Gates Package — page 1045

-and middle-income countries. the entire world another 70 days after that. If it's a two-dose vaccine, that means producing some 16 billion doses roughly six months after getting approval. Because it costs so much to develop a new product, the companies that invent new vaccines try to recoup their costs as quickly as possible by selling doses at the higher prices that rich countries can afford. Even if their original production process results in a treatment that's quite expensive, they have little incentive to redesign it, because then they would have to go through a new regulatory review. For a number of vaccines, the solution has been to work with manufacturers in developing countries to come up with a new vaccine for the same disease, while also making sure that the cost of manufacture is very low. This is far easier than inventing the vaccine in the first place because you know it's possible to make a vaccine, and you understand the immune response that you need to provoke. The pentavalent vaccine--which protects against five diseases--is a great example. The most widely used one was invented in the early 2000s, but there was only one manufacturer, and at more than $3.50 per dose,22 it was quite expensive for low- and middle-income countries. Our foundation and its partners worked with two vaccine companies in India--Bio E. and Serum Institute, the same two that more recently started producing COVID vaccines--to develop a pentavalent vaccine that would be affordable everywhere. Today that vaccine costs about $1, and it is given to 80 million children a year. That's a sixteen-fold increase since 2005.23 Similar deals have led to new vaccines for two major killers of children: rotavirus (which causes diarrhea) and pneumococcal disease (a severe respiratory illness). As I was writing this book, India announced that it would expand access to the pneumo vaccine from less than half the