Vaccinations Save Lives - Everywhere
Dr. Jerome Kim, director general of the International Vaccine Institute (IVI), has both a scientific and political role. He talks with us about his work with manufacturers to create vaccines for the developing world, while working with governments to generate demand and the capacity to deliver vaccine programs.
Impact: What is the role of the IVI?
Dr. Kim: IVI’s mission is to discover, develop and deliver safe, effective and affordable public health vaccines. It is one of the few organizations that
has devoted itself to providing cost-effective vaccines for diseases that many of the larger pharmaceutical companies are not concerned with.
Impact: What are the challenges?
Dr. Kim: The vaccines needed in the developing world are often for diseases that no longer trouble the developed world. We work with organizations like Gavi, the Vaccine Alliance, that make it worthwhile for companies to develop vaccines for what we call neglected tropical diseases. They can then supply vaccines at low or no cost to the countries that need them. We help to ensure the countries are able to implement a vaccination program, and work with them to increase the uptake.
Dr. Jerome Kim
Impact: How do you achieve this?
Dr. Kim: Our objective is to reduce the burden of infectious diseases through vaccination. Of course, the most important person in that process is the one who is vaccinated and protected. But behind it all is a very complex system. First, you have to convince a manufacturer it is worth their while to produce the vaccine. That means you need to generate demand. To do that you have to convince a country’s ministry of finance to buy the vaccine. They only do that on the recommendation of their ministry of health, which in turn may only recommend purchasing a vaccine if WHO technical experts say it will reduce the disease burden. Finally, in the case of developing countries, the country can only buy it if Gavi can provide it at the right price.
Impact: What is the biggest obstacle?
Dr. Kim: Probably funding. When you look at Group A Strep, which kills 500,000 women of childbearing age a year through rheumatic heart disease, it is hard. Until last year, there was only a million dollars a year in research funding for vaccines for it, because it is not a big problem in the United States and Europe.
Impact: And vaccines for diseases common to both developed and developing countries?
Dr. Kim: Rotavirus vaccine is a good example. It is a premium vaccine that was licensed in the United States in 2007. By 2009, the US hit 70 percent vaccination and the number of cases dropped to almost undetectable. The WHO decided the world should use it, and its expert group, SAGE, recommended it. So far, 90-plus countries have put it into their national vaccination programs. But by 2015 only 20 percent of children worldwide had received all three doses. The problem is the amount of vaccines the big companies commit to Gavi. Sometimes they renege on their commitments, as Merck did in 2018. In addition, in developing countries there are often not enough people to administer and run vaccine campaigns.
The market for Covid-19 could be 7 billion people, so we hope there will be more than one vaccine.
Impact: How confident are you that a Covid-19 vaccine would get global distribution?
Dr. Kim: It is an issue. The US is developing a vaccine at warp speed and will make a lot of it. But who is going to distribute it to Tanzania, Mozambique or Ghana? CEPI, the Coalition of Epidemic Preparedness Innovations, is willing to fund vaccine development at a cost accessible to developing countries, but someone will still have to manufacture and distribute it. The market for Covid-19 could be 7 billion people, so we hope there will be more than one vaccine.
The vaccines needed in the developing world are often for diseases that no longer trouble the developed world.
Impact: What are the issues around vaccine delivery in developing countries?
Dr. Kim: It is far safer to give a cholera vaccine by opening a bottle and telling someone to swig it or giving them a patch to put on their arm, rather than getting a nurse to inject it. But big manufacturers are not incentivized to spend the millions required to transition their injectable vaccines into these methods of delivery, since the countries that need them receive them at low or no cost.
Impact: How can you build global manufacturing capacity?
Dr. Kim: The majority of vaccines – by number, not value – used by Gavi are produced in India, Korea, China and Indonesia. So, capability is distributed around the world, but needs to be rationalized. It is probably not tenable for every African country to have their own vaccine manufacturing capability, but you might develop it in South Africa, Kenya or maybe Senegal. It would depend on the market, technical capability, and their commitment to buying, say, 90 percent of what is produced. In the end it is a business. To make manufacturing sustainable and produce at scale to a lower price, you need a population of about a hundred million.
Every $1 you invest in vaccination saves a total of $44 in cost to society.
Impact: What are the advantages of vaccination beyond disease immunity?
Dr. Kim: There is a far broader societal impact. If you vaccinate children with pneumococcal conjugate vaccine, their grandparents do not die of invasive pneumococcal disease. If you are a family with a daily income of $2 and a child is sick, mom has to stay home and they drop below the poverty level, often for months after the child recovers. This means the children work and do not go to school. Infections also contribute to delays in cognitive and physical development. Unvaccinated children have lower performance in school. Vaccination also lowers birth rates because mothers no longer fear their children dying. With vaccinations you have a more productive society. For all these reasons, every $1 you invest in vaccination saves a total of $44 in cost to society.