INTRODUCTION -- HEALTH IN LOW-INCOME COUNTRIES -- The Disease Environment in Low-Income Countries -- Weak Health-Care Infrastructure -- Malaria, Tuberculosis, and HIV/AIDS -- The Impact of Cheap, Simple Technologies -- THE PAUCITY OF PRIVATE R&D TARGETED TO THE NEEDS OF LOW-INCOME COUNTRIES -- The Extent of R&D Targeted to Low-Income Countries -- The Scientific Potential for New Vaccines -- MARKET AND GOVERNMENT FAILURES -- Why Target Foreign Assistance to Vaccine R&D? -- The Patent Tradeoff -- Low-Income Countries and Intellectual Property -- Social versus Private Return: Some Quantitative Estimates -- The Role of Public Purchases -- . THE ROLE OF PUSH PROGRAMS -- Meningococcal Meningitis: An Example of a Successful Push Program -- A Cautionary Tale: The USAID Malaria Vaccine Program -- Incentives under Push Programs -- THE POTENTIAL ROLE OF PULL PROGRAMS 55 The Effect of Market Size on Innovation -- The Impact of Financial Incentive Programs -- Examples of Pull Programs Stimulating Research -- Advantages and Limitations of Pull Programs -- PULL PROGRAMS: A MENU -- Commitments to Finance Purchase of Products and Patents -- Patent Extensions on Other Pharmaceuticals as Compensation for Vaccine Development -- Best-Entry Tournaments -- Expanding the Market for Existing Vaccines and Drugs -- DETERMINING ELIGIBILITY -- Basic Technical Requirements -- Independent Adjudication Committee -- Market-Test Requirement -- Exit Clauses -- HOW MUCH SHOULD WE PROMISE TO PAY FOR A VACCINE? -- What Market Size Is Needed to Spur Research? -- Cost-Effectiveness: What Is a Vaccine Worth? -- HOW SHOULD PAYMENT BE STRUCTURED? -- Paying for Multiple Vaccines and Market Exclusivity -- Bonus Payments Based on Product Quality -- Increasing the Promised Price over Time -- Avoiding Windfalls -- Industry Consultations -- SCOPE OF THE COMMITMENT -- What Diseases to Cover? -- Vaccines, Drugs, and Other Technologies -- Incentives for Agricultural R&D -- MOVING FORWARD WITH VACCINE COMMITMENTS -- Making a Commitment Legally Binding -- The Politics of Creating Markets for Vaccines and Drugs -- Potential Sponsors of New Markets for Vaccines and Drugs -- References.

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