Vaccinating against Vice

The technology and political interest are there, but inoculating kids against bad habits might do more harm than good

By Shannon Klie
Betterhumans|9/30/2004

The bell rings and Bobby rushes outside to meet his friends in the field behind the school. When he gets there some older boys are smoking. One of them smiles at Bobby and hands him a cigarette. "Wanna drag?" he asks. At 13, Bobby has never smoked before. Not wanting to look like a geek, he takes the cigarette. He inhales, sputters and coughs. The smoke burns his throat and makes his eyes water. He tries again. He doesn't cough, but the cigarette tastes horrible.

Over time, other children become addicted but not Bobby. When he was younger, his parents vaccinated him against nicotine as part of a government-sanctioned program. He can't feel nicotine's pleasurable effects, so doesn't get addicted to cigarettes.

Far-fetched? Not at all. Successful trials with nicotine and cocaine-specific vaccines could make Bobby's story a reality soon. And it was widely reported this summer that the British government could soon be considering a program to vaccinate children against addiction to nicotine, cocaine and other drugs. So the technology and political interest are there.

But while the allure of using neuropharmacological treatments, such as drug-specific vaccines, as weapons in the ongoing war on drugs might be hard to resist, many scientists and ethicists believe that such government-mandated inoculation could cause more harm than good.

The high cost of addiction

Governments around the world are desperate to curb the rate of addiction and its soaring costs. In May 2004, the World Health Organization (WHO) reported that tobacco kills 4.9 million people each year—more deaths than caused by alcohol use, illegal drug use, suicides, motor vehicle accidents, murders and HIV combined. This number is expected to double in the next 20 years. In 1999, the US Centers for Disease Control and Prevention (CDC) estimated that smoking costs US$75.5 billion in excess medical costs and US$81.9 billion in mortality-related productivity each year. Governments in countries with national healthcare programs have added concerns. The Canadian Centre on Substance Abuse , for example, estimates that illicit drugs cost Canadians CDN$1.35 billion each year.

Nicotine and cocaine create feelings of relaxation, pleasure and euphoria that make these drugs highly addictive. Nicotine activates nicotinic receptors in the brain, stimulating the release of neurotransmitters, such as dopamine, that generate positive sensations. Cocaine produces feelings of euphoria by binding to dopamine reuptake transporters, which results in a build-up of dopamine in the nucleus accumbens—the pleasure centre of the brain.

The body's immune system is very good at responding to foreign threats and expelling them, but drugs such as nicotine and cocaine are too small to stimulate the immune system.

But now, scientists have found a way to force the body to produce antibodies that attack these tiny, addictive molecules.

A nicotine vaccine being developed by the Boca Raton, Florida-based pharmaceutical company Nabi , for example, consists of a nicotine compound attached to an immunogenic protein—a large protein that stimulates the immune system. When the vaccine is injected, it stimulates an immune response that releases nicotine-specific antibodies into the blood. When someone who's vaccinated smokes a cigarette, the antibodies bind to the nicotine and the resulting molecules are too large to cross the blood-brain barrier, so no neurotransmitters are released and the usual high associated with smoking is reduced or prevented entirely.

A cocaine vaccine being developed by the British, Berkshire-based pharmaceutical company Xenova works in much the same way, only it targets cocaine molecules rather than nicotine molecules. This June, the company released the results of its most recent study, in which 58% of cocaine-addicted adults achieved and maintained abstinence during a 12-week period and 42% continued to be cocaine-free after six months. Xenova CEO David Oxlade told New York's Daily News that these are very promising results since the relapse rate with other treatment programs is between 70% and 100% after a few weeks.

Neither Nabi nor Xenova would give an expected market date for their vaccines. Frank Vocci with the US National Institute on Drug Addiction (NIDA), which partially funds the Nabi nicotine vaccine, says it will take at least four years until the vaccine hits the market. He estimates that Xenova's cocaine vaccine might be available in five.

Cost-savings versus cognitive liberty

Before these vaccines become available for public consumption, governments and policymakers will need to develop strategies and ethical guidelines to determine how to use them. The benefits of healthcare and law-enforcement savings, as well as gaining political points with some of the electorate, could motivate many governments to proceed. But many scientists and ethicists say that this would be a mistake.

When considering a program to vaccinate high-risk children against addiction, policymakers must consider the risk of stigmatizing a group of children, says Kathleen Glass , director of the Biomedical Ethics Unit at McGill University in Montreal. Glass says that the government would in effect be signalling out certain children and telling them, their parents and potentially the world that they are likely to become addicts. Since an immunized individual's status would appear in their medical records, this could lead to stigmatization and discrimination—possibly affecting whether or not someone could get a job or qualify for insurance.

Stephanie Anderson, with the Davis, California-based Center for Cognitive Liberty and Ethics , agrees. "The labeling of 'high-risk' children is very disturbing in that it essentially amounts to cognitive profiling," she says. "It is not within a government's jurisdiction to guess what future decisions one might make and then react according to such suppositions. It is dangerous for the government to play doctor to our nation's children, but it is even more frightening for them to claim to be fortune-tellers."

There is concern that a government-run vaccination program would in effect be a program of forced cognitive modification. The word "vaccine" suggests an irreversible and permanent immunity to certain drugs. Many people wonder whether a government, or even parents, should be allowed to make a choice for children that would affect their ability to enjoy some things for the rest of their lives.

The Center for Cognitive Liberty and Ethics advocates three principles in a world of mind-altering technologies: brain privacy, autonomy and choice. Anderson says that a public policy of childhood vaccinations against addiction would violate all three principles and the negative consequences of the policy would far outweigh the benefit of possibly having fewer addicts. "To concede that the government, or any authoritative body, has the right to hardwire an individual's brain against possible behaviours or thoughts would be fatal to the core of our notion that we are a free people," says Anderson.

But while the intent behind such a program raises important concerns about an individual's cognitive rights, existing technology wouldn't involve any permanent changes. The antibody levels associated with the vaccines currently in development peak about three months after injection and then steadily decline. Regular booster shots would be required through adolescence in order to maintain an optimum level of antibodies in the blood. And even when the antibody levels are high, teenagers could overcome them by using higher doses of drugs or by using drugs for which they haven't been vaccinated.

"Parents would not therefore be making an irreversible decision to deprive their children of the choice to smoke tobacco or use cocaine as an adult or to use either drug for therapeutic purposes," says Wayne Hall , the director of the Office of Public Policy and Ethics at the Institute for Molecular Bioscience at the University of Queensland in Australia.

This relieves the "mind control" issue of existing addiction vaccines, but it raises other practical concerns. Repeated vaccinations would be costly and inconvenient. Efforts to increase the duration of the vaccine and to create multiple-drug vaccines would result in extensive clinical trials to establish their efficacy and safety, thus increasing the vaccines' cost. Hall says that the high cost of vaccinating children and teens could therefore preclude public funding for a universal vaccine. This could result in higher socioeconomic children, who are at a lower risk for addiction, being the most likely to get vaccinated.

The quick-fix dilemma

Beyond mind control and cost concerns, there are also concerns about people relying too heavily on the vaccines. Growing evidence suggests that addiction, or at least a person's predisposition to becoming addicted, has a strong genetic component . Scientists hope that the new vaccines will prevent someone already predisposed to becoming addicted from getting hooked on drugs by blocking their pleasurable effects. But vaccines are only a partial solution, as many psychosocial factors, beyond genetics, contribute to addiction.

Glass says that if the vaccines were to replace all other forms of treatment, people might relapse or attempt to overcome the vaccines with higher doses of drugs once their unresolved psychological and social issues became too much to manage.

There's also concern that using vaccines to prevent addiction is another sign of society's growing dependence on biochemical solutions to behavioral problems—there are different pills to make you thinner, happier and more at ease in social situations, and now there's a shot that will help you just say "no" to drugs. "We like to look for quick fixes and silver bullets when addiction is a huge social problem," says Glass. "Is it appropriate to vaccinate children for things that are basically social choices that they make?"

Anderson points out that a policy of giving children drugs to prevent them from taking other drugs does them a great disservice. Instead of teaching children how to evaluate all the evidence and make informed decisions, such a policy teaches them that individual decisions have no place in a society where the government determines what is good and what is bad. "Giving them real information about drug use would prove far more effective in the long run," says Anderson, "than supplanting the freedom of thought to make individual decisions regarding one's own mind and body with a government-mandated syringe."

Hall also has doubts about the efficacy, safety and cost of a program of childhood vaccinations against addiction. "The public has not been given an opportunity to consider the pros and cons of the measure and of competing, less coercive ways to achieve the reasonable goal of preventing various forms of drug addiction," he says. "Drug vaccines are most likely to make only a modest contribution to our efforts to improve addiction treatment."

Based on these doubts, Hall says it would be unlikely for any informed government to institute a program to vaccinate children against addiction. But this doesn't preclude the use of vaccines as part of an overall treatment plan.

These vaccines will eventually be available for therapeutic use and parents might request them for their children. But Hall stresses that they shouldn't be used in this preventative manner in adolescents until they have been used extensively in dependent adults.

Vocci agrees that researchers should first use the vaccine in dependent adults as a therapeutic measure to help them quit. If this is successful then it should be used as a protective measure in high-risk adults—people who are abusing a drug but don't meet the criteria for dependence. Only after evidence was gathered from these two populations would Vocci consider recommending that the vaccines be used in adolescents and children.

"Any kind of public health measure should have an evidence-base for the recommendation," Vocci says. "We're a long way off from gathering the evidence that one would need to make a recommendation that a program of childhood vaccination could be done."