Aug 17, 2004 -- The United Kingdom may take "don't do drugs" to an entirely new level. Several members of the Government-appointed "Brain Science, Addiction, and Drugs" expert committee proposed a national vaccination program for one of the fastest growing child welfare concerns worldwide — drugs.
Under the program presented to Parliament late last month, children in "high risk situations"—children whose family or socio-economic circumstances might make them more susceptible to drug addictions—would be vaccinated against drugs like cocaine, heroin, and nicotine, all closely linked to severe addictions.
Dr. David Nutt, Professor at the University of Bristol, a member of the committee and drugs advisor to the Government was reported in the July 25th Brit newspaper The Independent on Sunday, saying: "People could be vaccinated against drugs at birth as you are against measles. You could say cocaine is more dangerous than measles, for example … addiction and smoking are major causes of premature death."
Even in its very premature stages, the proposal has sparked controversy on both sides of the Atlantic.
"The very idea [of child drug vaccinations] would be highly unethical," says Dr. Max Mehlman, a Law and Biomedical Ethics professor at Case Western Reserve University, in Cleveland, OH. "We have a lot of information missing, particularly safety risks."
"How are we going to know if it's safe? How will we even know if it's working?," Mehlman continues. "Are we going to give [children] cocaine [to test the safety or effectiveness]? It's absurd."
Dr. Margaret Cho, a Bioethics professor at Stanford University, in Palo Alto, CA, adds that while those safety questions are a definite concern, "the prospect of launching a national program to alter behavior, possibly without consent and without examining the long-term effects much more closely is truly frightening."
Safety concerns involving children and the anti-drug vaccinations are echoed even by Xenova, a British biotechnology firm of Berkshire, England. Their anti-drug vaccine testing—the only testing of its kind made public in the UK—has just begun on nicotine, and is slightly more advanced with cocaine.
"We are not aware of any plans to introduce our vaccines to children," Veronica Cefis-Sellar, head of Xeonva's Corporate Communications, explains. "Our vaccines have been created and tested only on consenting adults, and we have not been approached regarding any child inoculations." Cefis-Sellar adds that the anti-cocaine vaccine will not be made available to the public for at least another 2 years.
A is for Apple, C is for Cocaine
The basis behind the UK proposal is simple—drugs and drug-related activities cost money, lots of it. Why not cut the drugs at the source and prevent addiction in the first place? The committee suggests that it would save the economy an estimated £16 billion, or nearly $29.5 billion.
Dr. Donald Landry, an associate professor at Columbia University Medical School/New York Presbyterian Hospital, in New York, NY, was among the first to succeed with an anti-cocaine vaccine, but says that he is still undecided regarding the British proposal.
"The question really is whether we should sign up an entire population for the volitional action of a few," Landry explains.
"But we do it. We now require the Hepatitis B vaccine for every child in America," he adds. "The only people who are at risk [for Hepatitis B] are health workers, intravenous drug users or needle sharers, or people who are sexually promiscuous and often have unprotected sex. Not your average child."
Cho echoes his concerns. "This vaccine is encouraging the belief that we can make problems go away," she says. "The only way we're going to do that is by talking to our kids and knowing where they are and who they're with."
"It's not that there is no place for a vaccine like this," she continues. "But it's not here, with kids."
The Way They Work
The vaccines work similarly to other vaccinations. Antibodies that recognize cocaine as an intruder are injected into the bloodstream. Once the anti-bodies have been introduced, they attach themselves to the cocaine, preventing and "neutralizing" the effect of the drug.
Cocaine, a very small chemical molecule in comparison to most "infections," can usually slip through undetected and alter the body to get the high associated with the drug. However, even if you do take some cocaine with the antibodies in your system, your body will not respond with a high.
Work is underway researching another type of vaccination, one which would teach the body to make its own antibodies against the drug like most traditional children's vaccines such as polio or the measles. The current anti-cocaine antibodies are part of another vaccine type. To keep the antibodies in your system, the current vaccine would require booster shots like those for tetanus with much more frequency, maybe as often as every few weeks.
Considering the involved process, Landry's skepticism towards using the vaccines as a preventative is not unwarranted.
His thoughts are shared by Dr. Kim Janda, a professor at the Scripps Research Institute in La Jolla, CA, and principle investigator of Scripps' work towards a drug super-vaccine. He says he doubts that there could be the long-term effects necessary for a child's inoculation.
"You'd need an almost constant booster," Janda says. "We have no idea if this would work in the long-term, and at this point, [an initial vaccine] definitely wouldn't last through the interim years" until the child is of an age to try cocaine.
"People have this idea that [an anti-drug vaccine] is a magic cure to surmount addiction," he adds. "It's just not realistic."
Back to the Future
There is no doubt that if they worked well, immuno-pharmacological agents like the anti-drug vaccines or one of the Food and Drug Administration's most recent approvals, Campral, an addiction aid for alcohol dependent individuals, would change the world of addiction treatments.
Dr. Paul Appelbaum, former Vice-President of the American Psychiatric Association, director of the Law and Psychiatry program, and professor and chair of the Psychiatry program at the University of Massachusetts Medical Center, in Worcester, MA, says that the vaccine "could be good at controlling that craving that comes with withdrawal."
But Appelbaum stresses that the vaccine's "first use is treatments for people who already have an addiction and have made a voluntary decision" to quit.
Preliminarily, Appelbaum notes that Xenova's 58% success rate is unusually high. "In any one round [of addiction trials] you have a 10-20% success rate, and it's usually many rounds before that number becomes higher. Ultimately, 58% is a big step forward," he explains.
"If it's successful it could be extremely helpful," Appelbaum continues. "There is no doubt that some people have a heightened susceptibility to general addiction. If we have the genetic ability to medicate, vaccinate, or block a specific abnormality, that would have an even broader impact."
Beyond preventing relapse, Janda suggested treatments like these anti-drug vaccines could possibly even counter-act overdoses.
However, single substance users are uncommon, as Appelbaum notes: "what we really should look at is a vaccine targeted against multiple addictions."
Ultimately, Janda and many others note "If you don't have the desire [to stop addiction], it's useless. There are so many drugs out there; you'll just find another drug;" vaccine or no vaccine.