World Bank HIV Vaccine Industry Study: Draft Summary

We recognise that this idea is neither new, nor without problems both of a legal and
political nature. We would therefore expect its implementation to take some time,
and we would regard it as additive to the other "pull" strategies discussed above.
Arguably, however, the World Bank is one of the few institutions which has a
reasonable chance of overcoming the objections.
"Push" recommendations
"Push" mechanisms are fundamentally less attractive than "pull" mechanisms because
they, by definition, require the selection of a specific approach or company for
support. Whilst more money spent on a very difficult problem might result in a
solution, it is also possible that such money will be misdirected. There is also a risk
of duplication of the work of other agencies.
These comments nothwithstanding, we would recommend that the World Bank
engage selectively in "push" investments, with two objectives:
* Sharing the cost and therefore risk of late stage development
* Reducing the cost and accelerating product adaptation for LDCs where
required.
We therefore recommend that the World Bank pursue LDC lending opportunities to
support the development of trials infrastructure and fund LDC efficacy trials of
vaccine candidates where justified by scientific review. We think it likely that
another agency will need to take a more proactive role in brokering contacts between
Western companies and appropriate potential LDC trial sites.
We also recommend that the World Bank fund product adaptation for LDCs in
advance of efficacy trials.
In general, we do not believe it is appropriate for the World Bank to fund
manufacturing capacity, either directly or through technology transfer. In part, this is
because we believe that capacity will be adequate if effective "pull" mechanisms are
in place, in part because it is hard to see any value to the public sector accruing from
capacity installed in support of vaccines which fail. This is in contrast to trials
funding, which may be expected to advance understanding of the virus, even if no
product results. An exception to this might be where capacity has been fixed prior to
any effective market guarantee being in place.
In conclusion, we do not think that implementation of the measures recommended in
this summary will guarantee the development of an HIV vaccine within any given
timeframe. We believe however that they will have three valuable effects. We would
expect an increase in private sector interest and effort in the field; we think that
access to a vaccine once developed will be vastly enhanced; and we think that the
development of new approaches to meeting global public health priorities will have
significant applicability elsewhere.