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Appendix G MECHANISMS USED IN OTHER COUNTRIES TO ENSURE VACCINE SUPPLY Country Belgium Canada Denmark Extent of Government Involvement The Office Vaccinogene within the Ministere de la Sante Publique et de la Famille is the only government-sponsored establishment producing vaccines. It produces only smallpox vaccine, which, at present, is used to maintain emergency stocks for Belgium. While the government has no financial holding in any vaccine manufacturer, it does maintain adequate supplies of the following vaccines by contracting with producers and importers: live polio (oral); tetanus adsorbed; diphtheria and tetanus adsorbed (DT); diphtheria, tetanus, and pertussis adsorbed (DTP); measles, mumps, and rubella (MMR), or combinations thereof; yellow fever vaccine (for international travel); and cholera and typhoid (for Army and international travel). The Ministry of Health also grants funds to the Institut Pasteur du Brabant for production of DTP, cholera, typhoid, and Bacillus Calmette- Guerin (BCG) vaccines. The government has minority shareholding in Connaught Laboratories, Inc. through the Canadian Development Corporation. This shareholding will be returned to the private sector in the future. The government is not involved in company decision making. The National Serum Institute, which provides rcee vaccination against whooping cough, diph- theria, polio, tetanus, and tuberculosis, receives funds from the government treasury. The Institute produces most of the vaccines and imports a small amount. The Institute is cur- rently the only vaccine manufacturer in Denmark. _ . . . . . . 192

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193 Federal Republic The government has no financial involvement of Germany in any vaccine production enterprise. In the past, Land Vaccination Agencies produced smallpox vaccine, but these were closed with the discontinuance of smallpox vaccination. France Rhone-Poulenc, a nationally-owned holding company, has a 51 percent interest in Institut Merieux. In Janury 1985, Institut Merieux acquired a 51 percent interest in the Institut Pasteur (production) and first rights to any vaccine research from the Pasteur Foundation. Japan Netherlands Sweden Switzerland Several independent manufacturers are subject to fairly tight government controls. All vaccines included in the national immunization program (DTP-polio combination; DT-polio combination; rubella; measles; and BCG for high-risk groups) are produced at the National Institute for Public Health and Environmental Hygiene. In 1986, an MMR vaccine will be included in the national program. A state-owned institute manufactures or procures vaccines. There is no government involvement in the Swiss Serum Institut. United Kingdom The Centre for Applied Microbiology and Research (of the Public Health Labor atorY Service) is supported by government funds and currently produces anthrax vaccine and botulism toxoids for use in the United Kingdom. The government is not involved financially in any commercial production of vaccine. The Secretary of State for Social Services can apply for and hold product licenses for vaccines that manufacturers choose not to hold. The Secretary then arranges for production of such vaccines, and may underwrite costs. The government also purchases vaccine directly from manufacturers.