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1st appeared 24 February 2000

New Incentives Needed to Deliver Vaccines, Drugs to Poor Nations

Three million children die every year from diseases that could be prevented with available vaccines. Another five million people die from malaria, tuberculosis and HIV/AIDS because no vaccines exist to prevent these diseases.

People in developing nations suffer and die from diseases that no longer threaten the United States and other industrial nations -- and the death toll will continue to climb dramatically unless a global approach is put in place to solve the problem, according to UCSF health experts.

"In planning policy incentives and interventions to develop and distribute much–needed drugs and vaccines in developing nations, decision makers must understand that no single strategy can solve the problem of under-investment in diseases of the poor," says Richard Feachem, PhD, DSc (Med), founding director of the UCSF Institute for Global Health and professor of international health at UCSF and UC Berkeley.

"Interventions are needed all along the vaccine and drug development and delivery process," he said. "Simply increasing foreign aid budgets will not solve the dangerous structural problems with drug and vaccine delivery and development."

This week, Feachem and his colleagues at the Institute for Global Health, along with the Geneva-based Global Forum for Health Research, issued a worldwide call-to-action to high-level officials with a stake in global health issues.

About three dozen health leaders from around the world convened in the Bay Area over the weekend for the first global health forum of its kind to discuss the complex issues and to hammer out recommendations. Action steps were released Tuesday and will be developed into a full proposal for presentation to President Clinton in early March and for distribution to the world’s policy makers.

Participants in the meeting included representatives from the World Health Organization, World Bank, World Trade Organization; executives from biopharmaceutical companies including Glaxo-Wellcome, Chiron, Aventis Pasteur, and Smith Kline Beecham; health officials and corporate leaders from India, Indonesia, South Africa, China, Europe and Canada; the US government and Congress; members of private funding organizations; and academics with interests in global health.

The participants agreed that private industry has a right to recoup its investment costs and make a reasonable profit, and government has a responsibility to provide the funding and incentives to ensure more equitable development and distribution of lifesaving vaccines and drugs. With this in mind, the delegates identified a combination of incentives that they believe governments could enact that would also benefit industry and, ultimately, the poor who suffer needlessly in developing countries. Two sets of interventions were outlined to provide incentives for both smaller biotechnology companies and larger pharmaceutical companies:

• "Push interventions" – Programs that reduce the cost of research, providing incentives for biotechnology companies to engage in research that would benefit those afflicted with disease in developing nations. These include: increased funding for research on developing world diseases, public sector venture capital funds, tax credits on research and development of vaccines for targeted diseases, harmonization of licensing processes, and expedited approval of drug and vaccine products.

• "Pull interventions" – Programs that guarantee the development and establishment of markets for products, a priority for both biotech and larger pharmaceutical companies. These include: establishing vaccine and drug purchase funds that provide guaranteed markets, creating markets to purchase products in less developed countries, and providing tax credits for sale of vaccines.

• In addition, the group concluded that public/private partnerships can create "win-win" situations to accelerate the development of drugs and vaccines.

"Unless industry and governments worldwide work together to better meet the health needs of the developing world, the differential in health between rich and poor will only widen," Feachem said.

Failure to improve drug and vaccine development and delivery will have a great cost. Malaria, for example, will soon become untreatable as parasites are quickly becoming resistant and there are few new drugs in the development pipeline. AIDS will cause growing devastation in Asia as it has already in Africa – an HIV vaccine, and affordable treatments, are still years away.

Leaders at the forum also agreed that several existing proposals deserve strong global support. These include:

• The Clinton Administration package that includes funding, tax credits and other incentives to deliver existing vaccines and spur development of new vaccines;

• World Bank consideration of a $1 billion International Development Association credit program for purchase of drugs and vaccines in less developed countries, infrastructure development and poverty-alleviation measures;

• Other legislative proposals now before the U.S. Congress, including a forthcoming proposal from Sen. John Kerry (D-MA) that would provide funding and incentives for vaccine research and development;

• The Global Alliance for Vaccines and Immunization (GAVI), through funding from the Bill and Melinda Gates Foundation and others, a collaborative effort to purchase and deliver vaccines and encourage development of priority vaccines.

"While these proposals hold great promise and deserve widespread support, no one of these proposals will solve the problem on its own," Feachem said.

The potential of biomedical science and biotechnology to deliver powerful new drugs and vaccines continues to grow. Today, the great majority of research and development in both public and private laboratories is devoted to diseases that afflict the rich.

"However, rapidly expanding scientific capacity means policy changes can leverage significant results for international public health," Feachem said, "and growing international awareness of the cost of disease in developing countries should lead to increased public support for efforts to expand the fight against diseases of less developed countries."

Links:

Leaders to Discuss How to Deliver Fruits of Biotechnology to Developing World

Director of New Institute for Global Health to Discuss Program's Goals

Source: Rebecca Higbee, News Services

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