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2 Vaccines: Part 2 Supply and demand Professor Melissa Leach - Brighton, UK All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

3 Current SUPPLY challenges

4 Infrastructure and access "VaccineBySandraRugio" by Sandra Rugio

5 Infrastructure and access Ensuring coverage with basic existing vaccines now recognised to require a health systems approach "VaccineBySandraRugio" by Sandra Rugio

6 Expanding coverage with newer antigens "Clark- Offit- rotavirus- inventors" by The Children's Hospital of Philadelphia All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

7 Expanding coverage with newer antigens Especially: hepatitis, meningitis, pneumococcus, rotavirus "Clark- Offit- rotavirus- inventors" by The Children's Hospital of Philadelphia All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

8 Developing variants "Saving Lives with SMS for Life" by Jeffrey Gluck All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

9 Developing variants Bespoke solutions for particular regions/populations/epidemiological conditions "Saving Lives with SMS for Life" by Jeffrey Gluck All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

10 Near eradication Poliodrops" by USAID - USAID Bangladesh

11 Near eradication Challenges and live vaccines, particularly with polio Poliodrops" by USAID - USAID Bangladesh

12 Developing new vaccines "Gardasil vaccine and box new" by Gardasil_vaccine_and_box.jpg: Jan Chris:an

13 Developing new vaccines Some recent successes (e.g. HPV), but some key diseases highly challenging due to nature of microbehost interaction (e.g. malaria, HIV) "Gardasil vaccine and box new" by Gardasil_vaccine_and_box.jpg: Jan Chris:an

14 Developing delivery technologies "14234CDC Flumist" by CDC/ Douglas Jordan, M.A All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

15 Developing delivery technologies Vaccines without needles or refrigeration "14234CDC Flumist" by CDC/ Douglas Jordan, M.A All course materials are published by the ARCADE Projects under the Crea:ve Commons A<ribu:on Non- commercial- ShareAlike 3.0 Unported license.

16 Funding for innovation Flickr/Lester Public Library

17 Funding for innovation Southern and one-off markets less profitable for pharmaceutical companies Flickr/Lester Public Library

18 Funding for innovation Vertical Horizontal

19 Funding for innovation Silver bullet, disease-specific funding versus health systems strengthening Vertical Horizontal

20 Demand constraints Supply challenges

21 Types of vaccination DEMAND Passive compliance Social demand Active demand Culturallygrounded active demand Under pressure from health workers Based on a perception of general benefits from vaccination, or general trust in biomedicine Adherence to vaccination programs by an informed public that perceives the benefits of and need for specific vaccinations in biomedical terms Based on specific, sometimes nonbiomedical, reasons for appreciating vaccination

22 And NON-DEMAND A pejorative discourse Willingness but inability to go Refusal of specific vaccinations Resistance, questioning the whole need for vaccination Narratives implicit and explicit in the approaches of policymakers and frontline health workers How demand and the reasons for it are understood shapes the policy strategies adopted

23 Sources Slide 4 VaccineBySandraRugio" by Sandra Rugio vacina_ofelia.jpg. Licensed under Creative Commons Attribution 3.0 via Wikimedia Commons Slide 5 "Clark-Offit-rotavirus-inventors" by The Children's Hospital of Philadelphia (photo credit) - Figure 3 (doi: /journal.pbio g003) of: Gross L (2009). "A broken trust: lessons from the vaccine autism wars". PLoS Biol 7 (5): e DOI: /journal.pbio PMID PMC: Licensed under Creative Commons Attribution 2.5 via Wikimedia Commons Slide 6 "Saving Lives with SMS for Life" by Jeffrey Gluck from USA - Saving Lives with SMS for Life. Licensed under Creative Commons Attribution 2.0 via Wikimedia Commons

24 Sources Slide 7 Poliodrops" by USAID - USAID Bangladesh. Licensed under Public domain via Wikimedia Commons Slide 8 "Gardasil vaccine and box new" by Gardasil_vaccine_and_box.jpg: Jan work: Photohound (talk) - Gardasil_vaccine_and_box.jpg. Licensed under Creative Commons Attribution-Share Alike 2.0 via Wikimedia Commons Slide 9 "14234CDC Flumist" by CDC/ Douglas Jordan, M.A. - CDC PHIL, image # Licensed under Public domain via Wikimedia Commons Slide 10 Bill and Melinda Gate Foundation Flickr/Lester Public Library

http://www.arcade-project.org Vaccines: Part 1 A history of policy context, impacts and approaches Professor Melissa Leach - Brighton, UK All course materials are published by the ARCADE Projects under

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