Markets for vaccine in the developing world, no matter how large, probably cannot be served adequately with anything but low-price vaccine. Up to the present, this has posed a serious barrier for U.S. vaccine makers, they and others acknowledge. Yet, noted one workshop speaker, there is no reason to think that the principles of the open market, including differential pricing, should not apply to U.S. vaccines as they do to many other products. In the past, resistance in Congress to this type of cross-subsidization has dissuaded manufacturers from selling reduced-price vaccine to the developing world. Given the considerable potential benefits of such practices, both for U.S. vaccine manufacturers and to U.S. public health, workshop participants from both the public and private sector expressed the view that steps to overcome this resistance would be worthwhile.

According to some at the workshop, public-private partnerships will play a key role in the provision of new and more-effective vaccines to children throughout the world, particularly those in poorer regions. Such joint ventures, while costly and prone to a variety of problems in their implementation, will be crucial if technology from the industrialized world is to be successfully transferred to the developing world, they suggested. Any number of approaches to achieving this goal are possible; it is important for the success of such efforts that industry and the public sector continue to talk to each other in an open and collegial manner. Indeed, dialogue between the two sectors must continue if progress toward the goals of the CVI is to be realized.