Washington D. C.

1
Vaccine Research, Availability . . . and Reality
Perspectives of international health
humanitarian assistance communities

• Washington D. C.
• March 15, 2001

Mark Miller, MD Fogarty International Center,
NIH Millermark_at_nih.gov
2
Global Vaccine Programs A Short Course

• Pre 1974 RF efforts in YF vaccine development
  smallpox eradication, routine vaccination in lt 5
  of global birth cohort (few developing countries)
• EPI introduction of 6 basic antigens
  DTP, OPV, BCG, Measles, YF (1988)
• 1985 US Institute of Medicine, vaccine priorities
  (domestic and international volumes)
  (Research-Military, NIH)
• 1990 UNICEF Universal Childhood Immunization
  80 coverage achieved World Summit for Children
  (CVI)
• Poliomyelitis eradication gears up
  
• Subsequent recommendations to add vaccines
  HB (1992) Hib (conditional) (1997)
  Other vaccines added MMR, JE (Regional
  leadership, PAHO, WPRO)
• 1999 Global Alliance for Vaccines and
  Immunization Gates Foundation

3
Global Unity? CVI to the GAVI
Vaccine companies
UNICEF
GATES F.
R D Institutions
UNDP
National Control Authorities
WORLD BANK
Non-governmental Organizations
WHO
Immunization Programs
ROCKEFELLER F.
Bilateral AID
4
Number of Vaccines Routinely Used in Developing
and Established Market Countries
Rotavirus
Varicella
Influenza Pneumococcal
Measles Mumps Rubella DPT Poliomyelitis
Hepatitis B Haemophilus Influenzae
Measles DPT Poliomyelitis BCG
Hepatitis B
Estimated future use after licensure in
1998 Used in 50 of global birth cohort
5
Control of Infectious Diseases
EPI plus Target Diseases
100
Acute Respiratory Infections
Acute Respiratory Infections
Rubella
Rubella
Acute Respiratory Infections
Diarrhoeas and Enteric Fevers
Diarrhoeas and Enteric Fevers
Diarrhoeas and Enteric Fevers
JE
JE
JE
Other Parasites
Other Parasites
Other Parasites
Polio1
Malaria
Malaria
Malaria
HIV/STD
HIV/STD
HIV/STD
Prevented
Pertussis
Dengue
Dengue
Dengue
Tetanus
Yellow Fever
Measles
Hepatitis B
Tuberculosis
Diphtheria
S. pneumoniae (1.2)
Hib (0.50)
Hib (0.50)
Hib (0.50)
Hib (0.50)
S. pneumoniae (1.2)
Rotavirus (0.8)
RSV (0.5)
RSV (0.5)
RSV (0.5)
Rotavirus (0.8)
?
?
?
?
?
?
?
?
0
?
?
1.2
3.2
2.1
1.0
1.2
0.03
3.0
3.7
0.6 0.3 1.0
2.1
1.0
1.2
0.03
3.0
3.7
1.2
2.7
Annual deaths in the absence of immunization
(millions) (or 1lifetime disability)
6
Policy Analysis for HB, HiB, SP
Annual incidence (non discounted) low- to
upper middle-income countries Policy analysis of
the use of hepatitis b, Haemophilus influenzae
type B-, Streptococcus pneumoniae- conjugate and
rotavirus vaccines in national immunization
schedules. Health Economics, 1999.
7
Although these vaccines would be considered
cost-effective, why have they not been taken up
into routine vaccination schedules in all
countries? What would be the demand in SSA for
an AIDS vaccine priced at 15?
8
Number of Countries Adopting Hepatitis B Vaccine
into National Immunization Programs
9
Countries Using Hepatitis B Vaccine in Routine
Vaccination Schedule
10
Factors Associated With HB Vaccine Uptake Into
National Schedules
Highest quartile relative to lowest Vaccine 18
(2000) 2223-2230
11
Estimated probability of hepatitis B vaccine
uptake into national schedules
12
Estimated probability of hepatitis B vaccine
uptake into national schedules
13
Estimated probability of Hib adoption and current
actual use
14
Estimated probability of Hib adoption and current
actual use
























Probability


0
.66
to
1
(31)



0
.33
to
0
.66
(21)

0
to
0
.33
(126)
?
Use as of October, 1998
15
Factors to influence (short term)
16
Major Population Movements
17
Conclusion

• Initial CE studies show that certain
  under-utilized vaccines would be categorized as
  best buys
• Need better marketing of the public health value
  to appropriate decision makers
• Parameters associated with vaccine adoption
  (coveragegt vaccine cost gtgt disease burden)
• Indicates the relative strengths of associations
  and the need to build infrastructure/reduce cost
  to countries
• Concurrent commitments to infrastructure has not
  kept pace with technology advancements
• Experience with HB vaccine uptake can be used to
  illustrate demand curves for other vaccines
• Aid to identify countries most likely to adopt
  new vaccines and to estimate future vaccine
  manufacturing and financing needs

18
(No Transcript)