TODAY S VACCINATION ECOSYSTEM STATUS MARKET-SHAPING PRINCIPLES, PRACTICE, IMPACT AND LESSONS LEARNT GAVI PERSPECTIVE

Transcription

1 TODAY S VACCINATION ECOSYSTEM STATUS MARKET-SHAPING PRINCIPLES, PRACTICE, IMPACT AND LESSONS LEARNT GAVI PERSPECTIVE Aurélia Nguyen Tuesday 20 January 2015, Veyrier-du-Lac, France

2 AGENDA Market shaping in the Gavi context Objectives Practice Results so far Challenges

3 GAVI, THE VACCINE ALLIANCE Gavi, the Vaccine Alliance, is a public-private partnership focused on saving children's lives and protecting people's health by increasing access to immunisation in poor countries

4 (from left to right): Gavi/2013/Adrian Brooks, Gavi/2012/Sala Lewis, GAVI/Olivier Asselin, Gavi/2012/Adrian Brooks CURRENTLY SUPPORTED GAVI VACCINATION PROGRAMMES Routine Campaign Stockpile (for outbreak response) Pentavalent Pneumococcal Rotavirus Human papillomavirus Yellow fever Measles second dose Inactivated polio vaccine Yellow fever Meningococcal A Measles-rubella Japanese encephalitis Yellow fever Meningitis Cholera (Ebola) For Board review Malaria

5 GAVI ADOPTED AN EXPLICIT STRATEGIC GOAL TO SHAPE VACCINE MARKETS 4 Strategic goals guide Gavi s mission, Vaccine goal Health systems goal Financing goal Market shaping goal Accelerate the uptake and use of underused and new vaccines Contribute to strengthening the capacity of integrated health systems to deliver immunisation Increase the predictability of global financing and improve the sustainability of national financing for immunisation Shape vaccine markets to ensure adequate supply of appropriate, quality vaccines at low and sustainable prices

6 AGENDA Market shaping in the Gavi context Objectives Practice Results so far Challenges

7 WHICH IS UNDERPINNED BY SUPPLY & PROCUREMENT OBJECTIVES These objectives aim to meet Gavi s market shaping goal by balancing supply and demand, ensuring security of supply, minimising the cost of vaccines, and fostering development of appropriate and quality vaccines

8 AGENDA Market shaping in the Gavi context Objectives Practice Results so far Challenges

9 DEMAND FORECASTING IS A CORE ACTIVITY Demand forecasting Provides early recognition and estimates future needs Gain better understanding of Gavi s vaccine markets Allows Gavi Alliance and manufacturers to effectively plan for the long term GAVI Alliance Strategic Goal 4

10 Doses (Millions) 100 EXAMPLE SDF: HPV DEMAND Base Unconstrained*: Total Required Supply for 94 Countries by Financing Other Nigeria Graduated Eligible 2014 SDFv9 Base Uncon (3 dose) 2014 SDFv9 Base Uncon (2 dose) * Scenario: National base unconstrained. Gavi eligible demand is forecasted to peak at 30 million doses in 2026 Categories: - Eligible: Includes doses that Gavi directly finances and doses that are co-financed by the country. - Graduated: Doses related to countries that have introduced HPV with Gavi support and have graduated during the forecasting time period. - Other: Doses from Gavi73 countries that introduce HPV without Gavi and non-gavi eligible LMICs.

11 SUPPLY AND PROCUREMENT ROADMAPS SET TARGETS & ENSURE COORDINATION Vaccine-specific documents: Short to long term view of how the market should evolve for particular vaccines and identification of mechanisms to influence the supply and price environment and achieve set targets Roadmap structure Market intelligence Alliance coordination Objectives prioritized GAVI Strategy Target outcomes Objective 1 Target outcome TO 1 Target outcome TO 2 Objective 2 Target outcome TO 8 Action plan Interventions Accountable, Responsible, Supporting Measured Output Due Date / Status For TO 1 For TO 2 Etc. Market analysis

12 AGENDA Market shaping in the Gavi context Objectives Practice Results so far Challenges

13 SINCE 2001, GAVI HAS INCREASED THE VACCINE MARKET SUPPLIER BASE 5 suppliers from 5 countries of production 2001 Source: UNICEF Supply Division

14 SINCE 2001, GAVI HAS INCREASED THE VACCINE MARKET SUPPLIER BASE 15 manufacturers* from 11 countries of production 2014 China 1 4 * Includes 13 Gavi suppliers and manufacturer of select pre-qualified Gavi vaccines Source: UNICEF Supply Division and WHO list of pre-qualified vaccines, 2014

15 HOWEVER, SOME GAVI VACCINE MARKETS ARE MORE MATURE THAN OTHERS Manufacturers with pre-qualified vaccines (as of Dec 2014) Pentavalent Yellow fever Rotavirus PCV Men A Supply = Demand Yes (2013 is first year) No No (product preference imbalance) Yes (needs careful management) Yes MR Yes HPV IPV JE Yes Yes (needs careful management) Yes Cholera

16 GAVI IS SET TO ACHIEVE ITS 2015 PRICE TARGET, BUT MORE NEEDS TO BE DONE Cost to fully immunise a child with pentavalent, pneumococcal and rotavirus vaccines reached a new low in mid 2014 * Future targets are not publicised to avoid setting a minimum price. Source: UNICEF Supply Division, 2014.

17 AGENDA Market shaping in the Gavi context Objectives Practice Results so far Challenges

18 PENTA/PCV/ROTA PROJECTED TO ACCOUNT FOR >75% OF VACCINE COSTS

19 HOW TO ENSURE FINANCIAL SUSTAINABILITY FOR GRADUATING COUNTRIES? 19

20 MANUFACTURER PRICE COMMITMENTS FOR GRADUATED COUNTRIES Pentavalent* Pneumococcal Rotavirus HPV Manufacturer Commitment to graduated countries Crucell Access to Gavi price through 2020 Sanofi Pasteur / Shantha 3 years access to Gavi price post-graduation** Biological E LG Life Sciences Panacea Serum Institute GSK Pfizer GSK Merck GSK Merck No commitment No commitment No commitment No commitment Access to AMC tail price (AMC supply significantly diminishes from ~2023) 5 years price freeze post-graduation Access to AMC tail price (AMC supply significantly diminishes from ~2023) 5 years price freeze post-graduation No commitment 5 years price freeze post-graduation No commitment Notes: Gavi is currently engaging with manufacturers to try to extend the scope of some of these commitments and to secure commitments from additional manufacturers. Sanofi Pasteur / Shantha agreement also covers YF and Measles. * GSK is not expected to supply pentavalent vaccine to Gavi countries after 2014 ** For first 16 countries only 20

21 WHAT INNOVATIONS WILL MAKE A DIFFERENCE? Thermostability Reduction of vaccine damage from exposure to high or low temperatures Presentation & Packaging Size and doses per vial Vaccine labelling and tracking Devices Vaccine preparation/delivery technologies Combinations & Schedules Multiple antigens in one vaccine Number or timing of doses Appropriate, effective, safe Improving protection/safety conferred in GAVI countries

22 VACCINE DELIVERY INNOVATION: UNIJECT Product gained prequalification in December 2014 Developed to meet needs of low/lower-middle income countries New delivery model Simplifies vaccine administration - Reduction of average time per injection Could facilitate outreach - Greater official lay vaccinator integration into immunization activities - Reduces missed opportunities by ensuring syringe and vial always available together - Decreased weight and volume (versus 1 dose vials only) Availability to Gavi-supported countries under review Initial use (limited to the current capacity) Evaluate

23 EBOLA VACCINE INNOVATION: A MARKET FAILURE & HUMAN SECURITY CHALLENGE Affects the entire region, continent WB: Ebola could cost West Africa US$ 32 billion by 2015 IMF: sub-saharan Africa growth forecast >17,000 down cases from 5.5% to 5% (largely Ebola) > 6,000 deaths Morbidity and mortality from other diseases on the rise >17,000 cases > 6,000 deaths Surrounding and high-risk countries with risk of further spread to other parts of the world

24 4 RECOMMENDED AREAS FOR GAVI ACTION # cases (illustrative) Current outbreak Potential future outbreak (magnitude unknown) Future outbreak with stockpile present 1 Production & Procurement funding 2 2 Time Funding vaccine roll-out Funding vaccine roll-out 3 Future outbreak preparedness 4 Recovery of health and immunisation systems

25 CHALLENGES WITH MEASURING RESULTS Can Gavi s existing SG4 indicators be improved? The aim is to have meaningful, transparent and measurable indicators of progress in shaping vaccine markets SG4 indicators Security of supply -> Move to measuring healthy markets Change in vaccine price-> Move to measuring a more holistic view of costs Appropriate Products??? *Future targets are not publicised to avoid setting a minimum price Gavi/2012/Olivier Asselin Source: UNICEF Supply Division, 2014

26 THANK YOU