manufacturing plants. In theory, the consortium would improve the quality of developing-country vaccine manufacturing, enough so that these producers would become attractive partners for manufacturers in the industrialized world. The plan requires developing-country partners to adopt an entrepreneurial operating style, and it depends for its success on collaboration between them and private-sector manufacturers.
Initial reactions of the private sector to the idea of a consortium were lukewarm, however. Several vaccine manufacturers expressed the fear that such a consortium would become a competitor for private-sector customers and for this reason would be opposed by them. Others at the workshop pointed out that the proposal seems to fly in the face of a worldwide trend away from public-sector production and toward privatization. The author of the plan, who heads a public-sector vaccine plant in the United States, emphasized that the consortium would be motivated by public-health rather than commercial motives. As an additional protection, joint-venture agreements could be written specifically to manage actual or perceived threats to industry, including competition. The plan envisions a number of potential benefits to private-sector participation, including that industry could gain important footholds in future markets through collaboration with the public sector. In addition, since the consortium would do the “heavy lifting” of technology transfer, the private sector could join in—perhaps by selling bulk vaccine for combination with DTP—at a later, less-risky stage of vaccine development.
DISCUSSION SUMMARY
The CVI has suffered through considerable conceptual and organizational uncertainty for much of its short existence. Due to a variety of recent changes, the initiative now seems better positioned to help bring more effective vaccines to the world’s children. As one speaker noted, the CVI is the visionary force for such efforts.
According to a number of workshop participants, significant involvement of the U.S. public and private sectors may be required for the ultimate success of the CVI. Some U.S. firms are developing products that, while designed primarily to meet developed-world needs, might also be of use in poorer regions of the world. Still, the likelihood of U.S.-made vaccines being sold in the developing world currently appears low. For private industry to become more involved, industry representatives said, there must be convincing evidence of markets for vaccine in the developing world. The creation of this “demand pull” is being aided by an international move away from free gifts toward vaccine self-sufficiency through purchase or production. Efforts to determine disease burden in selected countries combined with cost-effectiveness studies of vaccines might very well hasten this trend, according to several participants. The prospect of guaranteed, long-term purchases of vaccine also may improve the likelihood of industry participation.
Markets for vaccine in the developing world, no matter how large, probably cannot be served adequately with anything but low-price vaccine. Up to the present, this has posed a serious barrier for U.S. vaccine makers, they and others acknowledge. Yet, noted one workshop speaker, there is no reason to think that the principles of the open market, including differential pricing, should not apply to U.S. vaccines as they do to many other products. In the past, resistance in Congress to this type of cross-subsidization has dissuaded manufacturers from selling reduced-price vaccine to the developing world. Given the considerable potential benefits of such practices, both for U.S. vaccine manufacturers and to U.S. public health, workshop participants from both the public and private sector expressed the view that steps to overcome this resistance would be worthwhile.
According to some at the workshop, public-private partnerships will play a key role in the provision of new and more-effective vaccines to children throughout the world, particularly those in poorer regions. Such joint ventures, while costly and prone to a variety of problems in their implementation, will be crucial if technology from the industrialized world is to be successfully transferred to the developing world, they suggested. Any number of approaches to achieving this goal are possible; it is important for the success of such efforts that industry and the public sector continue to talk to each other in an open and collegial manner. Indeed, dialogue between the two sectors must continue if progress toward the goals of the CVI is to be realized.
