番茄社区

This is a sidebar to a story on whether global polio eradication can be achieved.

While the novel oral polio type 2 vaccine (nOPV2) offers some hope that poliovirus may still be eradicated globally, supply-side issues have posed long-standing challenges to global vaccination programs.

Awi Federgruen, PhD, of Columbia Business School and a board member of , said vaccine production is still the most critical and most overlooked factor in global eradication efforts.

The current marketplace for poliovirus vaccines is under-prepared to meet the needs of people around the world in ramping up vaccine campaigns, even without the addition of nOPV2, Federgruen said.

"It is very much a supply chain problem," he told 番茄社区. "The supply side is probably the most important bottleneck at this point."

Federgruen doesn't want to downplay concerns about lagging vaccine uptake in communities with historically low rates of immunization, but he believes the most pressing concern is the capacity of pharmaceutical companies to produce the necessary supply to ensure those campaigns are successful.

Supply issues will likely lead to "major shortfalls over the next decade, even at the end of the next decade, because there [isn't] enough capacity," he said.

Still, there is time to address this problem, he said. Government programs that encourage public-private partnerships in vaccine production could reverse the trend of decreasing supply. The reason for the decline in vaccine production, he said, is the lack of financial return to the companies that are investing resources to produce polio vaccines. It's a losing business model, but a program designed to support pharmaceutical companies that make those investments could help increase supply over time, he said.

"Suppliers aren't ready to enter the market because the prospective revenue costs or investment costs are enormous," Federgruen said. "They need to be paid back over a long period of time, and the revenue stream -- given the commitments that purchasing organizations have been making -- is very uncertain for the future."

One past example, which Federgruen described in , involved the creation of a $1.5 billion fund that repaid companies based on the level of investment made to produce "a pneumococcal vaccine for low-income countries."

But there are other less expensive ways to encourage investment in producing more polio vaccines, according to Federgruen. He suggested that governments could start making longer-term commitments to purchase vaccine supplies over a decade or more. This method would allow companies to invest and plan for a longer future of vaccine development and supply, he said.

This level of commitment from companies will be critical for future support of global immunization efforts, Federgruen said. He also noted that the ability to meet demand could become even more important because of the possibility that eradication is no longer the endgame for poliovirus.

"These are problems that can be contained successfully as we have been doing with polio, but they can't be eliminated. The name of the game is containment," he said. "But containment requires discipline and requires routine vaccination campaigns."

The discipline and regular immunization efforts, he said, will likely continue to increase demand for those vaccines as the world transitions from a plan of eradication to one of containment.

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