BOSTON — Eleven-year-old “Ned Kelly” is in for his annual physical at a clinic in Boston’s Jamaica Plain neighborhood. As part of his check-up, he’s getting a booster shot to protect him against Lyme disease. Ned doesn’t like needles, but he holds still while Dr. Joel Kaye squeezes the pink serum under his skin.
“Little pinch,” says Dr. Kaye, “we’ll be home free. All right, good job!”
Ned is lucky, because he’s one of the select few who can get the vaccine that gives him immunity against Lyme disease.
WBUR delves into the difficulties of tracking Lyme disease, explore the history of attempts to develop a vaccine, spotlight the latest thinking on treatment, and tell the stories of patients who know these issues firsthand.
Ned is lucky because he’s a dog.
At the MSPCA Angell Animal Medical Center, dogs are regularly vaccinated against Lyme. Ned’s owner, Joe Turchin, lives in Falmouth. Ticks are bad there and Lyme is prevalent.
Turchin’s glad he can protect his dog. But he wishes there were a human vaccine, too.
“You know, if there were a vaccine,” Turchin says, “our doctors would be suggesting it to us, certainly for those of us on the Cape and the islands. Because it’s a horrendous plague!”
Actually, modern science has given us a human vaccine against Lyme disease.
Too bad we don’t use it.
“Lyme disease is the only infection I know of where we have a safe and effective vaccine, but it’s not available to the public,” says Dr. Allen Steere, the physician who uncovered the disease. Steere was 33 years old back in 1975 when he was sent to the Connecticut town of Lyme to look into a mysterious cluster of kids who had gotten arthritis.
“Four or five months into the investigation, we came to suspect that ticks may be involved,” Steere said of his team’s work. They had found a previously unknown disease, and ever since, Lyme has been Steere’s life’s work.
After the discovery, he and other scientists first isolated the spiral-shaped bacterium that causes Lyme disease, and then they looked for ways to make people immune to it. Today, Steere’s laboratory is at Massachusetts General Hospital. He says finding a biological pathway to vaccinate against Lyme was a major milestone.
“Lyme disease was epidemic in certain locations, particularly in the northeastern United States,” Steere says. “So here was the possibility of really changing that.”
By the mid-1990s, two pharmaceutical companies began trials of candidate vaccines.
Dr. Gregory Poland is a vaccinologist at the Mayo Clinic. He says the vaccines helped people build up lots of antibodies that killed the Lyme agent relatively quickly. “So that when a tick bites you and sucks your blood, it is sucking up the antibodies out of your blood,” Poland says. “Those antibodies go into the tick’s gut, kill the Lyme organisms so that when that tick then regurgitates into your skin, you don’t get Lyme disease.”
Poland says as innovative as these vaccines were for killing the Lyme bacterium before it even got into your body, they weren’t perfect. You had to get booster shots, so it took a year to become immune. It wasn’t approved for children 14 and under. Still, for those 15 and above, it worked pretty well. Human trials conducted by Steere showed that about 80 percent of those vaccinated gained immunity.
“People are fed up! This is a terrible situation we’re in, which means that a vaccine still makes sense.”
Introduced in 1998, the vaccine sold well at first. But then opponents spoke out: self-described ‘vaccine victims’ — perhaps similar to people today who claim the MMR vaccine causes autism. Back then, they said that the Lyme vaccine gave them arthritis.
“And this sort of got into popular lore,” Poland recalls. “It got on the Internet. There were a number of East Coast lawyers who started putting together class-action lawsuits. There were anti-vaccine advocacy groups that were formed.”
And there were threats against the scientists who had worked to help protect people against the disease. Poland had to hide where he lived. Steere got a security detail.
The clinical data did not back up any of this. The trials had not shown such side effects. The Food and Drug Administration and the Centers for Disease Control looked into the claims, and then continued to recommended that people exposed to tick-infested areas get the vaccine.
But it was too late. Sales had plummeted. Four years after offering people immunity against Lyme, SmithKline Beecham stopped making the vaccine. The second vaccine-maker, Pasteur Mérieux Connaught, saw what had happened and never put out its own product.
“Now with the withdrawal of the vaccine, people are doing all kinds of things,” Poland says.
Poland notes that since then, Lyme has become more widespread and is now the most common tick-borne disease in the country.
“I’m personally aware of individuals, who in desperation have gone to veterinarians and remarkably convinced the veterinarian to inject them with the canine vaccine,” he says.
Despite the growing demand for access to a human vaccine, many drug companies say not they’re not interested in working on one.
“There are so many diseases,” notes Farshad Guirakhoo, senior director of external in North America at Sanofi Pasteur, the vaccines division of the drug giant Sanofi. His company is working instead on a vaccine for dengue fever.
“For diseases like Lyme disease, the medical need is smaller,” Guirakhoo says. “So we need to put our resources toward where the medical need is greater and then you can make the vaccine.”
With little to no interest from drug companies, some people want government to step in — even state government. Earlier this month, at a hearing of the new Massachusetts Lyme Disease Commission, veterinarian Sam Telford suggested the Bay State license GlaxoSmithKline’s FDA-approved vaccine.
“We all know that the market has changed,” Dr. Telford said then. “People are fed up! This is a terrible situation we’re in, which means that a vaccine still makes sense.”
Telford arguess the state could make it at the UMass Biologics Laboratory in Jamaica Plain, a facility that has made other vaccines before. GlaxoSmithKline would not say whether it would consider such an option.
So for now, there’s no sign of any vaccine becoming available. And if there were, Poland says the old opponents are already promising to fight the introduction of any new Lyme vaccine.
“So we know scientifically how to develop a vaccine that would protect against all this human misery,” Poland says with an air of regret. “And yet, for these societal and cultural reasons, not scientific reasons, that will not be done in the foreseeable future in the U.S.”
Steere is a little more hopeful. The man who first connected the mysterious affliction to the ticks of Lyme, Conn., back in 1975, has worked on the disease his entire professional life. Losing the human vaccine that he had helped along, he admits, was a major setback. But he doesn’t want to assign blame.
“Multiple things happened,” Steere says. “What I’d like to see happen now, is that it’s possible to move on. Even make a better vaccine. I think that’s still possible.”
Until that day, people are going to have to try to protect themselves. Long pants. Insecticides. Body inspections. People are going to have to keep living with Lyme.