Access to Vaccines: Where are we, Why are we there, Where do we need to get to? Martin Friede Initiative for Vaccine Research

Transcription

1 Access to Vaccines: Where are we, Why are we there, Where do we need to get to? Martin Friede Initiative for Vaccine Research

2 Vaccines work, but vaccine preventable diseases are still a significant cause of under-5 mortality Source: Rota: Preliminary data (US Centers for Disease control), Hib and PCV: John s Hopkins University, other causes: WHO - Global Health Observatory 2 2

3 Inequities in coverage 3

4 % coverage Children in many countries still don t benefit from all recommended vaccines HepB and Hib almost at level of traditional vaccines MCV2 catching up fast, Rubella still underused New vaccines on different growth trajectories bcg dtp3 hepb3 hib3 pcv3 rotac mcv2 rcv1 Source: WHO/UNICEF Estimates of National Immunization Coverage, July

5 The issues Numerous infectious diseases for which no vaccines yet available Available vaccine access inequitable multiple reasons Global capacity Lack of competition Affordability Evidence Procurement Distribution. 5

6 Holistic view of Access Approval Manufacture Development Innovation Need Policy Procurement Distribution Administration Evaluation 6

7 Innovation of new vaccines Approval Manufacture Policy Procurement Development Innovation Need IP Funding Evidence Distribution Evaluation Administration 7

8 More researchers, more patents.. Patents on vaccines per year

9 Vaccine funding by year and sector HIV Vaccine Funding by Year and Sector Malaria Vaccine Funding by Year and Sector Total Pharma Total Pharma TB Vaccine Funding by Year and Sector Total Dengue Vaccine Funding by Year and Sector Pharma Total Pharma

10 Patents on TB, malaria, HIV, RSV, Dengue All patentees compared to 'big pharma' Patent family count total vaccin patent families patent families 5 major players

11 Effect on Business Models $ $ $ $ $ $ $?? 11

12 Effect of 'Frivolous' patents $ $ $ $ $ $ $?? 12

13 Development Innovation Need Development Manufacture and Approval Manufacture Approval National regulatory agency Policy Market, market, Procurement market! business model Scale and economy Distribution of scale Value proposition (burden, impact) Clinical capacity Funding Evaluation Administration 13

14 Economy of Scale Cost per dose volume 14

15 A Holistic View of Access Development Innovation Need Approval Evidence Manufacture! Effectiveness, impact Delays! Policy Procurement Distribution Administration Evaluation 15

16 Procurement Approval Manufacture Policy Procurement Development Innovation Need Cost Benefit, Effectiveness Cost per dose Competition Number of doses Total cost Distribution Evaluation Administration 16

17 Procurement Approval Manufacture Policy Procurement Development Innovation Need Cost Benefit, Effectiveness Cost per dose Competition Number of doses Total cost Distribution Evaluation Administration 17

18 Distribution and Administration Approval Manufacture Policy Procurement Development Innovation Need Cold chain, transport, Health care workers Hesitancy Distribution Evaluation Administration 18

19 Novel Vaccine Delivery Technologies Easier to transport (no cold chain, light weight) Easier to administer (no needle) Fewer administrations BUT. New formulations cost more!! Is the added cost worth the ease of delivery and administration? 19

20 Total Systems Effectiveness coverage Point at which a higher cost easier to deliver product may be cost-effective Distance from central or regional store Hypothetical country. 20

21 Evaluation and Need Approval Manufacture Policy Procurement Development Innovation Need Measure Communicate Distribution Evaluation Administration 21

22 Holistic view of Access Approval Manufacture Development Innovation Need Policy Procurement Distribution Administration Evaluation 22

23 The current downstream challenges Inadequate systems Trained human resources Vaccine supply chains Information systems Vaccine supply & price Reaching the 5 th child Availability Financing Pricing & procurement Unregistered & migrant populations Failure of integration: missed opportunities Conflicts and crisis Hesitancy and refusals 23

24 Solutions exist: the challenge is to scale them up Inadequat e systems Vaccine supply & price Reaching the 5 th child Norms and standards; capacity strengthening Innovations in supply chain technology and design A systematic approach to strengthening information systems Improving vaccine supply intelligence Vaccine pricing transparency and procurement support Improved costing and budgeting tools Mapping missed populations and improved microplanning Reducing missed opportunities Guidelines and support for vaccination in humanitarian emergencies Addressing hesitancy and refusals 24

25 Thank you