New Smoking Vaccine: Promise But Problems

Almost half of all smokers will die as a result of their smoking, and tens of millions more will suffer from crippling conditions, so a new nicotine vaccine now being tested holds great promise if it can help many of the estimated 46 million U.S. adult smokers — about 20% of the adult population — to quit, as most of them wish to do. However, there are a number of potential problems with the smoking vaccine approach, according to Action on Smoking and Health (ASH).

The vaccine — like nicotine patches, gum, sprays, and inhalers — treats only half of the problem; it will not help the millions of potential quitters who are not addicted to nicotine; because it requires many (not just one) shots, some smokers may quit the program prematurely or not be able to afford continuing treatment; and some people might smoke
more cigarettes to overcome the desensitizing vaccine’s effects, says Prof. John Banzhaf, Executive Director of ASH.

Cigarettes have a particularly tenacious hold on smokers — making smoking harder to give up than heroin or cocaine — because of two separate components which make smoking cessation so difficult, especially if both components are not separately addressed as part of the treatment process..

The majority of cigarette smokers have a physiological addiction to the nicotine — a drug more addictive for many than heroin or nicotine. This means that their bodies have changed so that any interruption in their regular ingestion of nicotine creates strong feelings of withdrawal.

But, in addition, most cigarette smokers also have a strong psychological habituation to having cigarettes, and associating them over long periods of time with activities like waking up, having a morning cup of coffee, trying to type a complex documents on a computer, etc. So, giving up smoking, like giving up any deeply ingrained habit, creates psychological problems and pressures totally unrelated to nicotine.

One technique which has helped smokers to quit is to give them small slowly-administered doses of nicotine in gum, patches, inhalers, and sprays — a technique known as nicotine replacement therapy. While the nicotine does not completely eliminate the problems and feelings of withdrawal, it reportedly does help to take the edge off the craving for the addictive drug nicotine which smokers continue to feel.

The new nicotine vaccine reportedly works differently. Instead of administering nicotine — a dangerous drug which can help trigger heart attacks and other cardiovascular problems — the vaccine induces the smoker’s body to form antibodies to the nicotine which bind with the drug so that it cannot be readily used by his body. In effect, by denying the smoker the drug-type stimulus he previously got from inhaling nicotine, it is designed to dampen his desire to continue smoking.

But the vaccine, like nicotine replacement therapy, does not attack the psychological component of the compulsion to smoke. So, just a millions of smokers found that simply slapping on a nicotine patch did not by itself get them to quit, current smokers may find that even a vaccine which totally eliminates the stimulus effect of nicotine may not be enough if the psychological component is not attacked with new coping mechanisms, external support, etc.

Although most smokers have physiological addictions to nicotine which range from mild to virtually unbreakable, millions of smokers have no physiological addiction to nicotine at all, but are nevertheless unable to quit solely because of the habit’s psychological hold. For them, the vaccine would probably provide no more help than a placebo, since they would miss not only the cigarettes, but the related rituals which have become such an ingrained part of their daily lives like lighting the cigarette, inhaling the smoke, blowing it out into the air, etc.

Unlike most vaccines which require only one injection or two at the most, initial trials with the new vaccine show that smokers require multiple injections of the vaccine — perhaps as many as eight or more — for it to become effective. Unfortunately, in the real world, many smokers may not be willing to commit to — or simply not be able to afford — a long regimen of taking time off from work to visit a doctor’s office for multiple injections. Others may simply drop out.

Finally, one real concern is that smokers may feel such a strong physical urge for the stimulus only nicotine can bring that, faced with a situation in which their bodies have been substantially desensitized to the drug, they will be strongly tempted to compensate by smoking even more than before — just as some former smoker would put on two or more nicotine patches. This, of course, would substantially increase the risks they already face from smoking.

In any event the new vaccine called NicVac is now being tested in the first Phase III trial by Nabi Pharmaceuticals of Rockville, Maryland, under a $10 million grant from the National Institute on Drug Abuse [NIDA]. The small company also has reached an agreement under which pharmaceutical giant GlaxoSmithKline will pick up the cost of developing and marketing the new vaccine if the Phase III trials are successful.

Prof. Banzhaf of ASH says that there probably is no single program, injection, pill, or device which would make it possible for most smokers already trying to quit to do so. But since the success rate of existing smoking cessation treatments and programs is so abysmal, almost anything would be an improvement.

Smoking costs the American economy almost $200 billion dollars each year, most of which is paid by nonsmokers in the form of higher taxes and inflated health insurance premiums. So any technique which could help even only 20% of smokers quit would save about $40 billion a year — about half of all the money required by current legislative health reform proposals.

Instead of slashing Medicare spending on senior citizens, taxing premium health insurance policies won by labor unions, creating a new marriage penalty, and imposing other unpopular taxes, we could largely pay for health care reform simply with a modest increase in the effectiveness of smoking cessation, says ASH.

PROFESSOR JOHN F. BANZHAF III
Executive Director and Chief Counsel
Action on Smoking and Health (ASH)
America’s First Antismoking Organization
2013 H Street, NW
Washington, DC 20006, USA
(202) 659-4310 ** ash.org