Challenges for Public Private Partnerships in vaccine development

Diseases such as AIDS, tuberculosis (TB) and malaria continue to have a devastating impact in the developing world. The emergence of Public Private Partnerships focusing on the development of vaccines and medicines offers new hope for treatment and prevention, as long as they can balance the differing interests that drive each sector.

In 2005, more than threemillion people became infected with HIV in sub-Saharan Africa, and nearly twoand a half million died of AIDS-related illnesses worldwide. At least 300million acute cases of malaria occur globally every year. Approximately twomillion people die each year from TB, mostly in South East Asia, the WesternPacific and Africa.

A paper from the OpenUniversity, in the UK, examines the impact of new Public Private Partnerships (PPPs) to develop vaccines and medicines, using theInternational AIDS Vaccine Initiative (IAVI) as a case study.

The IAVIwas set up in 1996. It aims to further HIV vaccine research by funding clinicaltrials. It also aims to ensure that any effective vaccine developed will becheap and readily available in the parts of the world that need it most –sub-Saharan Africa and Asia. The IAVI operates in 23 countries and has thesupport of donors including the Gates Foundation, the UK Department forInternational Development, the United States Agencyfor International Development and the World Bank.

Much previous research onvaccine development has tended to assume that the likelihood of discovering anew vaccine depends directly on the amount of resources invested. Such anapproach focuses on boosting government funding or providing incentives forprivate research.

The authors studied the IAVIto focus instead on the organisational and institutional structure of vaccineinnovation. They found that the IAVI:

• combines the roleof a private pharmaceutical company with the objectives of a development agency
• works as a‘knowledge broker’, facilitating relationships between communities,non-governmental and governmental organisations through providing informationand advocacy
• increasingly worksas an ‘integrator’, leading and directing innovative activities
• employs people both from the private sector and from the developmentsector, who may have quite different objectives.

The authors point to aconstant tension within PPPs such as the IAVI –between a public and a private ethos, and between scientific efficiency and sustainability.They conclude with two key questions and one recommendation for policymakers:

• As a funder of new scientific opportunities, can the IAVI be astrong knowledge integrator whilst remaining open to the full range oftechnological opportunities?
• Can the IAVIoperate sustainably to benefit all those involved, offering leadership ininnovation without sacrificing its focus on access and advocacy?
• Policy thinkingmust go beyond discussion of market incentives and look more critically at theinternal dynamics of how vaccine development takes place.