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Making Markets for a Much-Needed Vaccine

By Elizabeth Heubeck

Pneumococcal disease, though preventable by vaccine, is a major cause of pneumonia and meningitis that kills 1.6 million people around the world every year. Until recently, however, it was rarely even recognized as a public health concern. That has changed, thanks largely to the efforts of a 20-person research team led by associate professor of International Health Orin S. Levine, PhD '94. The PneumoADIP (Accelerated Development and Introduction Plan) team has helped convince some of the world's most powerful leaders—G8 financial ministers from Canada, Italy, Norway, Russia and the United Kingdom, plus the Bill & Melinda Gates Foundation—to fund a much- needed, long-term supply of the pneumococcal vaccine to the world's poorest countries.

On February 9, the alliance of international donors committed $1.5 billion to the effort, effectively launching the first Advanced Market Commitment (AMC) to speed the development and availability of the pneumococcal vaccine. The AMC pilot is a first step toward creating a market for life-saving vaccines in impoverished countries.

The AMC approach was championed early on by Ruth Levine, PhD '90. "We asked ourselves, 'What would bring commercial manufacturers [of vaccines] more actively to the table for research and development? What if we promised to pay in advance?'" recalls Levine, a health economist with the Center for Global Development (and no relation to Orin Levine).

Given the situation, AMC seemed a plausible, win-win solution. Sponsor countries and foundations would provide a financial commitment to subsidize the purchase cost of future vaccines to developing countries for an agreed-upon period of time. In turn, vaccine manufacturers would produce effective vaccines for the chosen countries at affordable prices. But first, both sides—potential sponsors and the pharmaceutical industry—had to be convinced of the plan's feasibility.

So Levine convened a working group that met for more than 18 months. G8 leaders reviewed and endorsed the report in 2005.

"Then a huge amount of technical work was done to identify which vaccine should be put out there," Levine says.

At the Bloomberg School, Orin Levine and his colleagues with PneumoADIP pieced together data to demonstrate to the sponsors why the pneumococcal vaccine was the best choice for the AMC pilot. Their efforts were funded by a $30 million grant from the Global Alliance for Vaccines and Immunization (GAVI). They pored over data on 72 of the poorest countries to forecast the expected supply and demand of the pneumococcal vaccine for each nation over the next 20 years.

The group found a woefully short supply of pneumococcal vaccine to meet an ever-growing demand. "Right now, globally, there are only 40 to 50 million doses of supply. To meet the ultimate demand, we need 150 to 200 million doses per year," Levine says. The AMC pilot program will fund an adequate supply of the pneumococcal vaccine for the next 7 to 10 years; plans to sustain the supply indefinitely are under way.

Levine predicts the AMC pilot program will save the lives of 5.4 million children by 2030.