13. Recent Trends and Innovations in Development Assistance for Health

The International AIDS Vaccine Initiative was established in 1996 with support from the Rockefeller Foundation as an innovative way to give a boost to AIDS vaccine R&D. Optimism about AIDS vaccines in the late 1980s had given way to a series of failures and to discouragement by the end of the decade. R&D efforts were spending less than US$100 million a year. Neither governments nor private vaccine companies were investing much in research into AIDS vaccines.

IAVI's mission was defined as ensuring the development of a safe, effective, and accessible vaccine for use throughout the world. IAVI's activities were to include a combination of global advocacy, policy analysis and reform, and investments in carefully chosen R&D projects focusing on the most promising vaccine candidates.

IAVI's collaboration with the private sector has occurred at several levels. Funding for IAVI has come from six governments (Canada, Denmark, the Netherlands, Norway, the United Kingdom, and the United States); the European Union; and the World Bank, as well as from private foundations and companies. IAVI's vaccine development partnerships take many forms. They typically include an academic developer and a biotechnology company, plus researchers, laboratories, and clinical trial sites in developing countries such as India, Kenya, and Uganda. Private companies generally manufacture test lots of the AIDS vaccines and undertake bioengineering studies and enhancements to the vaccine. IAVI generally shares the risks and costs of the partnerships with the private codevelopers, while ensuring that developing countries will have access to the vaccine at an affordable price if it turns out to be effective.

Since IAVI embarked on these vaccine development partnerships in 1999, it has spent a total of about US$200 million in this area. Five vaccine candidates are undergoing clinical trials in eight countries in Africa, Asia, Europe, and North America. IAVI is poised to spend another US$300 million in R&D during 2005-7 in an effort to accelerate the discovery, development, and licensing of a vaccine to prevent HIV infection. IAVI is also trying to stimulate expanded use of donor funding for R&D in the field of AIDS vaccines and is calling for governments to increase public financing from the current amount of around US$600 million a year to US$1.2 billion annually. At the same time, IAVI has proposed that donors create a purchase fund of several billion dollars to serve as a promise to buy large numbers of doses of an efficacious vaccine from qualified manufacturers. The U.K. government has committed itself to joining such an advance purchase fund and is urging others to join it ("Gordon Brown to Earmark" 2004).

The health and economic stakes are enormous. Without improved HIV prevention tools, an additional 100 million HIV infections are likely over the next two decades, resulting in huge economic losses. IAVI estimates that an efficacious vaccine could prevent 2 million AIDS deaths a year and generate billons of dollars in lives saved and antiretroviral treatment costs averted.

Source: IAVI 2004.