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entire health R&D spending.2 Historical, socioeconomic, and geographical distances may once have served to justify that extreme imbalance; they make little sense now, as pressures from epidemiological and demographic mobility grow and multiply.

The Workshop

These core concerns led the Forum members to ask more specific questions about the present and future challenges of infectious diseases, questions then used to organize this workshop. They were:

  • What is the public health agenda for emerging and reemerging infections in those areas where specific responses will be required from industry, and what products are needed?
  • Of those, which product areas are already a focus of significant industry research and development (R&D) efforts and which product areas are, in effect, "orphans," unlikely to be developmental priorities because their market future is somehow unappealing, especially if they present complex and costly technical challenges?
  • What approaches have been used to assure the development of products that are not profit makers but are nonetheless essential to the health of some significant population, that is, "social products"? Which of these approaches might reward further exploration as a way to deal specifically with the issue of emerging infectious diseases?

Because the ramifications of these questions are so varied and extensive, the decision was made to take case material as a point of departure for analysis and discussion. The primary case chosen was the Children's Vaccine Initiative (CVI), with case material on the Malaria Vaccine Development Board and International AIDS Vaccine Initiative added to expand the basis for discussion. Conceptualized in the late 1980s, launched subsequent to the World Summit for Children in late 1990, and a continuing focus of international effort since, the CVI has accumulated enough history to provide many lessons about strategies, tactics, and issues, all potentially valuable for thinking about how to attain a reasonable level of preparedness for infectious diseases as they emerge and re-emerge at some level of compelling concern.

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