Under-five deaths by cause, developing countries, 1990. Cut slices: Vaccine-preventable diseases. SOURCE: State of the World's Children, 1993.

the deaths in children under age 5 years. Acute respiratory infections kill more than 2 million people every year (Ransome-Kuti, 1991), and an estimated 1 million to 2 million people, most of them children, die from malaria each year (Institute of Medicine, 1991). Vaccines for these three sets of conditions are in various stages of development but are not yet available for use.

These concerns, coupled with the recognition that genetic engineering and new vaccine technologies could permit the development of a new generation of childhood vaccines and that the translation of these scientific advances to vaccines needed by developing countries was lagging, led to the establishment of the Children's Vaccine Initiative (CVI).


The CVI is both a concept and an organization. The initial focus of the CVI, launched after the World Summit for Children in New York City in September 1990, was to accelerate efforts to develop vaccines that could enhance the performance of EPI (World Health Organization/Children's Vaccine Initiative, 1991a, 1992). A number of specific, desirable features of future children's vaccines were proposed (see the box "What Is the Children's Vaccine Initiative?"). Vaccines incorporating some or all of these

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