Burning Questions: Fighting a Silent Killer -- Pneumonia

April 10, 2008
Star-Ledger (USA)

Pneumonia will take the lives of 2 million children this year in developing countries.
Orin Levine, a professor at Johns Hopkins University's Bloomberg School of Public Health, has been touring the world to raise $1.5 billion to entice drugmakers to produce more pneumonia vaccine.

He heads pneumoADIP -- for Pneumococcal Vaccines Accelerated Development and Introduction Plan -- which is underwritten in part by the GAVI Alliance, a global vaccine advocacy group.

Before boarding a recent flight to Switzerland, Levine spoke with The Star-Ledger about his crusade to stop the biggest killer of the world's children.

Q. Who would have thought pneumonia was such a big disease?
A. People are surprised to hear pneumonia is the No. 1 killer of children. It's the cause of more deaths than HIV/AIDS, malaria and measles combined.

Q. Is it preventable?
A. We have good, safe vaccines. In this country, we've vaccinated every kid since the year 2000. But, for a number of reasons, those vaccines are not being used in the poorest countries in the world.

Q. How many doses are needed?
A. Prevnar, a vaccine for infants that protects against seven strains of the pneumococcal bacteria, earns Wyeth Pharmaceuticals about $2 billion a year for producing about 40 million or 50 million doses a year. In the developing world, we need on the order of 200 million doses a year.

Q. Why isn't the marketplace meeting the demand?
A. This is a perfect example where market forces lead to scientific breakthrough, but not the additional research, development and manufacturing capabilities we need for the poorest countries.

Q. How do you fix it?
A. We approached this problem by acknowledging industry is in a commercial environment and can't be asked to lose money on every dose. For developing countries and donor nations, they only have so much resources for these aid projects. It's got to be a sensible and good use of money.

Q. So, the $1.5 billion is the carrot?
A. We're putting upfront the money and setting out the terms. If you make a vaccine that works as well or better than Wyeth's, you can qualify for the $1.5 billion. If a developing country, let's say Haiti, says it likes your vaccine, Haiti will give you the money (from its portion of the fund) and take the vaccine. It's an innovative way for developing countries, donors and industry to all get something they want.

Q. Was this Johns Hopkins' idea?
A. I wish I could claim credit. It was an idea that began with an economist at Harvard and taken up in 2005 by a Washington think tank called the Center for Global Development.

Q. In the pharmaceutical world, $1.5 billion is not a tremendous amount of money. How are the drugmakers responding?
A. The major vaccine suppliers have said they are willing to tailor their vaccines for poor countries and build factories to manufacture as long as they can sell at a price that allows them to break even. They have been very supportive.

Q. Who are your target drugmakers?
A. The way it's set up, any company can (participate) as long as it's a quality vaccine, it meets the criteria and, most importantly, you only get paid if a developing country demands your products. The companies with advance-stage vaccines include GlaxoSmithKlein and Wyeth, and the companies with products in their pipeline are very diverse. We're talking about Big Pharma, but also the Chinese, Cubans, Indians and Brazilians.

Q. What's the end game?
A. If this is successful, and we can meet demand, we can prevent somewhere between 5 million to 8 million child deaths by the year 2030.

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