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New incentives are needed to spur research and delivery of vaccines and drugs to poor nations, say w

First health forum of its kind gathered powerful group of academic, corporate
and world health leaders to define action steps for creating global markets for
drugs and vaccines

Three million children die every year from diseases that could be prevented
with available vaccines, and 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.”

Feachem and his colleagues at the Institute for Global Health, along with the
Geneva-based Global Forum for Health Research, today 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 are being
released today (Tuesday, Feb. 22) 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 U.S. 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
capitol 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.  “Using one or a combination of these
push-pull interventions to deliver existing and future vaccines and drugs would
give credibility to these multi-lateral efforts in the eyes of industry.”
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.  A tax
credit on vaccine sales, for example, depends on the existence of a market. 
The GAVI, World Bank and purchase fund proposals work towards filling this
demand gap.  Furthermore, tax and other incentives must be designed so they do
not impose inflationary pressures on vaccine and drug prices to the developing
world.

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.”

The Institute for Global Health was established in May 1999 by UCSF and UC
Berkeley, in close collaboration with Stanford University, and with leading
corporations and organizations in the Bay Area.  The Institute conducts
research, develops and evaluates policy, provides high-level training, and
forges consensus on joint action among leading scientists and policy makers
from all parts of the world.