Of preventives and cures

A couple of weeks ago, Gordon Brown, Britain8217;s Chancellor of the Exchequer, made a promise. The United Kingdom, he said, would buy up t...

A couple of weeks ago, Gordon Brown, Britain8217;s Chancellor of the Exchequer, made a promise. The United Kingdom, he said, would buy up to three hundred million doses of a new malaria vaccine for the developing world. It was a welcome sign that the West is finally paying attention to the most important problem in global public health; namely, the spread of infectious diseases like malaria, tuberculosis, and AIDS. It was also something else: a dramatic innovation in the way those diseases are fought.

That8217;s because the vaccine that the UK promised to buy doesn8217;t exist yet. There are several good candidates for a malaria vaccine, and one of them, being developed by GlaxoSmithKline, showed excellent results recently in a clinical trial in Mozambique, where it cut the risk of developing severe malaria by fifty-eight per cent. But there are still years of testing and hundreds of millions of dollars in development costs before any viable product could be sold. What Brown8217;s announcement guarantees is that if an effective vaccine emerges there will be someone to buy it at a fair price.

Usually, a company that invents something useful doesn8217;t have much trouble selling it. But vaccines 8212; especially for diseases in the developing world8212;are notorious exceptions to this rule. To begin with, Third World countries have unimaginably tiny amounts to spend on public health8230; And then the market value of a vaccine may be a fraction of its social value. If you8217;re vaccinated, it not only makes you safer; it makes me and my children safer, too. So though you might be willing to pay the vaccine-maker just two dollars for a shot, its value to your community might be twenty times as great. Governments, of course, could make up the difference, but, historically, they haven8217;t been willing to. Instead, they8217;ve used their regulatory and bargaining powers to drive prices down to the bare minimum.

The result is that drug companies have put very little money into vaccine research. They8217;d much rather invest in an anti-arthritis drug that well-insured Americans will take every day than a vaccine that may never command a fair price8230;

When the private sector isn8217;t providing the innovations we need, the traditional answer is to have the government stump up for R038;D. This is what8217;s called 8220;push8221; funding, because the government chooses among various options and gives its favorites a push. In the case of a malaria or TB vaccine, this means that the government sizes up candidates, offers grants, and subsidises drug companies, universities, or its own research teams as they experiment with the vaccines. In fact, that8217;s what the United States did at the beginning of the nineteen-eighties, when it funded a number of malaria-vaccine projects.

Excerpted from an article by James Surowieck in the December 20 issue of 8216;The New Yorker8217;