Priorities for the National Vaccine Plan (2010) / Chapter Skim
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5 Vaccines and Global Health
5 Vaccines and Global Health
Pages 121-138
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From page 121... ...
Several developments justify the inclusion of global vaccine issues in the plan. The world is not as it was when smallpox was declared eradicated in 1980; air travel and global trade have grown exponentially, and the scientific and commercial entities that develop, manufacture, and market vaccines span the globe.
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From page 122... ...
Global funding, from both private philanthropy and government aid, has markedly increased to support the purchase of newer and costlier vaccines, such as pneumococcal conjugate vaccines. The stakeholders for Goal 5 in the National Vaccine Plan include an array of public, private, and not-for-profit entities.
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From page 123... ...
These themes include the following: • Programmatic and infrastructure challenges, including most prominently surveillance and epidemiologic research to provide burden of disease data needed to inform vaccine research on and the development of new vaccines and to assess rates of vaccine-related adverse events, • The promise of PDPs and the U.S. government role, • Competing priorities: program-specific versus broader health infrastructure objectives and investment; periodic intensification of immunization (e.g., polio campaigns)
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From page 124... ...
. The story of meningococcal conjugate vaccine for Africa's meningitis belt offers one case study of a novel kind of partnership to facilitate vaccine development for a market with limited financial potential.
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From page 125... ...
. 2001 Gates Foundation awards WHO and the non-governmental organization PATH $70 million for the Meningitis Vaccine Project (PATH, 2009)
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From page 126... ...
In Chapter 1, the committee recommended two priority actions pertaining to the development of new and improved vaccines for both domestic and global use. The first action would be to prioritize new and improved vaccine candidates, and the committee has recommended that separate but similar information-gathering and decision-making processes be undertaken to set vaccine priorities for domestic and global health objectives.
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From page 127... ...
Infrastructure limitations include obstacles in obtaining and maintaining cold-chain equipment, lack of sufficient and appropriately trained health care personnel to administer vaccines safely and manage all aspects of immunization programs, and lack of systems to monitor vaccine use and potential adverse events (in addition to disease surveillance)
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From page 128... ...
Recommendation 5-1: The National Vaccine Plan should call for the engagement of U.S. federal agencies and partners to support immunization capacity-building to implement new vaccines in low- to middle-income countries through the provision of exper tise and financial resources necessary to incorporate new vaccines, strengthen immunization infrastructure, and achieve higher levels of vaccination.
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From page 129... ...
. The vaccine industry may not have sufficient incentives, such as an ability to recoup high research and development costs and a reasonable return on investment, to develop vaccines solely for low-income countries (Batson and Milstien, 2008)
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From page 130... ...
. PDPs have emerged specifically to address neglected diseases that affect low-income countries and novel "social technology" that has the potential to transform research and development to meet global health needs.
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From page 131... ...
However, certain international pricing mechanisms set the same price for low- and middleincome countries. This may keep certain vaccine prices unnecessarily low and thus limit the manufacturer's ability to recoup research and development costs for vaccines for diseases endemic to low- and middle-income countries.
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From page 132... ...
Vaccines are about improving health Vaccines are about economic development It is critical to use the vaccines that exist It is critical to develop the better vaccines that today may be used tomorrow Need to leverage the risk management Need to leverage the innovation and efficiency benefits of long-term partnerships benefits of competition Differential pricing: expanded access, Differential pricing: anti-efficiency, hard to justice enforce, unfair to middle-income nations Recommendation 5-2: The National Vaccine Plan should endorse active U.S. engagement in the development of global policy frame works to further global adherence to differential pricing in order to ensure access to needed vaccines in all countries.
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From page 133... ...
. CDC also has described several important criteria for decision making when developing surveillance systems: usefulness, flexibility, acceptability, portability, Box 5-1 Purpose of Vaccine Adverse Event Surveillance Adverse event surveillance serves several different purposes that are of vary ing importance to immunization programs.
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From page 134... ...
. At the committee's June 2009 meeting with stakeholders for Goal 5 in the draft National Vaccine Plan, the committee heard that when surveillance data are not used, or findings are not communicated to the workers who gather and report data, the willingness to conduct surveillance may be adversely affected.
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From page 135... ...
Although surveillance of adverse events following immunization in low- and middle-income countries is extremely limited and the underlying infrastructure is also limited, some targeted efforts have shown that adverse event surveillance is possible, especially in areas that have a basic public health infrastructure, such as health districts and personnel who can take reports and, in turn, convey them to central authorities. REFERENCES Batson, A
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From page 136... ...
2005. Design and implementation of cell-PREVEN: A real-time surveillance system for adverse events using cell phones in Peru.
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From page 137... ...
. Draft Strategic National Vaccine Plan.
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From page 138... ...
2009. Statement by the President on Global Health Initiatie.
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