Vaccines against poverty

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.Vaccination has made a greater impact on global health to date than any other medical intervention (1). As well as alleviating death and suffering, the widespread implementation of vaccines results in improved economic development (2). Much of the global benefit from vaccination has come through the delivery of vaccines to infants in low- and middle-income countries (LMICs) through the Expanded Programme on Immunization (EPI), which was introduced in 1974. The EPI has been key for the delivery of vaccines against diphtheria, tetanus, pertussis, measles, poliomyelitis, and tuberculosis to more than 80% of the world’s children (3) and is being used to roll out vaccines against Haemophilus influenzae b (Hib), rotavirus, and pneumococcus. The success of the EPI in LMICs has been underpinned by support from the Global Alliance for Vaccines and Immunisation (GAVI) Alliance, which was established in 2000 as a public-private partnership with a mission to improve global health through increased access to vaccines in low-income countries (4). Vaccination has stayed at the forefront of global health policy in the new millennium with United Nations Millennium development goals (MDG) 4 and 5, to reduce childhood mortality and improve maternal health (5), very much focused on infectious diseases. With considerable support of the Bill and Melinda Gates Foundation (BMGF), the 2010s were declared the Decade of Vaccines, with new funding pledged for vaccine research and development and for the delivery of vaccines to LIMCs at the 64th World Health Assembly in 2011 (6) and the endorsement of the Global Vaccine Action Plan (GVAP) (7) at the 65th World Health Assembly in 2012.