PharmTech: Some goals of the administration and of USAID are to increase access to healthcare and treatment in developing nations, shorten the time of getting new vaccines to market (moving a 15-20 year timeframe closer to 1-5 years), and accelerating scale up of drug development. In what ways is USAID working to achieve these goals? Are there other important goals on USAID¹s agenda in terms of global health efforts?

Batson: One of the major obstacles to providing timely and quality treatment in the developing world is the inability to access health facilities. The reasons for this are many. Often times the nearest clinic is simply too far from the community where an individual lives. Other times the costs of services are too high or social norms prohibit women from seeking the care they so desperately need.

Through the Global Health Initiative, we are working to integrate healthcare services, so that when a woman travels to a clinic to receive treatment for HIV, she doesn’t have to travel to another clinic for pediatric services for her child. We are also working to train and empower community health workers who bring critical health services directly to the communities. The idea of offering health services at the community levels is critically important when you consider that 80%of people in the developing world will likely never set foot in a health facility.

PharmTech: How can new drug products, including vaccines, be better introduced to developing populations? What are the key priorities in terms of advancing technology (e.g., meeting transportation or distribution challenges)?

Batson: Countries need to know how best to use data to find their greatest numbers of missed children and target those children with optimal approaches whether that means outreach, quarterly child health days, school-based approaches or targeting indigenous populations. Distribution and cold-chain challenges vary from country to country and in some larger countries, state to state. Clearly countries have identified cold chain as a rate-limiting step with regard to new vaccine introduction. The supply chain has largely been undervalued and many countries do not have an adequate record of the status of cold chain equipment, maintenance requirements and trained logisticians.

PharmTech: What can industry expect going forward in terms of working with USAID to get its new products or vaccines to developing nations? What type of assistance may be provided and what are the timeframes?

Batson: USAID is going to continue to focus on what we do best. That is we will continue to work with our partners at global, regional, and country levels to provide varying support. We work with WHO and UNICEF, as well as our other donor partners, GAVI, the Gates Foundation, and most importantly, countries themselves. USAID is not the only partner to industry with regard to getting programmatically suitable vaccines developed and used in developing countries. Together, the US government makes tremendous investments in vaccines from basic research and development to field level strengthening of immunization programs.

PharmTech: Can you talk about the large commitment the US recently made to GAVI and what this will achieve? Does USAID have any other financing programs in the pipeline?

Batson: To reiterate, one of the most transformative technologies at our disposal is vaccines. The United States' coordinated support for GAVI complements the efforts of the National Institutes of Health, the Centers for Disease Control and Prevention, and USAID in the research, development and sustained use of vaccines in robust, country owned immunization programs.

The US commitment leverages the billions of dollars that other donors have committed to GAVI, multiplying the impact of our funding more than eight-fold, and allowed GAVI to negotiate a price reduction of 67% on rotavirus vaccines so more of the world's most vulnerable people will be protected against preventable diseases.

Combined with other donors, our funding will enable the Alliance to provide countries with sufficient amounts of programmatically suitable vaccines to immunize an additional 243 million children in the poorest countries with vaccines against pneumococcal disease, rotavirus, Haemophilus influenzae type b (Hib), hepatitis B, meningitis A, and yellow fever, and ensure the complete rollout of pentavalent vaccine. Experience delivering vaccines to expanded target populations could also serve to strengthen immunization programs to put the world in a position to save more lives with potential future vaccines against malaria, tuberculosis, and HIV.

PharmTech: Once a new drug or vaccine is introduced a developing-nation market, what are USAID's goals for ensuring that the country can sustain the administration, purchase, and distribution of that product?

Bastson: We strongly support the GAVI co-financing strategy that requires all countries to make a co-payment for every dose of vaccine provided to that country through GAVI procurement. The relatively recent revisions to the GAVI's co-financing policy requires a larger payment for countries closer to 'graduation.' We want countries to be mindful of their financial obligations but we want to continue working with our partners on the expansion of the evidence base for decision making so that when countries have to make hard decisions about how to spend their money, they will realize the tremendous health impact vaccines have.

PharmTech: Many individuals seem to be opposed to global health efforts compared with say, focusing on the US healthcare system at home. What can be done to overcome this perspective?

Bastson: We recognize that global health is vital to our national security. Improving the health of people in the developing world drives economic growth, fights poverty, and strengthens families, communities and countries. Investing in the health of people in developing countries reduces the instability that fuels war and conflict. Fighting global disease directly protects our health in the United States because infectious diseases know no borders. A continued effort to communicate the value and incredible return on investment from our global health efforts will be key to maintaining this support through the uncertain economic times ahead.