Pushing and Pulling for Vaccine Access

Hot on the heels of the thoroughly discouraging spate of New York Times stories last week on AIDS, I decided to hunker down with a report on vaccine access in developing countries — which at first seemed like yet another depressing read. Instead, what followed was a legitimate, practical plan to spur vaccine access around the world.

The report, from Oxfam and Medecins Sans Frontieres, starts by laying out the obvious challenges involved: New vaccines cost too much, and Big Pharma won't research vaccines for poor countries whose people have no purchasing power.

But there's no hand-wringing in the report over these facts. If we want to encourage better access, all we have to do is show pharma that money can be made in the process. So the authors lay out two mechanisms for boosting vaccine access — 'pushing' access through funding, and 'pulling' research and development through industry-oriented incentives.

Let me explain.

The 'push' model is best used in situations in which a vaccine already exists, but has yet to be adapted to the developing world. Under this model, companies that already have a vaccine are 'pushed' to share it in exchange for money, technology or training. The Meningitis Vaccine Project is one good example of such a successful effort — thanks to the project, a vaccine for meningitis should be available in sub-Saharan Africa by the end of this year.

The 'pull' method is a bit more complicated. It's also more critical. The goal of the model is to spark research and development for cases of disease that don't already have vaccines, but for which a vaccine would obviously be a game changer — for example, malaria and AIDS. The model supports the creation of a subsidized market — a pool of funds from governments and donors — that would be available in the event such a vaccine could be developed.

A key player in this push is the Global Alliance for Vaccines and Immunisation, or the GAVI Alliance. The Alliance works across a spectrum of parties to push vaccine development for kids in the developing world. It's the primary example out there of the 'pull' method — convincing pharma that money does exist to pay for vaccines if they are created.

Except maybe it doesn't. As is the trend these days, GAVI has a $4.3 billion funding shortfall, which may delay its efforts to introduce two new vaccines: one to prevent severe diarrhea caused by rotavirus and another to prevent pneumococcal disease.

But until the pharma industry is taken over by philanthropists who are willing to take a loss (or not make quite as big a profit) on a life-saving vaccine, the best bet for vaccine access in the developing world will be initiatives like the Meningitis Vaccine Project and GAVI. A mix of push and pull, one that brings slow — but promising — progress.

Photo Credit: Svadilfari