1
|
Malvolti S, Pecenka C, Mantel C, Malhame M, Lambach P. A financial and global demand analysis to inform decisions for funding and clinical development of GBS vaccines for pregnant women. Clin Infect Dis 2021; 74:S70-S79. [PMID: 34725684 PMCID: PMC8775646 DOI: 10.1093/cid/ciab782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Despite group B Streptococcus (GBS) being a leading cause of maternal and infant morbidity and mortality, no vaccine is currently available. To inform vaccine developers, countries, and funders, we analyzed the key factors likely to influence the demand for a GBS vaccine and the long-term financial sustainability for a vaccine developer. Methods Using population-based forecasting, we estimated the demand for a GBS vaccine; using a discounted cash flow model we estimated the financial viability for a vaccine developer. Results Demand for this vaccine can be significant if countries adopt policy recommendations for use, in particular, the largest ones, most of which have a burden that justifies use of the vaccine, and if financing for the vaccine is made available either by countries or by funding mechanisms such as Gavi, the Vaccine Alliance. Conclusions This analysis suggests the potential for financial and commercial viability for a vaccine developer pursuing the commercialization of a GBS vaccine. Risks exists in relation to the clinical trial design and costs, the level of competition, countries’ ability to pay, the administration schedule, and the availability of policies that encourage use of the vaccine. To reduce those risks and ensure equitable access to a GBS vaccine, the role of donors or financers can prove very important, as can a coordinated operational research agenda that aims at clarifying those areas of uncertainty.
Collapse
Affiliation(s)
| | | | | | | | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Kaye PM, Mohan S, Mantel C, Malhame M, Revill P, Le Rutte E, Parkash V, Layton AM, Lacey CJ, Malvolti S. Overcoming roadblocks in the development of vaccines for leishmaniasis. Expert Rev Vaccines 2021; 20:1419-1430. [PMID: 34727814 PMCID: PMC9844205 DOI: 10.1080/14760584.2021.1990043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/04/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The leishmaniases represent a group of parasitic diseases caused by infection with one of several species of Leishmania parasites. Disease presentation varies because of differences in parasite and host genetics and may be influenced by additional factors such as host nutritional status or co-infection. Studies in experimental models of Leishmania infection, vaccination of companion animals and human epidemiological data suggest that many forms of leishmaniasis could be prevented by vaccination, but no vaccines are currently available for human use. AREAS COVERED We describe some of the existing roadblocks to the development and implementation of an effective leishmaniasis vaccine, based on a review of recent literature found on PubMed, BioRxiv and MedRxiv. In addition to discussing scientific unknowns that hinder vaccine candidate identification and selection, we explore gaps in knowledge regarding the commercial and public health value propositions underpinning vaccine development and provide a route map for future research and advocacy. EXPERT OPINION Despite significant progress, leishmaniasis vaccine development remains hindered by significant gaps in understanding that span the vaccine development pipeline. Increased coordination and adoption of a more holistic view to vaccine development will be required to ensure more rapid progress in the years ahead.
Collapse
Affiliation(s)
- Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Sakshi Mohan
- Centre for Health Economics, University of York, Heslington, York, UK
| | | | | | - Paul Revill
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Epke Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vivak Parkash
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Alison M. Layton
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Charles J.N. Lacey
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | | |
Collapse
|
3
|
Malvolti S, Malhame M, Mantel CF, Le Rutte EA, Kaye PM. Human leishmaniasis vaccines: Use cases, target population and potential global demand. PLoS Negl Trop Dis 2021; 15:e0009742. [PMID: 34547025 PMCID: PMC8486101 DOI: 10.1371/journal.pntd.0009742] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/01/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
The development of vaccines against one or all forms of human leishmaniasis remains hampered by a paucity of investment, at least in part resulting from the lack of well-evidenced and agreed estimates of vaccine demand. Starting from the definition of 4 main use cases (prevention of visceral leishmaniasis, prevention of cutaneous leishmaniasis, prevention of post-kala-azar dermal leishmaniasis and treatment of post-kala-azar dermal leishmaniasis), we have estimated the size of each target population, focusing on those endemic countries where incidence levels are sufficiently high to justify decisions to adopt a vaccine. We assumed a dual vaccine delivery strategy, including a wide age-range catch-up campaign before the start of routine immunisation. Vaccine characteristics and delivery parameters reflective of a target product profile and the likely duration of the clinical development effort were considered in forecasting the demand for each of the four indications. Over a period of 10 years, this demand is forecasted to range from 300-830 million doses for a vaccine preventing visceral leishmaniasis and 557-1400 million doses for a vaccine preventing cutaneous leishmaniasis under the different scenarios we simulated. In a scenario with an effective prophylactic visceral leishmaniasis vaccine, demand for use to prevent or treat post-kala-azar dermal leishmaniasis would be more limited (over the 10 years ~160,000 doses for prevention and ~7,000 doses for treatment). Demand would rise to exceed 330,000 doses, however, in the absence of an effective vaccine for visceral leishmaniasis. Because of the sizeable demand and potential for public health impact, a single-indication prophylactic vaccine for visceral or cutaneous leishmaniasis, and even more so a cross-protective prophylactic vaccine could attract the interest of commercial developers. Continuous refinement of these first-of-their kind estimates and confirmation of country willingness and ability to pay will be paramount to inform the decisions of policy makers and developers in relation to a leishmaniasis vaccine. Positive decisions can provide a much-needed contribution towards the achievement of global leishmaniasis control.
Collapse
Affiliation(s)
| | | | | | - Epke A. Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, United Kingdom
| |
Collapse
|
4
|
Affiliation(s)
| | | | | | | | | | - Greg Widmyer
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| |
Collapse
|
5
|
Malhame M, Baker E, Gandhi G, Jones A, Kalpaxis P, Iqbal R, Momeni Y, Nguyen A. Shaping markets to benefit global health - A 15-year history and lessons learned from the pentavalent vaccine market. Vaccine X 2019; 2:100033. [PMID: 31384748 PMCID: PMC6668221 DOI: 10.1016/j.jvacx.2019.100033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 11/18/2022] Open
Abstract
Market shaping for health products used in lower-income countries strives to benefit public health. As a funder of vaccines, Gavi, The Vaccine Alliance (Gavi) has goals for its market shaping efforts, achieved through a strategy developed and implemented by the Gavi Secretariat, UNICEF, the World Health Organization (WHO) and the Bill & Melinda Gates Foundation (BMGF). A case-study of Gavi's fifteen-year engagement with a vaccine against diphtheria, tetanus, pertussis, hepatitis B and haemophilus influenzae type b (pentavalent) provides evidence of the benefits and potential risks of trying to influence markets. During 2001-18, Gavi disbursed US$3.5 billion to support use of 50 million pentavalent doses annually before 2005, increasing to ∼300 million doses annually by 2016. During this time, eight manufacturers invested in vaccine development and manufacturing and the first two manufacturers have subsequently ceased production. Following its strategy, Gavi implemented coordinated market interventions including technical assistance to manufacturers, improving market information transparency, risk-sharing agreements and innovative procurement aiming to stimulate and capitalize on a competitive market. In 2018 supply allows ∼80 million children per year to be immunised, a sixteen-fold increase from 2005, with vaccine-related costs per child for donors and countries of one-quarter the 2005 level. Lessons learned include the importance of frameworks and strategies; the need to adjust interventions with changing conditions; the important role of manufacturers; and the potentially powerful effects of interconnected markets. This case study is limited by its focus on a single health product in a specific market, however the lessons can inform other market shaping efforts when taken in context. While countries and children have improved vaccine access, risks of financial sustainability and continued manufacturer investment in Gavi vaccine markets are being monitored. Gavi should continue implementing a market shaping strategy, adjust with market conditions and expect and measure unintended consequences.
Collapse
Key Words
- B, billion
- BMGF, The Bill & Melinda Gates Foundation
- DALY, disability-adjusted life-years
- DTP, diphtheria tetanus pertussis vaccine
- DTwP, diphtheria tetanus whole-cell pertussis vaccine
- Gavi, Gavi The Vaccine Alliance
- Global health
- HMF, Healthy Market Framework
- HepB, hepatitis B vaccine
- Hib, haemophilus influenzae type b vaccine
- IPV, inactivated polio virus
- Immunisation
- M, million
- MIC, middle-income country
- Market dynamics
- Market shaping
- NRA, National Regulatory Authority
- PAHO, Pan American Health Organization
- PRG, Procurement Reference Group
- Pentavalent
- Roadmap, Supply and Procurement Roadmap
- SPS, Supply and Procurement Strategy
- US$, United States Dollar
- Vaccines
- WAP, weighted average price
- WHO, World Health Organization
Collapse
Affiliation(s)
- Melissa Malhame
- Corresponding author at: 1041 Talbot Avenue, Albany, CA 94706, USA.
| | - Edward Baker
- Gavi, The Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, Grand-Saconnex 1218, Switzerland
| | - Gian Gandhi
- UNICEF Supply Division, Oceanvej 10-12, Copenhagen 2150, Denmark
| | - Andrew Jones
- The Bill & Melinda Gates Foundation, 500 Fifth Ave. North, Seattle, WA 98109, USA
| | - Philipp Kalpaxis
- UNICEF Supply Division, Oceanvej 10-12, Copenhagen 2150, Denmark
| | - Robyn Iqbal
- The Bill & Melinda Gates Foundation, 500 Fifth Ave. North, Seattle, WA 98109, USA
| | - Yalda Momeni
- UNICEF Supply Division, Oceanvej 10-12, Copenhagen 2150, Denmark
| | - Aurelia Nguyen
- Gavi, The Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, Grand-Saconnex 1218, Switzerland
| |
Collapse
|