Access to Vaccines Index: the data is in, analysis can begin.
The Access to Medicine Foundation is introducing a new tool for action: the Access to Vaccines Index will examine how vaccine developers and manufacturers are improving access to vaccines in those countries facing the highest barriers. The methodology for the first Access to Vaccines Index sets out the findings of our consensus building process, which distilled the global health community’s expectations of vaccine companies.
As of June 2016, the companies analysed in the Access to Vaccines Index have completed their data submissions. The Foundation’s research team is preparing to analyse this data in its ongoing research process. The focus is on the three key areas where stakeholders agree that pharmaceutical companies can contribute to access to vaccines: 1) undertaking R&D that addresses high-priority gaps; 2) taking steps to improve the affordability of their vaccines in low-resource settings; and 3) ensuring the reliable and effective supply of vaccines where they are needed. In the coming months, our research team will be analysing this data to uncover which access mechanisms are working, where and why. Our analysis will be set against the changing backdrop of global vaccine-access issues. For example:
Research & Development
The recent outbreak of Zika virus, and the subsequent global race for a vaccine, has highlighted the importance of companies responding to vaccine R&D priorities. Sanofi is the largest pharmaceutical company currently developing a Zika vaccine, alongside a number of other public and private organisations, including the Butantan Institute, Bharat Biotech, and the US government. Other companies, such as GlaxoSmithKline, Johnson & Johnson, Merck & Co., Pfizer and Takeda, are investigating how they might contribute.
A recent development in vaccine research on Clostridium difficile – a growing infection that is closely related to antibiotic use and resistance – will likely support efforts to develop a low-cost vaccine. The final report of the UK government Review on Antimicrobial Resistance (AMR), released in May 2016, has recommended targeted vaccine R&D as a key part of the global response to AMR. As Dame Sally Davies, Chief Medical Officer for England explained, “Vaccines have a vital role to play in combatting drug resistance, by preventing infections in the first place.”
April 2016 saw the worldwide switch from using the trivalent oral polio vaccine (OPV) to the safer bivalent version, which targets only the two strains of polio still circulating. This has been accompanied by the introduction of the inactivated polio vaccine (IPV) in all countries – this provides important benefits but has historically been more expensive.
This switch is a critical transition in the polio eradication endgame, and is dependent upon affordable global access to IPV. Serum Institute of India’s IPV price reduction in 2014 has already contributed to this goal, and the Bill & Melinda Gates Foundation’s US$38 million partnership with Takeda to produce a low-cost IPV (announced in May 2016) will support further progress towards eradication.
Manufacturing & Supply
The yellow fever outbreak currently impacting Central Africa is largely due to an ongoing vaccine shortage – demonstrating the importance of companies working with other stakeholders to ensure vaccines are manufactured and supplied in a way that meets local needs.
As Dr Margaret Chan, Director-General of WHO said at the sixty-ninth World Health Assembly (WHA) held at Geneva recently: “The lesson from yellow fever is especially brutal. The world failed to use an excellent preventive tool to its full strategic advantage… The world has had a safe, low-cost, and effective vaccine that confers life-long protection against yellow fever since 1937.”
There are only four yellow fever vaccine manufacturers in the world – Bio-Manguinhos, FSUE of Chumakov, Institut Pasteur de Dakar and Sanofi – and while supply has been scaled up in response to the outbreak, UNICEF foresees that shortages will persist through 2017.
Access to Vaccines on the global agenda
The importance of access to vaccines was highlighted at the WHA as “one of the cornerstones of universal health coverage,” and “critical to the achievement of the health-related SDGs.” The WHA also acknowledged that there is a pressing need for better systems to address access issues: to support the development of vaccines where market incentives don’t exist; to monitor supply and demand to prevent shortages; and to ensure transparency in vaccine prices in order to foster sustainable access to affordable vaccines.