Delivering Vaccines to Where They’re Needed Most
August 6, 2013
In advance of the many health-related discussions to take place in September at the Clinton Global Initiative, the Social Good Summit, UN week and other such events, the Skoll World Forum asked some of the world's leading voices in global health to paint a comprehensive picture of key trends, challenges and opportunities to realizing healthcare access and treatment around the world. *In partnership with Forbes, a new post will be published everyday through Friday, August 9th. Check back for more!*
Rahim Kanani: You bring a unique perspective to global health work, coming from a long career in the pharmaceutical and vaccine industries. What are some of the lessons you’ve learned or “aha” moments you’ve experienced in your work on broader global health and development issues?
Kevin Reilly: Personally, I’ve developed a deeper appreciation for the complexity involved in running successful immunization programs. From the point of view of the vaccine manufacturer, you focus on the specific activities needed to move a vaccine successfully through the stages of development, but the many challenges involved in delivering and distributing that vaccine in developing countries may be less obvious. Getting a vaccine successfully from the factory door to the arms of millions of children in low-resource settings—that’s an enormously complicated task. Increasingly, I see pharmaceutical and vaccine manufacturers engaging in the dialogue about strengthening immunization and distribution systems to ensure vaccines get to where they are needed. Vaccine manufacturers were among the key partners involved in the early conversations that led to the formation of the GAVI Alliance, for example. They could see that global immunization rates were stagnating and that something needed to be done.
Similarly, I see growing awareness among global health organizations about the difficult, multiyear process required to develop vaccines and how that process influences the price. Where some organizations may once have advocated for a flat price of, say, less than $1 per dose for developing countries, now I think there is greater appreciation for the fact that new vaccines are extremely complex and expensive to develop. There are more efforts now to create a productive dialogue between manufacturers and global health organizations and to think creatively about funding structures and other mechanisms that may expand access to vaccines while also recognizing the need of manufacturers to ensure the financial health and well-being of their own corporations.
Rahim Kanani: What makes public-private partnerships between business, government, and civil society an effective way to tackle global health challenges? And what are some examples of big pharmaceutical companies partnering with other sectors?
Kevin Reilly: Vaccine manufacturers have a long history of providing vaccines at heavily discounted prices for use in the developing world, a practice that stretches back over half a century. For example, early in my career, I was involved in helping to provide polio vaccine to UNICEF for 2 cents per dose. While the prices have gone up for various reasons, this practice is still active today and is a critical factor in many vaccines reaching millions of children in the developing world.
From the standpoint of business, one of the keys to success for public-private partnerships is recognition that vaccine and pharmaceutical manufacturers have an important contribution to make but also have corporate interests that they must protect as well. So companies are striving to find that balance between using their discoveries to maximize the good they can do for people around the world and achieving a reasonable return on their investment.
I was also involved in helping bring Prevnar, the first pneumococcal conjugate vaccine, to market as president of Wyeth Pharmaceuticals’ Vaccine and Nutrition Division. Wyeth and GAVI entered into a discussion early on about how the vaccine could help meet the needs of developing countries, where pneumonia is the leading cause of death in young children. Through those conversations and GAVI’s innovative financing mechanism, Wyeth was able to make special arrangements for the supply of the vaccine, thus accelerating the availability of a new, complex vaccine in low-income countries.
Rahim Kanani: Is developing a vaccine the hardest part, or is it the delivery and distribution of that vaccine to the developing world?
Kevin Reilly: Both are essential for successful health outcomes—and both are immensely challenging. Developing a vaccine involves a relatively narrow set of activities driven by scientific and clinical research work. Since 2000, barely a handful of new vaccines have been developed. That’s because this is complicated work dotted with setbacks and failures along the way. You try things in the lab that fail, or things don’t work out clinically the way you predicted they would based on results in the lab. Prevnar was 17 years in development and went through ownership by three different corporate entities on its way to market.
On the other hand, vaccine delivery is a broad-based, multidimensional, and cross-sector activity involving many different systems and stakeholders. Ideally, you aim to bridge the two sides of this process, to develop a vaccine that is safe and effective while also being suited for efficient distribution and delivery. Sometimes, the complex biological and scientific factors involved in vaccine development limit your ability to optimize design for the distribution and delivery of the vaccine —for example, it may have special cold chain requirements that make it difficult to reach remote areas.
PATH’s work on the MenAfriVac® vaccine is a good example of how vaccine development, distribution, and delivery are inextricably linked. PATH and the World Health Organization worked with dozens of global collaborators over a decade to develop the vaccine against deadly meningitis A. Simultaneously, they worked with countries across Africa’s “meningitis belt” to build their capacity to integrate the vaccine into their health programs by strengthening disease surveillance, enhancing lab capacity, and reaching out to policymakers, health workers, and journalists with information and training. Recently, the vaccine became the first in Africa approved for transport and storage outside the traditional cold chain. To date, more than 100 million Africans across ten countries have received this new vaccine.
Rahim Kanani: It’s clear that businesses do a tremendous amount of work in researching and developing new drugs and vaccines to fight disease and illness. What role should governments and educational institutions play in terms of investment and research, and how can they complement each other?
Kevin Reilly: Businesses primarily focus on developing products directed at specific disease targets. In many cases, they are building on the broad base of knowledge created by academic and government research facilities. A lot of this early, upstream research may not be highly visible, but it provides a crucial foundation for the specific products coming out of pharmaceutical and biotech companies. This base of knowledge is a critical asset for the progress of health and medicine, and because this approach has been most successfully applied in the US, I believe it also gives the US a significant competitive advantage. This allows business to focus on the specific development work needed to deliver a product—work that usually involves large investments and significant risk-taking associated with the success or failure of the project. I think that matching of risk capital with high-risk activity seems appropriate.
Increasingly, we are seeing drug and vaccine manufacturers coming together with global health organizations to reduce the lag time between product launches in the developed world and the developing world. This is a relatively new trend, and a welcome one. With Prevnar, for example, Wyeth was in dialogue with GAVI soon after the vaccine launched in 2000 in the US and Europe about how to accelerate the launch of the vaccine in developing countries.
Rahim Kanani: Finally, as someone with more than 30 years of experience in this space, what are some of the leadership lessons you’ve learned along the way when it comes to advancing global health?
Kevin Reilly: Patience and persistence. These are essential elements of success in improving health around the world. The development of drugs and vaccines is an extremely long and high-risk process. Maintaining momentum requires an unwavering faith in the final objective and an unrelenting focus on doing what it takes to get there. The same is true in other kinds of global health initiatives. Some of these programs take decades to reach fruition. Polio eradication, for example, has been a global health priority for more than 50 years. In the case of polio, it’s not a matter of developing a vaccine. We’ve had the vaccine since the 1950s. It’s overcoming the challenges of delivering the vaccine to every child in every village in every country around the world. The global health community has been pushing on this for years, knowing what a powerful payoff there will be if we are successful.