Tackling a problem jointly

At their meeting in Queenstown last week, the Australian and New Zealand Prime Ministers announced a joint initiative to fund a trans-Tasman project that will evaluate some potential vaccine candidates for tackling the persistent problem of rheumatic fever and the consequent rheumatic heart disease that is seen in parts of our two countries’ populations.

Both countries have some very active research into this problem, and there are several vaccine candidates in different stages of development. However, tackling rheumatic fever has not been seen as a priority for the major vaccine developers for a variety of reasons. The joint funding by the Australian and New Zealand governments is needed because while rheumatic fever may not be a global priority, it is certainly one for Māori, Pasifika and Aboriginal populations.

The project arose from discussions initiated by Mr Key while visiting the Auckland Medical School. In turn, this led to the Prime Minister requesting my Office and that of my Australian counterpart, Professor Ian Chubb, to work together to promote the development of a joint proposal by scientific experts in the field from the two countries. The proposal was subjected to independent international review by distinguished experts. This enabled both myself and Professor Chubb to independently make recommendations to our Prime Ministers.

Developing any vaccine is complicated and fraught with scientific problems. Rheumatic fever is caused by an immune reaction to a bacterium, the group A streptococcus. There are many strains of the bacterium worldwide, and the vaccine needs to deal with the strains that cause disease in our populations. It should also target components of the bacterium that make it less likely that vaccine resistance will evolve, and the vaccine itself should not cause the damaging immune reaction. There was sufficient evidence from the scientists’ work to date that these issues can be addressed. Thus we recommended that an initial funding be made to progress the science to a point where a decision could be made to take a vaccine into clinical development.

I am delighted that the two Prime Ministers felt able to commit resources to this project. We are still some way from a clinical trial of a vaccine suitable for New Zealand, but this is the essential next step. It is also an illustration of how New Zealand and Australian science planners and scientists can work constructively together more closely than they have in the past.

The prospect that a vaccine against rheumatic fever will be available some years into the future does not obviate the continued need for public health approaches to tackle the issues that lead to such a high incidence of this disease in parts of our population — something that has been remarkably resistant to reduction over some 40 years since I was a young paediatrician.