The Financial Sustainability of New Vaccine Introduction in the Poorest Countries :

Transcription

1 The Financial Sustainability of New Vaccine Introduction in the Poorest Countries : Evidence from the First Phase of GAVI (Global Alliance for Vaccines and Immunization) Patrick Lydon lydonp@who.int Session: Affordability & Sustainability of Immunization Programs in Low Income Countries 1

2 The Sustainability Problem The vaccine development pipeline Future Underused Traditional YF Diphtheria Pertussis Tetanus Polio JE Rubella Measles Cholera HepB Typhoid Hib (conj) // // Vaccine Development Pipeline Malaria HIV/AIDS Dengue Mening (conj) HPV Rotavirus Pneumo (conj) TB Reaching MDG - 4 requires accelerating the introduction of new life saving in the poorest countries that have significant potential for child mortality reduction The problem: New are cost-effective but cost much more from cents to several $ Increasing tension between "best-buy" buy" for health and what is affordable for health systems What is a model for financial sustainability of new vaccine introduction in low income countries? A good model is needed given many more available in the near future 2

3 The GAVI Model ( ) 2006) The vaccine development pipeline The case of accelerating Hepatitis B and Haemophilus influenza type b (Hib) in 72 countries with GNI per capita < $1,000 Future Underused Traditional YF Tetanus Polio JE Rubella Measles Cholera HepB Hib (conj) Malaria HIV/AIDS Dengue Mening (conj) HPV Rotavirus Pneumo (conj) HepB & Hib TB The model for financial sustainability Create a global fund for (GAVI Fund of over $1 billion) Stimulate demand by guaranteeing 5 years worth of free Increased volume would lower prices to affordable levels after 5 years This period would be sufficient to plan the transition of financial responsibility and ensure financial sustainability Diphtheria Pertussis // // Vaccine Development Pipeline The tools for countries The financial sustainability plan (FSP) Excel based tool for current and 10 year forecasts of costs, financing and gaps 3

4 Evidence from the GAVI Model Expenditures on Immunization Review of findings Expenditures on immunization Sources of variation Immunization Financing Trend in vaccine prices Financial sustainability Health Systems Financing Sustainability Immunization Financing Data & Methods FSP tool data extracted into an online Immunization Financing Database For 50 countries with good regional representation 4

5 Immunization Expenditures Expenditure Needs per Infant ( ) $30 $25 $20 $15 $10 $5 $15.6 $10.9 $4.7 $20.1 $12.0 $8.1 $24.5 $12.4 $12.1 $17.5 $11.5 $6.0 Expenditures are on the rise. Will average $17.5 per child during with HepB and Hib Up from a baseline expenditure of $6 to sustain coverage with basic Average scale up by a factor of 2 to 3 depending on income group Main source of variation linked to Changing expenditure profile - largely driven by new (> 50%) Poorest countries tended to introduce the more expensive combination of GAVI supported (HepB-Hib) Hib) C Other sources of variation $- < $1 per day < $2 per day < $3 per day Average countries countries countries x3.3 x2.5 x2.0 x2.9 Scale-up Needs Sustaining Gains (baseline expenditures) Factor of increase in cost 5

6 Sources of Variation Population size >$30 per infant in small countries (Max = $42) and <$5 in large countries (Min=$3) Even for similar coverage levels Development, income and coverage Country Grouping For countries < $1,000 GNI per capita Shared health systems cost Delivery strategies Coverage Current Expenditure on Routine Immunization % DTP3 $ per infant Scale Up Needs Factor of increase in cost Shared Health Systems Cost % Total immunization expenditures Expenditures on Campaigns % Total immunization expenditures Fragile States 47% $ % +51% Poorest 65% $ % +35% Intermediate 84% $ % +25% Least Poor 86% $ % +17% 6

7 Sources of Variation Non-Vaccine Cost per Infant ($) Cost coverage relationship is non-linear Indication of economies and diseconomies of scale happening at different levels of coverage Would imply different levels of investment to reach higher coverage levels Draft findings. More research is need to confirm these 1 0 <50% >50% - <60% >60% - <70% >70% - <80% DTP Coverage Group >80% - <90% >90% Baseline Year Weighted Avg. (Baseline and Current Year) 7

8 Immunization Financing Expenditure Needs per Infant ( ) $30 $25 $20 $15 $10 $5 $- $4.2 $5.5 $3.0 < $1 per day countries $15.6 $1.5 $5.2 $2.1 $4.3 $4.2 $14.9 $4.9 $9.3 $5.6 < $2 per day < $3 per day Average countries countries $20.1 $24.5 $17.5 Immunization financing also on the rise Majority of the increase from national governments (>20% increase) GAVI has become a major source of additive financing. Particularly in the poorest of the poor Still a $4 funding gap per child remains For completing the HepB and Hib agenda - despite GAVI monies Variability in gaps linked to level of government funding Concerns about financial sustainability in the poorest of the poor Financial transition is far from assured Government GAVI Multilaterals Bilaterals Other donors Funding Gap Avg. cost per infant 8

9 Vaccine Prices and Volume US$ per dose (UNICEF Prices) $4.0 $3.5 $3.0 $2.5 $2.0 $1.5 $1.0 $0.5 $0.0 Price and Volume of DTP-HepB-Hib Millions of Doses Procurred throught UNICEF SD Most important factor of success of the GAVI model and financial sustainability is a reduction in the price of to affordable levels The US$ price of HepB and Hib combination increased between The price - volume effect of the model is unclear in the absence of a healthy competitive vaccine market Price per Dose (US$) Total Doses Procurred 2 per. Mov. Avg. (Price per Dose (US$)) 2 per. Mov. Avg. (Total Doses Procurred) 9

10 Financial Sustainability Gov Funding for Immunization (% Gov Health Financing) 2.5% 2.0% 1.5% 1.0% 0.5% Increasing Government Funding Fragile, 6.0% Poorest, 3.8% Average, 2.1% Intermediate, 2.6% Least Poor, 1.0% 0.0% 0% 20% 40% 60% 80% 100% Gov Funding for Immunization (% Total Funding) Size of bubble represents current expenditures on immunization as a % of government health expenditures At current prices, the introduction of HepB and Hib will represent 4% to 6% of government health budgets in the fragile and poorest countries Although < $1 per capita ($0.6) Can average 9% for countries that introduced DTP-HepB HepB-HibHib And >20% in some countries Pressure on health budgets of moving down the pipeline will be a concern Future Underused Traditional YF Diphtheria Pertussis Tetanus Polio JE Rubella Measles Cholera HepB // // Vaccine Development Pipeline Typhoid Hib (conj) Dengue Mening (conj) HPV Malaria Rotavirus Pneumo (conj) HIV/AIDS TB 10

11 The GAVI Model ( ) 2006) - Summary Between , 2006, GAVI succeeded in accelerating the introduction of HepB and Hib in over 55 of the poorest countries While the benefits outweigh the costs, financial sustainability is far from assured Not a failure of the model itself or the tools Scaling up with new in poor countries had greater than expected cost implications on immunization programmes and not just A healthy competitive vaccine market with high demand can lower vaccine prices More time is needed to plan a financial transition away from GAVI I Fund resources The FSP was a valuable tool As a building block to setting priorities, mobilizing resources, and using resources effectively for immunization Improved the understanding of the financial sustainability challenges of introducing new and paving the way for future ones Capacity building in costing and financing in countries Increased linkages with broader strategic planning processes in the health sector 11

12 Immunization Financing Website In partnership with the Immunization financing 12 ihea 6th International World Congress Explorations in Health - Copenhagen, 8-11 July 2007 Countries Database Tools Options Resources