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January 3, 2007

Vaccines for the Vulnerable Around the World

By Orin Levine and Michael J. Klag

It's flu season, and many Americans have been to the doctor or school clinic for a flu shot. These shots protect us - especially the most vulnerable, our children and the elderly - from the season's harshest bugs, and prevent a simple infection from turning into something much worse.

In the world's poorest countries, the picture is much different. Each year, 2 million to 3 million children in developing countries, mainly in Africa, die from diseases that could be prevented by vaccines available today.

The most common cause of these vaccine-preventable deaths - a bacterium known as pneumococcus that leads to bacterial pneumonia, meningitis and other diseases - is a growing problem in need of urgent attention. AIDS increases its risk by nearly 40 times, and antibiotic resistance makes treatment less effective. If pandemic influenza strikes, more than 4.5 million additional cases of childhood pneumococcal pneumonia will occur worldwide before it runs its course.

Millions more children die from diseases such as malaria and HIV/AIDS that don't yet have vaccines but could within the next 10 years.

Market forces have failed to answer the call for solutions. Now, a unique partnership of the world's wealthy countries brings hope that we can overcome this market failure and beat these killer diseases. If successful, it will provide scientists and manufacturers the opportunity to develop, test and deploy the vaccines faster than ever.

The return on this investment? The prevention of 4 million child deaths from pneumococcal disease.

A major roadblock to developing and deploying vaccines that prevent such diseases is the initial high investment required by companies. To recoup their investments, companies often charge $50 to $100 per dose in developed countries - beyond the means of poor countries that often spend less than $15 per person each year on all health care. Manufacturers are reluctant to invest millions on the research and development necessary to create viable and desperately needed vaccines if they are unable to recoup their costs.

The 2006 Group of Eight summit in St. Petersburg, Russia, took the first step in addressing this problem by proposing an innovative financing mechanism called an "advanced market commitment," or AMC. Italy, Canada and the United Kingdom committed to financial support for such a mechanism; some other nations have expressed support but have made no monetary commitment. This approach provides front-loaded financing for vaccine development, creating a market that will attract manufacturers. Bound by legal agreements, sponsor countries or foundations agree to provide financial commitments to subsidize the purchase cost of future vaccines for a period of time, and vaccine manufacturers agree to meet criteria for vaccine effectiveness and to provide the vaccine at affordable prices.

Manufacturers receive payment only if their product is demanded by poor countries, ensuring that the sponsors' funding goes to support vaccines that meet the needs of these countries. An independent body ensures that the vaccines conform to rigorous standards for safety and efficacy. In this way, the mechanism will speed creation of vaccines to treat the most prevalent communicable diseases in the world's poorest countries and provide them at affordable, predictable prices.

The AMC is a new way for partners in the private and public sectors to solve an old problem. Working together, the Global Alliance for Vaccines and Immunizations, global health experts and representatives from developing countries have come up with an operating structure and an initial pilot project. Working with the World Bank, an independent committee of experts chaired by the former health minister of Malawi recommended pneumococcal disease as the best candidate for the pilot project.

The lifesaving benefits of this pilot project will be realized only if donor governments and foundations make concrete funding pledges that can drive development and production. It is estimated that the pilot pneumococcal vaccine project would require donor contributions of $1.5 billion over seven to nine years. Britain, Canada and Italy have committed to $1 billion. The United States should join these allies by pledging $30 million next year as the first installment on its commitment.

Today, thousands of the world's poorest children will die from treatable, preventable pneumococcal diseases. We cannot continue to accept the delays of the past as inevitable. With innovative approaches such as advanced market commitments, for the first time we have market-based solutions to market failures. All that's needed is political will from donor countries and foundations to leverage the best efforts of scientists and increased capacity from vaccine companies.

Working together, governments and companies can make sure that children in richer and poorer countries no longer need to be worlds apart.

Dr. Orin Levine is executive director of the Global Alliance for Vaccines and Immunizations' PneumoADIP program and associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. His e-mail is olevine@jhsph.edu. Dr. Michael J. Klag is dean of the Bloomberg School of Public Health.

Article originally published in the January 3, 2007 edition of the Baltimore Sun. 

2007, reprinted with permission of the Baltimore Sun