Taking vaccines to the “Old World”

Introducing New Vaccines Into Developing Countries: Obstacles, Opportunities, Complexities

By JOHN CLEMENS and LUIS JODAR
Published: April 5, 2005
Nature Medicine

This review type article presents ideas about how vaccines are being brought into the developing world. I found these points particularly interesting because they pertain to the major obstacles to new vaccine introduction:

1. Although in the 1980s coverage of the BCG vaccine for infants had reached 80% in sub-Saharan Africa, that percentage has dropped to less than 50% in 2000. Negative gains like these are sure to play a factor in bringing in new vaccines, especially if old vaccines are still not being used as they should.
2. There has been an increasing gap in the type of vaccines used in developed nations versus developing nations. This has been caused by the innovation of improved vaccines that tend to be more expensive and thus producers favor their introduction into developed nations.
3. There is a difference in the type of vaccines demanded by the developing world and developed nations. Producers are inclined to manufacture vaccines that will yield the highest gain; therefore vaccines for diseases that generally affect developing nations are being overlooked/underfunded.
4. The increase in recent regulation for the development of new drugs has caused an exponential increase in the cost of research and development. There is much uncertainty about how developing nations will deal with increased costs.
5. People of different countries respond differently to vaccines. Randomized trials are largely neglected in developing nations and the efficacy of a new vaccine made for developed nations may be greatly overstated in developing nations.

The article goes on to explain the complexities that entail introducing new vaccines along with new opportunities to introduce vaccines that were previously non-existent (push mechanisms, private/nonprivate funding, and copy-cat vaccine production).

What was most interesting to me as I read this article was the 5^th obstacle that the authors mentioned. It seems that the problem that faces most developing nations in receiving new vaccines is the cost. The focus of much health media today revolves around new discoveries in developed nations and how the new drug will cost hundreds of dollars per dose and how that is controversial because poorer nations cannot afford them. Yet, the authors of the article highlight the fact that this expensive medicine may not even work well in other populations. Furthermore, the authors mention how conducting secondary trials in developing nations after the drug has been released in developed nations can delay the release of crucial medications by years only to find out that the drug’s efficacy is compromised. The additional cost of such trials can also be insurmountable, creating a whole other set of complications.
So while a considerable amount of energy goes into the cost aspect of introducing new vaccines (that is not to say that cost is not important), a new focus should be introduced that ensures new vaccines are effective in different populations.