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Report calls for more vaccine research and immunization support

Wednesday, 25 September 1996: In a new, comprehensive study of the progress and potential in immunization, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) say that over the next 15 years, revolutionary new vaccines generated by scientific advances could save the lives of some eight million children who now die each year from infectious diseases.

However, The State of the World's Vaccines and Immunization, released today in Washington, DC, warns that despite dramatic advances in molecular biology and genetic engineering, the promise that science holds for development of new and improved vaccines and immunization services may be squandered tragically unless the international community continues to back scientific research and global immunization with adequate resources for new vaccines.

"This report highlights many of the successes and challenges in our global efforts to protect children from vaccine-preventable diseases," says the foreword by UNICEF Executive Director Carol Bellamy and WHO Director-General Dr. Hiroshi Nakajima. "If our organizations and our partners can give the world a better understanding of the value of vaccines and immunization, the success of the past 20 years in saving millions of children's lives will be dwarfed by the successes of the next two decades."

The 160-page report, prepared by the WHO Global Programme for Vaccines and Immunization (GPV) in collaboration with UNICEF:

• Chronicles the progress of the worldwide Expanded Programme on Immunization (EPI) in its efforts against polio, measles, neonatal tetanus, diphtheria, pertussis (whooping cough), tuberculosis, hepatitis B and yellow fever, and addresses such issues as vaccine prices, quality and supply, the need to enhance the recognition of the value of vaccines, questions of intellectual property rights, the cost of vaccine development and improvement, and improving immunization practices;
• Reviews the status of vaccines available but not widely used in developing countries including those against Haemophilus influenzae (Hib), rubella, chickenpox, Japanese encephalitis, hepatitis A, cholera and typhoid fever, due partially to the initial high cost of these vaccines and a lack of data on incidence and disease burden;
• Provides a progress report on new vaccines under development -- including those against pneumococcal disease, meningococcal meningitis, respiratory syncytial virus, rotavirus, shigella, ETEC (enterotoxigenic Escherichia coli which causes diarrhoea), HIV/AIDS, malaria, schistosomiasis and dengue -- a small proportion of vaccines in development against more than 60 different diseases; and
• Outlines the most recent developments in immunization, including advances in monitoring vaccine quality, vaccine supply, disease surveillance, and the status of developments in the cold chain for vaccine delivery and storage.

The report also highlights advances in the fight against polio. By the year 2000, polio is expected to be eradicated -- eventually saving governments over $1.5 billion a year in immunization costs. Noting that during 1995, almost half the world's children under five -- a record 300 million -- received supplementary doses of polio vaccines during special national immunization days in many countries, the report also outlines the latest campaign called "Kick Polio Out of Africa" launched this year by WHO, Rotary International and other partners to immunize an estimated 50 million children on the continent over the next three years.

"While immunization experts are confident that polio can be eradicated by the year 2000, there is increasing concern over a shortfall in donor funding," the report says, noting that although previously almost 80 per cent of the resources needed for polio eradication came from countries themselves, the focus on poorer countries will now require more support from donors. WHO estimates that an additional US$600-800 million will be needed -- for vaccine purchases, personnel, training, research, logistics and the cold chain, and the development of a global laboratory network.

The concern over resources is not limited to the polio eradication campaign. The report also says that while inununization is a proven success and advances in science are continuing, the increased cost of vaccine development and immunization, if met with flagging resources, could severely jeopardize the capabilities and hopes of researchers, health care providers and public health authorities in their bid to make the world safer for young children with new vaccines.

At today's prices, for example, it costs no more than US$1 for the original six EPI vaccines (at UNICEF-discounted prices), and another US$14 for programme costs (laboratories, transport, the cold chain, personnel and research) to fully immunize a child.

However, development of a second generation hepatitis B vaccine in 1986 -- the world's first genetically engineered vaccine -- signalled that the days of cheap vaccines were over. Initially marketed at US$150 for three doses -- 150 times the cost of the original six EPI vaccines combined (at UNICEF-discounted prices) -- by 1994 this vaccine alone accounted for almost a third of the turnover in the global vaccine market. Even at the discounted prices being offered to UNICEF, the cost of a course of hepatitis B vaccination is higher than a course of the original six EPI vaccines.

"The new generation of vaccines are expected to be many times more expensive than those in use today," the report says, noting that research and development costs for a single vaccine can range from US$50 million to US$200 million. "Vaccines are likely to cost not cents but dollars a dose from now on."

One current problem facing immunization programmes is that most vaccine development takes place within the private sector in the industrialized countries where the most profitable markets exist. As a result, most vaccines are tailored to diseases occurring in industrialized countries. Yet such diseases occur also in developing countries, and may take a more severe form.

"Greater advocacy is needed to ensure that vaccine research and development is driven not only by commercial interests but by public health goals as well," the report says. "However, vaccine manufacturers must have financial incentives -- such as the guarantee of a large market in developing countries -- to develop vaccines for the less profitable markets."

Taking a new approach to immunization advocacy is the Children's Vaccine Initiative (CVI), launched at the World Summit for Children in 1990 by UNICEF, WHO, the United Nations Development Programme (UNDP), the World Bank and the Rockefeller Foundation. CVI pursues a radical agenda aimed at improving the global supply and quality of existing vaccines, orchestrating a dialogue between the public and private sectors on the research and development of the new vaccines, and developing strategies to ensure that these vaccines will be affordable for use in developing countries.

The outcome of efforts to finance new vaccines, the report concludes, will hinge on the success of four key strategies: targeting donor support to the neediest countries; a "tiered" pricing system by manufacturers, or tailoring prices to the ability to pay of different markets; a commitment by governments and donors to increase the amount they now spend on vaccines; and advocacy to encourage governments, donors and the general public to recognize the value of vaccines on the basis of their health impact in individual countries.

"Although undoubtedly a Herculean task, changing attitudes to vaccines would not cost large amounts of money," the report says. "In the long run, treatment to save the lives of children not immunized against vaccine-preventable diseases and the legacy of disabled children will cost a lot more -- both in money and needless suffering for children and their families."

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