process unfolding over a considerable period of time. The CVI would need to adopt a more comprehensive approach to the total cycle and to a range of approaches for reducing its duration in some kind of partnership with industry.
The implications of this prospective cross-sectoral strategy would prove to be far greater than anticipated, rooted as they were in distinct sectoral cultures, divergent incentive structures, and mutual perceptions that augured poorly for authentic collaboration. The public sector had historically denigrated the profit motive, correspondingly mistrusted all industrial motivation, and did not fully understand the real costs and effort involved in developing a vaccine. The private sector viewed the public sector as motivated by ideology, not economically realistic, and unpredictable, and feared the vagaries of politics and bureaucracy as essentially threatening to what it saw as its legitimate interests. A core strategy for the CVI was, necessarily, to build trust between these two traditional adversaries. Its leadership needed, therefore, to be concerned with educating both sectors, demonstrating that doing well in terms of profitability and doing good on a humanitarian level were compatible, and somehow modifying the structure of incentives for the vaccine industry—domestic and international—to produce those products defined by the public sector as priorities. The fact that, at the outset, the CVI suffered from a surfeit of bureaucracy and turf struggles would, for a while, constrain its ability to meet its own objectives.
The CVI began with only a vague notion of what would be implied by "public-/private-sector collaboration," especially in a product area with so little apparent economic appeal and with so little hard cash as evidence of public-sector commitment to the Initiative. "Funds available" to the CVI Secretariat leveled off between 1993 and 1995 at about $2 to $3 million a year, including funds earmarked by donors for particular tasks. These levels are seen as insufficient for critical new activities such as communications and work with industry and, even though overall income looks as if it may grow, donor specifications will continue to limit program flexibility.
The initial CVI meetings, with government representatives at the table and industry representatives around the sides of the room, accurately reflected the CVI worldview in its early days. Another early cultural artifact was the limited presence of industry overall, confined as it was to a relatively few individuals with whom there had been some kind of historical relationship. And, because they were not suppliers of vaccine to UNICEF or to the Pan American Health Organization (PAHO), U.S. vaccine producers were not adequately included in these first encounters.
These phenomena no longer prevail. The range of industries involved with the CVI has expanded and industry's representatives are brought into dialogues sooner in a more consultative fashion, although some feel still not soon enough; and the cross-functional, cross-organizational team approach has slowly proved more