This exploratory qualitative article analyzes the potentially rate-limiting factors affecting value chain dynamics during adjuvanted-vaccine development. Adjuvants are considered immunostimulating substances that can be added to a vaccine. Although adjuvants have the potential to elicit adverse reactions, they also offer certain benefits. After approximately 90 years of R&D, why have only four adjuvants been approved? Although ample literature is available describing the risks and benefits, it remains unclear as to how these potentially rate-limiting factors compare. Experts - representing knowledge institutes, industry and regulatory/public health authorities - were approached in order to collect a unique weighted-ranking dataset on rate limiting factors. Based on the principal-agent theory, there is a partial conflict of interests between the internal perceptions on the challenges faced. Additionally, content analysis reveals four underlying social constructs influencing this perception, namely: attitudes towards risk management, innovation strategy, valuation and funding. This study was designed to explore the topic of rate-limiting factors, and not intended to solve the issues. Moreover we offer previously unpublished and practical insights on the topic, and offer a validated starting point for further research. Ultimately, we would advocate more transparency on reasons for project discontinuation; sharing lessons learned from failed attempts could prove valuable for advancing the field of virosciences.

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Keywords Adjuvanted-vaccine, Key opinion leader, Principal-agent theory, Qualitative interview, Rate-limiting factors, Research and development
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Journal Technological Forecasting and Social Change
Pronker, E.S, Weenen, T.C, Commandeur, H.R, Claassen, H.J.H.M, & Osterhaus, A.D.M.E. (2014). Scratching the surface. Technological Forecasting and Social Change. doi:10.1016/j.techfore.2014.04.017