The No-More-Pneumonia Fund

Drug companies are hailing a new market-based program that will help fund pneumonia vaccines in the developing world--where countries typically get access to new products about two decades later than wealthier nations.

The first Advance Market Commitment (AMC) totals $1.5 billion, and offers a guaranteed price to manufacturers that supply the vaccine in poor countries. In this way, AMC creates financial incentives for firms to compete to market--and create demand for--their products in the developing world.

Italy, the United Kingdom, Canada, Norway, and Russia, together with the Bill and Melinda Gates Foundation, are funding the pneumonia AMC. Experts from the World Bank and GAVI Alliance will now face the gnarly task of determining whether or not to grant eligibility to the single vaccine on the market, Wyeth's blockbuster Prevnar. Arguing against inclusion is the fact that Prevnar does not cover the strains most prevalent in poor countries. On the plus side, it's better than nothing--its immune-boosting effects confer at least partial protection--and would get the program up and running.

Jim Connolly, executive vice president and general manager of Wyeth's vaccines business, said that the AMC's administrators are debating whether to fund Prevnar immediately or wait for future generations of the vaccine. "We think the impact this vaccine can have is dramatic," he said. "But at this point we're not sure what the criteria are."

Both Wyeth and GlaxoSmithKline have late-stage second-generation vaccines aimed at delivering wider immune coverage. But the AMC commitment isn't likely to speed up the clinical programs. "What an AMC might do for us is make us rethink our manufacturing decisions," Connolly explained, adding that the current production of three to four million doses pales in comparison with the 250 million doses that would be needed if all children worldwide were vaccinated.

Yet while AMCs provide the funds to pay for vaccines on a larger scale, they don't guarantee uptake. "One of the issues that still remains is the demand--and the capacity to supply that demand," said Deborah Myers, director of external and government affairs at GSK Biologicals. "There needs to be awareness of the disease and how to prevent it."

To increase awareness, GSK has been leading sessions at NGO meetings in hard-hit capitals like Nairobi. It also plans to sponsor patient education efforts. But actually getting the vaccines into poorer, rural regions will require the seasoned efforts of humanitarian groups like UNICEF. "UNICEF has the ground logistics to distribute the vaccine," Myers said. "There are not many organizations that can do that."

Still, she noted, GSK--like other companies looking for solutions to increase drug access in the developing world--wants to make the program a success. "It's a novel, creative mechanism to address significant unmet need," Connolly said.