TT Procured by UNICEF

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1 TT

2 TT Procured by UNICEF ,000, ,000, ,000, ,000,000 50,000, Routine SIA

3 TT historical demand and forecast overview Upcoming Tender Period

4 Millions of doses Trends in TT vaccine offered to UNICEF TT vaccine offered to UNICEF Good supplier base but still high dependency on one source One new supplier obtained WHO prequalification in end 2007, enhancing supply availability and vaccine security

5 Summary Elimination by 2012 MNT Investment Case ( ) has given campaigns and routine program a boost. Funds through IFFIM IC for vaccines are fully utilized Active fund raising for SIAs beyond 2009 Routine demand for most part is funded through country financial resources

6 TT Tender quantities TT Upcoming Tender Period Routine 106,500, ,000, ,000, ,000,000 SIA 60,000,000 30,000,000 30,000,000 30,000,000 Total 166,500, ,000, ,000, ,000,000

7 MEASLES

8 Number of Doses Measles procured by UNICEF ,000, ,000, ,000, ,000,000 50,000, Routine Supplementary

9 Measles Procurement Overview & Future demand Upcoming Tender Period Historically demand has been mainly driven by campaigns Large catch up campaigns in and some in Quantities do not include potential demand for India SIA

10 Millions of doses Trends in Measles vaccines offered to UNICEFavailability Measles vaccine offered to UNICEF Drastic reduction in the number of suppliers offering WHO pre-qualified vaccine to UNICEF over the past 10 years High dependency on one manufacturer Measles containing vaccines are classified as high priority for WHO PQ

11 Mixed results in terms of affordability Weighted Average Prices for Vaccines BCG stable demand, 4 suppliers, stable pricing DTP, declining demand, 2 suppliers per presentation, increasing prices TT growing demand, 4 suppliers, adjusted prices, now stable Measles growing demand, 3 suppliers, increasing prices

12 Summary Global Measles mortality reduction by 74% need to Sustain achievement Expect stabilized demand with; Increased routine, including 2 dose as per SAGE recommendation, will add to routine demand. Sustained follow-up campaigns, intervals based on 1 st dose coverage, but average every 3 years * Both posing future funding challenges for countries Measles campaign is often use as the main vehicle for integrated campaigns Continued monovalent measles vaccine supply needed in the future

13 Measles Tender quantities Measles Upcoming Tender Period Routine 75,500,000 70,000,000 75,000,000 75,000,000 SIA 79,800,000 95,000,000 70,000,000 50,000,000 Total 155,300, ,000, ,000, ,000,000

14 MMR

15 MMR Historical demand and forecast overview 7,000,000 Upcoming Tender Period 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000, Original Quantity on LTA Quantity Procured Current Tender Quantity Forecast to Suppliers at beginning of Year Current Forecasted Quantity The main increase in demand is for 1 one country, introducing MMR in their routine program as of 2009, therefore demand picture can change substantially Increased quantity only partially due to MR campaigns in 2007

16 Summary Very limited availability / long lead-time for unplanned demand Countries are strain aware / sensitive -There is strong strain preference from countries -At times the preference been influenced / diverted based on price and availability Large price differences between different products Limited sustainable external funding available countries need to include in their own budget The projection / scenario for MR will not impact the MMR demand

17 MMR Tender quantities MMR Upcoming Tender Period MMR 10 4,855,000 4,800,000 4,900,000 5,200,000 MMR 1 795,000 1,000,000 1,000,000 1,000,000 Total 5,650,000 5,800,000 5,900,000 6,200,000

18 MR

19 MR Procurement Overview - Future 30,000,000 25,000,000 Upcoming Tender Period 20,000,000 15,000,000 10,000,000 5,000, Original Quantity on LTA Quantity Procured Current Tender Quantity Forecast to Suppliers at beginning of Year Current Forecasted Quantity Currently 2 WHO pre-qualified suppliers, high dependency on one Substantial portion of the demand in 2009 is for one country campaign

20 MR Tender quantities MR Upcoming Tender Period Routine 1,351,623 1,700,000 1,700,000 1,700,000 SIA 4,500, ,000,000 1,000,000 Total 5,851,623 1,700,000 3,700,000 2,700,000

21 Future of MR vaccine? June, 2008: Rubella as part of GAVI investment strategy introduced to GAVI the Board (for endorsement, not financial decision) Rubella: cause of congenital rubella syndrome (CRS) when infected in early pregnancy It is estimated that there are 110,000 cases of CRS each year and poses high disease burden on poorest countries

22 Future of MR vaccine? October, 2008: Rubella part of the portfolio for GAVI to consider for future investments (HPV, JE, Rubella, Typhoid) at the October 08 Board Mindful of the current financial environment, the Board deferred any financial commitment related to the vaccine investment strategy for further review

23 Doses (M) MR VACCINE DEMAND GIVEN INTEGRATED ADOPTION FORECAST Rapid Impact Vaccine Demand including Wastage Routine Vaccination Catch-up Campaign Periodic Campaign Boost Vaccination Buffer Stock Stock Pile Vaccine Demand including Wastage Routine Vaccination Catch-up Campaign Periodic Campaign Boost Vaccination Buffer Stock Stock Pile Total * Source: Applied Strategy Oct 27,

24 # of Countries Adopting Vaccine MR INTEGRATED ADOPTION FORECAST Vaccine Need: 72 VISP Scope: 46* Rubella Bangladesh Bhutan Cambodia Haiti India Mongolia Nepal Solomon Is Tajikistan Viet Nam Indonesia Korea, DPR Myanmar Yemen Burundi Eritrea Ghana Pakistan Rwanda São Tomé and Principe Uganda Malawi Zambia Cameroon Congo, DR Côte d'ivoire Gambia Benin Burkina Faso Kenya Niger Senegal Togo Lesotho Mali Mozambique PNG Tanzania Timor-Leste Zimbabwe Afghanistan Comoros Djibouti Congo, Rep. Guinea Sierra Leone * Source: Applied Strategy Oct 27, 2008 * 14 GAVI countries have already adopted rubella; 12 are not expected to be eligible based on projected MCV coverage rates < 80% through 2020

25 mil ds A Possible scenario for MR introduction through catch up campaigns : ,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000, Assumptions: Delay the introduction by 3 years compared to rapid impact plan Total 300 mil ds for Distribute quantities throughout 5-6 years

26 Total tender quantities of Measles containing vaccines Measles Total 165,000, ,000, ,000,000 MR Total 1,700,000 3,700,000 2,700,000 MMR Total 5,800,000 5,900,000 6,200,000

27 UNICEF VACCINES Thank You

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