HEALTH CARE/Joan Retsinas

Philanthropy at the G8: Vaccines

Philanthropy at the G8 sounds like an oxymoron. This elite cadre began in the mid-1970s as the G6: the United States, France, the United Kingdom, Germany, Italy and Japan. Canada and Russia joined later. These are the "have" nations.

This club ponders such weighty concerns as climate change, computer crime, terrorism and trade. The group is not a social service agency. Stressing the global interconnectedness of nations, the G8 is vitally interested in its trading partners -- the "have-less" countries with strong emerging markets that promise wealth for investors. The G8 is less interested in the "have-not" countries.

Africa is a continent of "have-not" countries. Once upon a time, the "have" countries seized on Africa, mining its ores, deforesting its timber and harvesting its crops. Yet decades of searing poverty, genocidal wars, political corruption, million-dollar debt, epidemic diseases and famine have reduced the utility of Africa as a trading partner. Cruelly put, the G8 nations -- some of which exploited entire peoples under colonial rule -- no longer have such strong strategic interests there. Even the debt is uncollectible.

So the G8's recent decision to intervene in the vaccination market deserves praise. Africa needs vaccines. Millions of people die from diseases that might be halted by vaccines.

In the traditional economic model, need will translate into demand and demand will spur supply. If millions of people suffer from a disease, that suffering will spur pharmaceutical companies to research cures. Remember the polio epidemic in the United States in the 1950s: The Salk and Sabin vaccines followed soon afterward. The company that makes the successful vaccine can make a profit. If the pharmaceutical companies don't espy sufficient profit, the government will offer incentives.

Today Americans are vaccinated for a medley of diseases, including whooping cough, polio, smallpox, diphtheria, measles and chicken pox. Yet, consider rotavirus. It can cause fatal diarrhea. Hardly any American gets it; hardly any American internist diagnoses it. Yet in the developing world, thousands of children have it.

The need for a vaccine for rotavirus is huge. But in money terms, the demand is nil. Africans are too poor to constitute the sort of consumer demand that would spur pharmaceutical companies. And African governments are too poor to offer subsidies to those companies.

As for pharmaceutical companies, they are not social service agencies either. They exist to make a profit for their shareholders (a group that includes the millions of Americans with IRAs and 401(k)s in mutual funds). The companies will not invest money in developing a vaccine without the prospect of compensation. They may not expect the blockbuster profit they make from a new anti-cholesterol drug, but they don't expect to lose money.

At a recent meeting, the G8 nations pledged to give companies the crucial incentive. As a pilot, the G8 nations would offer from $800 million to $6 billion to subsidize the purchase of a vaccine for one disease. Presumably, companies would compete to make the best vaccine. Eventually, the successful manufacturer would sell the vaccine at a discount.

Logistical decisions remain. The G8 must pick one disease from six contenders: HIV/AIDS; malaria; tuberculosis; pneumococcus; rotavirus; and human papillomavirus. Each virus has its lobby, and the arguments for malaria over HIV or pneumococcus over tuberculosis show the limits of G8 philanthropy. This is a competition, and one disease will win the prize.

The G8 must also decide each country's contribution. That may test the philanthropic enthusiasm of member-nations. Finally, the G8 must convince pharmaceutical manufacturers to accept this pledged subsidy.

There are naysayers who argue that, more than vaccines, African nations need a strong public health infrastructure, clean water, low-cost preventive measures (like mosquito netting to guard against malaria-carrying mosquitoes) and food. Yet the argument for vaccines need not be framed as a set of choices. Of course African nations need more than vaccines. But they need vaccines too.

The G8 nations are pledging to manipulate market forces to propel pharmaceutical companies to make those vaccines. For the "have" nations, that marks an overdue investment in a much-exploited continent.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, April 15, 2006

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