Despite remarkable achievements in infectious disease control, more than 20 major pathogens responsible for significant global morbidity and mortality remain without licensed, effective vaccines. This so-called 'vaccine gap' disproportionately burdens low- and middle-income countries (LMICs), exacerbating health inequities and threatening global pandemic preparedness. This review comprehensively examines scientific and technological advances that are actively bridging the vaccine gap, with emphasis on novel platform technologies, immunological innovations, and translational strategies. We conducted a systematic narrative review of literature published between 2015 and 2024, encompassing peer-reviewed articles, WHO reports, clinical trial registries, and regulatory agency databases. Six transformative technology clusters were identified: (1) mRNA and self-amplifying RNA (saRNA) platforms enabling rapid antigen production; (2) viral-vectored vaccines with improved immune breadth; (3) structure-guided antigen design using cryo-electron microscopy and artificial intelligence (AI)-driven protein engineering; (4) broadly neutralising monoclonal antibodies as surrogate vaccine benchmarks; (5) mucosal and inhalable delivery systems targeting tissue-resident immunity; and (6) combination adjuvant systems amplifying magnitude and durability of protective responses. Clinical translation is exemplified by candidates against HIV-1, tuberculosis (TB), respiratory syncytial virus (RSV) in infants, and Plasmodium falciparum malaria. Convergence of AI-assisted rational antigen design, next-generation mRNA platforms, and innovative adjuvant-delivery pairings represents a paradigm shift toward vaccinatable diseases previously considered intractable. Equitable access frameworks and regulatory harmonisation across LMICs remain critical unresolved challenges.
T. Ikrar, Wachyudi Muchsin, Alfi Sophian· Antiviral Research· 0 citations
Gynecologic malignancies-including cervical, endometrial, ovarian, vaginal, and vulvar cancers-represent a major and largely preventable source of mortality in low- and middle-income countries (LMICs). In 2022, an estimated 1.47 million new cases and over 680,000 deaths were reported globally, with mortality disproportionately concentrated in resource-constrained settings. The survival gap between LMICs and high-income countries (HICs) remains profound, reflecting systemic policy and health system failures in prevention, early detection, and access to treatment. This narrative review synthesizes evidence from PubMed/MEDLINE, Embase, Cochrane Library, and World Health Organization (WHO) databases, prioritizing literature published between January 2015 and December 2024, with a focus on epidemiology, health system constraints, and policy-relevant interventions. LMICs account for approximately 94% of global cervical cancer deaths, with the highest mortality observed in East Africa (age-standardized mortality rate 35.3 per 100,000). Persistent survival disparities are driven by late-stage diagnosis, limited screening coverage, inadequate radiotherapy infrastructure, workforce shortages, and restricted access to essential and novel therapies. However, evidence demonstrates that cost-effective and scalable interventions-including single-dose human papillomavirus (HPV) vaccination, screen-and-treat strategies, HPV self-sampling, task-shifting models, and international training partnerships-can substantially improve outcomes when embedded within national cancer control policies and supported by sustainable financing mechanisms. Reducing these inequities requires policy-driven, system-level reforms that prioritize prevention, strengthen service delivery, and expand equitable access to care, aligning national strategies with global frameworks such as the WHO 90-70-90 targets to achieve sustainable cancer control in LMICs.
Dewi Setiawati, Wachyudi Muchsin, Alfi Sophan· Cancer· 0 citations
