Lock in, the state and vaccine development: Lessons from the history of the polio vaccines

摘要

Over the past two decades pharmaceutical industry interest in the development of vaccines against infectious diseases has grown. At the same time various partnerships and mechanisms have been established in order to reconcile the interests of private industry with the needs of public health systems (especially in the developing world). The general assumption is that, lacking resources and competences, the public sector has little or no role to play in vaccine development. Drawing on the concept of 'lock in', and the history of vaccines against poliomyelitis, this paper advances a different set of considerations relevant to the role of the public sector. It was thanks to public sector R&D, driven by technical and public health considerations, not commercial ones, that a vaccine that had been virtually 'locked out' of the world markets was improved, and expertise in its production sustained. This vaccine now plays a crucial role in current attempts at eradicating polio. It is suggested that despite subsequent changes in vaccine technology, their different incentive structure requires acknowledgement in current discussion of the potential contribution of public sector vaccine institutes to vaccine innovation.