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AIDS vaccines could one day be an important tool for bringing the HIV pandemic under control - but only if they are made available to everyone who needs them. Therefore, to be truly effective, an HIV/AIDS vaccine would have to be readily available to and affordable for all men, women and children living throughout the world.
Plans for ensuring access cannot wait until we have already identified an effective vaccine. Experience with other vaccines, such as the Hepatitis B vaccine, has shown that there can be considerable delays between licensure and actual access in the developing world. Each year, three million children in the world die of diseases that could have been prevented with vaccines that exist today. This inequitable model must not be repeated with AIDS vaccines.
In order to ensure ready access, multiple political, economic and structural challenges must be addressed with action and advocacy.
One of the first challenges is financing. Over 95% of new HIV infections occur in resource-limited countries where governments and individuals have extremely limited funds to purchase vaccines and other health care products. International organizations such as UNICEF and the Vaccine Fund distribute vaccines internationally. These entities could help to purchase HIV/AIDS vaccines when they become available, but it is likely that additional funding commitments will be needed to manufacture, purchase, ship, store and distribute the vaccine. In order to ensure rapid global access to an AIDS vaccine, rich countries, international organizations, and other funders will need to work together to create significant resources to purchase and deliver HIV/AIDS vaccines in advance of their discovery.
Today there are some useful models for how this might happen. The Global Fund to Fight AIDS, Malaria, and TB is one example of an international effort to expand purchasing capacity for necessary health products. In the past, legislative proposals have sought to create purchase funds for AIDS and other vaccines. Others have proposed that donor countries and donor organizations "pre-commit" to buying AIDS vaccines for global use when these products become available under so-called Advanced Market Commitments (AMCs). The AMC concept, as a method of encouraging investments in neglected diseases, was endorsed by the G-7 finance ministers in 2005.
Another challenge is health care infrastructure (including health clinics, laboratory facilities, and trained health care personnel) in many communities where vaccines will be needed. Many resource-poor countries have childhood immunization programs which achieve relatively high levels of national coverage. But an HIV/AIDS vaccine which is, initially, likely to be delivered to adults, will probably require new delivery systems including staff, clinics, storage, transportation and a host of other inputs which are lacking in many settings around the world. We know this is likely to be the case because coverage rates of highly-affordable vaccines which can be distributed through existing childhood immunization programs are still quite low. The vaccine for yellow fever is sold for as little as four cents (US$0.04) and yet millions of children still do not receive the vaccine.
The Global Alliance for Vaccines and Immunization (GAVI), UNICEF, and other organizations are working to improve immunization rates around the world and we must continue advocacy work in this vein so that when an effective HIV/AIDS vaccine becomes available, it can be distributed to those who need it most.
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