Just a week after the June 13 GAVI replenishment congress, at which public and private donors committed $4.3 billion to continue funding efforts to immunize the world’s poorest children, another vaccines summit played out in Seattle. The Pacific Health Summit, a yearly conference examining a different global health issue, convened June 21-23 with the goal of connecting decision makers in science, industry, policy, and public health to improve health by combining the latest in scientific advances with industrial innovation and effective policy. Past topics have included multi-drug resistant tuberculosis, maternal and child health, malnutrition, and pandemic influenza.
Specific aims of the Pacific Health Summit included
- Highlighting the changing landscape of the vaccine field, evolving roles of different stakeholders, and implications for the future of research, development, manufacturing, funding, delivery, and distribution of vaccines.
- Providing a launching pad for cross-sector and cross-region innovation, collaboration, and investment
- Increasing understanding and appreciation of all sectors’ role in the field
- Augmenting momentum created by other vaccine events and initiatives in 2010-11
A particular focus of the Summit was to address the challenges of vaccine development and delivery in the developing world, where supply issues are complex, prices must be lower than in developed countries, and the public health needs are great.
Speakers at the Summit included representatives from the UK Department of Health, the Wellcome Trust, the Bill & Melinda Gates Foundation, multinational and middle-income country pharmaceutical companies, India’s Ministry of Health and Family Welfare, the GAVI Alliance, the World Bank, the Chinese Center for Disease Control and Prevention, PATH, USAID, and corporations such as UPS, Coca-Cola, Microsoft, and Chevron.
The History of Vaccines was selected to be the visual exhibit at the Summit. Its timeline materials were reproduced in the conference meeting area, and a computer kiosk was devoted to the History of Vaccines website. History of Vaccines staff and College of Physicians of Philadelphia CEO George M. Wohlreich, MD, attended the meeting.
The Summit’s 250 participants re-visited several major themes at the various sessions.
The cold chain. The challenges of maintaining the vaccines cold chain in the developing world are enormous. Several participants mentioned that much spending on vaccines in the developing world is related to maintaining the proper temperature for vaccine storage. Vaccine stock may be lost due to temperature fluctuations – sometimes from inadvertent freezing, and sometimes from inability to keep the vaccine cold enough. Specific questions arose about where exactly in the chain value can be extracted and whether any degree of variability exists in temperature requirements–which might lead to cost savings if, for example, a vaccine could be stored for even a short time at higher temperatures.
Tiered pricing. Many stakeholders expressed the desire to see wide availability of multi-tiered vaccine pricing based on the ability of countries–and perhaps even regions within countries– to afford vaccine. Participants discussed this in relation to GAVI-eligible countries (currently 56 countries with a Gross National Income equal to or lower than $1500 USD per capita) as well as middle-income countries.
Non-multinational vaccine industry. The emergence of vaccine manufacturers in India, China, Brazil, and other countries is profoundly re-shaping the vaccine market. A case in point is the work by PATH, a nonprofit devoted to vaccine research and deployment, to engage the Serum Institute of India in developing a meningitis A conjugate vaccine for use in the meningitis belt of sub-Saharan Africa. After the multinational pharmaceuticals announced themselves unable to produce the vaccine for the targeted price of .50 USD a dose, PATH contracted with a European manufacturer to supply antigen and the Serum Institute of India to produce the vaccine for the desired price.
Technology transfer. The opportunities and obstacles to technology transfer from multinational pharmaceutical companies to middle-income country companies figured prominently in the discussions. A degree of technology transfer has already taken place, and opportunities for future transfer are many. An unknown question embedded in these opportunities is how deeply the middle-income country pharmaceutical companies can engage in their own research and development.
The fifth child. The challenges of vaccinating the “fifth child” – that is, the hardest to reach of the world’s poor children—were widely discussed. Moderators consistently called on the audience to think about how to reach the poorest of the world’s people. An increasing commitment to social science research in understanding the best ways to reach underserved communities was held up as a possible tool in this effort.
Co-financing. A consistent theme in discussing GAVI vaccine financing and national health systems was the importance of co-financing of immunization activities by low-income countries. “Skin in the game”—a commitment by national governments to use GAVI funds to augment, rather than replace, immunization spending in GAVI-eligible countries—was a frequent request and was seen as a way to ensure commitment to the project of bringing healthcare to all children in a country.
Whether the Summit organizers’ hopes of fostering specific actions and new collaborations will bear out remains to be seen. It is, however, apparent that the challenges of reaching the fifth child are great.
Further information about the Summit can be find at the links below.