Extending vaccines to the worlds poorest

October 31, 2009

Joe-Cerrell-410.jpg–Joe Cerrell is director of Global Health Policy and Advocacy at the Bill & Melinda Gates foundation. He oversees the foundation’s global health communications, public policy, and international finance. The views expressed are his own. –

I recently took my three-year-old twin daughters to their annual doctor visit, where they received their latest round of routine vaccinations.  Thanks to the miracle of vaccines, I know my daughters will be protected for life against measles, tetanus, and other diseases that were once serious threats. But incredibly, millions of children in poor countries still die from diseases that could easily be prevented with the effective, affordable vaccines that Americans take for granted.

Fortunately, that is starting to change.  This week, a landmark report from the World Health Organization, UNICEF, and the World Bank concludes that a renewed global push on childhood immunization has raised the number of children vaccinated to an all-time high.  The authors find that vaccines now save 2.5 million lives worldwide every year.

(Read related Reuters story: Global immunizations hit record but miss millions.)

As we continue expanding access to basic vaccines that have existed for decades, we also need to ensure that new vaccines quickly reach children in need.  Typically, when new vaccines are invented, they don’t become available in poor countries until years, or even decades, after being introduced in the U.S. What’s more, effective vaccines don’t yet exist for some of the developing world’s biggest killers, like malaria and HIV.

This situation is a classic case of markets failing the world’s poorest people. Because poor countries have limited ability to pay, vaccine makers have little incentive to make the enormous investments required to develop and manufacture new vaccines for the developing world.  So vaccines remain unavailable where they could save the most lives.

Now, innovative thinking on global markets promises to bring long-overdue change.

One of the most exciting new approaches takes aim at pneumococcal disease, a leading killer of children worldwide. While relatively unknown to Americans, pneumococcal disease causes the deaths of more than a million young children worldwide each year, 90 percent of them in developing countries.

If you’re an American parent like me, your kids are probably protected against pneumococcal disease by a vaccine called Prevnar, made by Wyeth.  But this and other pneumococcal vaccines were designed for use in wealthy nations.  They don’t protect against the types of the disease that are common in the developing world.

That is about to change thanks to a groundbreaking partnership launched with financial support from the governments of Italy, the UK, Canada, Norway, and Russia, along with the Bill & Melinda Gates Foundation.  Known as the Advance Market Commitment, or AMC, the effort could save the lives of seven million children over the next 20 years.

The AMC applies a concept that is simple but had never been tried before.  In essence, the six donors have made a promise:  If vaccine makers develop and produce affordable pneumococcal vaccines designed specifically for poor countries, then the donors will buy them.  By committing $1.5 billion, in advance, they’re helping to create a predictable market where none existed before.   With the necessary incentives in place, vaccine makers can make the investments needed to develop the new vaccines and manufacture them on a large scale.

To qualify for the AMC, participating companies must make long-term, binding commitments to provide the new vaccines at affordable prices.   Thanks to donor funding and the manufacturers’ pricing commitments, developing countries will be able to purchase the vaccines at guaranteed prices of no more than $3.50 per dose.  The first of the new vaccines could become available as soon as 2010.  Developing countries are already signing up to purchase them.

If the AMC for pneumococcal vaccines proves successful, a similar model could be used to quicken the development of other urgently needed drugs and vaccines, such as new vaccines against tuberculosis, the cause of some 1.8 million deaths worldwide each year.

The AMC is one of several new initiatives that are creatively using market principles to save lives in the developing world.  For example, through a partnership launched earlier this year, donors are negotiating with manufacturers to dramatically reduce prices on the most effective drugs against malaria.  By making these prices comparable with those of older, much less effective drugs, they hope to greatly increase the number of patients who are successfully treated.  In another effort, the World Bank and donor governments have quickly raised billions of dollars for childhood immunization by issuing bonds in the global capital markets.  The funding unlocked by these bonds could help to immunize 500 million children worldwide.

Vaccines are arguably humanity’s greatest scientific achievement, and have already saved countless lives over the last 50 years.  Today, the AMC and other new approaches offer more ways to extend the benefits of vaccines to everyone in need.  With millions of lives still at stake, it’s time to use them.


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The error in logic is yours.

You believe that there is only one correct action, and this is the action you choose to support. So you believe that as the correct action is self-evident, it is the action which comes first and the planning which comes second.

The reality is that when a leader makes a decision, he is not just deciding to act. He is deciding whether to act at all, and if so which action is the correct one to make.

And in reaching that correct decision, the practical realities of each option must inevitably be considered. After all, why take action if it is impossible to do so or when the result is ineffectual?

An example is people who believe capitalism has failed. They conclude that capitalism is flawed, that it harms others and that the system must be removed. They believe this conclusion is self-evident.

What they don’t do is figure out how capitalism can be ‘fixed’. Nor do they figure out how they will end the system, what the system will be replaced with, or how society will be moved from one system to the other. So for all their ideas, they have no actual solutions.

Likewise with the curing of global poverty. The sheer number of populations in the third world prevent them from having a quality of life remotely comparable to the developed world.

And this is even without accounting for growing populations, future oil levels and global warming. All of which will worsen the problem within the next few decades.

Your ideas about casting aside materialism and helping all of humanity is not new. Many people have thought the same thing, proclaimed it as self-evident and insisted that it must be done as soon as possible.

But what they always fail to do is figure out how it will be done. All ideas and no solutions. And so, their ideas remain unworkable.

Posted by Hmmm | Report as abusive


The reason you are having trouble with my logic is because the solution really is just as simple as choosing to value the lives of your fellows over and above your own good pleasures.

We are by nature social beings. We need each other just to survive. But instead of paying attention to what nature has placed in us by design, we choose ignore it in favor of justification of self gratification at the expense of others.

Your argument is quite rational and logical. The problem is that human beings are not lead by logic or reason. The role of the mind is to find the paths that lead to the fulfillment of desire. And desire is housed in the heart. Therefore human beings are first and foremost creatures of feeling.

As the saying goes, “if you don’t mind, it doesn’t matter”. Deciding whether to act at all is a decision in and of itself. So choice still precedes logistical considerations.

It is exceptionally easy to flout technicalities as the main culprit to lack of progress. But these considerations are directly tied to the human desire for profit/comfort/pleasure.

All considerations boil down to these desires and nothing more. Capitalism is indeed flawed. It can be fixed simply enough just by putting it in its place. Right now we have ‘for profit’ educational institutions, health systems, and housing sectors. All of these have suffered and have caused citizens to suffer.

Areas that deal specifically with human development health and security should not be ‘for profit’ endeavors. And the reason should be obvious.

How would for profit police and fire protection pan out? Not very well at all. In these instances we understand that it is vitally important that these protections be available to the population at large. Humanitarian work is likewise of such importance that it must not be placed in the hands of the profit seeking sector. The desire for profit simply takes precedence over the work to be done.

Capitalism works for things that are not at the center of human development and well being. And so, the remedy for capitalism is restraint. Capitalism must be kept out of areas central to human well being and development. These tasks are more suited to socialistic methods of action. Yes socialistic. Just like our police, fire departments, K-12 educational systems. Apply the appropriate system for the task at hand and then refine the system to make it better at what it already does well.

For the buying and selling of goods and services capitalism is fine. But also remember that those who extolled the virtues of capitalism are the very same people that came to the government of the people with their tails between their legs asking for us to bail THEM out. And after these die hard capitalists took the people’s money, they immediately turned around and demand that each citizen pay their “debts”.

Your argument is weak. You are attempting to justify the failure capitalism by pointing to technicalities that never the less, are still under human control and therefor subject to human desire. Remember the AIG CEO doing God’s work article? God’s work is done by the prophets. Not the profits.
Keep justifying a system that requires a percentage of the population to be in abject poverty and you may well find yourself on the underside of that system. Then you can comfort yourself in knowledge that at least business is good.

We are not animals and we should not be content to live as such.

As I said, all ideas and no solutions.

You believe that the truth is self-evident. That human behaviour of today is incorrect, and that it must be changed into the ‘correct’ behaviour.

Why then, are things as they are? In a system which now self-perpetuates itself and cannot be removed from a society now dependent on it? That doesn’t sound like the current system is flawed to me, rather it seems like the current system has reached equilibrium.

Rather then point out the ‘flaws’ in capitalism, how about giving us an alternative system and how we will change to it?

Keeping in mind, of course, that the entire wealth of the world is caused by corporations and profit-seeking ventures. And without a factor of profit, there is no need for corporations to contribute their money to any of your plans.

Capitalism doesn’t finance police or fire services, true. Rather, it finances the nations who provide these services.

Imagine that all the companies and corporations in America suddenly go somewhere else and take the banks with them. No employment, no company tax, no exports, no bank loans. How long do you think government services will last?

Humans are social and feeling creatures, to a point. But we are biological creatures first, on a planet of scarce resources, seeking individual profit.

All creatures, big and small, live in a world of limited resources. They seek to maximise their gain, avoid running out of resources and successfully competing against others.

And where creatures form a community, it to maximise the gain of the many at the loss of the few, with the individual’s goal of biological profit.

Human behaviour is economic behaviour. All we humans did is take the same scarcity problem which forms the basis of nature itself and called it economics.

And I think you will find that even the barest of crumbs from the mouth of profits has cured more poverty then the words from the mouths of prophets ever will.

Essentially, that is what all charity is. The crumbs of capitalism. When we give some of what we have to the poor, remember that it is the sheer wealth of corporatism which makes it possible. No corporations means no wealthy nations, meaning no charity to give.

Posted by Hmmm | Report as abusive


To quote your last post:

“Keeping in mind, of course, that the entire wealth of the world is caused by corporations and profit-seeking ventures. And without a factor of profit, there is no need for corporations to contribute their money to any of your plans.”

Now we get to the heart of it. It is the idea of what we consider to be wealth and profit. Money is considered wealth. And a surplus of money gained from selling is considered profit. Why is money valued? Because money can be used in our society to bring pleasure and comfort. We can trade money for any bright shiny material bell or whistle we have enough money to buy.

Do you bury your money? Do you eat it? Do you wear it? Of course not! You buy stuff with it. And this is at the very heart of the profit motive. People want to make money so that they can buy neat stuff with it. And so we work for people who have money and are willing to pay for our services. Or we go out and create a business of our own through which we can earn money so that we can buy our material comforts and pleasures.

To key in on a portion of your post:
“And without a factor of profit, there is no need for corporations to contribute their money to any of your plans.”

It’s not that there isn’t a need. Rather there is no desire. And that is a whole world of difference. There doesn’t always need to be a direct return on investment. And most times there shouldn’t be anyway. Also, we aren’t talking about MY plans here. At least I’m not anyway. I’m talking about the superiority of altruistic motivation over self serving motivations such as profit.

But altruistic thinking is an order of maturity higher than our current state. You believe that without profit (if there isn’t something in it for me), then there is no incentive to act (why should I help you?).

“Humans are social and feeling creatures, to a point. But we are biological creatures first, on a planet of scarce resources, seeking individual profit. All creatures, big and small, live in a world of limited resources. They seek to maximise their gain, avoid running out of resources and successfully competing against others.“
And here of course you are quite correct. We are indeed biological creatures. But you stop short of recognizing just how superior you are to other forms of life on this planet. Of course you share the bondage of biological needs. But you also have a creative mind that allows you to bring your ideas into objective reality. And you have a body that is designed to work with objective reality for the purpose of manifesting your desires in the outer world. This ability allows you as a human being to move beyond the pull of simple biology. If we didn’t have this capacity there would be no such thing as human civilization. We would live only as animals searching for the next meal and the next mate.

Also we have a cultural misconception that is very common about competition. Competition is a game of mutual support. Each contestant pushes and indeed assists the other “players” to do their best. And the “contest “ is to see how much better the results of “X” endeavor can be made. All competitors are supposed to help each other. And the resulting good is intended for everyone.

While any portion of the population suffers for lack basic human needs, the whole of the population will eventually suffer. Where all needs are met there is no desperation. There is no fear. And no desire for violence. By “all needs” of course I mean physical, mental, emotional, and spiritual needs. The latter being a personal journey. Housing, education, health, and security must be socialized. And this shouldn’t come as a shock. We already have socialized police, fire protection, k-12 education, and military branches. So health, education, and housing, all of which are vital human needs should be no different.

In answer to your statement:
“And I think you will find that even the barest of crumbs from the mouth of profits has cured more poverty then the words from the mouths of prophets ever will.

Give a man a fish and feed him for a day. Teach a man to fish and feed him all his life.
This is the value of the words of the prophets. Profits on the other hand are here today and gone tomorrow. Profit is the fish given for a day. The poverty you speak of is not outside you. It is inside you. In a poor house full of love, where one eats, two eat. In a rich house full of selfishness where one eats no one else eats. Instead they get your version of charity. “Essentially, that is what all charity is. The crumbs of capitalism.”

Another small light to cast into your misunderstanding:
“When we give some of what we have to the poor, remember that it is the sheer wealth of corporatism which makes it possible. No corporations means no wealthy nations, meaning no charity to give.”
When we give of what we have it is because we choose to give. It’s not because a corporation allows us to give. You are a human being with a mind. And you are bright. But you still have yet to realize your own worth. Corporations, and capitalism, and money, etc… all come from the mind of the human being. That which is inside you and gives life and mind to you, is not rooted in this matter that find yourself in. As a human being you have something far greater at your root. Altruism prioritizes this root above all else in this world. With life and love being the foundation of existence. All systems developed by the human mind will reflect the foundations upon which they are built. The foundation upon which we currently build is selfishness. And selfishness breeds suffering. And no amount of selfish work will make selfishness itself any less poisonous to your heart. Give because you love and it will be a blessing. Give for want of profit and it will be a curse.

You speak of money as if it were worthless. It is a measure of worth.

It buys you the food you eat, the clothes you wear, the home you live in, the car you drive, electricity, clean water, health, and all the technology you take for granted.

All of these things are provided to you because you pay for them. If you didn’t pay for them, there would be no reason for anyone to make these things or provide them to you.

And where do you get the money to pay for them? From your work. From some form of contribution you make to the economy (i.e. society) which indicates that you are worth having the food, water, shelter and space to which you are accustomed.

Or alternatively, if you are not worth anything to society, there are enough other people of worth that you can live off the sweat of their brow instead of your own. Thanks to a nation wealthy enough to give government benefits.

The corporations are the reason for the immense wealth of the society in which you live. Whether you choose to give the money you earn to a charitable cause or not is your will. But whether you had a job to earn that money, or an economy to gain that money, or a country where you are wealthy enough to part with that money, is the will of the corporations.

Your definition of competition has no bearing with the actual meaning of the word in biology or society. It is merely your idea of what you think competition ‘should’ be as opposed to what it is.

Competition is the struggle for the lion share of resources, where the strong get the most and the weak get little. Where the group as a whole gain, it is at the expense of those who do without. Where the weak gain charity, it is because the group is rich enough to spare it. Look to animals in nature, or plants, society or economics. It is all the same.

And as for the words of prophets? Nothing you have said has been anything remotely to do with teaching men to fish.

Rather you believe in giving them fish each day, and feeding them for the rest of their lives at the expense of others. And expecting corporations to do the fishing forever, for other people, for free.

You think that the single force driving the economy, profit, should somehow cease to be. This makes as much sense as deciding your car doesn’t need wheels, and still expecting it to drive you somewhere.

We have two choices.
-We can have corporations, poverty and charity.
-Or we can have no corporations, no poverty and no charity.

Why would having no corporations mean no poverty? Because we would all be equally suffering and destitute. Meaning no rich, and hence no poor.

Posted by Hmmm | Report as abusive