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Frontiers of Public Health: Vaccine Man

Chris Hartlove

Frontiers of Public Health: Vaccine Man

Fifteen years. That particular chunk of time greatly bothers Orin Levine. Once the hepatitis B and Haemophilus influenzae Type b (Hib) vaccines were approved for use in wealthy countries, it took that long for them to even begin to be used in poor countries. Levine, PhD '94, director of the International Vaccine Access Center (IVAC), is committed to eliminating that kind of delay. He recognized an opportunity in the pneumococcal conjugate vaccine (PCV), which was approved in 2000 and protected against seven strains of bacteria that can cause pneumonia, meningitis and sepsis. (Second-generation vaccines now protect against 10 and 13 strains.) Starting in 2003, Levine led PneumoADIP, a pioneering $60 million effort supported by the GAVI Alliance. Its goal was to coordinate donors, vaccine makers and governments to speed PCV distribution. As a result, second-generation vaccines are being distributed in some African countries at the same time as in the U.S. and Europe. Expanded access to the vaccines will save an estimated 5 million children's lives over the next 20 years. In mid-summer, Johns Hopkins Public Health's editor Brian W. Simpson spoke with Levine, an associate professor of International Health, about PneumoADIP, vaccine pricing and his blog for The Huffington Post.

Why devote your career to vaccines?

I think the most important thing for me is that vaccines are tools for social justice. They really work well at diminishing disparities in health. Whether you're rich or poor, living in difficult circumstances or comfortable ones, when you're vaccinated, you're protected. And I find that appealing.

The history of distributing vaccines to developing countries is pretty dismal.

Until about the early '70s, only about 5 percent of the world's children were getting routinely immunized. If you think about that, we only have 30 years of experience rolling out these new vaccines. Maybe we should cut ourselves a wee bit of slack that we didn't roll out everything as fast as we would have liked.

PneumoADIP changed things. How?

It set out to accelerate development and introduction of pneumococcal vaccines in the places where they were needed the most. We played a kind of central coordinating role. We worked with the World Health Organization, UNICEF, the GAVI Alliance, vaccine manufacturers, developing countries, international financing groups and donors like the Gates Foundation or national governments. It's really a function of coordinating the actions of all of those groups.

Give us an example of PneumoADIP's impact.

Well, the vaccines started to roll out last year, but a lot of the research occurred in The Gambia. The Gambian pneumococcal vaccine trial essentially catapulted pneumococcal vaccines in the global health field because it showed that three doses of the vaccine reduced all child deaths by 16 percent, which is an incredible impact. In the Gambia trial, that was 7 deaths prevented for every 1,000 children that we vaccinated.

Did you have the sense that PneumoADIP would be a transformative project?

Yes. We knew that we had been given a golden opportunity. We knew this was probably the single best opportunity that had ever presented itself to the public sector and the vaccine community to get it right.

What are advanced market commitments (AMCs)?

Newsweek said AMC is like a carrot on a stick. It says to vaccine manufacturers, if you make safe, effective vaccines for developing countries and they're affordable, donors will buy them and pass them on to the developing countries at a price that they can afford. Industry gets its money back, and developing countries get a lifesaving vaccine. To me, it's just a smarter way to use our investments in global health. It's making sure that the developing countries get the vaccines in the formulations that they want at the prices that they need.

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