I wish to thank the Society for inviting me to give the Introductory Talk in this Symposium. It is going to centre around what might be called ‘epitope specific’ immunization and I want to draw your attention to a number of factors which will be bound to affect any new approach to the development of vaccines. To begin with, it is now clear that complex antigens, such as those associated with parasites, present many different epitopes to the immune system. These epitopes are ‘seen’ by different cell types using different receptors and epitope recognition can activate a number of different effector systems.

The modern biology era in which molecular analyses dominate and immunology, cell biology and molecular genetics are prominent, has created unprecedented opportunities for the vaccine developer. The need for new and improved vaccines against many infectious disease agents is also great, no more so than for the protozoan and helminth parasite scourges of the rural poor in the tropical, less-industrially developed world. Despite the opportunities and needs, no vaccine against any human parasite yet exists nor does any molecular vaccine against any parasite; this chapter is a general discussion on the reasons for this state of affairs that assuredly will change soon.

The purpose of this work is to review the progress towards malaria vaccination that has been made over the last four or so years, and the prospects and difficulties as they now appear. Although some of the older literature will be referred to as necessary background, it is not treated here in any detail. The reader who wishes for a fuller historical perspective should see, for instance, Brown (1969), Cohen & Mitchell (1978), Desowitz & Miller (1980), Mitchell (1984), Miller, David & Hadley (1984), Heidrich (1986) and, specifically for a consideration of sporozoite vaccination, Nussenzweig & Nussenzweig (1984, 1986). Naturally, any summary of vaccination will lean on the immunology of the disease, but malaria immunology is not reviewed here in its own right. The reader requiring the most recent attempt to cover this field should see the work edited by Perlmann & Wigzell (1988); some individual chapters of that volume will be referred to below.

The need for a vaccine(s) against cutaneous leishmaniasis and the populations at risk for whom such vaccines should be developed are briefly discussed. The current human vaccine studies are reviewed, as are some experimental mouse studies with emphasis on Leishmania major infection relevant to vaccine development. Based on the information available from the mouse model and those data which are being sought in human studies, the benign nature of the cutaneous disease, the ease with which L. major can be manipulated to yield the required material, and the ongoing practice of leishmanization which allows rapid evaluation of candidate vaccine(s), it is suggested that a vaccine, at least against L. major, is imminent in the not too distant future.

Vaccination against human schistosomes in laboratory hosts is now a reality. A number of different parasite molecules have been shown to confer partial protective immunity against challenge infection with Schistosoma mansoni or Schistosoma japonicum in rodent or primate hosts. These antigens are unusually diverse in their structure and stage specificity. Interestingly, although all of the vaccine molecules characterized are situated in the tegument, their exposure on the parasite surface, in most instances, is transient and/or non-essential. The properties of four of these immunogens, glutathione-S-transferase (P26,28), paramyosin (Sm97), GP38, and GP18 are discussed. Despite the identification and recombinant synthesis of several promising protective antigens, vaccination of humans against schistosomiasis remains in the realm of fantasy. At the technical level, a major problem is the failure of any of the current vaccine immunogens and immunization protocols to induce levels of resistance sufficient for significant reduction of human infection or disease. Once this important hurdle is passed, human immunization trials should be attempted as the potential beneficial impact of a vaccine against schistosomiasis remains enormous.

Parasitic diseases inflict major losses on livestock production throughout the world. Currently, control of the diseases relies largely on prophylactic or therapeutic application of anti-parasitic drugs. In many instances, these measures are only partially effective. Moreover, they must be applied frequently, are therefore costly and time-consuming, and lead to the selection of drug resistance within the parasite populations. Thus, it has been recognized for several decades that effective methods of vaccination against parasitic diseases would have a major impact on livestock production. However, despite considerable efforts over the last 30 years, only a few parasite vaccines are currently in use and all of these involve the administration of live organisms.

Previous articles in this volume have considered the whole question of parasite vaccines from the immunological point of view. A backcloth of general concepts (Roitt, 1989) and strategies in the viral area (Schild, 1989) precedes consideration of problems specific to parasite vaccines (Mitchell, G. F. 1989). This leads on to reviews of progress to date in the development of vaccines for leishmaniasis (Modabber, 1989), malaria (Mitchell, G. H. 1989) and schistosomiasis (Sher, 1989) and in the development and use of veterinary vaccines (Morrison, 1989). I have been asked in this final chapter to take one step back from all of this and provide the alternative, chemotherapeutic, perspective. The reasons for the request are particularly pertinent, though rarely stated: antiparasite drugs already exist; if parasite vaccines are in fact developed, the way these drugs are used and the whole question of whether or not new ones are required, will have to be reconsidered. It is also a timely one: it is clear that the whole concept of a series of vaccines for the control of parasitic diseases has been so well sold, some would say oversold, that it is impacting on the resolve within the pharmaceutical industry to undertake new chemotherapeutic developments, at a time when this is already under severe strain because of financial considerations (Gutteridge, 1987 a). Hence my title: Parasite vaccines versus anti-parasite drugs: rivals or running mates?. I will try to answer it by, in turn, addressing three key questions. Why are we attempting to develop parasite vaccines? Will we be successful? If we are, will there still be a need for chemotherapy?

This meeting included talks which covered both the principles and problems of vaccine development and others that extensively reviewed the present state of progress towards the goal of antigenically defined parasite vaccines for human and veterinary use. Several speakers, particularly Drs Morrison and Gutteridge, pointed out that in comparison with bacteria and viruses there are few vaccines available against parasites and these consist of attenuated organisms for veterinary infections. Therefore, despite the intensity of effort, better defined vaccines for parasites still elude us.