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A DEMANDING PROJECT: To rapidly disseminate products such as a future AIDS vaccine into the developing world, public health experts believe they must better gauge the demand for such products in poor countries.
© KAREN KASMAUSKI/CORBIS

Supplying desperately needed medicines to the developing world would be a lot easier if Big Pharma would bring its considerable resources to bear on the problems of global health. But even when public health groups can convince firms to supply their drugs at reduced cost, another problem remains: the countries in need can be unpredictable in their buying habits.

Consider that malaria affects more than 500 million people worldwide, and yet this past summer the Financial Times reported that French drugmaker Sanofi-Aventis faced half the demand it had expected for its anti-malaria compound artesunate. As a result, the company was contemplating destroying up to 10 million tablets of the drug. Swiss pharmaceutical giant Novartis had complained of similar troubles. After scaling up production of its malaria medication Coartem to 30 million treatments in 2005, it received orders for only 14 million treatments.

The global public health community has become increasingly sensitive to the problem of forecasting the developing world's actual demand for medicines, as opposed to the raw need. In one sign of the change, the Center for Global Development, an influential Washington, D.C.-based think tank, has convened a panel of economists, consultants and representatives from industry and public health to make recommendations for forecasting practices.

Among the groups leading the way are those devoted to global vaccine development, which already partner with firms to bring vaccine programs closer to fruition. Now these so-called public-private partnerships (PPPs) are constructing models designed to better understand the factors that influence developing nations' decisions about whether or not to adopt new vaccines.

Their projects run the gamut from relatively short-term analyses of emerging vaccines to more prospective, exploratory studies for still distant products. For the near term, groups known as accelerated development and introduction plans (ADIPs) have studied the possibility of more rapidly introducing new vaccines for rotavirus, a common diarrheal disease, and pneumococcus, a bacterium that causes pneumonia.

Looking farther ahead are partnerships such as the International AIDS Vaccine Initiative (IAVI) and the Malaria Vaccine Initiative, both of which have begun or completed new forecasting projects in the past two years.

The hope is that improved forecasting will increase demand as well as cooperation between industry and public health, which could in turn lead to greater investments. "It means everybody goes in with their eyes open," explains Wendy Woods of the Boston Consulting Group, which has worked with IAVI and other PPPs. "It's important for both sides to make the right decisions and know what to expect."

Catch-22, If not 33

Unpredictable demand creates a three-way catch-22 problem, as pointed out in a 2002 study commissioned by the GAVI Alliance, formerly the Global Alliance for Vaccines and Immunization. Poor countries have to know the price of a vaccine to see if they can afford it. Manufacturers, however, are hesitant to set a price unless they know how many doses will be bought. And aid donors cannot be sure they can subsidize a purchase without knowing the price and quantity of the sale.

Vaccine purchases have occurred anyway, but not without difficulty. In 2002, when GAVI convinced suppliers to manufacture extra courses of an existing vaccine against Haemophilus influenzae type b, poor countries were slow to buy it. "We were very naive at that time and thought countries would take up the vaccine much faster than they did," recalls Michel Zaffran, the group's deputy executive secretary. "The tools that we had available were very poor."

Hoping to keep from alienating manufacturers, GAVI instituted the ADIP programs in 2003. The new approach adopted by the ADIPs and other PPPs makes use of interviews with health officials in developing countries to figure out the preferences of those nations. Prior HIV vaccine forecasts, for example, failed to take into account the influence of price and political willingness on potential demand, says Gian Gandhi, manager of policy research and analysis for IAVI.