Since 2010, a revolutionary new vaccine has been introduced across several states in sub-Saharan Africa as a means of tackling deadly outbreaks of meningitis A – a longstanding threat to global health security in the region. The development of the vaccine MenAfriVac is a unique example of the triumphs that emerge from successful public-private partnerships and coordinated transfers of technology from high-income countries that have the capacity to develop such vaccines to low- and-middle income countries where manufacturing is possible at significantly reduced costs. The question now is whether a lack of willingness of governments to pay for this vaccine could keep it out of many countries where it is needed most.
The World Health Organization (WHO) estimates that every year more than 400 million people are at risk of bacterial meningitis epidemics across the ‘meningitis belt’ – an area spanning 26 countries from the eastern Horn of Africa to the coast of Senegal in the west. In 2009, a meningitis epidemic led to 80,000 reported cases and over 4,000 deaths in the meningitis belt but since 2010 one-off large-scale vaccination campaigns using MenAfriVac have resulted in no cases reported from the 16 implementing countries. But a recent study suggests that if countries make the wrong policy decisions regarding continued use of this vaccine, they could undermine and reverse these advances. It is essential therefore that the 10 remaining countries follow WHO advice and roll out the initial one-off vaccination campaigns to avert the hundreds of deaths that are predicted each year, and that all 26 countries begin including the vaccine as part of routine childhood immunization programmes.
Although MenAfriVac has been ready for wide-scale roll out in the meningitis belt since 2010 and has proven effective in decreasing deaths and cutting healthcare costs, important questions remain about its affordability, despite it being available at less than $0.50 per dose. Through the concerted efforts of a consortium of experts and the support of private foundations, the Indian vaccine manufacturing company Serum Institute was able to produce the vaccine for use in these 26 countries at such a low cost. Yet several countries have delayed purchasing the vaccine for initial one-off mass vaccination campaigns in anticipation of provision of the vaccine by the Global Alliance on Vaccines and Immunizations (GAVI) (an international vaccine fund), and during the waiting period are seeing their children continue to die in meningitis outbreaks. And these delays have occurred while several of these same at-risk countries have amassed vast revenues through sales of oil and natural mineral reserves, revenues that have played a role in economic growth but are not being used to protect those at risk of meningitis.
If it is because $0.50 a dose is considered by these countries too high a price to pay, despite rises in GDP, then there is a need for more robust assessments of the market forces that guide purchasing behaviour and inform decision making before investing in research and development for preventative interventions, especially when vaccines such as MenAfriVac are so effective.
Recognizing the value of market research is one way of achieving this. Evaluating the will and purchase capacity of developing countries as part of the research that goes into vaccine development will help ensure that these countries are themselves eventually able to finance the procurement of new vaccines, and not depend on international donor agencies and funds. Conducting simple market surveys can facilitate this, as can the inclusion of national health ministries in early discussions with vaccine manufacturers. Cross-sector discussions of this nature create clarity and understanding about the needs, and means, of stakeholders that will either collectively share the successes of pioneering vaccines or will together face the challenges that come with poor prior planning and low market demand.
This is one of the reasons behind the UN’s focus on partnership creation, highlighted in the recently agreed Sustainable Development Goals. Such partnerships and collaborative efforts are as integral to developing vaccines and other goods at low cost as they are in ensuring that innovative funding mechanisms - such as those requiring receiving countries to provide matched funding - can eventually lead to sustainability of procurement. Ultimately, policy-makers and donors must learn to better assess and stimulate market conditions before investing in research and development of products that are to be affordable in the developing country market.
Asha Herten-Crabb and Abbas Omaar, Project Coordinators, Centre on Global Health Security