Critics are challenging the way a major procurer of vaccines for the developing world operates.
The Global Alliance for Vaccines and Immunisation (GAVI), a public-private initiative that held a major funding meeting in London, United Kingdom, this week (13 June), raising US$4.3 billion, has come under fire for the way it spends its money.
"The GAVI model depends on giving more and more money, year after year, to get vaccines to poor countries in ways that are not self-sustaining and at prices that are unaffordable," says Donald Light, a professor at Princeton University, United States.
GAVI's decisions are skewed by the pharmaceutical companies that sit on its board, non-governmental organisation Médecins Sans Frontières and development charity Oxfam, tell The Guardian.
"Pharmaceutical companies' representation on GAVI's board creates a conflict of interest. The current structure is far too cosy," says Mohga Kamal-Yanni, senior policy advisor at Oxfam.
Meanwhile, the aid agency Merlin says that the alliance is failing to reach the poorest children in fragile states — where up to half of all children's deaths take place. Such states lack the clinics, vaccination teams and money to pay the small co-payment charge GAVI requires.
"Weak health systems are no justification for inaction," says Linda Doull, Merlin's director of health and policy. "Fifty per cent of children who die live in some of the most isolated areas of already vulnerable countries. Isn't their survival every bit as important as any other child's?"
Others caution that there is a lack of open debate over the long-term efficacy of some of the vaccines the alliance provides. For example, evidence from some studies shows that pneumococcal vaccines do not have a long lifespan as the small number of strains they target (up to 13) are quickly replaced by some of the other 80 disease-causing strains.
Kim Mulholland, professor of child health and vaccinology at the UK's London School of Hygiene and Tropical Medicine, says: "I want to see all the children in the world vaccinated against pneumococcal disease, but I want the appropriate vaccine, scheduled appropriately and, if there are problems with the effectiveness of the vaccines, we take measures to correct that.
"I want to see a scientific approach to this."