Gates Foundation commits $200M to develop affordable childhood vaccines

Last week, stakeholders in the global health landscape gathered at the 2nd Global Forum on Childhood Pneumonia in Madrid, Spain, where new commitments to combat the condition that kills about 700,000 children yearly were announced. At the forum, the Bill & Melinda Gates Foundation announced a new $200 million commitment to be awarded over the next 18 months to support the development and delivery of vaccines to prevent pneumonia, meningitis, and neonatal sepsis. Keith Klugman, director for pneumonia and pandemic preparedness at the Gates Foundation, said most of the money would go toward the development of affordable vaccines. These include four vaccines to address some of the leading causes of childhood mortality: The next-generation pneumococcal conjugate vaccine, or PCV; a vaccine for respiratory syncytial virus, or RSV; a vaccine for Group B streptococcus, or GBS, and developing a vaccine for Klebsiella. Having to introduce multiple vaccines could be beyond the reach of many countries and as such, Klugman said the foundation is trying to partner with the companies that are making these products. “They can make their profit in rich countries, but we want to ensure that the vaccine is available and affordable to Gavi [the Vaccine Alliance] and for poor countries as a charitable institution,” he said. By making contributions, Klugman said the foundation is striving to ensure that the time between the rollout of the vaccine in high-income countries and its rollout to Gavi countries is the shortest possible. “The funds that we've been describing here are all related to hopefully things that will change mortality in children dramatically by not only making sure that these vaccines reach clinical success and are actually made, but are available to poor countries,” Klugman said. For some middle-income countries where PCV has just been too expensive, the foundation revealed it funded the development of a more affordable next-generation pneumococcal conjugate vaccine, Pneumosil, under a partnership between the Serum Institute of India and PATH. About 22% of all pneumonia-related deaths are in children under 2 years old. Pneumonia has also been described as a major killer of children under 6 months of age who are being targeted with PCV. But following a child’s first month of life, the leading cause of pneumonia and deaths is RSV. “It's very exciting that now the first RSV vaccine for prevention of RSV disease in young children has been developed,” Klugman said. In February Pfizer submitted a biologics license application for its RSV maternal vaccine candidate to the U.S. Food and Drug Administration. A decision is expected in the second half of 2023. The Pfizer RSV vaccine is given to pregnant women who then make antibodies that cross the placenta and protect their babies. Klugman said if the vaccine is approved for introduction in America, it will completely transform the landscape and many countries in Africa will start to demand it. “RSV is the next very exciting vaccine,” he said. “We're working at the Gates Foundation to try and figure out how we can meet that demand and what studies would have to be done in poor countries.” On Wednesday the FDA licensed an RSV vaccine for adults — GSK’s Arexvy for adults ages 60 and older. The Gates Foundation is also working to protect children against the leading cause of death during their first day of life and a major cause of stillbirths, Group B streptococcus. Klugman revealed a GBS vaccine that the foundation is backing would be going to phase III clinical trials later this year. Attention is also being given to Klebsiella, which is a major cause of death for children born prematurely. “There is no Klebsiella vaccine either and so we're beginning to start to work to see if we can find a pathway,” Klugman noted. Gavi used the forum to commit to ensuring the sustainable and equitable introduction of the PCV vaccine in both former- and never-Gavi-eligible countries. This, it said, includes providing technical assistance, flexible funding for one-off vaccine introduction costs, and vaccine catalytic financing. Similarly, it said it is also working with partners to foster sustainable markets, raise awareness of new vaccine options, and build political will to prioritize pneumonia-fighting vaccines appropriate for each country's context. Gavi said it would also consider requests to waive co-financing obligations for the introduction of the PCV vaccine for countries that have experienced significant humanitarian crises for at least four years, which severely hinder the government's ability to meet co-financing requirements. At the forum, the health ministry of Somalia said the government would apply to Gavi to introduce PCV, rotavirus, and measles-rubella vaccines into routine childhood vaccination in 2023. “To realize this objective, the government requests a waiver for the co-financing of these vaccines that are critical to the reduction of the pneumonia burden in Somalia,” the ministry stated in their official declaration. No official response was publicly provided for Somalia’s request, but Gavi indicated that such a decision would be made by its board and be based on an assessment of the severity of the circumstances, the impact on the country's ability to co-finance, and its capacity to launch and sustain the new vaccine program. While a Gavi board decision regarding Somalia’s waiver application could provide antecedence on how to handle similar requests, the country and several others have committed to expanding their immunization programs. For countries where their high coverage of routine immunization programs was affected by the COVID-19 pandemic, they committed to getting it back to the pre-pandemic levels where they were reaching over 90% of all qualified children. There were also commitments to reach and reduce the number of zero-dose children and introduce already existing vaccines such as PCV and the vaccine for rotavirus, and others that some countries are yet to roll out.