The Bay Area Reporter - July 30, 1999
Bill Snow

HR 1274, the Lifesaving Vaccine Technology Act of 1999, introduced in the House of Representatives March 24 by Congresswoman Nancy Pelosi (D-San Francisco), is designed to address the fact that the marketplace for vaccines that could save in excess of seven million lives a year doesn't work. The reason is that the three biggest killers worldwide -- HIV, malaria, and tuberculosis -- have limited market potential in the developed world, where full price is paid for vaccines, while they would have enormous impact for the developing world and hence for us, directly and indirectly.

The U.S Institute of Medicine just published a study, "Vaccines for the 21st Century" by its Committee to Study Priorities for Vaccine Development, Division of Health Promotion and Disease Prevention. And on the whole, the biggest killers worldwide don't have the best prospects for "domestic public health importance." The Pharmaceutical Manufacturer's Association doesn't list one vaccine for these diseases in its 1998 list of 43 vaccines in development in their survey of pharmaceutical company research and development. The science is too difficult and the profit potential too uncertain. Yet scientists agree a vaccine for each is a real possibility as we have learned unprecedented amounts about immunity. So, early work on each is progressing but through public channels, with a pittance of investment. The president has endorsed the idea that the 21st century will be the century of biological breakthroughs, and many who disagree with him about everything else agree.

Most of the expertise to design and make vaccines, which are the greatest public health intervention of all time are in pharmaceutical and biotech companies that are not working hard enough on this thorny challenge. So, the Pelosi bill proposes a 30 percent tax deduction for any research and development done by private companies on vaccines or other biomedical prevention products for any infectious disease that kills more than one million people worldwide annually. Since companies determine the focus of their research by the cost, risk, and benefit, this relatively inexpensive tax break by government could tip the scales toward more active use of those resources and knowledge to solve these problems. Since 70 percent of the investment would still come from industry, only the most worthwhile projects would be pursued.

It's been said many times that prevention is, 16 to 1, more valuable than a cure. Vaccines are the only way any disease has ever been eradicated, and the developing world is being devastated by sickness and early death. If you're a conservative, think of the productivity and economic consequences of the largest part of the world having declining life expectancies and inadequate means to control infectious diseases, while the world gets smaller and smaller. If you're a liberal, think of the almost countless orphans and ruined lives, the inadequate health care facilities and budgets.

In exchange for the credit, companies would be required to present a plan for global access of any vaccine developed through the tax credit. Not much to ask, and much to gain without interfering with the profit motive, competition, or the extreme reluctance especially of drug companies to give out information about their costs or pricing policies.

The bill could be attached to this year's tax legislation, but the Republicans are too busy haggling over a monstrous tax cut to retain their traditional supporters and withstand elections, and the Democrats can hardly be heard in the rush to get votes by currying favor. As an example, last week's New York Times described a proposed tax credit in committee to help chicken farmers in the Delmarva Peninsula in Delaware dispose of 800 tons of chicken droppings every year by giving tax breaks to turn the manure into electricity, since it has been discovered to be too much of a pollutant in fertilizer. This is an admirable goal, and apparently more important to the Delaware senator and his Maryland neighbor who have seniority on the Senate Finance Committee. This appetizing proposal has run up against a colleague from Texas who is senior on Ways and Means in the House, however, because, as the Times says, "the tax credit could put chicken droppings in competition with oil and gas as a source of energy."

A Senate version of the Pelosi bill will be introduced shortly by Senator John Kerry (D-Massachusetts). If it gets enough support in the House, Senate, and administration, it could become part of the tax package that ultimately must be voted on by the end of the federal fiscal year, which is September. Meanwhile, the administration has promised $100 million for AIDS in Africa, which works out to be $4.50 for each of the 22 million Africans infected with HIV to say nothing about malaria and TB, which have proven for centuries to be endemic, and intractable. Wiping out these diseases, or just controlling them, would be good for business and good for public health, and good for us, here, where poor people and travelers are increasingly more susceptible to these horrible killers.

Swift's modest proposal to make unwanted children "sound useful members of the commonwealth" and "contribute to the feeding and partly the clothing of many thousands" was that a "young healthy child well-nursed is at a year old most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled." He therefore proposes that they "may at a year old be offered for sale to persons of quality and fortune through the kingdom, always advising the mother to let them such plentifully in the last months as to render them plump and fat for a good table." The profits would go to the mothers' landlords.

Swift was satirizing his times of course, when "the present situation of affairs is utterly impossible by all the methods hitherto proposed," noting that "they can't pick up a livelihood by stealing until they arrive at six years old." He was also the author of Gulliver's Travels, which was no children's story but a satire of government in his time, and still fresh and juicy today. There, he said, "Whoever could make two ears of corn or two blades of grass to grow where only one grew before, would deserve better of mankind, and do more essential service to his country, than the whole race of politicians put together." Modern science and technology, and politics, hold out the tantalizing prospect of real progress.

Access

Seventeen years after the development of a safe and effective vaccine for hepatitis B, hundreds of thousands of children in the world still do not have access to it. The World Health Organization's (WHO) Global Programme on Immunization has greatly expanded access to vaccines throughout the world, but this delivery system has been delayed by the high costs of purchasing vaccine. All the infectious diseases covered in the Lifesaving Vaccine Technology Act inflict their greatest mortality in the developing world, and often among children.

As the WHO has stated, "Allowing vaccines to slowly filter down to children in the poorer countries over 10-20 years is neither just nor equitable." The increasing use of biotechnology in the design of vaccines means that costs for the vaccines of the future are expected to be higher during their initial patent protected period than today's more traditional products.

The Lifesaving Vaccine Technology Act includes three provisions designed to maximize access to priority vaccines in developing countries.

1. Requires companies to establish a plan for global access to the vaccine. While this provision is non-binding, it will help governments and health authorities put public pressure on companies to work cooperatively to maximize access to vaccines.

2. Support for multi-lateral international efforts, such as a vaccine purchase fund. The World Bank and international public health organizations are moving towards creation of purchase funds and other approaches to expand access to vaccines after they are developed. This provision directs U.S. government agencies to play an active and supportive role in these efforts.

3. Support for flexible or differential pricing as one of several valid strategies to accelerate the introduction of vaccines. This provision gives congressional support to companies that choose to expand access to vaccines by offering lower prices to poorer countries. In the past, U.S. companies have been criticized for these pricing practices.

What's next?

More than 20 members of Congress have already signed on in support of the Lifesaving Vaccine Technology Act. It is also endorsed by the American Public Health Association, Global Health Council, AIDS Action, International AIDS Vaccine Initiative, AIDS Vaccine Advocacy Coalition, Reproductive Health Technologies Project, and Alliance for Microbicide Development. Other organizations are encouraged to send letters of support.

Every effort must be made to support this bill. People should call their representatives in Congress; call the president, vice president, and Office of National AIDS Policy; and talk to friends and relatives in other parts of the country, where key legislators are based.

For more information contact: Chris Collins, Office of Representative Nancy Pelosi, at chris.collins@mail.house.gov; or Sam Avrett, AIDS Vaccine Advocacy Coalition www.avac.com, or Savrett@aol.com; or Bill Snow at WmSnow@aol.com.

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