Center for Disease Control and Prevention’s “World Immunization Week”
Earlier this month, French pharmaceutical giant Sanofi Pasteur announced that it was pulling the plug on its partnership with the US Army to develop two promising new Zika vaccines. A Sanofi representative said they could not continue due to, firstly, a decline in infection rates which reduced the number of people available for clinical trials, and, secondly, lack of additional funding. The cancellation marked the end of a high profile and controversial public-private partnership (PPP) with the US government that had been initiated in 2016 to address the rapid spread of Zika throughout the Americas. It was a telling example of how, despite the surging popularity and frequent success of PPPs, they are not necessarily a panacea for solving global health challenges. Yet in an age when the number of dangerous pathogens is growing at rates faster than scientists can develop vaccines, and when the world’s largest funder of development assistance to health is pulling back from its commitments, policymakers need to take a closer look at what works – and what doesn’t – in public-private collaborations in global heath.
It might seem that with threats like Zika successfully contained we are in the midst of a lull in global pandemics, but it is unlikely to stay that way for long. According to the disease-tracking website ProMED mail, mosquitoes are entering new ecological zones at ever-faster rates, raising concerns that diseases once limited to tropical countries could become ubiquitous in more temperate climates. For instance, Aedes aegypti, the mosquito that spreads not only Zika but also dengue and chikungunya, has been seen in parts of California and Nevada where it had rarely, if ever, been found before. Brazil, only just recovering from outbreaks of Zika and yellow fever, now faces fresh threats of Oropouche fever, which is carried by biting midges and for which there is no vaccine. Recently, researchers in Brazil also isolated a form of malaria parasite that has spread from howler monkeys to humans, raising concerns about how to eradicate a virus that still afflicts large swathes of the developing world from South America to Africa.
Although the outlook might look grim, some of the most successful vaccine initiatives in the past have resulted from PPPs – showing that despite the failure of the US Army-Sanofi collaboration, there are viable ways to forge new vaccine partnerships in time for the inevitable next pandemic. Much of the rise in PPPs in the global health sector has been propelled by the likes of the Rockefeller Foundation and the Gates Foundation, creator of the GAVI Vaccine Alliance. The former started to provide financing for product development PPPs starting in the 1990s, which fuelled the transition from one-off governmental and multilateral partnerships with individual drug or vaccine candidates to a concentration on “portfolios.” These facilitate the creation of different product candidates simultaneously, which reduces risk for both public and private partners – and notably, was not the approach selected by the Army-Sanofi partnership.
The Gates Foundation has also been a key supporter of vaccine development PPPs, most recently granting $120 million to a new initiative on maternal immunization by the global health organization PATH. The grant is allowing PATH and its partners to attract top immunization experts and manufacturers, bringing together expertise for sustained work on every stage of the vaccine research and development process. The grant also facilitates the development of a broad portfolio on disease areas and functional areas, such as manufacturing and supply. Such stable, portfolio-based funding is key in developing new vaccines.
In addition to major philanthropists, private actors have also been critical drivers of vaccine initiatives. In the midst of the Ebola crisis Russian aluminium company Rusal, the largest foreign investor in Guinea, provided key backing for the government’s efforts to combat the virus. Forging a public-private partnership with government health ministries, Rusal donated medical equipment and provided funding for a comprehensive medical facility that has since been used as a centre for testing a promising new anti-Ebola vaccine developed by Russian researchers. Without robust private funding to support sustained government research initiatives, such an achievement would not have been possible.
It is telling that many of the elements that made such philanthropic – and private-driven initiatives successful were missing from the Army-Sanofi venture. In contrast with the most recent Gates-funded project, it was not focused on a portfolio of promising candidates, but only one vaccine for a virus that is no longer considered an emergency. Unlike both the Gates-Path project and the Rusal-funded initiative, it was short-term and lacked sufficient cash to continue. Perhaps most importantly, Walter Reed and Sanofi researchers were racing to develop new anti-Zika vaccines and drugs only after it had reached crisis levels – meaning that by the time they were ready to test them in the field the pandemic had diminished and it became more difficult to test their efficacy.
Such mismanagement underlines the importance of forming long-term partnerships to combat viruses well before they have the capacity to become pandemics. After all, according to a recent report on GAVI’s impact, vaccinations in the world’s poorest countries will have saved 20 million lives and $350 billion in healthcare costs from 2001-2020. Even more lives could have been saved and even more economic value created if long-term PPPs had been established in advance to develop new vaccine portfolios. With the Trump administration still mulling massive cuts to global health funding, we must hope that philanthropic and private actors will have the means to draw lessons from past failures, step in, and fill the gaps.
Image courtesy of CDC Global Health. [CC BY 4.0]
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