The hire that will define the future of developing and making available new drugs, vaccines, and diagnostics for poor countries will occur sometime in the next few months and I hope that we are all watching closely — very closely. The Global Alliance for Vaccines and Immunizations (GAVI) will need a new CEO, since it has announced that he will be leaving the position in October.

I call this out as a pivotal hire because GAVI not only has a critical mission — get vaccines to poor children to save lives — but it is also a canary signaling when the overall system for innovation and access to lifesaving technologies for the poor may be in trouble. The new social responsibility contract is based on the idea that if companies and other product developers are going to invest and work on products for the poor that bring them little financial return, then the public sector will ensure that cost-effective products that improve the health will have a way to get to those populations. This implied contract demands that corporations step up to use their assets to address unmet medical needs in developing countries, while making two demands of the public sector: (1) produce the funds to buy these products (at deeply discounted rates) for those who cannot afford them, and (2) develop systems to ensure that cost-effective, lifesaving products are made accessible to those in need.

There is not a better story in global health than the story of vaccines. There are new lifesaving vaccines that are ready to go into children’s arms (such as the rotavirus and pneumococcal vaccines), and the pipeline is bursting with vaccines in late stage development that, if successful, could radically change the impact we could have on the biggest killers of children around the world (including a malaria vaccine in phase 3 trials that has already demonstrated impact against clinical and severe malaria). The early success of GAVI in greatly accelerating the uptake of existing vaccines in the poorest countries fueled a treasure trove of new innovation for neglected diseases by small and large pharmaceutical companies.

But the canary is sick. The initial burst of support and funding for GAVI has stalled, as have GAVI’s efforts to get new vaccines to children in need. Rotavirus and pneumococcal vaccines were approved for inclusion in GAVI programs years ago and despite an Advance Market Commitment that raised $1.5 billion dollars to pay for pneumococcal vaccines, these vaccines are still largely unavailable. If GAVI incorporated all the currently available cost-effective, lifesaving vaccines into its programs, it would face a deficit of billions of dollars. Donor governments are for the most part showing little sense of urgency in ensuring that children in the developing world receive these lifesaving products. If the public sector fails to translate these medical breakthroughs into lives saved, it will have a chilling effect on the entire innovation system that we depend on to bring forward the lifesaving drugs, vaccines, and diagnostics that could improve health, and help countries to move out of the cycle of poor health and poverty. 

So, GAVI Board — we encourage you to be bold in your hiring. Not only are the children of the world depending on you to make a good choice, all the players in the innovation and access communities are looking to you for a choice that will lead us all into a new era of ensuring that all people benefit from the medical breakthroughs that address their health needs. Your boldness will have a ripple effect on the entire field of global health, and fuel the virtuous cycle that turns medical innovations into the improved health and well-being of the poor.

Melinda Moree is CEO at BIO Ventures for Global Health