Lag between discovery and production of new vaccines for the developing world

Communicable diseases represent a considerable burden in terms of suffering and costs. The decision to develop a new vaccine varies with perspectives. The public health perspective is influenced largely by cost-benefit ratios; the community perspective by a strong desire to alleviate suffering and disability from disease and from vaccine side-effects; and that of vaccine producers by demand, technological feasibility of development, and anticipated return on investment. Each of these perspectives is important. However, they often are mutually exclusive. From a humanitarian and epidemiological perspective, the most urgent needs related to communicable diseases are those of the poorest countries; in the industrialised world, with the exception of the vaccine for the acquired immunodeficiency syndrome (AIDS), public health priorities, evaluated in terms of the cost-benefit ratio, often differ from those of the market, which usually selects its priorities according to return on investment. The six vaccines used in the Expanded Programme of Immunisation (EPI) are offered cheaply through a highly efficient bidding system. It would have to be extended, under the same form or differently, to other vaccines, such as those for rabies, hepatitis B, or japanese encephalitis. For vaccines that are being developed, such as conjugated polysaccharide or acellular pertussis vaccines, it is difficult to foresee how these expensive vaccines can be distributed. The situation is even worse for vaccines to be developed specifically for the third world. To make these vaccines available to everyone there must be technology that enables producers to sharply reduce production costs, and a subsidy for research and development and production.