-
7/25/2019 The Introduction of Dengue Vaccine
1/12
The Introduction of
Dengue VaccineRichard T. Mahoney,
[email protected]
-
7/25/2019 The Introduction of Dengue Vaccine
2/12
Dengue is Important
Recent studies from Oxford suggest as many as !"million
infections per year
Dengue is the only ma#or infectious disease that isgro$ing
rapidly
There are no drugs or %accines, and %ector controlhas not
&een successful
The &urden of dengue is on health, society, andeconomics
Dengue has long &een underappreciated &ecause ofreliance
on D'()s
-
7/25/2019 The Introduction of Dengue Vaccine
3/12
Vaccine De%elopment
De%elopment has &een slo$* need to protectagainst four
%iruses +D-/01, interference in li%eattenuated %accines, lac2 of an
animal model, lo$
priority.
3y 4"4" there should &e se%eral %accines a%aila&le
4"5 6 7ano8 Pasteur +li%e attenuated1
4"9 6 Ta2eda and 3utantan:-I; +li%e attenuated1
4"! 6 Merc2 +su&unit1 originally de%eloped in ;a$aii
4"! 6 iocru?:alter Reed +puri8ed inacti%ated1
-
7/25/2019 The Introduction of Dengue Vaccine
4/12
Introduction >ailure
A' decade after each study %accine or malariainter%ention $as
appro%ed &y regulators, B
or fe$er lo$er and lo$er/middle incomecountries, and in most
cases less than 5B, had&egun to implement it.... The mean of
thepercentage of lo$ income countries &eginningimplementation
of each inter%ention after 8%e
years $as B and 4"B after " years.... -o lo$income country
implemented any of the ne$%accines in the 8rst 8%e years.A
7ource* 3roo2s ', 7mth T', de 7a%igny D, (engeler C.
Implementing ne$ healthinter%entions in de%eloping countries* $hy
do $e lose a decade or more 3MC
Pu&lic ;ealth. 4"4E12
+FG1* 9.
-
7/25/2019 The Introduction of Dengue Vaccine
5/12
-
7/25/2019 The Introduction of Dengue Vaccine
6/12
Important >rame$or2
'ccess has not &een $ell understood and has not, in my%ie$,
recei%ed the priority it deser%es and $hich thefailure to introduce
a&undantly demonstrates
There are se%eral reasons
Very fe$ donor staH come out of an access, e.g.mar2eting,
&ac2ground. Most often epi, la& or clinic.
'ccess is %ery complex as illustrated &y the
>rame$or2
'ccess professionals ha%e not done a good #o& of
clarifyingstrategies and priorities.
The >rame$or2 nicely di%ides pre/licensure $or2
frompost/licensure $or2 ma2ing it easier to see the
priorityareas.
-
7/25/2019 The Introduction of Dengue Vaccine
7/12
-
7/25/2019 The Introduction of Dengue Vaccine
8/12
Regulatory O%ersight
3ring together regulators from li2ely 8rstadopter countries to
examine issues in detailand discuss li2ely reuirements for
dossiers
>orge an agreement among li2ely 8rstadopter countries for
#oint re%ie$ of dossiers
-
7/25/2019 The Introduction of Dengue Vaccine
9/12
>orecasting
De%elop comprehensi%e models of dengue%accine introduction
comparing large num&erof introduction strategies allo$ing
countriesto understand $hat strategies $ill li2ely ha%ethe greatest
impact on disease.
De%elop comprehensi%e models of dengue
%accine demand &y country gi%en supplyconstraints allo$ing
countries to re8nestrategies
-
7/25/2019 The Introduction of Dengue Vaccine
10/12
-
7/25/2019 The Introduction of Dengue Vaccine
11/12
conomics
Prepare a credi&le cost of goods study topro%ide assistance
to procurement agenciesin negotiating purchase prices.
e sho$ed that CO< should &e much lessthat J."" per dose
at 3utantan facility.
-
7/25/2019 The Introduction of Dengue Vaccine
12/12
7ummary
'fter more than 9" years of eHort it is li2ely thatse%eral
%accines $ill &e a%aila&le for introduction &y
4"4" $ith one in 4"5.
The pu&lic sector has &een %ery poor in introducingne$
technologies particularly to the poorestcountries.
' clear and $or2a&le strategy for accelerating
introduction is needed in light of limited resources
' >rame$or2 such as proposed here could help assurea more
rapid impact on the dengue &urden of disease.
