The value of vaccination
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The value of
vaccination - extracted text
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CVI/CEN/9S.09 • Original: English • Distr.: General
The value of
vaccination
a profile of
t^evnwdion oftye
childrens Vaccine
Initiative
If ATfl NATE A CHILD
H^Mnation
The Secretariat of the Children's Vaccine Initiative thanks the following for their
generous contributions which supported its activities in the last year:
CVI co-sponsors
United Nations Children's Fund
United Nations Development Programme
World Bank
World Health Organization
The Rockefeller Foundation
The Governments of
Ireland
Japan
Switzerland
United States of America
and the
Fondatlon MSrieux
William H. Gates Foundation
Ordering code:CVI/GEN/98.09
Printed: November 1998
Copies may be requested from:
Children's Vaccine Initiative
1211 Geneva 27
Switzerland
Fax:+41 22 791 4888
E-mail: cvl@who.ch
►► Visit our new web site at www.vaccines.ch
©Children'sVaccine Initiative 1998
Principal author: Jan Powell
Cover and inside photographs: Lysiane Maurice
Design and layout by minimum graphics
This document is not a formal publication of the Children's Vaccine Initiative, and all
rights are reserved by the CVI.The document may, however, be freely reviewed,
abstracted, reproduced and translated, in part or in whole, but not for sale or for use in
conjunction with commercial purposes.
Printed In France
Ch
nis
05718
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A PROFILE OF THE MISSION OF THE CHILDREN S VACCINE INITIATIVE
Content#
Preface
5
Parti: The vaccination revolution
6
Part 2: Evolution and innovation
7
Part 3: Taking responsibility for health
9
Part 4: The will to succeed
15
Part 5: Vaccination for a new millennium
17
Annex 1: The Children's Vaccine Initiative: A forum for
exchange, a mechanism for commitment
Annex 2: Activities of the CVI Secretariat
19
22
5
A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
PREFACE
T^e cfri [drend Vaccine Initiative
The Children's Vaccine Initiative (CVI) is an international coalition of
partners committed to ensuring that the benefits of vaccination reach
all the world’s children. CVI is cosponsored by the United Nations
Children's Fund (UNICEF), the United Nations Development
Programme (UNDP), the World Bank, the World Health Organization
(WHO) and the Rockefeller Foundation. CVI brings together key
players on the vaccine stage - those involved in research,
development, licensing and production; in quality control, vaccine
procurement and delivery; those that fund these activities; and those
that assess the impact of vaccines and their usage - helping them work
together more efficiently to achieve common goals.
An important part of CVI's role is to recommend
how best the many different players in this
vaccine ‘continuum’ can cooperate so that the
health benefits of vaccines are widely and swiftly
shared. Recognizing that the vaccine world is in a
state of change, CVI established a Thsk Force to
identify new directions, new approaches. In 1998,
the Thsk Force published a Strategic Plan
proposing what should be done to ensure that
more children receive the life-saving vaccinations
they need. The Plan highlights specific actions to
be taken by national governments, by
international organizations, the donor assistance
community, the commercial vaccine industry, and
by academia and research institutions. The
background to the Plan and its main themes are
reflected in this paper.
We have reached a significant watershed - a
moment of enormous opportunity. The right
action must be taken now if we are not to waste
precious potential and needlessly lose millions of
young lives.
6
THE VALUE OF VACCINATION
PARTI
T^e vaccination revolution
A health revolution has taken place during the second half of the
twentieth century, a revolution that has been brought about by the use
of a range of safe, effective vaccines. It is only two hundred years since
the first vaccine, against smallpox, was discovered, yet today vaccines
save three million children from death each year and millions more
from suffering and disability.
In the early 1970s, fewer than 5% of the world’s children were
vaccinated at all. By 1990, a tremendous public health effort made it
possible to reach almost 80% of children born each year and vaccinate
them against six target diseases: diphtheria, tetanus, whooping cough
(pertussis), polio, tuberculosis and measles. Vaccines have brought
about the eradication of smallpox and controlled the transmission of
poliomyelitis to the point that - hopefully - this disease will also soon
be eradicated, while measles rates have also been drastically reduced.
This massive global mobilization has been called the greatest public
health achievement ever.
Since this first phase, the potential of vaccination has developed
rapidly. Basic biomedical research has made many more vaccines and
vaccine combinations available. These, and new vaccines at or near
production, can protect against many of the major childhood killers.
Moreover, the pace of vaccine innovation is likely to increase.
Investment in basic science over the last decade has yielded a better
understanding of infectious diseases and a wide array of new
approaches to combat them. New or improved vaccines against major
and growing threats to humanity - diseases such as HIV/AIDS,
malaria, tuberculosis and cancers arising from infectious diseases - are
finally within our reach.
In view of these multiple opportunities, the challenge is to find ways
to ensure that the vaccine success story continues - that the enormous
impact that vaccines have had on the health and well-being of the
world’s peoples is strengthened as we approach the new millennium.
7
A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
PART 2
Evolution and innovation
The two decades since the initial push to vaccinate the world's
children began have been years of amazing success. An essential part
of this success story has been the availability of traditional vaccines at
low prices and the willingness of industrial countries to invest heavily,
either bilaterally or through multilateral agencies, to provide the
necessary vaccines and support the immunization delivery
infrastructure in most of the developing countries. Thus, vaccine
supply and quality control mechanisms, laboratory networks and cold
chains to ensure the safe storage and delivery of vaccines have largely
been defined and established.
There is, however, no room for complacency. Since 1990, the dramatic
growth in vaccination coverage has levelled out and new vaccines are
not being widely introduced. And although around three million lives
are already being saved per year, many more could be protected by the
greater use of vaccines which are available now. It is estimated that the
wider use of vaccines against hepatitis B, measles, rubella (a cause of
birth defects), and meningitis and pneumonia caused by Haemophilus
influenzae type b (Hib disease), could prevent two to three million
further deaths annually and enormous suffering in children and
adults. In addition, vaccines just licensed or currently in the later
stages of development - such as those against rotavirus diarrhoea,
pneumococcal pneumonia, meningococcal meningitis in infants, and
cholera in older children and adults - could prevent two million
further deaths and widespread suffering each year.
These new products should be made widely available, more rapidly
than were their predecessors, to all our children. One potential hurdle
is that the new vaccines cost dollars, not cents, per dose. They are the
product of years of research and development, involving higher costs
and more complex production technology, making return on
investment more difficult to predict. When Dr Jonas Salk discovered
polio vaccine, he waived all intellectual property rights - his vaccine’s
‘patent’. But today, the public and private organizations investing in
vaccine development and production need a fair return on their
investment to stay in business, and this is largely secured by patents
and intellectual property rights, including royalties. Partly as a result
of this trend, and following a series of mergers and acquisitions,
8
THE VALUE OF VACCINATION
there are now only five or six major vaccine-producing companies
operating internationally, which largely determine which products
reach the market first. The global vaccination ‘system’ must find
ways to accommodate the reality that new vaccines will be more
expensive.
Complex country needs
The past decade has also seen fundamental change in the economic
climate and country capabilities. In the early days of vaccination,
developing countries received external funding to establish vaccination
programmes. Tbday, many of these countries have developed
economically to the point that they are able to finance all or part of
their programmes themselves. Such countries with strong national
immunization programme infrastructures now wish to pursue, in
addition to the original, sixvaccine formula, the use of
other vaccines according to
local disease prevalence.
Humanitarian assistance
partners, that are less able or
willing to accept the burden of
paying for immunization
programmes in all developing
countries, can thus focus their
support on the continuing
needs of the poorest countries.
Together to ensure vaccines for each child
This is a period of tremendous potential - both in terms of new
vaccines becoming available and the ability of countries and partners
to ensure that these vaccines reach the children. There is no simple,
single solution to the question of how this potential can be turned into
real benefit. A number of interlinked strategies, creating an innovative
and coordinated approach, are required if we are to make the most of
these many new opportunities and manage this period of change to
maximum advantage. Some of these strategies, elaborated in the 1998
CVI Strategic Plan, are discussed briefly in the pages below.
9
A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
PART 3
Taking responsibility for health
The CVI Strategic Plan defines and responds to needs in three key
areas, i.e. how to ensure that:
♦ limited external financial resources support the disease control
efforts of those in greatest need;
+ existing vaccines of high quality are accessible to more people;
and
♦ innovative research and development continue to take place on
all vaccine fronts.
Actions expected of the major players in the vaccine continuum to
achieve these aims, as well as those to be undertaken by the
Secretariat to the Children's Vaccine Initiative, are outlined in Annexes
1 and 2 of this document respectively.
The best use of scarce resources
Faced with the reality that more developing countries wish to tailor
their vaccination programmes to local priorities, and fewer
industrialized countries are prepared to provide support indefinitely,
what can be done to make better use of limited resources? Underlying
the CVI Thsk Force’s thinking has been the concept of responsibility
and the need for greater self reliance to ensure sustainability.
Countries must be encouraged to take responsibility for managing and
financing their own vaccine programmes. This approach will allow the
health benefits of vaccination to be shared more fairly by the world’s
poorest children.
In the past, traditional vaccines destined for developing countries have
been bought in large quantities for all at a flat rate price. This has
ensured supplies of vaccines, but it may not be the best approach for
the future since it does not take into account the rapid economic and
social progress which many developing countries have undergone.
lb target scarce resources in a systematic way to countries in greatest
need and reward efficient suppliers, the CVI Thsk Force is promoting
the UNICEF/WHO ‘banding’ strategy, which groups countries
according to their economic development and size. The smallest and
poorest countries (band A) have the smallest market and ‘voice’ and
10 THE VALUE OF VACCINATION
are the least able to negotiate price, finance their vaccine needs, and
hence should be the first target of external assistance. As a country's
GNP increases, so does its ability to cover vaccine costs with
correspondingly less external support. This system ensures that the ■
neediest countries, mostly those in sub-Saharan Africa, continue to get
the financial support they need, both for traditional vaccines as well as
for the introduction of new ones. Countries in band B are better able to
fund their own vaccines, at least for the six traditional, vaccinepreventable diseases, but may need additional external support to
introduce new vaccines. Countries in band C and D can afford to pay
all their vaccination costs either immediately or in the very near
future.
In encouraging governments to take progressive responsibility for their
own programmes, the UNICEF/WHO banding strategy also offers
manufacturers the opportunity to recognize the vaccine and economic
needs of the world’s poorest countries and set their prices for these
WHO/UNICEF banding strategy: encouraging financial sustainability of immunization
programmes and targeting assistance to those countries in greatest need
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OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
countries accordingly. Most important of all, it ensures that, at a time
when resources are stretched, the world’s most disadvantaged children
will not be deprived of access to vaccines that their richer neighbours
can take for granted.
In addition to promoting the targeting of external resources to
countries in greatest need, the CVI Secretariat strives, through
economic studies, to raise awareness in all countries of the 'value' of
vaccination. New options for financing vaccination will be examined at
a forthcoming international consultation.
Maximising what we have
The potential impact of vaccines can only be realized if they are
actually available. What, then, can be done to ensure that adequate
quantities of high-quality vaccines are accessible to all national
immunization programmes and used in the most rational fashion,
country by country?
A shortage of financial resources is not the only factor impeding the
provision of vaccines. In addition to assisting countries to pay for the
vaccines they need, the supply of good quality vaccines can be
improved by focusing on a number of other areas. Communication
between the national, regional, and international bodies concerned
with vaccine quality and administration can be enhanced; financing
infrastructures can be expanded and strengthened with the aim of
encouraging countries to become more self-reliant; National Control
Authorities need greater support to ensure the quality of all vaccines
used. In addition, there must be forward planning to secure the supply
of vaccines for both routine and special use, such as in emergency
situations. Above all, countries themselves must develop the
information and procedures that permit them to make rapid and
rational decisions regarding their own vaccination efforts. This entails
developing disease burden information and selecting national
priorities. The CVI Secretariat facilitates these efforts through financial
support and through the development of methods, such as those for
cost-effectiveness analysis, to aid in decision-making.
CVI also aims to maximise efficiency overall by integrating and
coordinating the specific efforts of the multiple players involved.
12 THE VALUE OF VACCINATION
The potential of new vaccines
The current decade has seen the development of an unprecedented
range of new vaccines while yet more wait in the wings. However,
although there have been extensive and promising trials, new vaccines
are not being widely and swiftly introduced. So what needs to be done
to change this? And what will help ensure that research and
development into new and improved vaccines continues to expand and
bear fruit?
The problems of delayed introduction are often linked to logistical and
financial obstacles rather than technical problems. Forward planning
involves identifying the vaccines most likely to be needed and
potential sources of supply. Furthermore, a variety of actions would
speed the introduction process, including:
♦ the development of guidelines for the selection and introduction
of new vaccines by immunization programmes;
♦ technical support for the design of new immunization
programmes;
♦ improved collection of data, particularly on disease burdens; and
♦ the assessment and dissemination of lessons learned from
countries that adopt new vaccines early.
The CVI 'agendas' to accelerate the introduction of Hib, pneumococcal
conjugate and rotavirus vaccines, developed with international
agencies and industry, identify for each vaccine what is required to
bring their benefits to all children, earlier.
Since modem vaccines have proved to be more complex and expensive
to produce than in the past, a vital motivation for the continued
development of new and improved vaccines will be the expected
financial return on investment. Tb safeguard the prospect of sufficient
return, there must be systems to protect the intellectual property
rights (IPRs) of vaccine developers, in line with the World TYade
Organization agreements on TYade Related Aspects of Intellectual
Property. Vaccine developers must also be assured assistance in the
negotiation of such rights so that new or improved vaccines can be
swiftly and widely introduced. The proper negotiation and
management of IPRs, together with transfers of technological 'know
how' on vaccine manufacture and supply, where appropriate, will help
ensure that vaccines reach those who need them, while generating
enough revenue to fund new vaccine research and development.
1 3 A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
Access to IPR and new technology can best be negotiated when all
parties recognize the prerequisites for successful partnerships.
Consultation between public and private sectors, such as that
sponsored by CVI in Bellagio, Italy in February 1997, can increase
understanding of these issues.1
While the anticipated return on investment will be a sufficient
incentive to move most new vaccines into the mainstream, it is vital
that the development of other vaccines, such as those to prevent
shigella dysentery, tuberculosis and malaria, is also encouraged. Such
vaccines have great public health potential, particularly in the world's
poorest countries, but may seem to offer little promise of commercial
return. They are therefore unlikely to survive in the competition for
commercial development without additional resources and special
attention.
The CVI
Secretariat plans
to address the
status of these and
other ‘orphan’
vaccines through
a special
consultation,
as well as by
considering the
potential of public
sector vaccine
research,
development and
production
institutions
contributing to
their ultimate
availability.
The continued development of new and improved vaccines clearly
depends on long-term support and commitment to institutions
engaged in these activities. It also needs closer partnerships between
1 Children’s Vaccine Initiative/Rockefeller Foundation Conference on the Global
Supply of New Vaccines, Bellagio, 3-7 February 1997 (document CVI/GEN/98.01)
14 THE VALUE OF VACCINATION
the public and private sector, between those concerned with public
health policies and those involved in the commercial development and
production of vaccines. The CVI strives to promote such dialogue,
inter alia through ensuring full participation of industry in all meetings
(e.g. in those which have taken place on combination vaccines,
rotavirus vaccines and acellular pertussis) and planning activities
(such as the Thsk Force on Strategic Planning).
Vaccination and tnintai liability
Underlying the CVI Ihsk Force Strategic Plan are the
interrelated concepts of self-reliance and sustainability.
Increasingly, assistance provided for immunization
services is geared towards enabling countries to manage
and finance their programmes themselves. There is
less emphasis on providing standard services or products
for all countries, more on helping countries to identify
their needs, to devise infrastructures for procuring,
financing and distributing the vaccines they choose, and
providing the technical support needed to carry out
defined aims. Encouraging countries to take on
responsibility for financing and running their own
vaccination programmes helps ensure sustainability and
continuity. At the same time, it frees scarce resources,
making them available to the world’s poorest countries,
which continue to rely on external assistance and,
therefore, for making vaccines available to children in
greatest need. CVTs support to increase national selfreliance includes the development of methods to assess
disease burdens, disease treatment expenditures and
vaccination policy cost-effectiveness, which can all
be applied at country level.
1 5
A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
PART 4
T^e will to succeed
The impact of vaccines on the health of the world’s children has been
enormous, perhaps greater than any other single health intervention.
And according to the World Bank, improved vaccination is one of the
best and most cost-effective health interventions that could be
undertaken, saving millions of lives and promoting sustainable
personal and economic development. Yet, as so often when things
work well, with time and familiarity we take them for granted.
This is particularly true of vaccination. As vaccination rates rise and
the threat of serious infectious disease fades, community perceptions
of the value of vaccination change. This primary weapon against
infectious disease
becomes under-valued.
Tragically, in some
countries, vaccination
rates have even fallen,
leading to the reemergence of
infectious diseases
which were previously
controlled. A prime
example is pertussis,
which infected large
numbers of children in
Europe in the 1980s
when public fears
about the safety of
vaccination outweighed
understanding of the
serious threat to health
that whooping cough
represents. Similarly, diphtheria reached epidemic proportions in the
former Soviet states, when the breakdown in the health infrastructure
left vaccination low on the priority list and many children
unprotected. Experience also shows that while people may be
prepared to pay high costs for drugs to treat an infection, they resist
paying the much lower cost of a vaccination which would have
prevented the disease in the first place.
16 THE VALUE OF VACCINATION
In view of such tendencies, what can be done to promote vaccination
as perhaps the most valuable and cost-effective tool in the fight against
infectious diseases, and the attainment of health?
The need for national and international advocacy
Efforts need to be channelled into increasing awareness among
decision-makers and society as a whole of the vital role that
vaccination plays in the control of infectious diseases. Tb achieve this
will mean supplying better information about the positive benefits of
vaccination and making wider use of mass media such as television,
radio and Internet. It should also include greater vigilance to counter
misinformation and to remind people of the real risks and impact of
infectious diseases on individuals and communities.
The CVI Secretariat cannot expect to undertake alone the daunting
task of raising public and policy maker awareness of the value of
vaccination in all countries where this is needed. Such a task needs to
be shared among all players involved. Ib this end, a multiorganizational Working Group on Advocacy and Information Exchange
has been created by the CVI Secretariat to catalyse and coordinate a
range of efforts directed at a variety of target audiences, and policy
makers in particular.
A culture of prevention
It is equally important to encourage and build support at grass-roots
level among health workers, among community leaders and among the
people who bring their children to be vaccinated - the parents.
Support at this level creates greater demand for vaccination services
which can in turn stimulate better and wider provision. Using
resources to build such a ‘culture of prevention’ is a cost-effective
investment that will pay dividends in terms of future health
protection. And, in addition to saving lives, the saving in disease
treatment expenditures that may be achieved by protecting more
children through vaccination is not to be under-estimated.
Establishing solid commitment to vaccination through long-term
advocacy efforts across many fronts is essential if the full benefits of
vaccines are to reach individuals and communities in the years to
come.
1 7 A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
PART 5
Vaccination for a new miUennium
The Children's Vaccine Initiative has reviewed its first seven years’
work and experience, and refined a plan of areas for action and
specific activities to be undertaken now and into the next millennium.
The 1998 CVI Strategic Plan is the culmination of these deliberations.
Progress achieved will provide a firm foundation on which to build,
and the opportunities we recognize today must not be lost because of a
lack of cohesive effort and support. Implementation of the Plan rests
collectively with the many contributors to vaccine development and
delivery. With these collaborators, the CVI Secretariat will continue to
monitor for gaps
in the overall
effort and ensure
that they are
addressed.
Simple
protection
An important
aim of CVI has
been to support
research on
simplifying
vaccine delivery.
This means
finding ways of
reducing the
number of doses
required to
provide protection; making the process of administering the vaccine
simpler and safer, preferably avoiding the need for injection with a
hypodermic needle; and making vaccines themselves more durable,
stable and of consistent good quality. Many steps have already been
taken towards the ideal concept of a single-dose ‘super vaccine’.
Advances in biotechnology have led to improvements in specific areas,
such as the development of mucosal delivery and combined vaccines,
which simplify the vaccination process. Such work, taking place in
18
THE VALUE OF VACCINATION
parallel with the development of new and improved vaccines, suggests
that we are, indeed, standing on the threshold of a new ‘golden age’ in
vaccination. We must maintain the vision of what might one day be
possible if we are to overcome the challenges of this demanding
intermediate stage. Finding the resources to support the research and
development processes which are already bearing fruit must be a
number one priority for all those involved in maximising the potential
benefits of vaccination. Since these simpler methods are often most
needed in countries where delivery infrastructure and capacity to pay
is weakest, the CVI Secretariat articulates their importance,
particularly to those funding research.
A right to health
The United Nations Convention on the Rights of the Child states that
every child has the right to attain the highest possible standard of
health. The Convention has been ratified by almost every country in
the world and enshrines international acceptance of the fundamental
human rights of children. But how can this theoretical support be
translated into real improvements in children’s lives? By putting the
CVI Strategic Plan into practice, we shall be taking steps to prevent
millions of children dying each year from infectious diseases, and
saving many more from suffering and the tragic consequences of
disability. We shall be turning human rights principles into practice.
The health protection offered by a simple, safe vaccination is the basic
right of the poorest child as well as his or her richer neighbour.
We have reached a significant crossroads. By taking
the right action now, millions of children and their
families can be saved suffering and death from
preventable diseases.
Let us not forsake tomorrow's children by failing
to act today.
1 9 A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
ANNEX 1
Children# Vaccine Initiative:
A forum for exchange,
a mecfyanidm for commitment*
T^e
7b make the potential benefits of expanding vaccination a reality,
individuals and organizations from both the public and private sectors
must collaborate by pursuing different actions based on their
comparative strengths and capabilities. The CVI offers all those
working in the vaccine “continuum" a forum in which they can
exchange information and interact, and a mechanism for committing
themselves to well-defined plans for reaching shared goals.
National governments should:
© create a budget line for national
vaccination efforts;
Research
institutes and
V
• meet UNICEF selfsufficiency targets;
Non
International
agencies
governmental
organizations
K
I and
ional
r
• design five-year national
plans for immunization;
cvi
encompasses
all members,
public and private,
of the vaccine
community
)n
Foundations V
Government^
concerned
with public *
agencies and
t
health
The
vaccine
industry
regulatory
bodies
• ensure that national
immunization pro
grammes use vaccines of
known good quality only;
• create, or strengthen,
National Control Authorities
responsible for vaccines;
• assess the rationale for any local,
government-supported vaccine production
and assure viability of supply for existing and new vaccine needs; and
o recognize the value of disease prevention through vaccination and
increase, accordingly, investment in both basic research and infectious
disease surveillance.
2 Extract from the CVI Strategic Plan, (CVI/GEN/97.04)
2 0
THE VALUE OF VACCINATION
International organizations should:
• develop recommendations that encourage all countries to
implement the widest practical range of vaccination activities to
protect children against infectious diseases;
• implement existing strategies and develop new ones to target
technical and financial support to the neediest countries, such as the
UNICEF/WHO procurement strategy for new vaccines;
• offer technical assistance based on the organization’s comparative
strengths (such as UNIDO offering its assistance to selected local
vaccine producers to help ensure the reliable manufacture of high
quality vaccines);
• propose inventive policies such as World Bank low-interest rate
lending to countries based on their vaccine purchases; and
• develop pro
active methods, in
collaboration with
industry, to guide the
introduction of
priority new vaccines
into use in developing
countries.
The donor assistance
community should:
• provide support
within the context of
national plans and in
accordance with
strategic global
recommendations on specific issues, such as self-sufficiency targets
and assessment of viability of local production, and
• teach selected countries how to procure quality vaccines at
competitive prices on the international market.
The commercial vaccine industry should:
• establish a 'partnership' with the public sector in the interest of
children's health. (This envisaged 'partnership' entails the public
sector emphasizing financial and procurement support to the neediest
countries);
2 1
A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
• review conclusions from public-private meetings, such as the
Bellagio Conference of 3-7 February 1997, and implement suggestions
therein;
• consider licensing intellectual property in a way that provides for
the production of new vaccines for all markets;
• consider tiered prices and tiered royalties to reduce the price of
vaccines to the poorest countries; and
o continue to invest actively in vaccine research and development.
Academia and research institutions should:
• review and implement relevant suggestions from public-private
sector coordination and collaboration meetings (such as the Bellagio
Conference).
Nongovernmental organizations, including foundations, should:
9 support the administration, procurement and delivery of vaccines
within their field operations;
• work in concert with international health agencies to strengthen
health care delivery infrastructures in the neediest countries.
22 THE VALUE OF VACCINATION
ANNEX 2
Activities oftfre CVI Secretariat3
In 1998 and beyond, proposed CVI Secretariat activities include the
following:
Consensus development: strategic planning and priority setting
• Consultations on:
— sustainable financing for vaccination programmes;
— the increasing problem of ‘orphan’ vaccines; and
— the future role of public sector institutions in vaccine research,
development and production.
• Assessment of the health and economic value of new vaccinati
options.
• Continued public-private sector dialogue
• Creating a supportive environment for v
harmonization of technical requirement
production quality.
• Identification o
supply throug
Demand, Su
• Conveni
Strateg
• Ensu
vaccine
• Assessi
strategic
industry
3 Extra
GEN
23 A PROFILE OF THE MISSION OF THE CHILDREN'S VACCINE INITIATIVE
• Promoting the introduction of Hib vaccine against meningitis and
pneumonia.
• Promoting the final testing and rapid introduction of pneumococcal
conjugate vaccines in developing countries.
0 Supporting planning for introduction of other ARI vaccines e.g., for
Respiratory Syntical Virus.
o Promoting early rotavirus vaccine introduction where most needed.
o Promoting wider appropriate rubella vaccine use.
® Assessing new vaccination technologies.
Advocacy, information exchange and resource mobilization
o Periodically convening the Working Group on
Advocacy and Information Exchange to guide
advocacy on vaccination by the CVI Secretariat
and collaborators.
o Widely disseminating the CVI Strategic Plan:
Managing Opportunity and Change - A Vision of
Vaccination for the 21st Century.
0 Completing and distributing widely a profile of
the Children’s Vaccine Initiative vision and
mission, including a synopsis of its Strategic
Plan.
® Completing and disseminating a series of
position papers on important issues in vaccine
development and supply to target audiences, e.g.
the economic case for investment in vaccination.
• Producing and distributing three issues of the
CVI Forum, emphasizing new vaccination
options.
• Planning seminars for European, African and
Asian policy makers on new vaccines.
0 Selecting the recipients for the CVI Jenner and Pasteur Awards.
• Survey, with collaborators, opinion leaders from multiple disciplines
and countries to establish a benchmark study of attitudes and
awareness regarding vaccine.
The Children's Vaccine Initiative (CVI)
is a global coalition of organizations from the public,
nongovernmental and private sectors, including the vaccine
industry, working together to maximize protection against
infectious diseases through the development and utilization
of safe, effective, easy-to-deliver and widely
available vaccines.
Launched at the World Summit for Children in 1990,
the CVI is co-sponsored by the
United Nations Children's Fund (UNICEF),
the United Nations Development Programme (UNDP),
the World Health Organization (WHO),
the World Bank and
the Rockefeller Foundation.
PROTECT AN
AI IUN
Children's Vaccine Initiative
1211 Geneva 27
Switzerland
Fax:+41 22 7914888
E-mail: cvi@who.ch
►► Visit our new web site at www.vaccines.ch
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