As vaccines are undoubtedly classified as pharmaceuticals, they have to
be submitted to strict non-clinical safety evaluation. The context of
their prophylactic use requires that every effort is made to ensure their
safe use. Their safety evaluation is complex as they act through a
multistage mechanism in which the vaccine by itself acts as a pro-drug,
antibodies and activated lymphocytes being the actual effectors.
Therefore, several potential toxicities must be considered: direct
toxicity of the test article, toxicity linked to the pharmacodynamic
activity of the vaccine, activation of pre-existing disorders, toxicity of
contaminants and impurities and other adverse reactions due to interaction
between the various components. Guidelines dealing with vaccines include
general guidelines applicable to all pharmaceuticals, such as ICH S6, and
also more specific documents which allow some flexibility in study design.
Among the various studies, if single-dose studies are generally part of
the quality control test battery, repeated dose studies are pivotal. The
animal model and treatment schedule selection and the parameters
investigated are critical for the relevance of this safety assessment.
Immunological and safety pharmacology parameters should be adapted to the
specific properties of vaccines and added to this type of study. Vaccines
intended for pregnant women or women of child-bearing age require
embryo-fetal and post-natal studies with an adapted design to obtain
appropriate fetal and maternal exposure during gestation with continuation
into the post-natal period. Tests exist to detect hypersensitivity or
autoimmune reactions, but require further validation. In addition to this
tailor-made approach, any adjuvant or active component added to the
vaccine formulation necessitate their own assessment using studies
routinely performed for new drugs. From this review, vaccine toxicology
would appear to be a separate discipline on its own whose predictivity
will be increased by new method development.
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"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"