Bethesda, MD, USA. Vaccinating children around the world against infectious diseases has saved the lives of millions over the past several decades. Now new opportunities exist to overcome remaining challenges — and save another 6.4 million lives over the current decade.

A special issue of the journal Health Affairs explores vaccines in the pipeline, creative models for developing and paying for vaccines, and overcoming remaining challenges in vaccine science, financing, and delivery.


Last year, the Bill & Melinda Gates Foundation committed an additional $10 billion over the current decade to make life-saving vaccines available to millions of children. Articles in Health Affairs explore the strategies that will be necessary to achieve that goal — from investing in new science and building creative models of vaccine development and financing to improving the supply chains that distribute vaccines from manufacturers to the most remote clinics. The following highlights from Health Affairs illustrate current events.

Successful Approaches to Vaccine Development and Delivery

Creative product development and financing models have been critical in boosting vaccine development and bringing vaccines to developing countries.

• One of the biggest recent gains came last year with the distribution of a new meningitis A vaccine to more than nineteen million people in three countries in West Africa. The vaccine costs less than fifty cents a dose. F. Marc LaForce at the Program for Appropriate Technology in Health and Jean-Marie Okwo-Bele at the World Health Organization describe the promise of this new vaccine.
  
  
• David Bishai of the Johns Hopkins Bloomberg School of Public Health and colleagues examine the public-private partnership behind the new meningitis A vaccine. Product development partnerships like this one have reinvigorated research on vaccines for neglected diseases, say the authors.
  
  
• Pharmaceutical companies are increasingly seeing the value of vaccines and investing in the industry, says Jean Stéphenne of GlaxoSmithKline Biologicals. With new life-saving vaccines available and many more in the pipeline, innovative financing models — including tiered pricing, where low-income countries pay less, and robust purchasing commitments from developing countries — are needed to move vaccines off the shelf and get them to the people who need them most.

Vaccines in the Pipeline

As many as twelve new vaccines may be rolled out in the next decade against diseases such as typhoid, malaria, and dengue. Researchers are at a critical point in vaccine development, but they will need to overcome a number of challenges in the near future. These include securing the financing needed to get potentially life-saving medicines over clinical and regulatory hurdles within the next three to five years.

• A malaria vaccine candidate is currently undergoing the last phase of human testing before submission to regulators. If it is shown to be safe and effective, the World Health Organization could recommend that countries start using it as early as 2015, say Christian Loucq and coauthors at the PATH Malaria Vaccine Initiative. With the costs to date of developing this vaccine covered, stakeholders now face the challenge of providing an approved vaccine to millions of people in developing countries, the authors say.
  
  
• According to Lewellys Barker and colleagues at Aeras, tuberculosis cases will continue to burden India, China, South Africa, Nigeria, and other countries unless partnerships are successful in overcoming technical obstacles and securing the funding needed to push promising new vaccine candidates through safety and efficacy trials. According to the authors, these partnerships must also foster political will in order to develop and make available new and powerful TB vaccines, an essential part of the strategy to eliminate the disease by 2050.
  
  
• The 1.4 billion people living below the World Bank's poverty level–the so-called "bottom billion" — are in desperate need of vaccines to treat one or more neglected diseases like hookworm infection and sleeping sickness, says Peter Hotez of the Sabin Vaccine Institute. Although some of these vaccines are in the early stages of development, an alliance of public-sector vaccine manufacturers in Latin American and Caribbean countries could push that effort along, especially if financial mechanisms are put in place to speed the process, he says.

Additional Challenges Ahead

To move forward, significant challenges need to be addressed in the science, distribution, and financing of vaccines.

• Most of today's vaccines are based on scientific knowledge from past centuries, and breakthroughs won't happen until dramatic new approaches are found, says Adel Mahmoud, a Professor in Molecular Biology and Public Policy at Princeton University. The author calls for a renewed focus on basic scientific research, the training of a new generation of specialists experienced in new sciences, and a global "road map" that spells out clearly-defined objectives for how vaccines will be developed and deployed. To ensure success, the leaders of developing nations must be at the forefront of these activities and invest their own countries' resources, author says.
  
  
• Without supply-chain improvements, the lives of millions of people who need vaccines will be put at risk, according to independent consultant Judith Kaufmann, Roger Miller of LMI, and independent consultant James Cheyne. Inadequate storage, distribution, and inventory management capabilities, among other problems, will only worsen when twelve new vaccines become available in low- and middle-income countries in the next decade. The authors recommend specific strategies to fortify supply chains, such as improving coordination between the people who finance and procure vaccines for shipment and those who receive and distribute them, and improving training for supply-chain managers.
  
  
• Many countries will need to take a stronger role in paying for and distributing vaccines to their children, several authors of articles in the issue note. For example, despite being a leading producer and exporter of vaccines, India is home to one-third of the world's unimmunized children. Inadequate investment by the Indian government and hostility toward vaccination in certain communities are partly to blame, according to Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics, and Policy, and Nirmal Kumar Ganguly, of the Translational Health Science and Technology Institute, in New Delhi, India. Reducing the burden of vaccine-preventable disease should be of the utmost priority, and India should increase its budget for routine immunization by $221 million per year to potentially immunize an estimated thirteen million more children, the authors say.

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