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The Fondation Brocher is an essential player in this vital thinking process: one which will help make us aware of the real challenges in using our resources for maximum impact on the health of the people of the world.

 

 

Professor Daniel Wikler, Harvard University

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November 5 - 7, 2018

Investigating innovative health technologies in the fight against infectious diseases and the mechanisms needed to accelerate innovation and to improve access to health systems – the case of vaccines

Organizers:

The potential of vaccines in the prevention, treatment and eradication of pathogens-specific diseases is enormous. They are the preferred weapon in the fight against infectious diseases. Most impressive examples include the global eradication of smallpox and the elimination of poliomyelitis in most countries of the world. Vaccination not only protects each individual receiving the vaccine but also exert a major action at the community level by preventing the transmission and the dissemination of the corresponding microbe, the so-called “herd effect”. As a consequence, vaccination against previously common childhood diseases such as measles, rubella or mumps, evolved from an act of individual protection to an act of solidarity towards the community to which the individual belongs. In this context, the current decrease in vaccination coverage in many countries raise major concerns that need to be urgently addressed as exemplified by the resurgence of measles in developed countries.

Collaboration is essential for innovation in healthcare. As stated by the World Health Organisation: “Public-private partnerships represent a potential for the private sector to innovate, develop new businesses, risk-sharing, improve the quality of services and accelerate access to advanced technologies.” Indeed, public-private partnerships dedicated to poverty-related and neglected diseases (PRNDs) have proven to increase accessibility of vaccines, diagnostics and treatments in low- and middle-income countries (LMICs). However, a number of important issues remain to be addressed. For example, hepatitis C is a major public health threat, however, the use of innovative curative medicines is hampered by their very high cost. Regulation drives up the costs of research and development and companies tend to charge whatever the market bears. Balancing cost-effectiveness and affordability of medicines requires careful analysis of real-world data using appropriate models such as the Markov model well known in economics and finance. Research on these questions must also take into consideration the need to provide sufficient incentives to pursue innovation endeavors in the pharmaceutical sector. Also, non-pharmacological strategies able to limit the dissemination of the pathogens or to identify the patients who will benefit from the innovative medicines should be part of the equation.

The I3h Institute would like to address the different facets of these problems, and in particular the decreased vaccination coverage, through an integrated interdisciplinary approach in a 4-days workshop at the Fondation Brocher in Hermance, Geneva. Research on global health governance, including accountability and transparency, and the industrial organization of public private partnerships, patent pools and Standard Setting Organizations in other sectors (e.g. the telecom sector), and the incentives needed to provide access to health technologies at affordable prices, may provide guidance on the costs and benefits of different ways to increase vaccination coverage. Particular attention will be paid to various strategies addressed by public-private partnerships (PPPs) dedicated to PRNDs, and we consider success formulas and pitfalls that might facilitate equitable access to medical care, in particular in LMICs. Indeed, business models based on licensing, differential pricing and advanced market commitments could provide building blocks for new collaborative models that might facilitate access to biomedical innovation.

There are several reasons for the decreased vaccination coverage worldwide. Firstly, a number of false allegations (for example the involvement of measles vaccine in the pathogenesis of autism, hepatitis B vaccine triggering multiple sclerosis, etc.) resulted in distrust in the use of vaccines, especially during childhood. Nowadays, it frequently requires long discussions, pronounced powers of persuasion and patience to convince parents and even some paediatricians about the benefits of vaccines. It is anticipated that this public concern about vaccine safety will   also hamper the development of maternal immunization which currently appears as a most efficient strategy to protect against certain infections occurring soon after birth. Furthermore, vaccine supplies are running short and the range of available vaccines is shrinking in the USA and several European countries, including childhood vaccines in routine use to prevent diphtheria, tetanus, and pertussis, measles, mumps rubella and varicella. Indeed, several recent mergers of pharmaceutical companies have led to market consolidation. Only a few “global players” are still manufacturing vaccines and their perceived duty to shareholders have resulted in some ceasing to produce less profitable vaccines. Similarly, former state owned or subsidized vaccine manufacturers are increasingly being forced to show a profit. In addition, the manufacturing of vaccines is much more complex than the manufacturing of classical chemical drugs so that failures to maintain quality standards in the production of vaccines have also contribute to insufficient supply. Vaccines have a limited shelf life and are extremely sensitive to temperature changes so that proper storage and distribution within an efficient cold chain are essential to maintain their quality over time, which are key issues in developing countries.

The shortage of vaccines supply is a major concern for organizations like UNICEF which procures over 2 billion doses of vaccine worldwide. They draw attention to the fact that industrialized countries begun to use different types of vaccines than those used in developing countries (e.g. pertussis and measles vaccines). The resulting divergence in the markets reduces the incentives for manufacturers to supply UNICEF at affordable prices.

Clearly, multiple competencies are needed to address these major issues for global health: i) Competencies in humanities are key to deal with the misperception of the risk-benefit of vaccines in our societies and to include vaccination in the overall concept of “health enhancement” developed by ethicists and philosophers; ii) Competencies in biomedical and pharmaceutical sciences are needed to improve the manufacturing of vaccines; iii) Competencies in economics are essential to develop new business models involving public and private actors, the need to provide them with efficient incentives, and taking into consideration the market differences across the world; iv) Competencies in public health are required to develop and implement policies for translation in the field of novel strategies to improve vaccination coverage.

The Institute for Interdisciplinary Innovation in healthcare (I³h) would like to organize a workshop to gather competencies in these different fields to develop interdisciplinary integrated research on how to improve vaccination coverage worldwide.