Ten thousand people, mainly children, will die around the world today from a vaccine-preventable disease.
If you live in the United States or another high-income country, your children will very likely have been vaccinated against Hepatitis B, Hib and pneumococcal infection. If you live in a developing country, they will very likely not have been vaccinated against these diseases, even though the vaccines are safe and cheap to produce. It isn't that we can't get the vaccines to children - more than three quarters of the world's children get some basic vaccinations. But these particular vaccines are too expensive to buy, even for the children we already reach with cheaper vaccines.
And so another ten thousand people will die tomorrow.
A further ten thousand people will die today of one of the diseases for which we do not yet have a fully-effective vaccine: malaria, HIV or tuberculosis. If millions of people in rich countries died of these diseases every year, there would be more investment in finding a vaccine. We might even have new vaccines by now. But because the people who suffer from these diseases are very poor, there is little commercial reason to make very risky, very expensive investments in R&D to find a vaccine.
These problems - lack of access to existing vaccines, and insufficient investment in the development of new vaccines - are not the fault of the pharmaceutical companies. Companies have legal duties to their shareholders: they can't just give away their products. And if they did, there would be no investors in the future willing to pay for the R&D on vaccines and drugs that we need for the future.
But 20 thousand people will die every day until we do something about it.
The Finance Ministers of the world's richest countries are meeting on Friday, in Washington, DC. On their agenda is a discussion about how they can create stronger financial incentives for the development of new vaccines, and for the purchase of those vaccines once they have been developed.
We are optimistic that the G7 Finance Ministers will continue to show the humanity, judgment and leadership that has resulted in the emergence of a package of policies to tackle this vital and urgent challenge.
There is no single solution to the problems of developing new vaccines while providing affordable and sustainable access to existing vaccines.
Donors are solving this problem with a package of at least five related programs:
- performance based funding for vaccine programs
- a global vaccine purchase fund (GAVI)
- public private partnerships
- the International Finance Facility for Immunization
- and possibly Advance Market Commitments
A new CGD brief, Vaccines for Development, looks at these policies and the way they fit together to address the policy challenge. We find that, together, these policies are the basis of a coherent response to the challenge; though none is a magic bullet that suffices on its own.
On the agenda for Friday's G7 Finance Ministers meeting is whether the richest countries should make an Advance Market Commitment to pay for the purchase of new vaccines for developing countries. That idea, which was developed by a CGD Working Group in 2004, has been endorsed in principle, and the G7 Finance Ministers agreed last December that they would aim to pilot the idea in 2006. There has been an enormous effort, led first by Italy and then by the World Bank and GAVI, to address technical issues on how this could be implemented.
The next stage, if there is to be a next stage, is for the Finance Ministers to select one or more diseases to focus on for the pilots, and to provide an indication of the size of commitment they might be willing to make. That will enable the technical discussions to move from the general to the specific. Questions such as how the commitment would be structured, or the nature of the specification a vaccine would have to meet, have different answers depending on the disease being targeted.
We do not expect Finance Ministers to make a firm, legally binding commitment on Friday. But we hope they will take a step further in their enthusiasm for the idea. For this idea to move towards implementation, the Finance Ministers will need to demonstrate leadership required to enable the next phase of technical work to progress.
We realize that governments are hesitant to make large commitments at a time of fiscal constraint. But there is enormous evidence that vaccines are one of the most cost-effective possible ways of providing assistance to developing countries. This commitment is unusual because if the program does not succeed in developing a new vaccine, it will cost the governments nothing. And if it does succeed in accelerating the development of and access to these critically important vaccines, it will be one of the most cost-effective uses of the money that taxpayers entrust to governments. Those governments who are most concerned about fiscal responsibility should not lightly turn away the opportunity to make a significant impact towards meeting the world's shared goals for reducing poverty.
As Friday approaches, we cross our fingers - or hold our thumbs, as they say in some parts of Africa - and hope that the G7 Finance Ministers are able to demonstrate once again the leadership and generosity that they have shown in the past by making the decisions needed to make progress towards an Advance Market Commitments. We wish them well, and look forward to an announcement on Friday evening which affirms our faith in the humanity, wisdom and judgement of the world's richest countries.