Prevention

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.

Dr. Jerome Kim: Director General - International Vaccine Institute Sören Kunz

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.

About

Dr. Jerome Kim

Jerome H. Kim, M.D. is a professor of medicine at the Uniformed Services University of the Health Sciences in the United States and is a fellow of the American College of Physicians and the Infectious Diseases Society of America.

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.

Dr. Jerome Kim
Director General International Vaccine Institute (IVI)

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.

Dr. Jerome Kim
Director General IVI

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.

Dr. Jerome Kim
Director General IVI

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.

CALL TO IMPACT
1 Large pharmaceutical companies must be incentivized to focus their resources on developing vaccines for infectious diseases. 2 Manufacturing a vaccine is only part of the solution; the infrastructure and capacity to run a vaccine campaign must be built up. 3 Fostering cross-country collaboration in the development of vaccines to make vaccines more affordable in the developing world.
Read the next topicVirus Wake-Up Call