Three diseases with the highest human and economic toll are malaria, TB and AIDS. Almost all malaria infections, more than 95% of new tuberculosis cases, and 95% of HIV infections occur in developing countries. The latest figures from Global Health Reporting count 39 million people worldwide infected with HIV, 300 million with acute malaria, and 15 million with TB. Treatments or prevention of these diseases are expensive, easy to abandon after ambitious pronouncements, and inevitably mired in multi-national politics. For many in public health arenas vaccinations are the most practical way to solve the problem, even if vaccine development is a scientifically challenging, long- term solution.
Public health challenges generally fall through the cracks of traditional market solutions because there is little financial motivation to solve these expensive, multi-faceted and politically cumbersome problems. This is particularly true for diseases that are present in countries in Africa and Asia. Malaria has been a killer in Africa and Asia for as long as we remember and prevention and control mechanisms have failed.
Only part of the failure is due to technology, however a vaccine offers a way to potentially cut through all the failures to stem the disease. The broad and all encompassing concept of a 'failure of the markets' occurs because for-profit pharmaceutical companies, almost exclusively based in the United States and Europe, have no incentive to research, develop drugs or treat diseases that are only prevalent in developing countries. According to one report by Medicin San Frontiers, 1393 new chemicals were developed as potential drug targets from 1977 through 1999. Of these, 13 were for "tropical diseases" (a group of diseases largely confined to tropical regions including, Dengue Fever, Cloroquine resistant Malaria, TB, Leprosy, Chagas, and others). Six of these thirteen were for military use. Drug development looks at potential profit not potential lives saved.
While vaccine development promises to circumvent a lot of entrenched problems it's susceptible to its own set of problems-- and also financing. The Wall Street Journal reports on funding initiativesin in the works that help finance infectious disease drug development in developing countries. In an April 26, 2005 article titled "Malaria Trial Could Set a Model For Financing of Costly Vaccines", the paper reports on several private/public funding collaborations to finance costly drug development. The hope is that these new financing models can "...step[] in where market mechanisms have failed".
There have been numerous proposals over the years aimed at lowering drug development costs by promoting research and collaboration between often competitive agencies. This effort is promising, according to the Wall Street Journal because it aims at two of the most problematic impediments to funding, the hesitation of drug companies to front research that they won't profit from, and the hesitation of individual countries to fund highly expensive public health initiatives for developing countries. The article highlights efforts to establish the International Finance Facility (IFF), by a group of European countries -- the US will not participate-- via government bonds:
"...floating government bonds geared specifically to supplying poor countries with available vaccines...countries go to the international bond market to obtain funds to speed up the purchase of existing...[and] new vaccines."
The Global Alliance for Vaccines and Immunizations (GAVI) also contributes to the IFF immunization project. The article describes a malaria initative for vaccine research project at GlaxoSmithKline PLC's GSK Biologicals unit in Belgium that after a long delay is now in clinical trials in Mozambique to test children using the newly developed vaccine. The effort had been abandoned due to a funding quagmire but has been revived through these collaborative funding efforts.
The second scheme being used to fund vaccine development involves "advance-purchase contracts", through which pharmaceutical companies are paid to develop medicines in advance. The idea was proposed and modeled by economist Michael Kremer. The contracts aim to motivate pharmaceutical companies to develop vaccines. It insures that the companies who bring a vaccine to fruition are reimbursed for their development efforts.
Of course, in addition to these ideas, there are others. The various alternative plans reflect the inevitable uncertainty that hovers overs any research efforts as well as dynamic politics, ever changing financial priorities, and . Senators Frist and Kerry introduced a bill in 2001 that would have allowed tax incentives for the development of infectious diseases. The Global Alliance for Vaccines and Immunization (GAVI) combines contributions from private sources such as the Gates Foundation, WHO, NGO's, and research organizations, with funds from national governments The organization strives to promote standardized resource allocation.
Of course their are concerns with the proposals. Some organizations that are involved with current prevention efforts like the Global Fund Global Fund's HIV/AIDS, TB and Malaria projects have concerns that the vaccine initiatives will distract the efforts of current prevention efforts like bednets.
