Vaccines against poverty

Abstract

With the 2010s declared the Decade of Vaccines, and Millennium Development Goals 4 and 5 focused on reducing diseases that are potentially vaccine preventable, now is an exciting time for vaccines against poverty, that is, vaccines against diseases that disproportionately affect low- and middle-income countries (LMICs). The Global Burden of Disease Study 2010 has helped better understand which vaccines are most needed. In 2012, US$1.3 billion was spent on research and development for new vaccines for neglected infectious diseases. However, the majority of this went to three diseases: HIV/AIDS, malaria, and tuberculosis, and not neglected diseases. Much of it went to basic research rather than development, with an ongoing decline in funding for product development partnerships. Further investment in vaccines against diarrheal diseases, hepatitis C, and group A Streptococcus could lead to a major health impact in LMICs, along with vaccines to prevent sepsis, particularly among mothers and neonates. The Advanced Market Commitment strategy of the Global Alliance for Vaccines and Immunisation (GAVI) Alliance is helping to implement vaccines against rotavirus and pneumococcus in LMICs, and the roll out of the MenAfriVac meningococcal A vaccine in the African Meningitis Belt represents a paradigm shift in vaccines against poverty: the development of a vaccine primarily targeted at LMICs. Global health vaccine institutes and increasing capacity of vaccine manufacturers in emerging economies are helping drive forward new vaccines for LMICs. Above all, partnership is needed between those developing and manufacturing LMIC vaccines and the scientists, health care professionals, and policy makers in LMICs where such vaccines will be implemented.

Fig. 1.

Global burden of disease from infectious causes. (A) DALYs and (B) deaths for all ages and (C) DALYs and (D) deaths in children aged less than 5 y in LMICs in 2010. Green bars indicate total DALYs and deaths for each disease/disease group. Red bars indicate DALYs and deaths for which no vaccine is available. Data are from GBD 2010 (8). LMIC data were derived by subtracting data from regions of HICs from GBD 2010 data: all of Europe, high-income North America, Australasia, and high-income Asia Pacific. Sepsis, maternal and neonatal sepsis; Childhood, tetanus, diphtheria, whooping cough, and varicella; Enteric, typhoid and paratyphoid fevers; RHD, rheumatic heart disease.

Fig. 2.

Global partnerships in development of vaccines for LMICs. Successful development of new vaccines for LMICs will rely on partnerships between HICs and LMICs and among both HICs and LMICs. These partnerships need to involve industry, academia, health care professionals and health policy makers in both groups of countries.