Awakening the global conscience: who will benefit from new vaccines in the 21st century?

The World Health Organization's (WHO) Global Programme for Vaccines and Immunization has three linked aims. The first is to give the so-called Expanded Programme on Immunization (EPI) vaccines to as many of the 125 million children who are born into the world each year as possible. The second is to ensure for the world an adequate supply of vaccines, and to safeguard vaccine quality. The third is in the field of vaccine research and development, not only coordinating the worldwide effort for new and improved vaccines but also preparing the way for their introduction into the EPI and continually to seek ways to simplify vaccination schedules. Enormous effort has gone into the polio eradication campaign. Following brilliant progress in both India and Africa, the goal of eradication by the year 2000 or shortly thereafter now seems achievable. Although a decision has not yet been taken, an attempt at measles eradication may well be the next huge challenge. The Global Programme for Vaccines and Immunization (GPV) is closely tied up with the Children's Vaccine Initiative (CVI) which is the name given to an umbrella organization which seeks to unite all the forces in the world promoting widespread use of vaccines. The chief functions of CVI are to be a strategic think tank, particularly as regards priorities; and to be a strong, consistent and effective advocacy group. Previously there had been some misunderstanding of the respective roles of WHO and CVI. These have now been cleared up by a dual stratagem--one single person, Dr JW Lee, as the administrative head of both Programmes; and one single Scientific Advisory Group of Experts or SAGE to guide the scientific aspects of both Programmes. The author has the honour of being Chairman of SAGE. It is apparent, however, that resource constraints are looming large in the affairs of both GPV and CVI. Clearly, the newer vaccines will be more expensive than the traditional ones, and the world must grope for new mechanisms to bring the fruits of the current upsurge of interest in vaccine development to all the countries of the world, not just the affluent ones.