Nineteen children in the United Kingdom have already been killed by an unusually aggressive bout of group A streptococcus infections, commonly called strep A, and the Centers for Disease Control and Prevention are worried it’s coming to America next. For many of us familiar with strep as a mere childhood nuisance, the deaths may be surprising. While death is usually rare in the industrialized world, strep claims as many as 500,000 victims every year.
There is still no vaccine for strep A, in no small part because from 1979-2006 the FDA effectively banned testing of experimental strep A vaccines in humans based on questionable evidence. As the tragic deaths in the UK have shown, neglecting even an apparently “mild” disease carries devastating costs in the long run.
The United States has the tools at its disposal to vanquish this disease. We can look to the model used to produce COVID-19 vaccines in record time under Operation Warp Speed. Above all, it is a question of political will.
COVID vaccines were developed at record speeds because the money was provided to buy them. Operation Warp Speed made $18 billion in guaranteed market commitments for the U.S. alone. This immense sum motivated rapid development of a huge array of potential vaccines, aided by critical research preparing for coronavirus vaccines by the National Institutes of Health.
The question, then, is whether we can similarly buy our way out of strep A and other infectious diseases. Vaccines are expensive and time-consuming products to develop, so the private sector is often wary of research into diseases with high global incidence and burden but without a clear path to profitability.
To correct this market failure, Operation Warp Speed built off the idea of “advanced market commitments.” The state names a price for any product delivered that meets its specifications, incentivizing development by guaranteeing the private sector a market for success.
It would be a mistake to think that such incredible measures should only be reserved for the most threatening of pandemics like COVID-19. Even something as innocuous as the common cold costs the U.S. economy $25 billion each year, and the flu kills more than a thousand people globally each day.
Eleven million Americans, mostly children, are infected with strep A every year. A 2008 study found that children with strep miss an average of 1.9 days of school, 42 percent of parents have to miss an average of 1.8 days of work, and the societal cost can be valued at $205/case in the U.S.
A 2007 paper on advanced market commitments estimated $5 billion as the amount that would lead to a strong likelihood of successfully developing the first vaccine against a disease. In 2021 dollars, that would mean paying a bit more than $20 per American.
Strep A vaccines are one of the projects typically seen as less lucrative because the disease is rarely serious in wealthy countries, but there have still been developments in the field. For example, a challenge study was recently conducted in Australia where 25 participants were deliberately infected with strep A in preparation for future trials to test treatments or vaccines.
Outlandish as that may sound, challenge studies are an important way to test vaccines quickly and were crucial steps in the successful development of vaccines for diseases like malaria, cholera and typhoid, among others. By giving volunteers a vaccine and then exposing them to the disease, it is very easy to rapidly gather powerful data on efficacy from a comparatively small group. The World Health Organization identified challenge studies as an important step in its strep A vaccine roadmap, especially because animal trials are not very useful proxies for understanding this disease.
What remains is to marshal existing research with the private sector’s capabilities and the government’s support and financial backing. The tools clearly exist to develop a vaccine and stop children from suffering from strep. Surely, $20 per American is a reasonable price.
Josh Morrison is the president of public health nonprofit 1Day Sooner as well as the founder of Waitlist Zero and the Rikers Debate Project.