One of the most significant philanthropic initiatives of 2010 was the start of a "decade of vaccines" supported by the Gates Foundation with a $10 billion commitment to reach more children around the world dying of preventable diseases.

This past week saw significant milestones in new research partnerships, rollouts of immunizations in hard hit countries, and new models for financing and developing vaccines. But with a major shortfall in funding, the effort faces some daunting challenges.

COURTESY OF PATH

Health workers in Burkina Faso prepare to give meningitis vaccinations.

--PATH and the World Health Organization introduced a new vaccine for bacterial meningitis, the first vaccine developed specifically for Africa, based on a new model that cut the cost to one-tenth of the $500 million usually required to bring a new vaccine to market. A key to the success of MenAfriVac, which costs about 50 cents per dose, was transferring technology to a manufacturer in India that was prepared to produce it far less expensively.

--A new vaccine to prevent pneumonia was introduced this week in Nicaragua, the same year it was made available in the United States. The delay in getting vaccines to developing countries has typically been as long as 20 years. Poor nations can't afford them, and drug companies can't make a profit there. But Nicaragua is one of the first places where a program called Advance Market Commitments (AMC) is being tried. While the vaccine was still in the testing phase, drug makers Pfizer and GlaxoSmithKline signed a deal with the Global Alliance for Vaccines and Immunisations (GAVI) to supply millions of doses per year to developing countries at a cost of $3.50 to $7 per dose in exchange for guaranteed purchases.

--PATH, the Seattle-based global health nonprofit, announced a new partnership with Merck and NYU Langone Medical Center to develop a malaria vaccine that would prevent the malaria parasite from entering the liver. PATH's Malaria Vaccine Initiative (MVI) is already working with GSK on another vaccine candidate in the final stage of clinical trials in seven African countries. With that one on the horizon, "we are ramping up our efforts to seek out and invest in scientific approaches for malaria vaccines that could potentially be even more effective and protect more people," said MVI Director Christian Loucq.

--And this week also brought news that British scientists are developing a new type of vaccine to eradicate polio with a "hoax virus" that tricks the body into developing immunity.

Could such milestones pave the way to successfully develop and distribute future vaccines against other big killers -- HIV/AIDS, malaria and tuberculosis?

Bringing multinational pharmaceutical companies, nonprofits, governments and universities together in so called public-private partnerships has enabled progress and is the way of the future, proponents say.

Yet newer vaccines cost more, and GAVI, the global health partnership that leads funding for most vaccines to developing countries, is currently facing a $4 billion funding shortfall. That's because donor nations and private donors are feeling the effects of the global economic crisis.

Reaching people who would benefit most hinges on bringing prices down dramatically, according to report by Oxfam and Doctors Without Borders.

"The new and most expensive vaccines continue to be produced by a handful of multinational pharmaceutical companies whose oligopoly status allows them to charge high prices," the report said.

It called for more vaccine R&D by U.S. public universities and labs, such as the U.S. Army-led development of several vaccines after World War II.

More low-cost producers are emerging in places such as China, India, Brazil and South Africa. MSF and Oxfam held up the PATH and WHO partnership with the Serum Institute of India as the type of model that should be encouraged with donor funds.

Dr. Janet Englund, a Seattle Children's Hospital doctor and professor of pediatric infectious diseases, said even with that model, the cost also depends on the complexity of the specific vaccine.

"If a vaccine is very difficult and expensive to manufacture... even all the best will and effort in the world can't get the price down as low as the MenAfriVac vaccine," she said.

Another issue is intellectual property. "If a particular company owns the technology to make a vaccine," she said, "then there are many legal issues to deal with, in addition to the scientific issues, production issues and the issues dealing with documenting efficacy."

UNICEF estimates that more than 9 million children worldwide under the age of five died from preventable causes in 2007, including pneumonia, diarrhea and malaria. This WHO child mortality report compared the $17 billion spent in North America and Europe on pet food with the $7.5 billion cost of scaling up vaccination and other types of prevention to reach every child in the developing world.

"More innovation is needed," writes Doug Holtzman, senior program officer in infectious diseases at the Gates Foundation. "In addition to expanding access for current vaccines, we must develop new vaccines that protect against a broader range of disease types and are more affordable."