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Giving developing countries the best shot: An overview of vaccine access and R&D

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Photograph by Nico Heijenberg

Vaccines have made possible some of the greatest public health successes in the past century.

Immunisation helps avert an estimated 2.5 million child deaths each year, as well as millions more bouts of illness and disability. Poor countries as well as rich have benefited, although developing countries almost always benefit only after long delays. Basic childhood immunisation is one of the few health interventions to which most of the world’s poor have access, free of charge and through the public sector. In fact, immunisation is one of the most equitable health interventions, protecting girls and boys alike, and reaching the poor within countries at higher rates relative to the wealthy than other services.

Despite their impact, vaccines have generally received less attention than drugs. But the vaccine landscape is shifting, and new opportunities, challenges, and debates have pushed vaccines to the centre of global health discussions. The issues are complex and the experience gained in the struggle for access to HIV medications is an imperfect guide. The basic principles—equitable access and research and development (R&D) based on needs—are the same, but vaccines differ from drugs in important ways.

There are multiple factors that make delivering vaccines to children in developing countries difficult. These include – among others – high prices of newer vaccines, the lack of R&D for better-adapted and needed vaccines, as well as weak health systems with corresponding health worker shortages. This paper will focus on the first two points, outlining some of the major issues and exploring possible solutions.

Two fundamental challenges surround vaccine access and R&D: First, the newest vaccines are often prohibitively expensive, in part because of a lack of adequate competition in the market, hindering their use in developing countries. Second, because there is little incentive for pharmaceutical companies to conduct R&D for diseases that affect populations with limited purchasing power, some diseases continue to be unaddressed by vaccines altogether, while many vaccines are not well-adapted for people in developing countries.

Giving developing countries the best shot: An overview of vaccine access and R&D