Situation
Each year, a preventable but devastating illness causes thousands of avoidable deaths in the world’s poorest communities. Cholera is an acute diarrheal disease characterized by infection of the intestine. Second only to pneumonia, diarrheal illnesses are the leading cause of worldwide child mortality. The disease affects as many as 4 million people every year and results in over 100,000 deaths worldwide.
According to the U.S. Centers for Disease Control and Prevention (CDC), most diarrheal deaths can be prevented by simple, low-cost interventions—but access to treatment remains a problem for those most vulnerable to cholera. Investing in solutions to tackle public health crises like preventable diarrheal death is at the heart of the foundation’s global health efforts.
Approach
Our strategic investment team worked closely with the foundation’s Enteric and Diarrheal Diseases (EDD) team to better understand the size and scope of cholera and its impact. After consulting with our EDD colleagues, we began to evaluate potential investments that could spur innovative solutions, including leveraging external sources of financing to complement the foundation’s resources.
Among the foundation’s key partners is the Global Health Investment Fund (GHIF), which the strategic investment team launched in 2012 to “crowd-in” commercial investment capital for global health research and development. Backed by a diverse group of both traditional and mission-driven investors, GHIF is a social impact investment fund that supports the development of drugs, vaccines, and diagnostics for diseases that disproportionately impact low- and middle-income populations.
When it came to the cholera challenge, we were immediately impressed by GHIF’s market analysis which identified in 2014 that there was significant unmet need for affordable vaccines. Historical manufacturing capacity, which was limited to fewer than 4 million doses per year, fell far short of the GHIF’s estimated annual demand of over 20 million doses per year for these life-saving products. Further, the existing vaccine was offered in heavy, fragile glass vials, and a lack of competition made the vaccine expensive for many of the countries that needed it the most.
Our EDD team introduced GHIF to EuBiologics, a small bio-pharmaceutical company headquartered in South Korea that had received support from the foundation and its partners to develop a cholera vaccine. After completing their review of the company’s ability to both address the cholera challenge and deliver an attractive financial return, GHIF led a $7.5 million round of private financing for EuBiologics, enabling the production of an improved oral cholera vaccine. The improved vaccine (Euvichol-Plus®) can be manufactured less expensively than the incumbent vaccine and is packaged in lightweight plastic tubes for easier distribution. Euvichol-Plus® is now widely available to public health ministries and nonprofit organizations working to control the disease in resource-limited settings, including refugee camps, natural disaster recovery efforts, and areas with underdeveloped water and sanitation systems.
Results
The partnership with GHIF and EuBiologics has been very successful. The price of oral cholera vaccine fell from $1.85 per dose in 2015 to $1.30 per dose in 2018, which represents a 30% cost reduction for budget-constrained public and nonprofit buyers. The cost reduction and plastic tube presentation have been transformative in expanding delivery of the vaccine to areas most susceptible to cholera.
Lessons Learned
Not only did the investment provide a direct benefit to the communities affected by cholera, it proved to be financially successful for our private sector partners, encouraging future investment in improving other life-saving products. GHIF recently realized a healthy financial return on its equity investment in EuBiologics after the company went public on South Korea’s KOSDAQ stock exchange.