Hard to make and hard to take: Exploring the current and future barriers to the development and implementation of antipoverty vaccines in sub-Saharan Africa.

Neglected tropical diseases (NTDs) encompass 20 conditions or groups of diseases that affect almost exclusively the rural poor in low- and middle-income countries (LMIC). NTDs cause severe and chronic disabilities, from disfigurement and cognitive defects to death, and present substantial public health and socioeconomic burdens. Amongst NTDs, infections by parasitic protozoans, helminths and arthropod and non-arthropod ectoparasites, are of critical importance, with soil-transmitted helminths (STHs) representing the most widespread and prevalent NTDs globally. Whilst mass drug administration is the current strategy for control of helminth (STH and schistosomiasis) infections, treatment alone is inadequate due to the absence of lasting immunity against reinfections and the persisting concern of emerging drug resistance. The prevention and ultimate elimination of parasitic NTDs would avoid unnecessary suffering and significantly reduce poverty; hence, the potential of effective antiparasitic vaccines offers hope to billions, particularly those in sub-Saharan Africa. Given the strong links between NTDs and poverty - both regarding the demographics of the most affected communities and the socio-economic impact that these diseases exert - vaccines for these conditions are often referred to as "antipoverty vaccines". Here, a comprehensive analysis of the current state of antipoverty vaccine development is provided, with a focus on the potential for antiparasitic vaccines. This encompasses both a review of the current scientific literature and an assemblage of key stake-holder perspectives obtained through semi-structured interviews, all aimed to assess the future directives, utility and acceptability of these vaccines. The causes behind the current paucity of antipoverty vaccines are explored and global policy recommendations to assist their development and acceptance addressed. There was unanimous agreement among stakeholder interviewees on the importance and value of antipoverty vaccines, although it was felt that this sentiment does not extend to funders or policymakers from the Global North. Such findings highlight the scientific challenges in/of creating these vaccines, and how such challenges are amplified by financial constraints. The lack of funding reflects low profitability and biases against diseases largely of morbidity rather than mortality, as well as potentially the issues of poor people in poor countries and race/ethnicity. Solutions to how barriers affecting vaccine uptake on the ground can be addressed are proposed, primarily involving increased access to healthcare infrastructure, enhanced compliance through education, and involvement of local communities in all stages of development and rollout.