World Bank HIV Vaccine Industry Study: Draft Summary

as lacking commercial credibility. They may therefore somewhat discount promises
over a hypothetical future product which are at variance with their current experience.
Preferences for different types of guarantee mechanism
Given the focus on risk, most of our conversations did not result in a systematic and
detailed discussion of this topic, and in many cases, such a discussion would have
been inappropriate.
The idea of a development prize found little favour with companies, whereas most
companies felt either a purchase fund or a per dose subsidy fund would be attractive.
However, most companies were clearly uncomfortable with the very hypothetical
nature of a conversation around details of how such a fund might work in practice,
given that in most cases product characteristics such as efficacy and production cost
have yet to be defined. A number of companies suggested that it would be useful for
the public sector to generate a minimum set of criteria which a vaccine should meet.
Further, it was suggested that the public sector should create scenarios as to efficacy,
demand, capacity and cost to begin to form the basis for a dialogue on mechanism
details.
Whilst most companies indicated understanding of, and support for, tiered pricing,
there was concern to emphasise that the lowest price would likely be dollars rather
than cents per dose. Some companies also expressed the concern that any subsidy or
purchase mechanism not cannibalise more wealthy market segments and therefore
segmentation would need to be applied.
Finally, some of the companies involved in the existing market felt that the best way
to attract investment for future product development for LDCs was to establish a
commercially attractive market for today's products. In effect, this suggestion would
create a situation analogous to OECD markets, where the development of future
products is funded from the revenue of today's products.
4. Interpretation and recommendations
A caveat
Our conversations with companies on what the public sector might do to stimulate
HIV vaccine development efforts ranged well beyond our original brief to examine
market based mechanisms. However, our client, The World Bank, is restricted by
charter and policy in what it can support. Our aim is to make recommendations where
the World Bank has a key or leading role to play. It is our hope that ideas outside the
World Bank's scope or competence will be shared with other public sector agencies
for their consideration.
A composite problem
We see four components to the problem of accelerating the development and
introduction of an HIV vaccine for the developing world. The fact that this is a

composite problem strongly suggests that it will not be susceptible to a single "silver
bullet" solution, market based or otherwise.