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Still, the strategies and learning from the CVI, from HIV/AIDS, and from the many mechanisms described in this report, offer plentiful options for stimulating research and development on products for emerging infectious diseases, at least some of which will be, for one reason or another, orphans that will need to be adopted creatively.


  • 1.  

    Institute of Medicine. Contraceptive Research and Development: Looking to the Future. PF Harrison, A Rosenfield, eds. Washington, D.C.: National Academy Press, 1996.

  • 2.  

    R Twombly. The future face of disease. Environmental Health Perspectives 105(2):184–186, February 1997.

  • 3.  

    The CVI now defines itself as "a coalition committed to expanding protection against infectious diseases, particularly through the development and introduction of new and improved vaccines" (CVI Secretariat, Conclusions from the CVI/Rockefeller Foundation Bellagio Conference on the Global Supply of New Vaccines, 2–7 February 1997, Geneva, World Health Organization, 1997).

  • 4.  

    A number of explanations have been offered for the vaccine renaissance, all of which probably apply. These include industry's gradual appreciation of the potential of the National Vaccine Injury Compensation Act passed in 1986; great advances in molecular and cellular biology and biotechnology, and the promise of genetically engineered vaccines; dedicated efforts to develop vaccines for such key needs as AIDS prevention; understandings about the infectious etiologies for some chronic diseases; greater awareness of the cost-effectiveness of vaccines as a public health measure; WHO's Expanded Program on Immunization (EPI) and a better than doubling of the number of vaccine doses purchased by UNICEF beginning in 1985; and growing concern about antimicrobial resistance (Institute of Medicine, 1996).

  • 5.  

    At the Summit, it was proposed that the ideal CVI vaccine should be given as a single dose (preferably orally); contain multiple antigens; and be affordable, heat-stable, effective when administered near birth, and effective against diseases not currently targeted (Institute of Medicine. The Children's Vaccine Initiative: Achieving the Vision. VS Mitchell, NM Philipose, JP Sanford, eds. Washington, D.C.: National Academy Press, 1993).

  • 6.  

    World Health Organization. Summary and Conclusions, and Presentation on Sustainable Vaccine Supply/Global Targeting Strategy and Market Segmentation: Tiering Vaccine Prices. Children's Vaccine Initiative/Rockefeller Foundation Bellagio Conference on the Global Supply of New Vaccines, 3–7 February 1997.

  • 7.  

    Mercer Management Consulting. Report on the U.S. Vaccine Industry. Commissioned by the Department of Health and Human Services, 1995. New York: Mercer Management Consulting. Summary of UNICEF Study: A Commercial Perspective on Vaccine Supply. New York: Mercer Management Consulting, 1994.

  • 8.  

    As of this writing, UNICEF has not found the funds it needs to purchase Hib vaccine.

  • 9.  

    In fact, most of UNICEF's purchasing from this group of suppliers is from a subset of the group. The balance of the traditional vaccines needed in the developing countries is satisfied through procurement and local production.

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