spaced out
South stuck between rock and hard place

A good example of how manouevring space for developing countries is being constrained is the case of the vaccine for measles, mumps and rubella (mmr). A generation ago, in Delhi you could get vaccinated only for measles and the vaccine was cheap. Now, under the routine immunisation programme in Delhi every child has to get the combined vaccine for mmr , which is double the price, at a conservative estimate. Either government shells out or the consumer.

This is not an isolated example. Worldwide programmes are being expanded to include combination vaccines or new ones, increasing per capita expenditure on immunisation.gavi, which consists of governments of developed and developing countries, un agencies, multilateral bodies and the pharmaceuticals industry (see box: Alliance board), plays an important role in restructuring national programmes.

Seventy-two countries, with a per capita income less than us $1,000, are eligible for gavi support. Till now, gavi has delivered underused vaccines, usually expensive vaccines for which supply far outstrips demand, to 27 countries and transferred funds to support immunisation in 24. But its expenditure statistics show clearly the direction in which it is pushing. The projected figures for 2005 show that gavi spent us $109 million on new vaccines and us $27 million on auto-disable syringes, while it spent only us $48 million