utes to economic development, reduction of poverty, and greater political stability. Reduction and eradication of infectious diseases overseas (e.g., polio, measles) also decreases the likelihood they will affect Americans traveling or working overseas and reduce the risk of importation into the United States by returning travelers, refugees, and immigrants. The U.S. interest in global health in general1 and in immunization in particular is motivated by many factors, including the interconnectedness of the world and a “humanitarian obligation to enable healthy individuals, families, and communities everywhere to live more productive and fulfilling lives” (IOM, 2009b:1).
Since the completion of the 1994 plan (HHS, 1994), the landscape of global immunization has changed dramatically. Low- and middle-income country manufacturers have gained increased prominence in manufacturing and furnishing affordable vaccines in these countries. In fact, most of the world’s supply of certain vaccines is manufactured by these companies. Philanthropic organizations and the public-private partnerships (such as product development partnerships [PDPs]) they support have emerged as major actors in vaccine research and development specifically for the developing world. Global funding, from both private philanthropy and government aid, has markedly increased to support the purchase of newer and costlier vaccines, such as pneumococcal conjugate vaccines.
The stakeholders for Goal 5 in the National Vaccine Plan include an array of public, private, and not-for-profit entities. The federal agencies with responsibilities for developing country vaccine issues (e.g., development, regulation, and use of vaccines for diseases not endemic to the United States) include the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID) in the Department of State, and the Department of Defense. USAID represents the United States in most global organizations that provide governance, develop policy, or coordinate financing for immunization. USAID also supports the ImmunizationBASICS program that supports lower income countries in policy development and aspects of capacity building. The United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the Pan American Health Organization (PAHO), and WHO’s expert committees play central roles in developing international vaccine policy and programs, and in advising and supporting developing countries’ own immunization policies and activities. In the past decade, foundations such as the Bill and Melinda Gates Foundation have emerged as major contributors to financing and innovation in the realm of immunization for low- and middle-income countries. The Global Alliance for Vaccines and Immunisation (GAVI) is a relatively new