Why Isn’t There a Vaccine for Lyme Disease?

Twenty years ago, a viable vaccine was on the market. What happened to it? Writer Sue Halpern answers this important question.

Sue Halpern is a widely respected author of fiction and non-fiction, and writes for The New Yorker magazine. Her article titled “Why It Took So Long to Develop a New Vaccine for Lyme Disease” appeared in the August 2021 issue of The New Yorker.

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Transcript of the Interview 

Mark at Insect Shield

Well, our guest today is Sue Halpern, who is a writer of fiction and nonfiction. She's written about eight books. I believe her most recent is Summer Hours at the Robbers Library, which is a piece of fiction. And the one before that, I think was called A Dog Walks into a Nursing Home. So that one is about a therapy dog. And I take it you're half the team on that one. 

Sue is also a writer for The New Yorker magazine. And in August of this year, she published an article called “Why It Took So Long to Develop a New Vaccine for Lyme Disease.” So that's what we want to talk to her about today. Because this question comes up a lot. A lot of people know that there was a vaccine for Lyme disease at one time, and now there is not. So that's kind of a big question as to how that came about. And then there's a lot of background. And Sue did a lot of research into this. So the article is in The New Yorker, and we're just gonna talk about the content there today. Sue, welcome. It's great to have you here.

Sue Halpern

Thank you. 

Mark at Insect Shield

So this article, as I said, so many people that know about Lyme disease, that's one of the first questions that they ask. Like, why can't we just prevent the disease by doing something in advance, taking a pill? Or? It's these products are available for pets, dogs in particular. So the question is, why can't we do something like that for humans? And then you took a look into how it came about that the vaccine existed and now there is none. So what was your original interest in this topic? 

Sue Halpern

Well, I live in Vermont, a place where for the longest time, we did not have deer ticks. We did not have Lyme disease. It was fairly rare. And primarily because of climate change, the range of the ticks is moving into these formerly more northern climes. And now they're a little warmer. And so Vermont, per capita, I think, has the most incidence of Lyme disease. And which is very weird, because for the longest time, we had almost none.

I like to go walking in the woods with my dog. And I just started to find myself kind of nervous about that, and uncomfortable about that. And I also knew a lot of people who had gotten Lyme disease, and of course, I would bring my dog to the vet every year, and she would get her Lyme vaccine, and then she would get the chews that she takes once a month to have those ticks die off on her before they can, start falling on me. So, it just seemed like this weird, perfect storm of nothingness. You know, it's like, I'm going to go walk with my dog who's not going to get Lyme, but I am, not seeming right. So I just started to look into it and found some really interesting things along the way.

Mark at Insect Shield

It sounds like and it sounded like there were a number of factors that kind of contributed to this demise of the vaccine. So it was fully developed. Right? And yeah, many people had actually gotten the vaccine.

Sue Halpern

Yeah. So this was 20 years ago. And 20 years ago, the incidence of Lyme was, not that great. Again, we didn't have the kind of climate change adjustments to our climate that we have now. And the ticks were fairly well localized in certain places. Particularly, it was very well known in Lyme, Connecticut, where it got its name, in Martha's Vineyard on Nantucket. Those parts of Long Island, so these are all sort of coastal areas. And so it wasn't that prevalent.

But there were researchers who wanted to do something about it. And they came up with a way, they believed, that would neutralize the bacteria in the gut of the tick by giving people a series of three injections, three vaccines. That's one vaccine, three shots. And yeah, a lot of people got it, it seemed to have an efficacy rate of just around 80 percent.

Mark at Insect Shield

So that's pretty high. 

Sue Halpern

Yeah. But a funny thing happened, which was that people who had what, what we could call like long Lyme, so Lyme disease that didn't get knocked out by a course of antibiotics, which are really important to take, when you find out that you've gotten it and gotten it early, but for a lot of people, it's too late. And they have all sorts of manifestations of Lyme disease, and, not unlike long COVID, you know, cognitive issues.

And in any case, a lot of those folks believed that the actual vaccine caused what they were calling Lyme arthritis. So a kind of rheumatoid kind of reaction to the vaccine, and they mounted a campaign to get the FDA to remove its approval of this vaccine.

And because of the way the FDA had approved it, which was in this way that made it open to individuals being able to sue the pharmaceutical company, they did, and there was a big class action suit against the manufacturer. And it just got to the point where it didn't seem economically feasible to keep this drug on the market. Because it was going to cost them a lot of money.

There was no good data to indicate that this drug, this vaccine did, in fact, cause arthritis. In fact, the research that was done seemed to indicate that the incidence of arthritis in the people who got the vaccine was the same as in a population that didn't get the vaccine, but that was too late. And so the manufacturer pulled it from the shelves, because doctors didn't want to prescribe it. And so it went away very, very quickly, within a few years and that was that.

Mark at Insect Shield

Wow. And, this is not an uncommon event, I guess where it's just more… it's easier for the company to pull the drug than, face all those lawsuits, even if they could fight it, I suppose and show that [the vaccine] was working. You mentioned also a couple other things. Yeah, the arthritis and then the fact that they could sue, and then the CDC had something to say about this vaccine as well.

Sue Halpern

Yeah, it was kind of interesting. The CDC, when they were recommending it, they called it a yuppie vaccine. And they, they made disparaging remarks about the fact that this would be a vaccine for, people who are wealthy enough to, vacation on Martha's Vineyard or buy, expensive Nike sneakers. It was very odd. I mean, seriously, it was like such an editorial comment. But again, at the time, there weren't that many cases of Lyme, and they were all centered on these kind of coastal, somewhat, tonier communities, at least to the extent that those were the people who are showing up at doctors’ offices with Lyme disease.

Mark at Insect Shield

Well, and that is an issue. Still today, I guess, that a lot of doctors are not even aware or don't have that much background in Lyme. So it's often difficult to kind of show that that that is what's going on. So maybe there was more “respect,” I don't know, for the folks that were coming in or saying, they had Lyme versus others. I mean, this is something that we've looked at. Doctors tend to think it must be something else. I mean, Lyme is not the first thing that they think of.

It actually depends on where you live. So if you live in one of these areas, in fact, it's it is one of the first things they think of so think of Lyme, think of anaplasmosis though, if there's a high incidence of Lyme in your community, doctors are going to be fairly well acquainted with it.

But if you're somewhere where they're not acquainted with it, and you come in with the same symptoms, that's not going to be what they think. But, we had this experience not that long ago, in our family, where a family member got bitten by a tick, but he did not know that. But he had all the symptoms of Lyme, and he thought he had the flu. Because they were somewhat similar.

First, he thought he had COVID. But he got many tests, and he did not have COVID. Then he thought he had the flu. And then he went finally to the ER, in a community where there was a lot of Lyme and the first thing the doctor said was, you've got Lyme, and we think you also have anaplasmosis, and we're going to start you on the drugs. And they did and they worked. So that was just a pure luck of being, seen by a doctor in a community where there was a lot of Lyme,

Mark at Insect Shield

Yeah, and I mean, some of the groups that we work with this is really one of their main focuses is just education of doctors, and then helping people get in touch with the doctor, that's more familiar with it. But, thanks to the Internet, there's more of an opportunity to get this information. And look at people who've gone through the same kind of thing.

There's, there's a gal by the name of Olivia Goodreau, who went through about a year and a half, I think of going to various doctors until she found some that said you must have Lyme. So, that was kind of an arduous and detrimental as you said, if you don't get the antibiotics fairly soon, then you're more kind of locked into this long term effects of the disease.

So then, in terms of what's going on today, with either a vaccine or I take it, there's some other avenues, not just vaccines, but different ways, things that people are proposing to solve the question here. And you looked at some of those as well.

Sue Halpern

Yeah, I was I mean, the obvious question that you raised before is like, why can my dog get this stuff and I can't. And so I started looking to see if anyone was working on some kind of preventative or some kind of therapeutic that would make this an easier disease to deal with. And I found a bunch of people, a bunch of research groups getting very close. There's a, there was a French, there is a French company called Valneva.

They came up with a vaccine that's very similar but a little more sophisticated than the original vaccine. And they have had good enough results that Pfizer has partnered with them and they're in their second Phase II clinical trial, this one for young people, because kids spend a lot of time outside in the grass, or ideally they do. So they are likely to see a lot of Lyme in children. So they're in that phase of their study. If that goes well, which it will, they'll go into Phase III, and they hope to have a drug out in the market probably by 2024/2025, something like that.

But there's this other group in Massachusetts, and I should say that almost everyone who's working on a Lyme disease vaccine or therapeutic now worked on the original vaccine. So there's a physician and researcher at the University of Massachusetts. And he and his team have come up with a monoclonal antibody. That's not a vaccine. It's a shot. And the idea is you get it once a year at prior to the height of Lyme season. It lasts about nine months. And then it sort of dissipates through your system and sort of hopefully the ticks do too outside and then you get the shot the next year.

It's not unlike, say a flu shot that you get annually, right. And they're about two to three years out as well from getting this thing approved. I read the other day that a researcher at Yale named Eric Fedrick, who again was one of the original Lyme vaccine researchers, is using mRNA to come up with a way to treat or to sort of neutralize the tick.

And then there's a group out in California that's taking the main ingredient of one of the dog and cat chews and repurposing that for humans. So again, that would be more likely to probably be like a pill that you take, but they're a little farther out. They're probably four or five years out, if not longer. 

Mark at Insect Shield

I'm not that familiar with the dog chews. [I hope] they come in good flavors. I imagine for the dogs, it's kind of like bacon.

Sue Halpern

Yeah, they're like beefy. I did joke with the guys who were making it like, please give us better flavors. You know, than beef. But then they said there would be no flavor. So… 

Mark at Insect Shield

Oh, that's a bummer. Yeah, so I mean, this is one of the questions that comes up is like, How do you approach this in terms of who should be taking these? I guess if it's a pill, and it's pretty easy, then you can kind of leave it to whoever determines that they think they're susceptible?

Sue Halpern

Yeah, it's the same with your dog. But I think I, they're testing this. Ideally, for people who live in places, where there's a high incidence of Lyme disease and a lot of ticks. Or if you're going to travel to a place, let's say, you're going to vacation on Martha's Vineyard, you don't live there, you still might want to get something, some preventative, you know. Nothing's going to be 100%. Obviously, that's the first thing.

The second thing is, all these things are, at least possibly not the mRNA vaccine that the guy or gal is working on. But all of these are specific to Lyme. And as there are a lot of different tick borne illnesses, and they're on the rise as well. So it's not like you can just take, get the shot, or get the vaccine or, swallow a pill or whatever, and then just, blithely walk in the woods and assume that, you're gonna not get bitten by a tick or not get Lyme disease.

And so, the ideal therapeutic would be something that would kill the tick, before it ever had the opportunity to bite you, and transmit whatever bacteria or in one case virus that could, create havoc in your body. So, so right now, a lot of what's being developed is Lyme specific, that just doesn't necessarily keep you safe from getting a tick borne illness.

Mark at Insect Shield

Oh, I see. So if the, I mean, most of these are in the gut of the tick beforehand. And so if you can prevent this gut transmission, then you're effectively preventing anything that's going to pass that way?

Sue Halpern

Well, it depends, because a lot of the gut transmission that is being worked on now is specific for the Lyme bacteria. So it's possible that the tick would be carrying other bacteria, or a virus and, and it wouldn't kill those.

So ideally, what you'd want to do is kill the tick, before it had an opportunity to latch on to you, or at least to transmit, it takes I think they say, like, some period of time, like 24 hours before it starts doing that. I don't know if that's true for anaplasmosis, or some of the other tick borne illnesses, 

But right now, I think the only danger that I can anticipate with any of these drugs has nothing to do with the drugs themselves. It has to do with a sense of complacency that might arise if you take this and you assume you're never going to get sick from a bite from a tick and you can't make that assumption anymore. Right? Just because all the other tick borne illnesses are also on the rise. They're just not as prevalent as Lyme.

Mark at Insect Shield

Exactly. So you've still got to be vigilant about if you're out in the woods, then when you come back, you've got to do that tick check. Yeah, that people talk about I should say. 

Sue Halpern

Yeah, I mean, I'm a, a firm advocate in basically bathing your clothes in permethrin, and, making sure that [you don’t] really give the tics an opportunity to crawl into your body by, putting your socks, pants, socks over your pants and tucking in your shirt. That kind of stuff. That does not mean that it won't happen, but it's, it lessens the opportunity for the tick to start spending a lot of time on your skin.

Mark at Insect Shield

Yeah, that's the key. Because they're, they're pernicious little... [They] find ways to get to where you're not gonna find them easily. And then they have these whatever you call it, they secrete a kind of chemical that that makes that bite less irritated, 

Sue Halpern

It's basically an anesthetic. So it numbs you, so you don't feel it. Yeah. Which is brilliant. Evolutionarily.

Mark at Insect Shield

Yeah, I mean, we've learned too about the stuff that they call “cement,” where the tick, once it latches on it has this kind of a fluid stuff that hardens. And it keeps that tick attached because it has to be attached for a long period of time. So I think even some researchers are trying to figure out how they can use this cement in other areas like surgery or stuff like that. So not with ticks involved, they wouldn't have to be, calling in the ticks for that part of the surgery.

But anyway, well, great. This, this is really interesting. Are there are there other things in the process that you looked into? Like I was wondering, I imagine when you do an article like this, there's other stuff that you looked at that maybe wasn't, didn't get the final cut and go into the article, but were there other things that you would have included? Or you found interesting? In terms of the research or whatever?

Sue Halpern

Yeah, there was one thing that was really interesting to me. Um, it was that I was talking to one of the main tick researchers, and he works a lot on Martha's Vineyard and Nantucket. And he's been doing it for, I don't know, 20 or 30 years. He told me that, the longer he works in a tick infested area, and the more ticks that climb all over him, the less likely he is to get sick, he finds that he has built up what he thinks is a natural immunity, given the fact that he's been bitten so many times.

And so there are researchers who are looking into that, and trying to figure out well, how did that happen? And so that's kind of interesting. I don't know that they're going to solve that particular problem. But it's just an interesting idea that he's no longer worried when he goes into the field that he's going to get Lyme disease, which may be foolhardy, but so far has been borne out. Yeah, he had gotten Lyme numerous times, just given the length of his, research and where he works. 

And then another person told me that he sprayed his pants, one leg with the permethrin and one without it. And then he watched on the leg where he had sprayed, the stuff he watched, the ticks just fall off one by one compared to the other side. You don't get to deal with the ticks. Right? But it was all in the name of research so…

Mark at Insect Shield

Well, I mean, we do the same kind of thing, with our clothing because it's impregnated with permethrin and then it's basically baked on so you don't have to apply it over and over, like you do with your own clothes. And then, yeah, I mean, one of the tests that we do is called a knockdown test. So you just look at, it's basically a kind of permethrin is an insecticide, unless you apply it to clothing and let it dry and then it's classified as a as a repellent.

So there's a difference there, in terms of the toxicity and stuff, but I mean, that's one of the things is just the awareness around ticks, and some of the those are easy things to let people know. Yeah, they need to tuck their pants into their socks and if they happen to be treated with permethrin and tucked into their socks that are treated with permethrin, it's just better. I mean, curing the disease is a lot more difficult or, doing a vaccine and so forth. So ideally, you're doing all those things.

Sue Halpern

I think is funny. I've just been, very adamant with my family about spraying the permethrin and have a can in my car, and I have it on my porch, just everywhere. And to the amusement, I would say, of my family, until someone got Lyme disease, and then it was like, Oh, you guess you were right. Like, unfortunately, I was right. So yeah, and we're not gonna solve this problem. You know, 100% by spraying our clothes, but it just gives us a fighting chance.

Mark at Insect Shield

Well, I like to hear [about that] test. It’s sort of subjective and spraying on half your clothing. The problem there, of course, is that the other half is still quite susceptible to the tick.

Sue Halpern

He was a researcher. So he had it under control. But, yeah, I think he knew exactly how many ticks he had released on, these guys collect ticks, because they want to study them. So yeah, [many] ticks at their disposal.

Mark at Insect Shield

I was gonna ask about that. Because I think some of the other books that you've written look at the kind of culture or how, what was the one on memory, where you were looking at the culture of the researchers, and maybe same with, the book on the library, the recent one where it was, the books are, of course, a draw, but then what really became the draw was the people in the library. Did you find, having talked to all these folks, that the researchers were quite interesting for various reasons?

Sue Halpern

Well, I mean, first of all, they're pretty interesting, just because almost all of them have been studying Lyme disease forever. And, just spending all of your time with ticks. I mean, it's a pretty specific and odd kind of passion. And, most of us run away from ticks. These guys are all like, really into ticks. Not that they like the ticks, but, but just like the idea that, and also just they feel comfortable with the ticks, most of us are freaked out by them. Yeah. So I thought that was really interesting.

And they have a like, without almost meaning to, there's almost like a fraternity of people who worked on the original vaccine, saw their work just get trashed, when that vaccine went out of favor, and have sort of been trying to work their way back to it. Over the years, particularly as the incidence of Lyme has climbed, and, no longer seems like it's a niche kind of problem.

Mark at Insect Shield

Right. So maybe not susceptible to that original criticism from the CDC.

Sue Halpern

I don't think that's happening again. But, and this is not if they do it vaccine, it's not a vaccine that you have to have. It's a vaccine that you choose to have. And so, to that extent, the kind of anti-vaccine sentiment that seems to be rampant in this country shouldn't really apply. Because no one's making you take this stuff. It's just it's a voluntary thing that you decide whether or not you want to do it or not.

Mark at Insect Shield

Well, this is slightly off topic, but I didn't really understand if that's the case. Why the original vaccine couldn't be defended on that basis. I mean, weren't they saying that there's a possibility that you would get this side effect, even if it was arthritis, and you have to basically understand that to get the vaccine?

Sue Halpern

Yeah, but I think because it allowed it to be open to a class action suit didn't really matter. Because if people were claiming that they got this thing in large numbers, if I don't know that this is the case, but if they were saying this is a rare potential side effect. And then, the people who were opposing the vaccine or, it were in large numbers. And as they were in the class action suit, it's sort of it's a chilling effect to have that, to have those were three or four suits, and they all got, they got consolidated.

But, once you do that, once there's that opportunity, I think it just, it just made it economically not viable. You know, they couldn't make enough to sell it. And, and they couldn't, have doctors prescribing it, because they didn't know and they didn't want to be responsible. So, sure, I don't know that rationality was actually, in play here, as it isn't in a lot of these anti-vaccine campaigns.

Mark at Insect Shield

Got it. Well, this has been awesome. So nice to have somebody that's really dug in to the details of vaccines for Lyme and looking at ways to prevent them and how, this answers the question for sure of why there's no vaccine today. But it does sound like they are some on the way and, and that there are other solutions as well to prevention.

Sue Halpern

Yeah, I would say so. I mean, except to hold on and assume that at least one of these is going to come to the market. And probably, my guess is, five or six years from now, there'll be many options for people. Yeah, again, tick borne illnesses are on the rise, and there are many different kinds, and they're all pretty, pretty pernicious. So, I'll be happy to take whatever I take and, feel a little more comfortable walking in the woods, but I am still going to be doing all the tick prevention stuff that I do.

Mark at Insect Shield

Right? Well, I'm hoping that Insect Shield is on your radar for those efforts. But I know that in general, it's permethrin that you're using, so that's great. Sue, thanks so much for joining us, and, if you find out more, please drop us a line and I'll include it on the post. So we'll put some links underneath the video on our post and then we'll let you know when it's ready. Thanks so much.

Sue Halpern

Great. Fantastic.