Health affairs
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So-called neglected tropical diseases are the most common infections of the world's poor. Almost all of the "bottom billion"--the 1.4 billion people who live below the poverty level defined by the World Bank--suffer from one or more neglected diseases including hookworm infection, sleeping sickness, or Chagas disease. ⋯ Nevertheless, some vaccines for these neglected diseases are now entering the clinical pipeline. In this article I describe how some antipoverty vaccine development is proceeding and offer recommendations for stimulating further development such as through pooled funding for innovation, developing-country manufacturers, and public-private partnerships for product development.
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Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world's unimmunized children. Fewer than 44 percent of India's young children receive the full schedule of immunizations. India's vaccine deficit has several causes: little investment by the government; a focus on polio eradication at the expense of other immunizations; and low demand as a consequence of a poorly educated population and the presence of anti-vaccine advocates. In this article we describe India's vaccine deficit and recommend that the government move quickly to increase spending on, and otherwise strengthen, national immunization programs.
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A new affordable vaccine against Group A meningococcus, the most common cause of large and often fatal African epidemics of meningitis, was introduced in Burkina Faso, Mali, and Niger in 2010. Widespread use of the vaccine throughout much of Africa may prevent more than a million cases of meningitis over the next decade. ⋯ International donors have already committed funds to support the new vaccine's introduction in Burkina Faso, Niger, and Mali, but an estimated US$400 million is needed to fund mass immunization campaigns in people ages 1-29 over six years in all twenty-five countries of the African meningitis belt. The vaccine's low cost--less than fifty cents per dose--makes it possible for the affected countries themselves to purchase vaccines for future birth cohorts.
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Immunization is one of the "best buys" in global health. However, for the poorest countries, even modest expenditures may be out of reach. The GAVI Alliance is a public-private partnership created to help the poorest countries introduce new vaccines. ⋯ Relatively better-off "intermediate" countries could support initially modest but gradually increasing co-financing levels. The countries soon to graduate from GAVI can generally afford to follow a rapid path to self-sufficiency. Co-financing for these countries needs to ramp up so that national budgets fully cover the costs of the new generation of vaccines once GAVI support ends.