the Phase 3 trial in older adults failed to show efficacy, and the company lost more than $1.5 billion in market value within hours of the announcement, as disappointed investors pulled their money [5].

This gives us some idea of the intense pressure faced by companies to deliver the next new ‘blockbuster’ vaccine. For a company like Novavax, with no products on the market yet, (just the potential of new products), investor confidence is crucial to financing the lengthy clinical trial and regulatory approval process.

Novavax then turned their attention to pregnant women, and in February 2019, announced favourable results (actually, not as favourable as they were hoping for, but nevertheless, they found a way to put a positive spin on them) from a Phase 3 clinical trial on pregnant women. The vaccine, called ‘Resvax’, is not only aluminium adjuvanted, it is also genetically-engineered with nano-particles. The press release stated “Our next steps include meeting with U.S. and European regulators to review these data and to discuss the path forward for licensure” [6].

The trials on pregnant women were funded in part, by an $89 million grant from the Bill and Melinda Gates Foundation, with the stated purpose “to advance to WHO Pre-Qualification the development of a respiratory syncytial virus (RSV) vaccine for maternal immunization to reduce the burden of RSV disease in infants less than six months of age in developing countries”[7-8].

Obviously, the burden of RSV disease falls mainly on developing nations, however, it’s likely that a new RSV vaccine will also be targeted at pregnant women in western countries.

One of the main ways to prevent respiratory disease in infants is via breastfeeding. A study published in British Medical Journal found that among 115 babies who had been hospitalized for RSV infection, only 8 were breastfed [9].

Given that breastfeeding rates are vastly lower in developing countries, one wonders why $89 million (and more) wasn’t spent to increase maternal nutrition and breastfeeding rates. As an example, in West/Central Africa, only a mere 20% of infants are exclusively breastfed for the first six months of their life [10].

One of the main groups promoting the need for an RSV vaccine during pregnancy, is the Oxford Vaccine Group, who admit that almost all infant deaths due to RSV are in developing countries [11].

The director of Oxford Vaccine Group is Andrew Pollard, who holds several patents relating to vaccines [12-13], and is Chair of the UK Department of Health’s Joint Committee on Vaccination and Immunisation, and the European Medicine Agency’s scientific advisory group.

Another member of the Oxford Vaccine Group, Matthew Snape, has been Principal Investigator in clinical trials of numerous RSV vaccine candidates. He is also the Director of the National Immunization Schedule Evaluation Consortium (NISEC) [14].

It is also interesting to note that the CDC has held a patent for an RSV vaccine, since 2010 [15]. How will that affect any future decisions regarding RSV vaccinations being promoted to pregnant women?


[1] CDC, Respiratory Syncytial Virus Infection (RSV), risk/infants-young-children.html. Accessed March 2019.

[2] Dudas RA, Karron RA. Respiratory syncytial virus vaccines. Clin Microbiol Rev. 1998;11(3):430-9.

[3] Delgado MF, Coviello S, Monsalvo AC, et al. Lack of antibody affinity maturation due to poor Toll-like receptor stimulation leads to enhanced respiratory syncytial virus disease. Nat Med. 2008;15(1):34-41. [4] FierceBiotech, Novavax craters after phase III RSV F vaccine failure; seeks path forward, seeks- path-forward. Accessed March 2019.

[5] CNBC, Novavax is down 80%. Here’s why its been really hard to develop an RSV vaccine, rsv.html. Accessed March, 2019.

[6] Novavax, Press Release: Novavax announces topline results from Phase 3 PrepareTM Trial of Resvax TM for prevention of RSV disease in infants via maternal immunization, details/novavax-announces-topline-results-phase-3-preparetm-trial. Accessed March 2019.

[7] Novavax, Bill & Melinda Gates Foundation, melinda-gates-foundation. Accessed March 2019.

[8] Bill and Melinda Gates Foundation,How We Work, Grant: Novavax, Inc, Database/Grants/2015/09/OPP1127647. Accessed March 2019.

[9] Downham MA, Scott R, Sims DG, Webb JK, Gardner PS. Breast- feeding protects against respiratory syncytial virus infections. Br Med J. 1976;2(6030):274-6.

[10] UNICEF Progress for Children, Nutrition Indicators: Exclusive Breastfeeding, Accessed March 2019.

[11] Oxford Vaccine Group: Vaccine Knowledge Project, Respiratory Syncytial Virus, Accessed April 2019.

[12] Justia Patents, Vaccine,, Accessed April 2019.

[13] Justia Patents, Compositions comprising OPA Protein Epitopes, Accessed April 2019.

[14] Oxford Vaccine Group, Matthew Snape, Accessed April 2019.

[15] Anti-RSV Immunogens and methods of Immunization, or+inas signee:disease+inassignee:control. Accessed April 2019.

15 Reasons Why Millions of People Once Died From ‘Infectious’ Disease


During the 19th century, the population of London swelled by more than six-fold, from 1 million to more than 6 million inhabitants, to become the largest city in the world [1].

All across the western world, as the Industrial Revolution took hold, vast numbers of rural folk moved into towns and cities. For example, in 1750, only 15% of the population lived in towns, but by 1880, a massive 80% of the population were urban dwellers [2]. The Industrial revolution, and city living, promised a better life but, for many, it became an unimaginable nightmare.

With housing in short supply, unscrupulous landlords turned buildings into tenements, and leased every spare inch to desperate families – dingy damp cellars, fire-trap attics and under-stair storage rooms, many without any ventilation or light. Just imagine the damp, mouldy air that these people were constantly breathing – it’s hardly a wonder that tuberculosis and pneumonia were the biggest killers, accounting for one-fifth of all deaths [3].

Disease and death were distressingly close in these crowded quarters: “…the report of a health officer for Darlington in the 1850’s found six children, aged between 2 and 17, suffering from smallpox in a one-roomed dwelling shared with their parents, and elder brother and an uncle. They all slept together on rags on the floor, with no bed. Millions of similar cases could be cited, with conditions getting even worse as disease victims died and their corpses remained rotting among families in single-roomed accommodations for days, as the family scraped together pennies to bury them” [5].


Entire streets had to share one outdoor toilet, which was usually in foul condition – cleaning supplies were expensive, and flies hung around in droves (and then made their way through open windows to nearby kitchens etc), and of course, diarrhoea was ever-present!

Sewerage drained into waterways via open channels in the streets and lanes, or simply lay stagnant in stinking cesspools of filth.

Henry Mayhew was an investigative journalist who, in 1849, described a London street with a ditch running down it, that contained the only drinking water available to residents. He said it was ‘the colour of strong green tea’, and ‘more like watery mud than muddy water’.

‘As we gazed in horror at it, we saw drains and sewers emptying their filthy contents into it; we saw a whole tier of doorless privies (toilets) in the open road, common to men and women built over it; we heard bucket after bucket of filth splash into it’ [6].


With no environmental laws in place, raw sewage poured into drinking water supplies, as did run-off and toxic waste from factories and animal slaughterhouses.

 “The spill-off from the slaughter-houses and the glue factories, the chemicals of the commercial manufacturers, and all of Chicago’s raw sewage had begun to contaminate the drinking water” [7].

In London, the River Thames, which was the source of drinking water for many Londoners, became a stinking flow of excrement and filth, as human, animal and industrial waste was dumped into it. “In the heatwave of 1858, the stagnating open sewer outside Westminster’s windows fermented and boiled under the scorching sun” [8].

During a cholera epidemic in London, in 1854, Dr John Snow realized that the only people who seemed to be completely unaffected were the workers at a local brewery – they were drinking beer instead of water [9]! The discovery that disease could be spread via water was revolutionary, and paved the way for massive sanitary reforms


With slow, unreliable transport, and no refrigeration, food was often past its use-by date. Diseased and rotting meat was made into sausages and ham. ‘Pigs are largely fed upon diseased meat which is too far gone, even for the sausage maker, and this is saying a great deal; and as a universal rule, diseased pigs are pickled and cured for ham, bacon etc’ [10].

Milking cows were often fed on ‘whisky slops’ and other rotting, cheap food, and therefore became diseased. ‘New York’s milk supply was also largely a by-product of the local distilleries, and the milk dealers were charged with the serious offense of murdering annually eight thousand children’ [11].

Before pasteurization, milk was treated with formaldehyde to prevent souring [12].

‘Fresh’ produce, when it was available, was not so fresh after all – often slimy, putrid and unfit for human consumption [13].


During the 19th century, countless mothers died during, or soon after, childbirth.

There were a number of reasons for this:

a) Rickets, and malnutrition in general, was rife,

b) Doctors, who had impinged into the female-only world of childbirth, took offense at the idea they had dirty hands, and refused to wash them [14],

c) chloroform and forceps were used unnecessarily, even in uncomplicated labours [15]

If the baby survived past infancy, they could generally look forward to a life of malnutrition, hard labor and improper care, often performed by older siblings.

During the Industrial Revolution, many mothers worked long hours in factories, leaving their young children in the care of hired ‘nurse-girls’, who were little more than children themselves, between 8-12yrs of age [16].

Many children ended up living on the streets, driven to stealing and pilfering in order to survive. ‘In 1848 Lord Ashley referred to more than thirty thousand ‘naked, filthy, roaming lawless and deserted children, in and around the metropolis‘ [17].


With the Industrial Revolution in full swing, and labour in short supply, children as young as three and four years old were put to work in sweatshops and factories. Many of the jobs involved long hours, working in dangerous conditions, such as around heavy machinery or working near furnaces [18].

Children were forced to do back-breaking work in the most appalling conditions: ‘Children began their life in the coal-mines at five, six or seven years of age. Girls and women worked like boys; they were less than half-clothed, and worked alongside men who were stark naked. There were from twelve to fourteen working hours in the twenty-four, and these were often at night…A common form of labour consisted of drawing on hands and knees over the inequalities of a passageway not more than two feet, or twenty-eight inches high a car or tub filled with three or four hundred weight of coal, attached by a chain, and hooked to a leather band around the waist’ [19].

Children were sometimes crushed or ground to death, or had limbs severed, in some of the more dangerous industries, such as underground mining [20]

Basically, millions of children had no childhood, but a monotonous, depressing existence.

‘Children had not a moment free, save to snatch a hasty meal, or sleep as best they could. From earliest youth they worked to a point of extreme exhaustion, without open air exercise, or any enjoyment whatever, but grew up, if they survived at all, weak, bloodless, miserable, and in many cases deformed cripples, and victims of almost every disease’ [18].

And to make matters worse, many children were constantly exposed to poisons, such as arsenic, lead and mercury, which were being widely used in industries, such as silk and cotton spinning [21].

Adulthood didn’t bring much change – hard labour, often for 12-16 hours per day. The terrible conditions and over-work, along with poor diet, aged people quickly: “…from the 1830’s photographs show working people looking old by their thirties and forties, as poor nutrition, illness, bad living conditions and gross overwork took their toll’ [22].


Factories spewed soot and waste into the air, unchecked and unregulated. Cities were covered in a layer of grease and grime [23].

It’s no surprise that lung and chest complaints were rife. And then there was the ever-present stench of open sewage, rubbish, animal dung etc.

Refuse, including the rotting corpses of dogs and horses, littered city streets. In 1858, the stench from sewage and other rot was so putrid that the British House of Commons was forced to suspend its sessions’ [23].

That episode became known as ‘The Great Stink’, and in 1952, atmospheric conditions coupled with coal-fire burning, led to the event now known as ‘The Great Smog” – which killed thousands within the space of weeks [24].

Even today, an estimated 9000 people die prematurely each year in London alone, due to air pollution [25]. Yet the levels of pollution in Victorian times were up to 50x worse than they are today [26] – how many lives must have been cut short because of the foul air poisoning their lungs?


Infant formula was first patented and marketed in 1865, consisting of cow’s milk, wheat and malt flour, and potassium bicarbonate – and regarded as ‘perfect infant food’ [27].

Over the next 100 years, breastfeeding rates dropped to just 25% [28], as social attitudes disdained the practice as being only for the uneducated, and those who could not afford infant formula [29].

Not only did millions of babies miss out on the nurturing of their mother’s breast, but their formula was poor quality, and often made with contaminated water in unsterile bottles, and milk quickly spoiled during warm weather without refrigeration.

It’s hardly a wonder that so many babies succumbed to diarrheal infections, such as typhoid fever.


Without a proper disposal system in place, alleys, courtyards, and streets became littered with rubbish and waste – sometimes knee-high, which was not only offensive-smelling, but a great attraction for all kinds of scavengers – rats, pigs, dogs, cockroaches and swarms of flies [30].


Because horses and donkeys were used to transport goods, they also had to be housed in overcrowded cities, often in close quarters to humans, since space was at a premium. Rotting carcases were left to decompose where they lay.

By late 19th century, 300,000 horses were being used in London, creating 1000 tonnes of dung per day [31].

Pigs roamed freely in the streets, ferreting amongst the rubbish – some towns recorded more resident pigs than people.

Animal slaughterhouses were located amongst high-density tenement housing – animals were constantly slaughtered in full view of the surrounding residents, and the sounds and smell of death were constantly in the air [32].


Due to the burning of coal, and wood fires, cities were blanketed in a thick, black smog that covered everything in grime.

The murk was so dense that countless accidents occurred, including horses and carts running into shop-fronts, or over pedestrians, or into each other [33].

Vitamin D deficiency was widespread, and in the late 1800’s, studies concluded that up to 90% of children were suffering from rickets [34]. In young girls, this often led to deformed hips, and later on, problems in childbirth.


Millions of families subsisted on the cheapest food possible, and many lived on the brink of starvation. Malnutrition was rife, with so little fresh fruits and vegetables in the diet.

Scurvy (Vitamin C deficiency) claimed an estimated 10,000 men during the California Gold Rush in the mid-1800’s [35]. Even in those who did not have overt signs of scurvy, a state of mild deficiency must have been prevalent, leading to weakened immunity to disease and infection.


If you thought blood-letting and leeches were bad, how about an injection of arsenic – proudly brought to you by Merck and Co [36]? Or a gargle with mercury – where’s the harm [37]?

And if you have smallpox, we’ll dab your sores with corrosives [38].

Treatment for syphilis included mercury rubs, bismuth injections, and arsenic injections – some patients endured more than 100 such injections [36].

It’s highly possible that the medical ‘treatments’ killed more people than the diseases they were intended to treat.

Hospitals were known to be breeding-grounds of disease, and over-run by rats, that were so numerous and hungry, they ate patients [39].


With less than 2% of the urban population with running water to their homes [40], and soap/detergents viewed as luxuries, washing of hands, clothes, plates and utensils had to be done with dirty, contaminated water – or not at all.

Note that items such as nappies and sanitary ‘rags’ also had to be washed – no ‘disposables’ in those days!


We now know that stress and fear take a huge toll on the body, resulting in immune system malfunction [41]. Can you imagine the mental anguish of being surrounded by abject poverty, and seeing no way of escape for yourself or your children? Or the panic of watching everybody you love succumb to a dreaded disease, and not having the knowledge or means to protect yourself?

Fear and hysteria ran high during disease outbreaks – during a cholera epidemic in the US in 1849 “thousands fled panic-stricken before the scourge…The streets were empty, except for the doctors rushing from victim to victim, and the coffin makers and undertakers following closely on their heels” [42].

Not to mention the stress of toiling for long hours in monotonous or dangerous work, with hardly a piece of dry bread to fill your hungry stomach?

Given the poor living conditions that millions suffered, it was hardly a wonder that average life expectancy was, tragically, just 15 or 16 years among the working class [43].


[1] GB Historical GIS / University of Portsmouth, London GovOf through time | Population Statistics | Total Population, A Vision of Britain through Time.

[2] [Porter R. The Greatest Benefit to Mankind, Harper Collins, New York, 1997]

[3] Publications of the American Statistical Association, Volume 9, Nos 65-72, 1904-1905, pp 260-261.

[4] Chesney K. The Victorian Underworld, Penguin Books, 1972.

[5] Porter D, Health, Civilization and the State – A History of Public Health From Ancient to Modern Times, Routledge, Oxfordshire, England, 1999.

[6] Mayhew H. A Visit To The Cholera Districts of Bermondsey, The Morning Chronicle, 24th September, 1849.]

[7] Byrne J, My Chicago, Northwestern University Press, Evanston, Illinois, 1992.

[8] Mann E, Story of Cities #14: London’s Great Stink heralds a wonder of the modern world, The Guardian, 4th April, 2016, Accessed January, 2019.

[9] Radeska T, The 1854 cholera outbreak of Broad Street, Everyone got sick except those who drank beer instead of water, Vintage News, 26th September, 2016,, Accessed January, 2019.

[10] The British and Foreign Medico-Chirurgical Review, Quarterly Journal of Practical Medicine and Surgery, Volume XXXV, John Churchill and Sons, London, Jan-Apr 1865, pp 32-33.

[11] Cole AC, The Irrepressible Conflict 1850-1865: A History of American Life, Volume VII, Macmillan, New York, 1934, p 81.

[12] Formaldehyde and Milk, JAMA. 1900; XXXIV(23):1496.

[13] Report of the Council of Hygiene and Public Health of the Citizen’s Association of New York, 1865, p 59.

[14] Wertz RW, Wertz DC, Lying In: A History of Childbirth in America, Yale University Press, 1989, p 122.

[15] Loudon I, Maternal Mortality in the Past and its Relevance to Developing Countries Today, American Journal of Clinical Nutrition, 2000, 72:241S-246S.

[16] Newman G, Infant Mortality: A Continuing Social Problem, Methueun and Co, London, 1906, p 95.

[17] Horn P. The Victorian Town Child, New York University Press, 1997.

[18] Willoughby WF, de Graffenried C, Child Labor, American Economic Association, Guggenheimer, Weil and Co, Baltimore, 1890, p 16.

[19] Cheyney EP. An Introduction to the Industrial and Social History of England, Macmillan, New York, 1920, pp 243-244.

[20] Lovejoy OR, Child Labor in the Coal Mines, Child Labor – A Menace to Industry, Education and Good Citizenship, Academy of Political and Social Science, 1906, p 38.

[21] The American Journal of Nursing, 1903, 3(8):664.

[22] Mearns A, Preston WC. The Bitter Cry of Outcast London: An Inquiry Into the Condition of the Abject Poor, James Clarke and Co, London, 1883.

[23] Noble TFX, Straus B, Osheim DJ, Neuschel KB, Accampo AE, Roberts DD, Choen WB. Western Civikization: Beyond Boundaries, Volume II, 6th Edition, Wadsworth, Boston, Massachesetts.

[24] Carrington D, The truth about London’s air pollution, The Guardian, 5th February, 2016, Accessed January, 2019.

[25] Vaughan A, Nearly 9500 die every year in London because of air pollution, The Guardian, 15th July, 2015, Accessed January, 2019.

[26] UK Air, What are the main trends in particulate matter in the UK? Chapter 7,, Accessed January, 2019.

[27] Stevens EE, Patrick TE, Pickler R. A history of infant feeding. J Perinat Educ. 2009;18(2):32-9.

[28] Hirschman C, Butler M. Trends and differentials in breast feeding: an update, Demography, 1981, 18:39-54.

[29] Riordan J; Countryman BA. “Basics of breastfeeding. Part I: Infant feeding patterns past and present.”, JOGN Nurs 1980., 9 (4): 207–210.

[30] Oatman-Stanford H, A Filthy History: When New-Yorkers Lived Knee Deep in Trash, Collector’s Weekly, Accessed Januray, 2019.

[31] Jackson L. Dirty Old London: The Victorian Fight Against Filth, Yale University Press, 2014.

[32] Annual Report of the Metropolitan Board of Health, 1866, Westcott and Co’s Printing House, New York, 1987.

[33] Heggie V, Over 200yrs of deadly London air: smogs, fogs and pea soupers, The Guardian, 9th December, 2016, Accessed January, 2019.

[34] Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062-72.

[35] Lorenz AJ, Scurvy in the Gold Rush.” Journal of the History of Medicine and Allied Sciences, 1957, 12(4):473–510.

[36] Cormia FE, Tryparsamide in the treatment of Syphilis of the central nervous system, British Journal of Venereal Diseases, 1934, 10:99-116.

[37] Swediaur F, Practical observations on the more obstinate and inveterate venereal complaints, J Johnson and C Elliott, London, 1784.

[38] Blumgarten AS. A Text Book of Medicine – For Students in Schools of Nursing, 1937.

[39] Vincent’s Semi-Annual United States Register, 1860, p346.

[40] Greene VW, Personal Hygiene and Life Expectancy Improvements Since 1850: Historic and Epidemiologic Associations, American Journal of Infection Control, August 2001, p 205.

[41] Rosen J, The Effects of Chronic Fear on a Person’s Health, Neuroscience Education Institute (NEI), 2017 Conference,, Accessed January, 2019.

[42] Cole AC, The Irrepressible Conflict 1850-1865: A History of American Life, Volume VII, Macmillan, New York, 1934, p 81.

[43] Greene VW, Personal Hygiene and Life Expectancy Improvements Since 1850: Historic and Epidemiologic Associations, American Journal of Infection Control, August 2001, p 205.