Interview: Dr. Gordon Perkin

Dr. Gordon Perkin Director of the Bill and Melinda Gates Foundation's Global Health Program, answers questions regarding the Malaria Vaccine Initiative.

Why is the Malaria Vaccine Initiative necessary?

Malaria is exacting an enormous toll on the health and economic development of hundreds of millions of families, most of who live in developing countries. It is estimated that 2.3 billion people, that's over a third of the entire population of the world, are at risk of infection, and that between 300-500 million people are infected each year. About two million individuals, mostly children, die each year.

Clearly, malaria is a terrible scourge. Although drugs that treat the illness have been around for some time, the malaria parasite is developing resistance. The world badly needs a vaccine. MVI has a very specific focus: to identify promising candidate malaria vaccines and fund their process development.

Who will provide guidance for MVI?

MVI is in the process of assembling an expert international Technical Advisory Group to guide MVI in making decisions about which vaccine candidates to focus on, and how best to support these efforts. The administrative aspects of MVI will be handled through a small secretariat at PATH, in our Washington, D.C., office with the majority of the grant from the Gates Foundation disbursed to malaria vaccine development efforts around the world.

Many have tried before - why isn't there a vaccine yet?

There are several identifiable reasons why a malaria vaccine has eluded researchers. The most glaring one, however, is the lack of investment in research on malaria, a disease that primarily affects developing nations. This is not a very profitable market in the eyes of some companies.

The public sector has been the primary source of funding for research on malaria, but this effort falls short of the public support and attention  for diseases such as asthma, cancer and even HIV. The private sector has failed to place a sufficiently high priority on malaria vaccine development -- perhaps because the perceived technical risks are too great and because the perceived markets are too difficult. These are valid concerns for the pharmaceutical industry.

From a public health point of view, however, the situation must be remedied. That's where MVI comes in. It believes, based on experimental evidence from previous clinical trials and from advice from experts in the field, that a malaria vaccine is indeed feasible and that the generous grant from the William H. Gates Foundation will allow us to make significant progress toward this goal.

How is MVI going to accelerate the development of a malaria vaccine?

As I mentioned, MVI is focused on filling critical gaps in the vaccine's development. One of these gaps is the lack of adequate process development for promising candidates. This is a very important component in the chain of events that gets a vaccine from an idea in the lab to the clinic in rural African villages, from "bench to bedside," as they say. Without promising data from clinical trials and clear indication that a vaccine can be produced, the private sector is reluctant to devote resources to the development of a malaria vaccine.

By speeding up the process by which candidate vaccine are moved closer to clinical trials and closer to commerical development, thus producing a body of critical data, MVI will significantly advance the malaria vaccine effort. 

Which vaccine approaches will MVI focus on?

This is where the Technical Advisory Group of vaccine development experts is critical. MVI is going to rely heavily on the wisdom of an international panel of experts in deciding which candidates to support. The field of malaria vaccine research, due in large part to the sparse funding situation, is relatively small. There are, however, even in a program this size, limitations on the number of projects MVI can support. The advisory group to MVI will enable the Initiative to select the appropriate recipients of funding.

Why have Bill and Melinda Gates chosen PATH to implement MVI?

I can hazard a guess here. PATH has a wealth of experience in designing and implementing international health programs. PATH has worked in 100 countries on over 950 projects. Needless to say, they are very familiar with the challenges of creating successful public health interventions.

In addition, we have recently been asked to manage another grant from the William H. Gates Foundations in the form of the Bill and Melinda Gates Children's Vaccine Program. With a commitment of $100 million, the CVP will require an incredible amount of organization, teamwork and skills that the Gates' are confident PATH possesses.

MVI, however, is in a class all its own, and so a unique and creative approach to the venture will be needed. I am convinced that PATH is the very best place for the birth of such a project because an entrepreneurial spirit is embedded in its character. MVI will benefit greatly from PATH's innovative approach to public health.