Market Incentives

Because there will never be enough donor money to fund all desired clinical research, the global health community is testing the stimulus power of market-based "pull" mechanisms, such as Advance Market Commitments (AMCs), which guarantee prices for new vaccines and drugs with low profit potential in the West. This approach is being used to fight malaria by subsidizing the purchase of artemisinin-based combination therapies (ACTs) that are effective, but too costly for most third world health systems. The Global Fund to Fight AIDS, Tuberculosis & Malaria recently launched the Affordable Medicines Facility–malaria (AMFm) to make ACTs available in Africa and Asia at nominal cost. The subsidies apply to fixed-dose combination ACTs, and aim to drive older, ineffective products out of the market.

Another AMC project supports development of new pneumococcal vaccines that can protect against pneumonia and other diseases that claim millions of lives each year. A broad donor coalition has committed $1.5 billion to guarantee a $3.50 price for pneumococcal vaccines suitable for Third World use, encouraging pharma companies to invest in research and expand manufacturing capacity for more effective products.

Invigorating Vaccines

Vaccines to prevent infectious diseases are the holy grail in fighting Third World diseases—and there's been some good news on that front. The PATH Malaria Vaccine Initiative is launching Phase III trials on a promising malaria vaccine developed by Glaxo, and the Aeras Global TB Vaccine Foundation has several drug candidates in early clinical trials. Rotavirus vaccines recently received a strong push from a WHO recommendation to include the product in national childhood immunization programs.

Speeding Flu Vaccine to Patients

This escalation to meet demand for flu vaccines is a bonanza for vaccine makers. Sanofi, Glaxo, and others are opening new manufacturing facilities in the US and abroad while foreign manufacturers—such as Sinovac Biotech in China—are gearing up production, and a number of small biotech firms are developing new vaccine production and testing methods. Novel antigens are in the works, and vaccine makers are moving forward with long-discussed cell-based manufacturing technology.

Squeeze on Funding

Yet despite significant increases in funding for global health over the past decade, international programs now face major budget cuts. A May 2009 Institute of Medicine report recommends nearly doubling US financial commitments to global health to reach $15 billion a year by 2012, but that's not likely to occur. The Obama administration has proposed a $63 billion, six-year global initiative to combat AIDS, as well as TB, malaria, and other Third World health problems. That's less per year than Bush's $48 billion, five-year funding plan for PEPFAR (the President's Emergency Plan for AIDS Relief), which has been praised for slowing the growth of AIDS in Africa and other poor nations.

The funding decline is squeezing resources at public–private partnerships just as they are poised to harvest rewards from over a decade of research. A 2007 Dalberg study estimates that full testing and registration of those projects in PPP pipelines would require $8.3 billion in funding, but that less than $1 billion is available. One solution may be for newly industrialized nations, such as China and India, to invest more in infectious disease research that would benefit their populations directly.

Jill Wechsler is Pharmaceutical Executive's Washington correspondent. She can be reached at jwechsler@advanstar.com