Leveraging Partnerships
Wayne Pisano
Next to clean drinking water and good nutrition, vaccines have saved more lives than any other public-health intervention in modern history. Immunization programs have wiped out smallpox, eradicated polio virus in the Western Hemisphere and begun to control childhood killers, such as measles and tetanus. According to the World Health Organization, vaccines prevent 2.5 million deaths worldwide annually. As additional vaccines are introduced worldwide, the number of lives saved and human suffering averted will continue to grow.
Despite these accomplishments, large gaps remain in the delivery of existing vaccines to people in poor countries and in development of new vaccines to combat diseases that are more common in the developing world. Pneumonia and diarrhea, for example, kill 3.8 million children younger than five each year although both are vaccine-preventable. And no effective vaccines are available to prevent infection by some of the largest killers in poor countries. These include HIV/AIDS, malaria and tuberculosis, which together kill many millions of people a year.
Experts in international health attribute the gaps to problems, or failures, in three key areas - science has yet to make needed breakthroughs against certain diseases; markets are not always able to support incentives to produce needed medicines; and public-health systems in poor countries have limited resources to deal with complex problems.
There is growing recognition that tackling complex and systemic problems in international public health are beyond the capacity of any one sector. Instead, there must be a collaborative approach. As former WHO director-general Gro Harlem Bundtland noted: "In a world filled with complex health problems, WHO cannot solve them alone. Governments cannot solve them alone. Non-governmental organizations, the private sector and foundations cannot solve them alone. Only through new and innovative partnerships can we make a difference."
Over the past decade, public-private partnerships (PPPs) have emerged as a potent tool to bring the benefits of modern medicine to the developing world. These collaborations bring together government, multinational corporations and civil society - including non-governmental organizations, private foundations and multilateral groups such as WHO - to address seemingly intractable health problems. Such partnerships take many different forms in terms of legal status, governance, management and operational roles, but they share the underlying assumption that each sector brings to the table particular skills and resources that, when combined, will result in innovative and effective approaches to improving the health of the poor.
For the partnership to work, each participating sector should derive some potential benefit. A study conducted for the World Economic Forum by Booz Allen Hamilton found that, to be successful, corporate involvement in PPPs must extend beyond social responsibility and have economic payoffs as well. The long-term fiscal benefits may be indirect. For companies, benefits may include opening of new markets, the reduction in tax obligations on donated products and the enhancement of corporate image. For governments in developing countries, benefits include access to products, improved infrastructure and availability of expertise. For non-governmental organizations, benefits may be increased legitimacy, an opportunity to learn from larger partners and the chance to work abroad.
Although governments have long worked with civil society organizations to further their health goals, private industry is a relatively new player at the table. In the pharmaceutical industry, the changed landscape is apparent. Multinational corporations are now working shoulder-to-shoulder with governments, non-government organizations, foundations and multilateral groups to alleviate human suffering and death from dozens of infectious diseases in the developing world. Sanofi pasteur is just one company that has embraced PPPs to bring life-extending and life-saving medicines to the world's poor. So far in 2009, the pharmaceutical industry has been involved in more than 200 public-private partnerships in poor countries. In addition to making drugs and vaccines available to the developing world for free or at deep discount, pharmaceutical companies are also lending their expertise to help build medical clinics, improve distribution routes for medicines and train medical professionals.
At sanofi pasteur, which is dedicated to saving lives through vaccines, we have been privileged to see first-hand the incredible successes possible with PPPs. For example, we have been the longest-standing corporate partner in the global campaign to eradicate polio virus. Begun in 1988, the effort involves WHO, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, Rotary International, governments in low- and middle-income countries and vaccine manufacturers. Since the effort began, worldwide incidence of polio has been reduced from 350,000 cases a year to fewer than 2,000. There are more than 5 million men, women and children who are walking around today who might otherwise have been paralyzed by polio.
The original goal of the polio eradication campaign was to wipe out polio virus by the year 2000. But even after 12 years of concerted effort, the virus still persisted in certain developing countries into the 21st century. In response, WHO instituted several innovative, microtargeted programs. For example, in 2005, WHO called for development of a new monovalent oral polio vaccine to combat the disease in Egypt. Sanofi pasteur responded by developing and producing the first new polio vaccine in more than a decade. Fifty million doses went to Egypt, which was declared polio-free a year later.
As part of the R&D-based vaccine industry, sanofi pasteur has been a partner of the highly successful Global Alliance for Vaccines and Immunization (GAVI) since its inception. GAVI, launched in 2000, leverages public and private partnerships to accelerate access to vaccines, strengthen health and immunization systems within countries, and introduce innovative new technology (including vaccines). Developed country donors, recipient governments, research and technical institutes, civil society organizations and vaccine industries partner with international organizations, private sector philanthropists and international financiers to find ways to fund and support immunization in the world's poorest countries.
Sanofi pasteur is also an active participant in the Pediatric Dengue Vaccine Initiative (PDVI), a product development partnership (PDP, which is a form of PPP that aims to accelerate the development and introduction of new vaccines) established in 2001 to accelerate the development of a safe, effective and affordable vaccine against dengue fever. The viral disease, which is spread by mosquitoes, causes high fever, incapacitating headache, muscle pain and rash. If left untreated, illness can progress to dengue hemorrhagic fever, shock and death. There are 50 million cases of dengue fever with 500,000 cases of hemorrhagic fever each year. Without appropriate treatment in an intensive-care setting, about 2.5 percent of those who contract the disease die. Other than mosquito protection and eradication, there are currently no measures available to effectively prevent the disease.
Soon the vaccine community hopes to have another success story as we pursue PPP models to combat the threat of pandemic influenza. Many organizations are already involved including the U.S. and European CDCs, the WHO and public-health agencies around the world. Roche Pharmaceuticals and GlaxoSmithKline are providing anti-viral drugs that are proving effective. Hospitals, businesses and health departments are readying their pandemic plans. Testing labs are identifying and typing respiratory infections. Multiple vaccine manufacturers, including sanofi pasteur, are working with the world's health and regulatory agencies to speed development of a vaccine that will stop this new virus and save lives. In late May, we received the H1N1 seed virus, allowing us to begin work on a vaccine. Through a collaborative framework, sanofi pasteur's goal is to develop a safe, effective and affordable vaccine that will protect everyone, including those in the developing world.
Wayne Pisano is president and CEO of sanofi pasteur.
This issue of GLOBAL HEALTH was sponsored, in part, by sanofi pasteur as a tribute to Beth Waters.
In Memory of Beth Waters: Reflections on a Lifetime Dedicated to Public Health Advocacy
Beth Waters was a communications professional committed to advancing the cause of vaccine development and delivery. Among her many achievements, she helped to create a model for improving access to HIV treatment that has been applied to scale up treatment for other diseases.
A reporter in the early years of her career, Beth was a senior managing director of Ogilvy Public Relations before co-founding Cooney/Waters Group, a health-care public relations and public affairs company in New York City. Beth was indefatigable in her work on vaccine advocacy, traveling the world to lend her intensity and expertise to her clients, governmental committees and non-governmental organizations; and promoting immunization against polio, HIV/ AIDS, avian influenza and meningococcal disease. Beth was a wise counselor, a creative problem-solver, and a relentless optimist.
She was a founding member of the advisory board of the Vaccine Education Center of the Children's Hospital of Philadelphia and a member of the HIV Vaccine Communications Steering Group of the National Institute of Allergy and Infectious Disease.
Beth Waters often said that her first job in immunization advocacy was as a child of nine. She was a "polio pioneer" - one of the children who participated in the U.S. clinical trials of the vaccine that would mark the beginning of the end of the scourge of the disease that crippled or killed children and young adults throughout the 20th century. An unrelenting crusader for the prevention of infectious diseases, her involvement with global polio eradication continued right through the last decade of her life. Indeed, much of her 30 years in communications and public affairs centered on advocacy for vaccines to protect against diseases in both industrialized countries and the developing world.
Every aspect of immunization intrigued her, from the intricacies of production and supply to the involvement of communities in clinical trials of candidate vaccines for mass immunization programs. Indefatigable in her efforts, she traveled the world to lend her intensity and expertise in international scientific forums and at the grassroots level, working with her client sanofi pasteur, governmental committees and non-governmental organizations.
"Beth's work exemplifies the power of communications in bringing together people and groups to advance the prevention and treatment of infectious diseases, most notably HIV/AIDS," said Wayne Pisano, chairman and CEO of international vaccines company sanofi pasteur. "It was impossible to slow her down. She fought for disease prevention with an energy and enthusiasm that was often as contagious as any of the microbes she battled."
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