EDITORIAL Opening the Gates for vaccine development inthe real world

‘‘In 100 years it will be clear that the ‘sea change’ inglobal health interest that took place in the earlytwenty-first century could be traced to two people: Billand Melinda Gates’’.

The quote above is taken from the winner of the2001 Lasker Award for Public Service [1]. The Billand Melinda Gates’ Foundation has certainlymade major contributions to vaccine developmentincluding 126.5 million dollars given to the Inter-national AIDS Vaccine Initiative to help the searchfor an HIV vaccine. This is extremely welcomefor the inherent, self-evident value of trying to pre-vent transmission of HIV; it is also remarkablefor the way the award has been structured. Aswith other awards from the Gates Foundation(http://www.gatesfoundation.org/), such as the$750 million 5-year grant to the Global Fund forChildren’s Vaccines, this latest award aims tocreate a market incentive for vaccine develop-ment [2]. Why is this concept so innovative andso necessary?

Successful vaccines have been developedthrough the actions of individual investigatorswho understand the specific disease, governmentagencies who fund the basic science aspects, andpublic companies who develop the candidatepreparations into practical vaccines. It would bemisleading to present this chain of responsibilityas a process of handing over a baton from onemember of a team to another; in practice, theprocess is haphazard, discontinuous, and onlymaintained by the enthusiasms of individualswithin each organisation. What are the incentiveswhich drive key individuals to proselytise, oftenat the expense of popularity within their organisa-tions? For the investigator, there is the knowledgethat their ‘‘favourite’’ virus is truly recognised asan important pathogen and that disease couldbe brought under control within a professionallife-time. For government agencies, there is theprospect that a vaccine could reduce the publichealth burden of disease and probably save healthcosts overall. For public companies, there is the

prospect of making financial returns for stock-holders while helping to prevent disease.

A recent report from the Institute of Medicineshows that some vaccines could save money in thelong-term, and many would be cost-neutral, yetlarge sums are needed up-front for their develop-ment costs [3]. Clinicians continue to expend vastresources on sub-optimal management of con-ditions which could be prevented, so there is aneed to divert some of these funds into preven-tion, while maintaining care for individuals. Theproblem is thus one of cash-flow coupled withsharing of financial risk among the variousstakeholders. As we have discussed previously,the cost can be considered a one-off revenue tocapital transfer [4], with a short time of repaymentdue to reduction in the costs of caring for infectedindividuals. However, these obvious financialbenefits are mis-represented by accountants whoinsist on discounting future savings. This occurseven though such standard cost accounting prac-tices are inappropriate and intellectually unjusti-fied for the health-care sector [5].

This is why the multi-million dollar award fromthe Gates Foundation is so welcome. It recognisesthe realities of vaccine development, and aims touse philanthropic funds to kick-start scientificallypromising development programmes stalled forlack of support. Thus, in the HIV example, it willprovide millions of dollars in each of five consecu-tive years to provide the cash-flow, confidenceand continuity necessary for the InternationalAIDS Vaccine Initiative to maintain a sustainedscientific effort. Furthermore, the award is a‘‘Challenge Grant’’ aiming to stimulate otherdonors to join an active development programme.In this way, a large guaranteed investment canprovide financial leverage to create a ‘‘marketincentive’’ to justify further investments. Thereturn on the investment is not equity but acommitment that a successful vaccine preparationwill be made available to the poorest of develop-ing countries at an affordable price. This concept

Reviews in Medical Virology

Rev. Med. Virol. 2002; 12: 67–68.Published online in Wiley InterScience (www.interscience.wiley.com).

DOI: 10.1002/rmv.349

Copyright # 2002 John Wiley & Sons, Ltd.

of ‘‘social venture capital’’ (www.iavi.org) offers anew paradigm for funding the initial costs ofnovel vaccines. If other donors can be persuadedto rise to the ‘‘venture philanthropy’’ challenge,[6] the opening quote may yet turn into reality.

P. D. Griffiths

REFERENCES1. Foege WH. The wonder that is global health. Nat Med

2001; 7: 1095–6.

2. Brandt R. Philanthropy. Gates gives booster shot toAIDS vaccines. Science 2001; 291: 809–11.

3. Stratton KR, Durch JS, Lawrence RS. Vaccines for the21st Century. Washington, DC.: National AcademyPress., 2000

4. Griffiths P. Vaccination policies and accountants. RevMed Virol 1998; 8: 59–60.

5. West RR. Economic rate of discount and estimatingcost benefit of viral immunisation programmes. RevMed Virol 1999; 9: 51–5.

6. Gura T. Biomedical philanthropy, Silicon Valleystyle. Nature 2001; 410: 140–3.

68 Editorial

Copyright # 2002 John Wiley & Sons, Ltd. Rev. Med. Virol. 2002; 12: 67–68.