The vaccines tradeoff

DW: What are the issues and the challenges in balancing the profit drivers of the pharmaceutical industry against our public health needs?

Professor Adrian Hill: The reality today is that there are about 20 vaccines that we would really like to have, that would make a big difference to public health. Lots of lives would be saved, sometimes millions, as in the case of tuberculosis or HIV, or hundreds of thousands of disease episodes - if we had better influenza vaccines. And the tradeoff is: how much do you invest for a given public health benefit? And that's what you'd like to see, that the big diseases get the greatest investment. But of course that's not what happens. What happens is that the diseases where the market is greatest are what global pharma companies have to go after. And what makes this all very difficult is that making vaccines takes longer than making new drugs. It might take 10 or 20 years to go from design to marketing of a new vaccine. It might take half a billion euros from the beginning to the end. So you have to think very carefully about what you spend money on, and the diseases that don't affect enough people are going to lose out.

And why are we seeing that? Is it because the vaccines that we're chasing and the issues that we're facing now are more complex? We've sorted out the basic ones, the big ones?

Yes. The easy vaccines have been made. They're on the market, they're working. We're left with very difficult disease targets like dengue, like malaria, like tuberculosis, where we don't have good vaccines, or we don't have any vaccine for many of these. And we don't know how to make them in many cases. We're trying to understand what would make a good HIV vaccine. That takes money, it takes clinical studies in humans, which are expensive - they have to be done carefully for all sorts of important safety reasons. And that all adds up to a lot of money.

But why does it cost so much money? Aren't we talking about a public health good, a public health necessity?

The reason it costs money, in one word, is safety. We're testing new technologies that often haven't been tested in humans before. We think they're probably safe, but what we have to do is prove that they're safe. The only way to prove something is very safe is to give it to thousands - not hundreds - of people, and follow those people carefully. That involves a lot of money, and it takes time. So there's no shortcut to demonstrating the safety of new vaccines.

You work on malaria. Surely that's a huge market?

Oddly enough, even though it's the biggest killer of children in Africa, and one of the biggest global health problems of all, it's not a big market. And that's because the people who really need a malaria vaccine are infants in Africa, who are at the most risk of dying. And there may be 30, 50 million of them needing a vaccine every year, but they can't, by and large, afford to pay more than a few cents. And that doesn't add up to a big global market for a big pharmaceutical company.

So what that means is that somebody else is going to have to pay. And today, many childhood vaccines in Africa are paid for by international agencies like UNICEF - so essentially funded by richer companies or, in some cases, by local governments. But for a malaria vaccine, there's no direct private market that's going to make companies invest in malaria vaccines.

But isn't there a way to legislate, to make pharmaceutical companies do the work that is necessary for the public health good?

No, there is no such legislation. Some companies do this for public benefit. For example, GSK, a company I work with, has invested fairly heavily in both drugs and vaccines for malaria, even though it's hard to see how they will get their money back. But it does provide public image benefit to the company, and it is a good thing to do. So what we'd like is [for] more companies to do that sort of thing, and maybe even divide up those diseases between them, so they're all tackling one tough target. That would be ideal.

But shouldn't there be legislation? Shouldn't there be a way to make companies that chase profits on certain, say, lifestyle drugs, that they are made to invest a certain amount of their money, their time, in the drugs and vaccines that help people, particularly in the most disadvantaged countries?

That's never been done before. It's an interesting idea. I'm not sure it would be the best idea, because effectively you'd be making people do something that they otherwise didn't want to do. The argument for it is that big companies have the facilities, particularly the manufacturing capacity, to manufacture something at the end of the day.

Probably a better way to do it is to allow non-profit groups - and there are a lot of these, very passionate about making new vaccines for important diseases - do the hard work, design the vaccines, take them into clinical trials, show proof of concept that they are working…and that can take a while…And then [the non-profits can] persuade drug companies - once they have something that they only really have to manufacture and sell - to take it on at that stage. I think that's a better model.

Professor Adrian Hill is the director of the Jenner Institute at Oxford University in the UK. He was a speaker at the European Commission's 2014 New Horizons for Vaccine Research and Innovation Conference in Brussels.