Vaccines have accomplished near miracles in the fight against infectious disease. They have consigned smallpox to history and should soon do the same for polio. By the late 1990s an international campaign to immunize all the world's children against six devastating diseases was reportedly reaching 80 percent of infants (up from about 5 percent in the mid-1970s) and was reducing the annual death toll from those infections by roughly three million.
Yet these victories mask tragic gaps in delivery. The 20 percent of infants still missed by the six vaccines--against diphtheria, pertussis (whooping cough), polio, measles, tetanus and tuberculosis--account for about two million unnecessary deaths a year, especially in the most remote and impoverished parts of the globe. Upheavals in many developing nations now threaten to erode the advances of the recent past, and millions still die from infectious diseases for which immunizations are nonexistent, unreliable or too costly.
This situation is worrisome not only for the places that lack health care but for the entire world. Regions harboring infections that have faded from other areas are like bombs ready to explode. When environmental or social disasters undermine sanitation systems or displace communities--bringing people with little immunity (because of disparities in nutrition and health care) into contact with carriers--infections that have been long gone from a population can come roaring back. Further, as international travel and trade make the earth a smaller place, diseases that arise in one locale are increasingly popping up continents away. Until everyone has routine access to vaccines, no one will be entirely safe.
In the early 1990s Charles J. Arntzen and Dominic Man-Kit Lam, then at Texas A&M University, conceived of a way to solve many of the problems that bar vaccines from reaching all too many children in developing nations. Soon after learning of a World Health Organization call for inexpensive, oral vaccines that needed no refrigeration, Arntzen visited Bangkok, where he saw a mother soothe a crying baby by offering a piece of banana. Plant biologists had already devised ways of introducing selected genes (the blueprints for proteins) into plants and inducing the altered, or "transgenic," plants to manufacture the encoded proteins. Perhaps, he mused, plants could be genetically engineered to produce vaccines in their edible parts, which could then be eaten when inoculations were needed.
The advantages would be enormous. The plants could be grown locally, and cheaply, using the standard growing methods of a given region. Because many food plants can be regenerated readily, the crops could potentially be produced indefinitely without the growers having to purchase more seeds or plants year after year. Homegrown vaccines would also avoid the logistical and economic problems posed by having to transport traditional preparations over long distances, keeping them cold en route and at their destination. And, being edible, the vaccines would require no syringes--which, aside from costing something, can lead to infections if they become contaminated.
Efforts to make Arntzen's inspired vision a reality are still quite preliminary. Yet studies carried out in animals over the past 15 years, and small tests in people, encourage hope that edible vaccines can work. The research has also fueled speculation that certain plant-based vaccines might help suppress autoimmunity--in which the body's defenses mistakenly attack normal, uninfected tissues. Among the autoimmune disorders that might be prevented or eased are type I diabetes (the kind that commonly arises during childhood), multiple sclerosis and rheumatoid arthritis.
By Any Other Name...
REGARDLESS of how vaccines for infectious diseases are delivered, they all have the same aim: priming the immune system to swiftly destroy specific disease-causing agents, or pathogens, before the agents can multiply enough to cause symptoms. Classically, this priming has been achieved by presenting the immune system with whole viruses or bacteria that have been killed or made too weak to proliferate much.