It's a capitalist world

A regular correspondent is irate that vaccines are made by for-profit companies, which causes no end of problems. There isn't a lot of profit in vaccines to begin with. You get them once or twice, unlike chemicals such as statins and anti-depressants that people take more or less forever. For diseases that mostly afflict poor countries, there's even less incentive to develop vaccines, obviously, because you can't charge a high price.

Now, you might think that setting up a not-for-profit corporation and investing some of the government and foundation funds that currently go to international health promotion in vaccine development and production would make sense. But the Bill and Melinda Gates Foundation writes to tell us that they're participating in another strategy, called Advance Market Commitments, AMCs, to extract vaccines from corporate manufacturers. This basically means that donors get together to promise manufacturers that they'll purchase at least a minimum amount of some vaccine. The theory is that the manufacturers know they'll make sales, so they agree to produce the product. The group has decided to start with an offer to buy vaccine against pneumococcal pneumonia. Sounds good, although as far as I can tell so far they don't have any manufacturers on board. We'll see.

By the way Americans don't hear much about the international health funding structures, in part perhaps because it's all rather byzantine but also because our corporate media and even our health bloggers as a class don't seem to care very much. So, just to start getting some of this story out there I'll mention that one of the partners in the AMC strategy is called the GAVI Alliance, a redundant and repetitive name derived from Global Alliance for Vaccines and Immunization. Apparently people couldn't agree on how to spell "immunization" so they just said to heck with it. GAVI includes UNICEF, the WHO, governments, foundations such as B&MG, and yup, the vaccine industry. As they say on their web site, "GAVI uses two mechanisms that draw heavily on private-sector thinking to help overcome historic limitations to development funding for immunisation. These mechanisms are the AMC and the IFFIm. The former reflects the need to meet disproportionately high costs in the early stages of implementing aid programmes; the latter developing countries' need for sustainable predictable funding." IFFIm stands for International Finance Facility for Immunization, which is basically a pool of long-term pledges from donors against which GAVI can borrow.

Which brings us to our next press release. It seems "The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria will host its Annual Conference June 23-24 where policymakers, business leaders and global health advocates will unite to take action on HIV/AIDS, tuberculosis and malaria around the world." Sponsors include Pfizer, Chevron oil, Johnson & Johnson, and Marathon Oil, which is taking the opportunity to give itself an award. Fareed Zakaria will be your genial host. Now, exactly what amount of credit or blame these oil and drug companies should get for the health of people in poor countries is matter we could discuss at some length. But the WHO, Obama administration, UN, and the whole gang have decided that constructive engagement is the way to go. This conference will let the corporations walk away with plaques and testimonials that say they're good guys after all. What we're really getting in return is another question.