malaria vaccines), and lack of political will (Mahmoud, 2005). Despite the array of challenges described above immunization is the most consistently delivered health service in most of the world, and coverage remains reasonably good. Efforts by global partners to increase the availability of vaccines in low- and middle-income countries have led to significant increases in immunization rates and lower rates of disease in the past few decades. Nearly three-fourths of children around the world complete their series of DTP (diphtheria, tetanus, pertussis) vaccinations.2 Moreover, the uptake of additional vaccines (e.g., hepatitis B, Haemophilus influenzae b [Hib]) into the routine Expanded Program on Immunization in developing countries has greatly increased. By 2009, 61 of 72 countries eligible for GAVI funding were expected to have introduced Hib vaccine into their routine immunization programs (PneumoADIP, 2009).
Vaccine manufacturers make products that have historically offered minimal or modest returns on investment in high-income countries in part due to uncertain demand and in part because vaccines are one-time or limited-use products (Milstien et al., 2006). Although the vaccine market in developed nations has experienced a kind of renaissance (Gapper, 2009), concerns about profitability remain strong in the context of the vaccine needs of lower income countries (Batson, 2005; Danzon et al., 2005). Consequently, the development of new vaccines for diseases that primarily affect poor counties has been slow. Innovative solutions have been devised to provide incentives for vaccine makers or to find alternate ways and partners to develop a needed vaccine. Manufacturers in developing countries supply an increasing proportion of vaccines purchased by or on behalf of developing countries. One concern is that as this segment of the global vaccine industry grows, its growing capacity for research and development paired with a potential shift from its current humanitarian focus could lead manufacturers away from a focus on traditional, low-cost childhood vaccines (Frew et al., 2008).
The story of meningococcal conjugate vaccine for Africa’s meningitis belt offers one case study of a novel kind of partnership to facilitate vaccine development for a market with limited financial potential. The collaboration has involved WHO, Program for Appropriate Technology in Health (PATH), U.S. government agencies, and a developing country manufacturer (Serum Institute of India, Limited) to develop a new vaccine against meningococcal meningitis with technological support from the public and nonprofit sectors (see the meningitis vaccine timeline in Table 5-1).
The areas of need in the field of global immunization include the following: