Although the Food and Drug Administration is celebrating its 100th birthday this year, federal government regulation of biologics
is even older. FDA's Center for Biologics Evaluation and Research (CBER) dates its origins to Congressional approval of the
Biologics Control Act of 1902, following a wave of deaths from tainted diphtheria antitoxin. The law established CBER's predecessor,
the Hygienic Laboratory of the Public Health and Marine Hospital Service, and gave it authority to license and inspect manufacturers
of smallpox and rabies vaccines, diphtheria and tetanus antitoxins, and various serums to protect against bacterial infections
such as scarlet fever.
Four years later, Congress passed the 1906 Pure Food and Drugs Act, which established FDA's predecessor, the Drug Laboratory
in the Bureau of Chemistry of the Department of Agriculture. This law authorized testing drug product strength and purity,
but did not establish premarket approval requirements and gave the government little authority to remove even ineffective
drugs from the market. FDA was established around 1930, at the same time that the Hygienic Laboratory became the National
Institutes of Health (NIH); biologics control remained part of NIH until it was transferred to FDA in 1972 (see Coordination
FDA did not gain any real teeth for regulating unsafe and ineffective products until another national health disaster roused
a public outcry. Congress approved the Food, Drug, and Cosmetic Act of 1938 after more than 100 people, including many children,
died in 1937 from a poisonous ingredient in Elixir Sulfanilamide. To prevent such catastrophes in the future, the new law
required manufacturers of drugs and biologics to test the safety of new products and submit the results in a new drug application
(NDA) before marketing (biologics still had to submit a biologics licensing application, or BLA). The law authorized inspections
of drug manufacturing facilities and established requirements for product labels.
Congress further expanded FDA's responsibilities in 1941 by requiring premarket testing of all batches of insulin for purity,
strength, quality, and identity. The Public Health Service Act of 1944 updated the 1902 biologics policy. And a Penicillin
Amendment passed in 1945 mandated similar testing requirements for that drug.
Vaccine development rapidly moved forward during this period. In the 1940s, government researchers developed methods to determine
vaccine potency, which led to improvements in vaccines for pertussis (whooping cough) and influenza. A major success was realized
with the development and testing of the Salk polio vaccine in the mid-1950s. And in 1966, agency researchers developed the
first effective experimental vaccine for rubella (German measles). The safety of blood and blood plasma products also improved
during World War II and beyond with the development of tests to detect hepatitis.
A major regulatory change occurred in 1962 when the dangers of Thalidomide use prompted Congress to adopt the Kefauver-Harris
Amendments. The new law required manufacturers to prove that drugs are safe and effective before marketing; it also formalized
good manufacturing practices, required adverse event reporting, and called for sponsors of clinical trials to obtain informed
consent from study participants.
AIDS SPARKS REVOLUTION
The 1980s was a time of important social and biomedical change in the US, with major consequences for FDA and biotech companies.
The first reports of HIV/AIDS cases appeared in 1981, prompting coordinated efforts to develop and approve immunoassay tests
and test kits to screen donated blood for the AIDS virus. AZT, the first drug to treat AIDS, was approved by FDA in 1987,
along with additional treatments for certain opportunistic infections. Demands from AIDS advocates for quicker access to promising
therapies also spurred a more risk-averse attitude at FDA, leading to rules expanding access to experimental drugs for seriously
ill patients, and permitting FDA approval of AIDS and cancer treatments based on early clinical results.
At the same time, policy makers encouraged development of innovative treatments for rare diseases by enacting the Orphan Drug
Act of 1983. The legislation provided extended market exclusivity for therapies that treat diseases affecting less than 200,000
people in the US, which has led to approval of nearly 300 drugs and biological products. These policies spurred development
of new therapeutic proteins and monoclonal antibodies able to target cancer cells more effectively, clear clots from coronary
arteries, and prevent anemia in ill patients.