June 10, 2011
The “global decade of vaccines” is upon us. Such was the call to action issued by the Bill and Melinda Gates Foundation in 2010. For their part, the Gates Foundation pledged $10 billion over the next decade to supplement vaccination programs worldwide.
This month s Health Affairs, funded by the Gates Foundation, is dedicated to the vaccine issue. Vaccines, as pointed out by editor Susan Dentzer, are a global health best buy cost-effective and reliable. But the number of voices, competing health priorities, and funding uncertainties make for a murky path forward. A few key issues to come from Health Affairs and the associated briefing (yesterday at the W Hotel in Washington DC):
The need for more developing country engagement
As Adel Mahmoud asserts in his perceptive critique of the global vaccine strategy (or lack thereof), [c]ountry-level leadership with a vision, determination, and persuasion is urgently needed for the global vaccine effort. There is no more room for paternalism. Too often, the global vaccine agenda has been set by international donor priorities, and absent have been developing country voices.
Part of this task of engagement is financial the establishment of the Global Alliance for Vaccines and Immunisation (GAVI) was an important step forward in catalyzing the effort to widen vaccine distribution. But GAVI is currently falling 2.3 billion short in its efforts for the next five years. There is significant debate about the structure of GAVI financing, and participating country co-financing, but if sustainability is the long-term goal, countries must share in the costs of new vaccines.
Engaging on the level of scientific research and manufacturing is also key. Currently, about half of the vaccines going through UNICEF for the GAVI Alliance are produced in India by organizations like the Serum Institute, the world s largest manufacturer of measles and DPT vaccines. Vaccine manufacturing in middle-income countries carries with it the benefits of cheaper production as well as country ownership in the process.
The role of innovative financing, including advance market commitments (AMCs), in bringing vaccines to market
To put it gently, the so-called anti-poverty vaccines are a tough business sell. Multinational pharmaceutical companies know that there is little to no profit to be made from vaccines for diseases that primarily affect those in low-resource settings. Incentives, including advance market commitments (AMCs), can play an important role in stimulating new vaccine development. Under the AMC mechanism, donor commitment to a future bulk purchase of a vaccine stimulates its development and speeds its entry into critical markets.
The test case for AMCs is the pneumococcal conjugate vaccine. In 2007, donors pledged $1.5 billion in subsidies for the vaccine, and in exchange, Glaxo-Smith Kline and Pfizer each committed to bringing 30 million doses to developing countries in 2010.
While we look forward to assessing the impact of the AMC pilot project, it s helpful to keep in mind that in many ways this vaccine was an ideal candidate for an AMC, since R&D costs were already a known quantity. It remains to be seen whether pharmaceutical companies will respond to AMCs when there is greater uncertainty about development costs and long-term pricing. We are likely to see more experiments in innovative financing going forward, as well as combinations of push (incentives to stimulate R&D) and pull (purchasing subsidies, like AMCs) mechanisms to stimulate development and deployment.
The promise of partnerships
Strung throughout the conversation about vaccine strategy in the 21st century is the promise of partnerships in stimulating R&D for new vaccines and in shortening the lag time between vaccine introduction and deployment in low-resource settings. An important case study here is MenAfriVac, the meningitis A conjugate vaccine (also produced by the Serum Institute). First deployed in December 2010, MenAfriVac benefited from a product development partnership between PATH and WHO. It s estimated that the vaccine has already reached 20 million Africans, and the project is also credited with shortening the delay to poor country deployment to five years. The low price here is crucial: at $.40/dose the vaccine is relatively affordable in low-resource settings.
Partnerships have the capacity to overcome several of the challenges facing vaccination campaigns in low-resource settings. The early successes of MenAfriVac suggest that partnerships could go a long way in overcoming a common paradox in the global push for vaccines that those most at risk of contracting vaccine-preventable diseases are also those who are most remote and can least afford the vaccine.
On Monday, world leaders will gather in London for a global vaccine summit, where funding for future efforts will be at the top of the agenda. Donor organizations are holding their breath, while also reminding policymakers of what’s in the balance: an estimated 4 million children whose lives could be saved by expanding vaccination campaigns through 2015.
Photo credit: Flickr: The Gates Foundation
