Few pathogens rival Streptococcus pneumoniae as a cause of childhood illness and death. According to the estimates of the World Health Organization, pneumococcal infections kill more than one million children aged less than five years every year--more than any other vaccine-preventable infection, including measles (1). Unlike HIV and malaria, effective vaccines for the prevention of pneumococcal infections are currently available (2).
Pneumococcal conjugate vaccines, like Haemophilus influenzae type b (Hib) conjugates, are safe and highly efficacious for preventing serious infections, such as sepsis, pneumonia, and meningitis (3-5). The vaccines also prevent ear infections and pharyngeal colonization and reduce transmission from vaccinated infants to unvaccinated contacts (6-9). A vaccine containing seven important pneumococcal serotypes has been routinely used for vaccinating infants in the United States since 2000. Its routine use has led to herd immunity, i.e. a decreased incidence of disease among unimmunized persons (10,11). Avaccine containing two additional serotypes of importance in developing countries (in total, nine serotypes) was recently shown to be highly efficacious for preventing pneumonia and invasive infections in African children, including those infected with HIV (5). Based on these results, pneumococcal conjugate vaccines appear to be promising tools for improving child health globally. Further research is still needed to assess their effectiveness in other geographic regions, such as Asia, where differences in the local serotype distribution may modify the impact the existing 9- or 11-valent vaccines can have, and more local data will be needed to support national decisions to introduce the vaccines.
Given its enormous global burden of disease, it would seem obvious that, once developed, highly-effective vaccines would be demanded by, and supplied to, developing countries. Unfortunately, the experience with Hib conjugate and hepatitis B vaccines shows that the uptake of these life-saving vaccines has been the slowest in the developing world where, ironically, they are needed the most (12-14).
To accelerate the availability of pneumococcal conjugate vaccines in developing countries, the Global Alliance for Vaccines and Immunizations (GAVI) has launched a project management team called the Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP). Based at Johns Hopkins Bloomberg School of Public Health, this team was awarded US$ 30 million to coordinate a targeted, multi-partner workplan to help GAVI achieve its objectives for pneumococcal vaccination.
LEARNING FROM THE PAST: LESSONS FROM HIB AND HEPATITIS B VACCINES
Hepatitis B and Hib vaccines are safe and effective, can be administered through routine immunization systems, and address important global health problems. These vaccines are routinely used for vaccinating infants in nearly all industrialized countries. However, even as much as 14 years after the introduction of Hib vaccines in industrialized countries, less than 10% of infants in the 75 poorest countries of the world were routinely receiving these vaccines (Fig. 1).
Several factors contributed to the slow uptake of these vaccines. One of the most important factors was the lack of a coordinated effort to address both demand and supply issues before launching of the vaccines in developing countries. While the public sector often sponsored surveillance and research demonstrating the burden of disease or effectiveness of vaccine, there was no accompanying communication effort to assure that the data reached policy-makers. Further compounding the problems, efforts to assure financing for the procurement of vaccine--especially in early years when supplies are constrained and product prices tend to be higher as firms recoup development costs--were limited. Manufacturers of vaccines saw little or no evidence of market demand--i. …