Meningococcal conjugate vaccine for Africa: a model for development of new vaccines for the poorest countries.

There are major disparities in drug and vaccine development for diseases that mainly affect the developing world, as opposed to those that affect industrialised nations. From the time of introduction of a new vaccine in Europe or the USA, the adoption of these vaccines in developing countries takes a decade or more. For example, hepatitis B vaccine and Haemophilus influenzae type b conjugate vaccines have been used routinely for over 10 years in North America and in most European countries, with very successful control of disease, but although these vaccines have also proven highly effective in developing countries, vaccine uptake has mostly been slow. Several factors have contributed to this situation, such as insufficient information on local disease burden, and questions of programme feasibility. However, the main reason is that the poorest countries cannot afford to purchase the vaccines. In 2001, three vaccine manufacturers developed group C meningococcal conjugate vaccines in response to public health concerns in the UK, where there had been about 10 000 cases of group C meningococcal disease and 1000 deaths during the previous decade. By contrast, no manufacturer was interested in developing a group A meningococcal conjugate vaccine for prevention of meningococcal disease in sub-Saharan Africa where, during the same period, there were more than 700 000 cases and 100 000 deaths. For virtually all diseases that largely affect poor countries, choice of drug and vaccine development is market driven, and is not based on disease burden or mortality. In response to this inequality, the public sector (International organisations [European Commission, WHO], Governments [Ministries of Health, Education, Science and Technology] and academic institutions) has encouraged pharmaceutical companies to develop new drugs or vaccines for use in poor countries by appealing to corporate altruism, and through provision of incentives (push strategies) such as funding for basic research, supporting the cost of clinical trials, or strengthening of field sites in developing countries. Because development of new vaccines is costly, these incentives have proved insufficient. Other than typhoid or cholera vaccines, no new vaccines have been developed for diseases that mainly affect the developing world. Increased funding from international donors and the inception of the Global Alliance for Vaccines and