The Vaccine Publicity Machine

Yesterday there was a big announcement from Professor Ian Frazer at the University of Queensland regarding his plans to begin clinical trials for a new vaccine that may help prevent some kinds of skin cancer. This is exciting news, especially in the country where the incidence of skin cancer is the highest in the world, and in a state (Queensland) that has highest number of reported melanomas. Scottish-born Professor Frazer is already a hero in Australia, having received numerous awards, including Australian of the Year in 2006 ("Ian embodies Australian know-how, determination and innovation"), for his work on the development of a vaccine to prevent papilloma virus infection, a vaccine more commonly known around the world as Gardasil. Human papilloma virus (HPV) infections cause nearly all cases of cervical cancer, which is the fifth leading cause of death of women worldwide. 

In the past 24 hours I have seen several news stories about Professor Frazer's announcement about the skin cancer vaccine. In these stories he has been referred to as the man "who developed the vaccine for cervical cancer," "the scientist who discovered the cure for cervical cancer", the "creator" of the HPV vaccine, and "the Australian scientist who pioneered the vaccine for cervical cancer." Here, on the UQ campus, it's hard not to see a photo of Professor Frazer somewhere, whether at a bus stop or in the latest glossy brochure heralding the university's achievements. Obviously, Australia is quite proud of Ian Frazer's accomplishments--as they should be. Gardasil is now available worldwide, with already over 16 million doses distributed just in the United States, as of June 30th of this year.

Just before we moved to Australia last year, I saw a story about the HPV vaccine in an American newspaper. It contained a brief history that featured the work of researchers at Georgetown University and the University of Rochester, but there was no mention of any research in Australia, except for the fact that it was one of 13 countries involved in the clinical trials of Gardasil. I ran a Google news archive search to see how often Frazer's name was mentioned in conjunction with Gardasil in the past three years.  After excluding Australian news sources, I could find only one or two entries.

So, why then is there nary a mention of the discoverer of the HPV vaccine outside of Australia? A 2006 article that appeared in the Journal of the National Cancer Institute, titled "Who Invented the VLP Cervical Cancer Vaccines?" may provide some answers. It turns out that four institutions hold the patents for the Gardasil vaccine--the National Cancer Institute (in the U.S.), Georgetown, the University of Queensland, and the University of Rochester. And, according to the peer-reviewed literature, "the development of the VLP/L1 vaccine was an incremental process with multiple contributors." There were five key discoveries that led to the various institutions and researchers each claiming credit for the vaccine:
1991: Expression of the human papillomavirus L1 and L2 proteins together, but not L1 alone, resulted in the formation of small VLPs described as "incorrectly assembled arrays" of subunits (reported by Jian Zhou, Ian Frazer, and colleagues at Queensland; Virology).

1992: HPV L1 expression in mammalian cells led to an L1 in cells that was recognized by monoclonal antibodies that bind conformational epitopes; no VLPs were produced in this study but it was considered important because the ability of L1 to self-assemble into VLPs and produce neutralizing antibodies depends on the native conformation of L1, which involves conformational epitopes (reported by Shin-Je Ghim, A. Bennet Jenson, and Richard Schlegel of Georgetown; Virology).

1992: L1 from bovine papillomavirus type 1 self-assembled into morphologically correct VLPs that induced high levels of neutralizing antibodies in immunized animals (reported by Reinhard Kirnbauer, Doug Lowy, and John Schiller at NCI and colleagues; Proceedings of the National Academy of Sciences).

1993: L1 from HPV 11 self-assembled into VLPs, later shown to induce neutralizing antibodies (reported by Robert Rose at Rochester and colleagues; Journal of Virology).

1993: L1 from HPV 16, taken from lesions that had not progressed to cancer, self-assembled more efficiently than the HPV 16 L1 that researchers everywhere had been using; the old strain was shown to be a mutant, possibly because it had been isolated from a cancer (reported by Kirnbaueer, Lowy, and Schiller at NCI and colleagues; Journal of Virology).
Thus, the way the Australian media wants to paint the picture of Ian Frazer as being some sort of Aussie Jonas Salk is misleading. Big discoveries in medicine, and science in general, can rarely be attributed to one person any more. Many people work on different pieces of the puzzle. Apparently, such (international) teamwork makes it difficult, however, for journalists to tell the whole story.