Making practical markets for vaccines

Two papers published on September 13 in PLoS Medicine raise concerns about whether world leaders are getting good advice on how best to fund the development and delivery of new vaccines.

Donald Light, Professor of comparative health care systems at the University of Medicine & Dentistry of New Jersey, discusses the report Making Markets for Vaccines produced by the Centre for Global Development and the Gates Foundation Working Group for Making Markets for Vaccines. Professor Light was a member of the CGD/Gates Foundation "Pull" Mechanisms Working Group for the report but finding the report impractical, he declined to endorse it. For this, he and others who dissented were de-listed as members in the report.

In his essay, Professor Light explains why he thinks the report's recommendations give poor advice to donor nations such as the United States and the U.K. He believes that they favor large pharmaceutical firms, delay saving lives, spend donations wastefully, and reward secrecy rather than sharing.

Professor Light reviews evidence to show that an advanced commitment is unlikely to induce much basic research to discover new, effective vaccines. Direct funding, such as the Gates Foundation's many initiatives, is faster and much cheaper than multi-billion dollar promises of future purchases. Professor Light recommends using advanced purchase commitments as a complement to paying for research and development, and he argues that terms should build in financial support as well as expert help to strengthen the public health delivery systems of recipient nations. Extensive delivery problems were not discussed and are not part of the report's recommended design. Light concludes that "advanced purchase commitments are a good idea when applied where they work best: on existing vaccines that could save millions from suffering and dying now. It seems morally dubious for a foundation or nation to do otherwise."

In a second essay, Jon Andrus and John Fitzsimmons, who direct the Vaccine Fund for the Pan American Health Organization, discuss their organization's priority to ensure the delivery of effective vaccines, and emphasize that equity is a crucial part of ensuring delivery. They discuss the challenges of making practical markets for vaccines, particularly of introducing new and underutilized ones such that they are available to children and families who need them most. They highlight the principles of access, accelerated regional disease control, and the development of a public-health infrastructure, and argue that a successful approach requires high-level political commitment. They conclude that "for vaccines, the challenge has always been, and will continue to be, to ensure that all communities benefit from the potential impact of these technologies."