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s more and more countries start to adopt the first global dengue vaccine, Indonesia, one of the largest endemic regions with a population of 251 million, hopes to develop its own vaccine to be used nationwide.

The Health Ministry said it would not use the vaccine issued by French drug manufacturer Sanofi that is currently being distributed in the Philippines, the first to be licensed globally to combat the mosquito-borne disease for people aged between 9 and 45, because it did not match with the types of dengue commonly found in Indonesia.

“The disease is caused by four closely related viruses, dengue virus [types] 1 to 4. The ones [prevented by the Sanofi vaccine] are only viruses 1 and 2, while those types are very rare in Indonesia. The ones that are common in Indonesia are [types] 3 and 4. So if we use the vaccine, it will be a waste,” the ministry’s director general for disease control and environmental health (P2PL), Muhammad Subuh, told The Jakarta Post.

Dengue or hemorrhagic fever, the world’s most common mosquito-borne virus, infects an estimated 390 million people in more than 120 countries each year, killing more than 25,000, according to the WHO.

In Indonesia, the fever claimed 907 lives last year from a total of 100,347 cases.

The WHO said a dengue vaccine represented a major step in controlling the disease as currently there were no specific dengue therapeutics and prevention is limited to vector-control measures. The WHO will publish a vaccine position paper outlining recommendations in July.

However, because the vaccine is not considered compatible with Indonesia, the government has decided to develop its own vaccine together with state-owned vaccine company PT Bio Farma.

“We want to look for a vaccine that is truly suitable for Indonesia and we hope we can start introducing it to the public in 2019,” Subuh said.

It would take at least three years for the government to distribute the vaccine because it would have to be thoroughly tested first, according to Subuh.

“We need to conduct lab tests, clinical tests and field tests,” he said.

He added that Bio Farma was currently conducting lab tests on a vaccine and had succeeded in isolating the type 3 virus.

“But how to turn that into a vaccine? It will take further research,” Subuh said. “After that, there will be clinical tests divided into two steps: animals and humans. That’s why the clinical tests can take two years.”

The last stage would be to test the vaccine on humans in the field, he added.

If the government succeeded in developing a vaccine, it could sell it to other countries with similar types of the virus, according to Subuh.

“If we succeed in isolating types 3 and 4 of the virus and conduct field tests and the vaccine turns out to be safe, then we could sell the vaccine.

“We should be able to do that because we have Bio Farma, which was able to develop a polio vaccine. Two-thirds of the global need for the polio vaccine is being produced in Bandung, where Bio Farma is located. We want to achieve a similar success [with dengue],” he said.

Sanofi’s vaccine took 20 years to develop and cost US$1.8 billion.

The company said the vaccine should prevent eight out of 10 cases of dengue hospitalization and up to 93 percent of cases of severe dengue hemorrhagic fever.

“This initiative sends a strong message to the rest of the [...] world that dengue vaccination is a critical addition to integrated disease prevention efforts,” Sanofi said in a statement.

Sanofi’s two-decade effort to develop the vaccine included 25 clinical studies in 15 countries. This saw 29,000 volunteers receive a vaccine that, aside from the Philippines, has also been registered in Mexico, Brazil and El Salvador.
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