Attachment 2
Accelerating an AIDS Vaccine for Developing
Countries
RECOMMENDATIONS PUBLISHED BY THE WORLD BANK
AIDS VACCINE TASK FORCE
1. Considering the impact of AIDS in developing
countries both on human and economic development a Task Force
was established at the World Bank to provide an analysis of comparatively
advantageous activities in 1998. In their recommendations the
Task Force now has identified a number of activities for the World
Bank and related agencies/bodies how they may contribute to the
development of an accessible, affordable and appropriate HIV preventive
vaccine for developing countries.
2. The Task Force acknowledges the activities
of the International AIDS Vaccine Initiative (IAVI) to focus subsidies
on vaccine candidates for developing countries and the substantial
public investments in basic research. However, overall HIV preventive
vaccine development activities and investments in this sector
are considered to be low due to the market failures inherent in
the development of a vaccine as a public good, the apparent lack
of individual and public willingness to pay in developing countries
and a low probability of return on investment for private companies.
3. The Task Force acknowledges that the
World Bank is only one of a number of international agencies that
can help to accelerate vaccine development. The European Union
governments of industrialised countries for instance are seen
to be in unique positions to offer tax breaks to industry for
certain types of research and development or to negotiate patent
law, both of which affect incentives to invest in research and
development.
4. The Task Force proposes three major areas
of activities where the World Bank has an advantage over other
actors in accelerating development of a vaccine for developing
countries.
5. Policy dialogue—The World Bank's
credibility and access to treasury and finance officials, as well
as development/health leaders are identified to put it in a strong
position to engage all actors in the policy dialogue surrounding
the development impact of AIDS and the key responsibility of government
to prevent the epidemic. Building on this dialogue on HIV/AIDS,
the World Bank could raise the level of political commitment to
support HIV/AIDS vaccine research and development and help to
forge partnerships between developing countries, industry and
international donors.
6. Push mechanisms. The World Bank could
undertake activities to directly reduce the costs and risks of
AIDS vaccine research and development. Main activities for the
World Bank's involvement in "push" intervention are
through contributions to the International AIDS Vaccine Initiative
and lending to developing country governments for key inputs for
vaccine development or clinical trials.
7. Pull mechanisms. "Pull" interventions
are seen to raise the expectations of a future return for a safe,
affordable, and low-cost vaccine that is effective in developing
countries. Such mechanisms are an expansion of lending for existing
vaccines and immunisation infrastructure, the establishment of
a vaccine purchase fund to be capitalised now or in the future,
contingent loans and guarantees (in which countries contract now
to purchase vaccine in the future), and the generation of a knowledge
base on the potential demand and the strategic use of an HIV preventive
vaccine.
8. The Task Force proposes that a successful
strategy is likely to incorporate intense policy dialogue accompanied
by both "push" and "pull" mechanisms, and
the simultaneous involvement of numerous international actors.
Regulatory policies on patents and liability in industrialised
countries may also have an important effect, but they are seen
to not easily be influenced by the World Bank.
9. The strategy proposed by the Task Force
includes both "push" and "pull" interventions
that build on the comparative advantages of the World Bank. The
proposed strategy uses existing instruments (such as lending,
policy dialogue and analytic capacity) to enable developing countries
to be better partners in AIDS vaccine development. The strategy
includes an increased coverage of childhood immunisation programmes
with existing cost-effective vaccines and the generation of knowledge
on the potential benefits, strategic use of, and public and private
demand for an AIDS vaccine in developing countries.
10. In addition, to ensure the effectiveness
of these efforts, the Task Force proposes that management launched
a broad discussion with the IDA community concerning new IDA-based
mechanisms that would assure adequate finance for a vaccine when
it becomes available, serve as a large, visible, and highly credible
commitment to the market for an AIDS vaccine for developing countries.
In the short run such new mechanisms may also serve to finance
key activities to accelerate the process.
11. One innovative approach the Task Force
considers to be appropriate is a "revolving fund" of
U$ 1 billion within the IDA. The fund would be "topped off"
as necessary at the time of each IDA replenishment, thereby providing
continuing financial commitment. Until a cost-effective vaccine
for the poorest countries becomes available the fund could be
used to lend for other "push" and "pull" mechanisms,
including finance of existing vaccines, AIDS prevention, and developing
country participation in vaccine trials. Part of this fund could
also serve to finance global partnerships or initiatives to address
the needs of poor countries. Simultaneous initiatives or matching
grant funds by other donors and private foundations would—in
the opinion of the Task Force—multiply the impact of World
Bank action.
12. Considering the urgency of the problem
and the inadequacy of existing mechanisms for ensuring rapid development
of the technology for an AIDS vaccine, the Task Force looks to
the meeting of IDA deputies in Lisbon in June 2000 to discuss
its proposals. A formal presentation of the recommendations to
the Board of the World Bank should be scheduled in Spring 2000.
13. Resource requirements for implementation
of the proposed programme are calculated to include U$ 1 million
in staff time for the next three to five years and an additional
U$ 2 million of DGF funding for global partnerships to support
development of an AIDS vaccine.
Summarised by Matthias Weinold, WDP, Hanover
| 
