Innogen · Publications · Working papers
A History of Vaccine Development and Partnerships in Africa
Innogen working paper no. 22
In an opening statement to a web-site detailing its activities and concerns, the World Health Organisation (WHO) declares that 'the two public health interventions that have had the greatest impact on the world's health are clean water and vaccines.' Paying tribute to the nineteenth-century investigations of scientist Louis Pasteur and physician William Jenner, (described as 'pioneers' in laying the foundations of modern preventive medicine), the WHO endorses vaccination as a powerful and positive form of intervention that, across continents, continues to spare millions from illness and death. Yet behind these enthusiastic public pronouncements in support of vaccination programmes and other forms of public health initiatives in combating disease, statistics suggest a rather bleaker and certainly more complicated picture.
The WHO's own figures show that close to two million children die each year from diseases for which low-cost vaccines are already in existence. In addition, there are 300-500 million clinical cases of malaria each year and 1-2 million deaths from this disease annually. Malaria claims the life of one child in Africa every thirty seconds.To date, no successful malaria vaccine has been developed, though, as I discuss in this paper, various forms of the vaccine are currently undergoing clinical trials. Then there is HIV/AIDS, which, whilst not reaching the levels in the West predicted in the mid-eighties, currently affects more than 40 million people with 5 million new infections annually. Three quarters of these infections are in Sub-Saharan Africa. Non-curative drug therapies may have lengthened life expectancy and improved quality of life for those living with HIV/AIDS in the West, but these drugs are neither widely available nor accessible in the African countries where they have the potential to benefit so many. When, in 1948, the WHO was founded with fifty-five national signatories and a Geneva based secretariat, the organisation announced that its goal was to secure internationally 'a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity'.4 Today, in light of the manifest failure to reach such standards, even up-beat statements have to be tempered by the WHO's acknowledgement that 'there is still a long way to go'.
Rather that viewing attempts to control disease through vaccination as a simple, (albeit protracted) linear process involving the transference of laboratory-generated solutions to receptive human populations, a more subtle account of vaccine initiatives must take account of a variety of factors. The development of vaccines involves the complex interplay of varying (and sometimes competing) political, economic and scientific/technological interests. The specific geographical and socio-economic contexts in which vaccines are tested and applied are also subject to variation. In an attempt to tease out and critically explore some of the conceptual issues at stake when discussing vaccine initiatives, this paper begins with a brief historical overview of WHO vaccination programmes in Africa. It then reviews existing literature on vaccine development and public health initiatives by focusing on the particular case of attempts of secure a vaccine for malaria. In conclusion, the paper looks at the current efforts to develop a vaccine for HIV/AIDS, considering not only the questions being posed by individual scientists, but also the key institutional players involved in informing and shaping such developments. By examining past and current literature on preventive public-health initiatives, this paper seeks to explore and elucidate how discussion of vaccination fits into the construction of understanding particular types of disease and into discourses of health and illness in Sub-Saharan Africa.