Why the evolution of vaccine resistance is less of a concern than the evolution of drug resistance

Type Journal Article Author David A. Kennedy Author Andrew F. Read URL https://www.pnas.org/content/115/51/12878 Rights © 2018 . https://www.pnas.org/site/aboutpnas/licenses.xhtmlPublished under the PNAS license. Series Perspective Volume 115 Issue 51 Pages 12878-12886 Publication Proceedings of the National Academy of Sciences ISSN 0027-8424, 1091-6490 Date 18/12/2018 Extra Publisher: National Academy of Sciences Section: Perspective PMID: 30559199 Journal Abbr PNAS DOI 10.1073/pnas.1717159115 Library Catalog www.pnas.org Language en Abstract Vaccines and antimicrobial drugs both impose strong selection for resistance. Yet only drug resistance is a major challenge for 21st century medicine. Why is drug resistance ubiquitous and not vaccine resistance? Part of the answer is that vaccine resistance is far less likely to evolve than drug resistance. But what happens when vaccine resistance does evolve? We review six putative cases. We find that in contrast to drug resistance, vaccine resistance is harder to detect and harder to confirm and that the mechanistic basis is less well understood. Nevertheless, in the cases we examined, the pronounced health benefits associated with vaccination have largely been sustained. Thus, we contend that vaccine resistance is less of a concern than drug resistance because it is less likely to evolve and when it does, it is less harmful to human and animal health and well-being. Studies of pathogen strains that evolve the capacity to replicate and transmit from vaccinated hosts will enhance our ability to develop next-generation vaccines that minimize the risk of harmful pathogen evolution.