Rethinking vaccines for developing nations

Gary Finnegan

Gary Finnegan

August 12th, 2011

Gary Finnegan

‘If the so-called ’ is to deliver better access for developing countries, then policymakers, NGOs and industry will have to be bold in changing how vaccination programmes are structured and funded, according to The Lancet.’

VaccinesCampaigners, including Bill Gates, have said this will be a crunch decade for global immunisation strategies, with leading to more specific and more affordable vaccines for the world’s poorest nations.

It is also the decade in which the WHO hopes to eradicate polio and wipe out measles, despite recent setbacks.

The Lancet
has published a series of articles looking at how best to capitalise on the momentum gathering behind global vaccination campaigns and donor initiatives.

New vaccines, new challenges

A paper written by a team of authors led by Dr Orin Levine says that while sophisticated new technologies may deliver new vaccines for malaria, tuberculosis, HIV and possibly even non-infectious diseases such as hypertension and diabetes, these are likely “to be more complex and expensive than those that have been used so effectively in the past”.

The paper, acknowledges the achievements of the World Health Organization’s Expanded Program on Immunization, and says that deciding which new vaccines countries should invest in will require sound advice from the WHO and other international organisations. The authors also advocate well-informed national immunisation committees who can provide local data on the disease burden.

“Introduction of vaccines might need modification of immunisation schedules and delivery procedures. Novel methods are needed to finance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to afford them,” according to the paper.

Reforms needed

In a separate piece by Helen Rees and Shabir Madhi, it is argued that fundamental reforms are required to how poorer countries access vaccines.

“Anticipated advances in vaccinology during this new Decade of Vaccines will only translate into reductions in global morbidity and mortality from targeted illnesses if fundamental restructuring means that the most marginalised countries (particularly in Africa and southeast Asia) gain access to new and established vaccines,” the authors state.

From a practical point of view, another feature article calls for improvements to production facilities and distribution channels as part of a holistic approach to delivering safe, high quality vaccines to the world’s poorest people.

Strong partnerships between the private sector, regulatory authorities, and national and international public health services will be required, according to the authors.

Public-private cooperation

The issue of public-private partnership in vaccination is tackled by Juhani Eskola and Terhi Kilpi of the National Institute for Health and Welfare, Helsinki, Finland.

In a thought-providing piece, the Finnish scientists examine the controversial issue of whether academic and government researchers should engage with industry.

The issue has been in the spotlight for some time, most notably in the wake of the 2009 H1N1 flu pandemic when the WHO came under fire because some of its experts had worked with pharmaceutical companies.

Eskola and Kilpi take the view that, despite some drawbacks, interaction between the public and private sectors must continue. In the past, they say, fruitful collaboration has resulted in the development of vaccines with significant public health benefits.

“Provision of vaccines is a necessarily public–private partnership because, with few exceptions, only commercial vaccine companies have found it feasible to follow through on the difficult and expensive responsibility of development of a high-quality, safe, and effective product. However, the public sector is the only sensible and practical source of much of the epidemiological, microbiological, and immunological data that are essential to the development and implementation of a vaccine.”

The authors add that comprehensive and structured disclosure of potential conflicts of interests is essential to preserving public trust in these relationships and, ultimately, maintaining an environment where new vaccines can be developed:

“Vaccine research and development benefits from maximum transparency, clear rules, and exchange of critical views on the research itself, rather than from discussion about the qualities and relations of the researchers,” the paper says.

What do you think needs to be done to improve access to vaccines for the developing world?


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