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Rights & Permissions Free Resources Display this book on your site! Related Titles Priorities for the National Vaccine Plan The Children's Vaccine Initiative:Achieving the Vision Other Related Titles The Children's Vaccine Initiative: Continuing Activities (1995) Institute of Medicine (IOM) Citation Manager Export the bibliographic data for this book in your chosen format Web Search Builder Use this book's key terms to search within this book, across our collection, or across the Web. Skim This Chapter Skim this chapter and use this chapter's key terms to search within this book. Reference Finder Paste in your own text to find books that relate to your topic. Citation Manager . "INTRODUCTION." The Children's Vaccine Initiative: Continuing Activities. Washington, DC: The National Academies Press, 1995. Please select a format: Page 1   E-mail Share on facebook Facebook Share on delicious Delicious Share on stumbleupon Stumble Share on twitter Twitter More Sharing ServicesMore The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. Promise and Problems: Hib, Pneumococcal, and Meningococcal Vaccines in the Developing World INTRODUCTION The three vaccines discussed in this report target diseases that are responsible for a significant amount of disease and death in developing nations. Unfortunately, as participants in the workshop learned, there is a dearth of good epidemiologic data in many poorer regions of the world. This not only makes it hard for researchers to design vaccines appropriate for a particular population, it also makes it hard to sell the benefits of vaccination to developing-country health ministries. Without convincing evidence of an infectious-disease problem, they are unlikely to favor spending scarce government funds on prevention. Even were such disease information available, there may be considerable technical and scientific barriers preventing a potentially useful vaccine from reaching those who could benefit from its use. The conjugation process employed to make the three vaccines considered by this workshop is complex, requiring significant technical skill and advanced manufacturing capability. Both are in short supply in the developing world. Workshop participants learned of several alternatives to the standard randomized placebo-controlled study that may, in certain situations, provide useful efficacy data. The public and private sectors have worked and will continue to work together in various aspects of vaccine development, including clinical testing, although the incentives and expectations in each sector may differ markedly. Perhaps the major barrier to the introduction of new vaccines against acute respiratory infections (ARI) and meningococcal pathogens is cost. For example, in the case of conjugate vaccine against Haemophilus influenzae type b (Hib), which has been shown highly effective over the last 5 years in children in Page 1 FRONT MATTER (R1-R8) CONTENTS (R9-R10) INTRODUCTION (1-1) ARI AND MENINGOCOCCAL MENINGITIS IN THE DEVELOPING WORLD (2-4) DETERMINING VACCINE NEED (5-7) OVERCOMING SCIENTIFIC AND TECHNOLOGICAL BARRIERS (8-13) PROVING VACCINE EFFICACY: THE CHALLENGE OF DEVELOPING-COUNTRY FIELD TRIALS (14-19) INTRODUCING AN EFFECTIVE VACCINE (20-26) Involving the U.S. Public and Private Sectors in the CVI (27-27) BRINGING CLARITY TO THE CVI VISION (28-28) TRENDS IN THE GLOBAL VACCINE SITUATION (29-30) RESHAPING THE EPI (31-31) A ROLE FOR INDUSTRY (32-34) FACILITATING GREATER U.S. INVOLVEMENT (35-38) DISCUSSION SUMMARY (39-40) APPENDIX A: PROMISE AND PROBLEMS . . . (FINAL AGENDA, LIST OF SPEAKERS AND PARTICIPANTS) (41-48) APPENDIX B: INVOLVING THE U.S. PUBLIC AND PRIVATE SECTORS IN THE CVI . . . (FINAL AGENDA, LIST OF SPEAKERS AND PARTICIPANTS) (49-54) APPENDIX C: ACRONYMS AND ABBREVIATIONS (55-56)

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The Children’s Vaccine Initiative: Continuing Activities: A Summary of Two Workshops Held September 12–13 and October 25–26, 1994 Promise and Problems: Hib, Pneumococcal, and Meningococcal Vaccines in the Developing World INTRODUCTION The three vaccines discussed in this report target diseases that are responsible for a significant amount of disease and death in developing nations. Unfortunately, as participants in the workshop learned, there is a dearth of good epidemiologic data in many poorer regions of the world. This not only makes it hard for researchers to design vaccines appropriate for a particular population, it also makes it hard to sell the benefits of vaccination to developing-country health ministries. Without convincing evidence of an infectious-disease problem, they are unlikely to favor spending scarce government funds on prevention. Even were such disease information available, there may be considerable technical and scientific barriers preventing a potentially useful vaccine from reaching those who could benefit from its use. The conjugation process employed to make the three vaccines considered by this workshop is complex, requiring significant technical skill and advanced manufacturing capability. Both are in short supply in the developing world. Workshop participants learned of several alternatives to the standard randomized placebo-controlled study that may, in certain situations, provide useful efficacy data. The public and private sectors have worked and will continue to work together in various aspects of vaccine development, including clinical testing, although the incentives and expectations in each sector may differ markedly. Perhaps the major barrier to the introduction of new vaccines against acute respiratory infections (ARI) and meningococcal pathogens is cost. For example, in the case of conjugate vaccine against Haemophilus influenzae type b (Hib), which has been shown highly effective over the last 5 years in children in

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participants learned