Models of Vaccine Finance and Their Potential Application to Group A Streptococcus Vaccines ^†

Background: Group A Streptococcus (GAS) leads to an estimated 600,000 deaths and 600 million cases of pharyngitis per year. There is significant interest in GAS vaccine development. However, without a clear market for such a vaccine in high-income countries, the mechanism to finance it is unclear. Methods: We consider three models of vaccine finance: industry, government financing, and philanthropic funding. We conduct a literature review to determine how existing vaccines have been financed. We then collect data on vaccine R&D funding, prices, coverage rates, and disease burdens. We analyze the data to show how disease burdens are associated with funding models and how funding models relate to coverage rates and prices. Results: Diseases with disproportionate burdens in high-income countries attract more industry funding and have higher vaccine prices and lower coverage rates. Diseases with mixed burdens (a significant burden in high-income and low-income countries, or mostly middle-income countries) attract more public financing. Diseases with exclusively low-income burdens have relied heavily on philanthropic funding. We illustrate these results using the example of the Pneumococcal, RSV, and HPV vaccines, which received substantial industry funding and had a substantial disease burden in high-income countries. Meningococcal disease and Hepatitis B are examples of vaccines with mixed disease burdens and substantial public support for vaccine development. Finally, the development of the Malaria vaccine is a model of philanthropic funding. Conclusion: Like Meningococcal disease and Hepatitis B, GAS has a mixed disease burden. Therefore, it is a prime candidate for government support through a phase three trial and the approval of a vaccine.