antigens, effective against diseases not currently targeted, and affordable.

Making vaccines heat stable would eliminate the need for constant refrigeration, a critical limiting factor in the success and coverage of EPI programs in many countries. Combining more than one antigen into a single dose (as is now done with diphtheria and tetanus toxoids and pertussis vaccine [DTP], for instance) could dramatically reduce the number of vaccines and the costs required to immunize a child fully. Some characteristics of a CVI vaccine will be of public health value to the United States. Indeed, U.S. vaccine manufacturers are investing in research to develop new combination vaccines and simpler methods for administering vaccines. In addition, a new range of vaccines needs to be developed against diseases for which vaccines are not yet available.

The organization of the global CVI has evolved since the World Summit for Children. At the outset, the founders of the CVI (the Rockefeller Foundation, United Nations Development Program, United Nations Children's Fund, the World Bank, and the World Health Organization) recognized that no single agency or organization has the resources and capabilities to achieve the goals of the CVI. They recognized further that the CVI needed to involve many different entities to achieve the vision of the CVI. This recognition led to the formation of the CVI consultative group which is composed of representatives of national immunization programs, multilateral, governmental, and nongovernmental organizations, and commercial and public-sector vaccine manufacturers. The consultative group meets annually and provides an international forum for discussion of new CVI initiatives and for marshaling broad-based support for the CVI. The activities of the CVI itself are carried out through task forces and product development groups. The task forces examine strategic, logistic, and policy issues relevant to the industrial development and introduction of CVI vaccine products, including such areas as quality control, epidemiologic capability in developing countries, and global vaccine supply. The product development groups promote, facilitate, and manage projects leading to the development of vaccines and related products. The three current product development groups are focusing their efforts on a single-dose tetanus toxoid vaccine, a heat-stable oral polio vaccine, and an effective measles vaccine for administration earlier in life (see Chapter 2). The global CVI is headquartered at the World Health Organization in Geneva, Switzerland.

THE INSTITUTE OF MEDICINE REPORT

The Institute of Medicine (IOM) was asked by the two agencies responsible for formulating the U.S. response to the CVI—the U.S. Agency



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