BRITAIN鈥橲 health experts are bracing themselves for a major outbreak of an entirely preventable disease. Amid fears about the safety of the MMR three-in-one vaccine, parents are requesting shots of individual vaccines and finding the cupboard is bare. Clinics have had no fresh supplies of mumps vaccine for months.
In Australia, doctors recently had to stop immunising toddlers against deadly meningococcus C bacteria after they too ran out of vaccine. As for the US, a crisis over smallpox vaccine supplies was only averted when a drugs plant in Pennsylvania uncovered 90 million doses lying forgotten in its freezers. And for much of the past year, vaccines for tetanus, diphtheria and whooping cough were in such short supply in the US that children were having to miss routine booster shots.
It gets worse. The vaccines for anthrax and smallpox haven鈥檛 kept up with the times: neither would meet safety standards if they were being developed today. And although new vaccines are desperately needed to treat diseases such as tuberculosis and malaria, 鈥淏ig Pharma鈥� has shown little interest in developing them. In short, our entire system for supplying and developing vaccines has become dangerously fragile. What鈥檚 going wrong?
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It鈥檚 true that inventing effective vaccines for AIDS, malaria and a few other diseases is proving tougher than anyone imagined. But scientific obstacles are only part of the wider story. Researchers have known for years how to make better anthrax and smallpox vaccines, yet only now, prompted by the threat of terror attacks, are funds available.
A good vaccine is nearly always the most effective way to tackle any infectious disease. Yet there is a dangerous disparity between the power of vaccines and the money we are willing to invest in them. Put simply, vaccines should cost more. Our first thought on hearing about some new experimental immunisation is often 鈥淲ill it be affordable for the world鈥檚 poor?鈥�. But a vaccine that never makes it to trial is no use to anyone, rich or poor.
As a microbiologist working for industry, I recognise that my motives might be open to question. True, the mandate of biotech and pharmaceutical companies is to make money. But they can do that perfectly well without vaccines 鈥� and many are. Since 1965, the number of American vaccine producers has dwindled from 37 to 10, and there has been a similar decline in Europe. Over the decades, vaccine researchers like myself make the trek to corporate boardrooms to convince our colleagues to invest in a better shot to fight some dread disease. But time after time, our projects can鈥檛 compete for profitability with the next Viagra or big ulcer drug. And that鈥檚 despite a renewed awareness of the importance of vaccines.
The millennium began with the launch of the Global Alliance for Vaccines and Immunization, designed to expand access to vaccines and develop new ones. To date GAVI has amassed just over $1 billion dollars towards that goal, roughly three-quarters of it from the Bill and Melinda Gates Foundation. But valuable as such efforts are, the vaccine industry cannot be run like a charity forever. The aim must be to make it in companies鈥� interests to invest in vaccines.
Yet even institutions and governments with a humanitarian vision are doing little to bring companies to the table, and a lot to drive them away. The US Centers for Disease Control and Prevention (CDC), for example, recently asked Wyeth Lederle Vaccines to slash the price of its pneumococcus shot from $58 to $48 dollars a dose. Vaccine advocates of all stripes often push for low prices in an effort to make them as widely available as possible. As noble as their intentions are, I鈥檓 convinced they are leading us to a vaccine crisis.
Consumers already massively undervalue disease prevention. Parents of a sick child who have the money will gladly spend $10,000 on a drug regime, yet many balk at spending a fraction of this on a couple of doses of a vaccine that would prevent the illness. Policy makers complain about the few hundred dollars it costs to give babies the standard package of shots. But how much is lifelong protection against diphtheria, whooping cough, tetanus, poliomyelitis, smallpox, measles, mumps, rubella and Haemophilus influenzae actually worth?
The answer is a lot more. Henry Miller and Stanley Falkow at Stanford University and I have suggested a few steps governments could take (Science, vol 297, p 939). Instead of asking for that $10 per dose discount from Wyeth Lederle, for instance, the CDC might have negotiated with the company to reinvest the money into more vaccine programmes. Governments should give tax credits to support vaccine research, extend patents on vaccines and streamline regulations to allow vaccines to be more easily exported.
In the end, rich countries and their citizens will need to shoulder much of the burden of inventing and manufacturing vaccines for poor countries and poor people. But developing countries, too, need to assign a higher priority, and therefore higher budgets, to vaccines.
Developing and distributing vaccines has always been great public policy. To reverse the continuing degradation of vaccine supplies, it will need to be made a good business as well.