V3P PRICE DIGEST VACCINE PRODUCT, PRICE AND PROCUREMENT. WORKING DOCUMENT 2016 edition

Transcription

1 V3P PRICE DIGEST VACCINE PRODUCT, PRICE AND PROCUREMENT WORKING DOCUMENT 2016 edition

2 This document has been prepared by the Expanded Programme on Immunization (EPI) of the Department of Immunization, Vaccines and Biologicals. It is a working document. For more information on this document or on vaccine price and procurement, please contact: V3Pproject@who.int. This publication is available on the internet on: Additional materials on immunization, vaccines and biologicals may be requested from: World health Organization Department of Immunization, Vaccines and Biologicals CH1211 Geneva27 vaccines@who.int Acknowledgements The team at WHO EPI thanks the several partner organisations and stakeholders who reviewed this document and provided inputs and comments. We would also like to thank Shawn Gilchrist for his work as the main writer of this document. Page 2 of 34 V3P Price Digest 2016 edition

3 TABLE OF CONTENTS ACCRONYMS... 4 BACKGROUND... 5 I. VACCINE PROCUREMENT ANALYSIS... 8 Key findings for all vaccine purchases, Key findings by vaccine, II. VACCINE PRICE ANALYSIS Key findings by vaccine, III. TABLES Disclaimer This Digest is a working draft and is based on analyses conducted in Any subsequent change in the data will not be captured in this Digest. Information contained in the V3P database is provided by participating countries and/or organizations procuring on behalf of countries that have agreed to share vaccine price and procurement data with V3P. Participating countries are solely responsible for the accuracy of the data provided. The information contained in the V3P database does not in any way imply an endorsement, certification, warranty of fitness or recommendation by WHO of any company or product for any purpose, and does not imply preference over products of a similar nature that are not mentioned. WHO furthermore does not warrant that: the information is complete and/or error free; and/or that (2) the products listed are of acceptable quality, have obtained regulatory approval in any country, or that their use is otherwise in accordance with the national laws and regulations of any country, including but not limited to patent laws. Inclusion of products in the database does not furthermore imply any approval by WHO of the products in question (which is the sole prerogative of national authorities). WHO will not accept any liability or responsibility whatsoever for any injury, death, loss, damage, or other prejudice of any kind that may arise as a result of, or in connection with the procurement, distribution and use of any product listed in the V3P database. Page 3 of 34 V3P Price Digest 2016 edition

4 ACRONYMS AMC Advanced Market Commitment ap acellular pertussis BMGF Bill & Melinda Gates Foundation DTaPHibHepB IPV Diphtheriatetanusacellular pertussishepatitis BHaemophilus influenzae type binactivated polio (also called Hexavalent vaccine) DTwPHepBHib Diphtheriatetanuswhole cell pertussishepatitis BHaemophilus influenzae type b (also called Pentavalent vaccine), the Vaccine Alliance GVAP Global Vaccine Action Plan High income country HPV Human papilloma virus IPV Inactivated Polio Vaccine LIC Low income country LMIC Lower middle income country = GNI/capita > $1,025, < $4,035. LPC Lowest Price Clause LTA Longterm agreement MAX Maximum MED Median MIC Middle income country MIN Minimum MMR Measlesmumpsrubella MSF Médecins sans frontières PAHO RF PanAmerican Health Organisation Revolving Fund PCV Pneumococcal conjugate vaccine Rota Rotavirus vaccine UMIC Upper middle income country = GNI/capita > $4,035, < $12,476 UNICEF United Nations Children s Fund UNICEF SD UNICEF Supply Division V3P Vaccine product, price, and procurement WAP Weighted average price WHO World Health Organisation wp whole cell pertussis WHO AFRO WHO Regional Office for Africa WHO AMRO WHO Regional Office for the Americas WHO EMRO WHO Regional Office for the Eastern Mediterranean WHO EURO WHO Regional Office for Europe WHO SEARO WHO Regional Office for SouthEast Asia WHO WPRO WHO Regional Office for the Western Pacific Page 4 of 34 V3P Price Digest 2016 edition

5 BACKGROUND At the request of member states, WHO has taken an active role to increase transparency of vaccine markets by collecting information on Vaccine Product, Price and Procurement through the V3P Initiative. This Digest is intended for use by government officials, particularly in selfprocuring countries. The digest provides information on the type of vaccine procurement, supply sources, product choices and vaccine price ranges, from countries reporting to the V3P in Making this information on vaccine prices available is expected to improve national decisionmaking for vaccine purchasing, new vaccine introductions, vaccine scheduling, and product choice, and overall inform procurement processes to render these more efficient. This Digest is organized according to 3 sections that provide analyses of both price and procurement data from countries reporting to the V3P initiative: 1. VACCINE PROCUREMENT ANALYSIS: this section intends to provide countries with an indication of vaccine procurement characteristics. 2. VACCINE PRICE ANALYSIS: this section intends to provide countries, particularly Middle Income Countries (MICs), with the price ranges for specific vaccines from all countries reporting to the V3P database. 3. TABLES: in the annexes, tables provide the background data behind analyses presented in this document. All data reported has been extracted from the V3P database as of August In order to focus on the most interesting analyses, based on prices paid and number of data points, a subset of vaccines were selected. Analyses in this report focus on the following vaccine types: DTwPHepBHib (also referred to as pentavalent); Acellular pertussiscontaining combination vaccines (apcontaining vaccines); Pneumococcal conjugate vaccine (PCV); Rotavirus vaccine (Rota); Human papilloma virus vaccine (HPV); and, Inactivated polio vaccine (IPV). Readers may access additional vaccine price and procurement information from reporting countries and procurement agencies (UNICEF and PAHO) on the V3P website: All of the data in this report is based on price and procurement data contribution from individual countries only (not the data shared by procurement agencies). The 50 countries contributing vaccine price data to the V3P database in 2016 (reporting 2015 data) are distributed as follows: Page 5 of 34 V3P Price Digest 2016 edition

6 WHO region Procurement method eligibility Income group Exclusively procuring through UNICEF Exclusively selfprocuring Mixprocuring* eligible & countries in transition eligible LIC LMIC UMIC Africa Eastern Mediterranean Europe SouthEast Asia Western Pacific TOTAL TOTAL * Partly selfprocuring and partly procuring through UNICEF Note: There is no direct participation from countries in the Americas, as their vaccine prices are made available to the V3P by the PAHO Revolving Fund (also available on the PAHO website). 1 Procurement method, eligibility and Income group refer to 2015 data. Income level is defined following the GNI per capita, Atlas method of the World Bank in 2015 was: LIC Low Income Country: GNI/capita < $1,045 LMIC Lower Middle Income Country: GNI/capita between $1,046 and $4,125 UMIC Lower Middle Income Country: GNI/capita between $4,126 and $12,735 High income country: GNI/capita > $12,736 or more. 2 Note to the reader: 1. Price information is very important to inform decisionmaking. However, factors such as programmatic implications and costs as well as other dynamics that can influence the efficient and effective delivery of quality vaccines to the population should be taken into consideration as well. 2. All data reported into the V3P database in 2016 is for the 2015 calendar year and is labelled 2015 data. 3. In this document, countries are grouped by their income level and eligibility status. This allows for comparisons between countries with similar characteristics. Grouping by income level is used as a proxy for a country s ability to pay. Countries are distinguished by eligibility status because countries have access to specially negotiated prices for many of their vaccines. 4. Classification of countries by income level and eligibility is based on the World Bank classification of countries by income groups 2 and eligibility 3, as available as of August In this document, countries refers to countries that were either fully eligible or transitioning out of support in i i List of countries counted as countries in this report (corresponds to eligibility in 2015). 49 eligible countries: Afghanistan, Burundi, Benin, Burkina Faso, Bangladesh, Central African Republic, Cote d'ivoire, Cameroon, DR Congo, The Comoros, Djibouti, Eritrea, Ethiopia, Guinea, The Gambia, GuineaBissau, Haiti, India, Kyrgyzstan, Kenya, Cambodia, Lao, Liberia, Lesotho, Madagascar, Mali, Myanmar, Mozambique, Mauritania, Malawi, Niger, Nepal, Pakistan, DPR Korea, Rwanda, Sudan, Senegal, Sierra Leone, Somalia, South Sudan, Sao Tome and Principe, Tajikistan, Chad, Togo, Tanzania, Uganda, Yemen, Zambia, Zimbabwe. And 24 countries in accelerated transition: Angola, Armenia, Azerbaijan, Bolivia, Bhutan, Congo, Cuba, Georgia, Ghana, Guyana, Honduras, Indonesia, Kiribati, Sri Lanka, Mongolia, Nigeria, Nicaragua, Moldova, Papua New Guinea, Solomon Islands, TimorLeste, Ukraine, Uzbekistan, Vietnam. Page 6 of 34 V3P Price Digest 2016 edition

7 5. Given the unevenness in the number reporting countries between regions, price ranges by WHO region may not be directly comparable. 6. Due to the complexity and national specificities of vaccine procurement, price data for any given country may not be directly comparable to others. Readers should use caution when interpreting data, taking into account specific contexts, circumstances and factors that may affect prices paid by individual countries, such as geographic region, income level, purchase volumes and contract terms. 7. Participating countries are solely responsible for the accuracy of the data provided. WHO does not warrant that the information is complete and/or error free. All prices shown are in USD ($) per dose, converted from local currency to USD using the World Bank official annual exchange rate. 4 Page 7 of 34 V3P Price Digest 2016 edition

8 I. VACCINE PROCUREMENT ANALYSIS This section intends to provide countries with an indication of vaccine purchase characteristics for vaccines across all countries reporting to the V3P database. Procurement characteristics are all elements of the procurement that surrounds the purchase of the vaccine, such as procurement method, presentation preferences, number of vaccines procured, etc. An analysis of vaccine price information is made in the subsequent section. A. Key findings for all vaccine purchases, 2015 This subsection presents key findings on vaccine purchases based on all vaccines procured by countries participating in the V3P database in 2016 (50 countries). The purchase data from the V3P database for all vaccines, manufacturers, presentation sizes, and income levels in 2015 is shown in Table 1. Pooled procurement is predominantly practiced by lower income countries Of all the 16 LMICs in the V3P database, 14 countries procured all of their vaccines (8 countries, 57%) or some of their vaccines (6 countries, 43%) through UNICEF. Countries receiving financial support from, the Vaccine Alliance (referred to as ), tended to procure exclusively through UNICEF (8 out of 13 LMICs, 62%), while non eligible LMICs only partially procured through UNICEF (2 out 3 non LMICs, 66%). In contrast, of the 16 non UMICs reporting in 2015, only 3 (19%) procured exclusively through UNICEF (no country procuring partially through UNICEF), and none of the 15 procured through UNICEF. Lower income countries procure fewer vaccine types & type is influenced by region and income countries and non LMICs both purchased a fewer number of vaccine types (27 and 17 respectively) compared to non UMICs and s (37 and 42 respectively). The most frequently purchased type of vaccine varied both by WHO region and by income level. Countries across different income groups procure from a similar number of vaccine suppliers countries procured from a slightly greater number of vaccine suppliers than non countries. The number of suppliers was similar between income groups of a similar size: 28 suppliers to 16 countries; 25 suppliers to 16 non UMICs; and, 23 suppliers to 15 non s. There were 9 suppliers to 3 non LMICs. The most frequent suppliers differ by country income level Serum Institute of India was the most frequent supplier to both countries and non LMICs. UMICs and s were most frequently supplied by Sanofi Pasteur, and GSK, respectively. The most frequent supplier by WHO region was Serum Institute of India, except for EUR. Page 8 of 34 V3P Price Digest 2016 edition

9 and non countries procure a similar number of presentation sizes The number of different presentation sizes purchased by countries and non was similar, ranging from a minimum of 4 in non LMICs to a maximum of 6 in non UMICs. The number of presentation sizes in countries was 5. By region, the number of presentations sizes purchased ranged from 4 in WPR to 6 in EUR (5 in all other regions). The most frequently procured presentation sizes differ by eligibility, income, and region The predominant presentation size purchased by countries and non LMICs was 10 dose vials, whereas non UMICs and s procured predominantly single dose presentations. Reasons for the differences, such as cold chain capacity restrictions in lower income countries, lower unit price, etc, are not explored in this document. The European and Western Pacific regions also predominantly procured single dose presentations whereas the other regions predominantly procured 10dose presentations. B. Key findings by vaccine, 2015 This subsection presents the findings of purchase analyses for specific vaccines procured by countries participating in the V3P database in 2016 (50 countries). Vaccines presented here are: DTwPHepBHib, ap combinations, PCV, Rota, HPV, and IPV. Wholecell pertussiscontaining pentavalent vaccine (DTwPHepBHib) The V3P purchase data for DTwPHepBHib vaccine for 2015 is shown in Table 2. The majority of DTwPHepBHib vaccine procuring countries were countries 16 of 25 (64%) of countries procuring DTwPHepBHib vaccine were countries. Other countries are purchasing different combination vaccines, including a preference for apcontaining vaccines in higher income levels. DTwPHepBHib vaccine procurement represented about 5% of all vaccine volumes reported to V3P in 2015 All purchases of DTwPHepBHib vaccines amounted to over 30 million doses (worth about $60.3 million), or about 5% of all vaccine doses reported to V3P in million doses were reported by countries. DTwPHepBHib vaccine was predominantly procured through UNICEF 20 of 25 purchasing countries (80%) purchased through UNICEF, with 94% of countries and 55% of non countries procuring through UNICEF. countries procured from a greater number of suppliers of DTwPHepBHib vaccine than non countries The total aggregate number of suppliers is highest for countries (5 manufacturers: Serum Institute of India, Janssen, Biological E, LG LifeSciences, Shanta Biotechnics), but most countries procure from one single supplier, sometimes two. Serum Institute of India is the most frequent supplier of DTwPHepBHib vaccine to all countries. Janssen is the most frequent supplier to countries and the European region. Page 9 of 34 V3P Price Digest 2016 edition

10 The most frequently procured presentation size of DTwPHepBHib vaccine was single dose There are 3 different presentation sizes procured by countries reporting to V3P (1, 2 and 10 doses). The predominant presentation size procured was the single dose, except in the African and EMRO regions where the 10dose presentation is the most frequently procured. Acellular pertussiscontaining vaccines (apcontaining vaccines) The V3P purchase data for select apcontaining vaccines for 2015 is shown in Table 3. As there are several apcontaining combinations available, table 3 in the annex and the paragraphs below represent analyses based on the three main combination used: DTaPIPV, DTaPHibIPV and DTaPHepBHibIPV. Countries procuring apcontaining vaccines were all from higher income groups (UMICs and s) 14 of 22 (64%) countries reporting to V3P and procuring apcombination vaccines were s, and 8 (36%) were UMICs. There was no LMIC or LIC reporting procurement of apcontaining vaccines in Of note, apcontaining vaccines were not supported by investment in apcontaining vaccine procurement represented about 4% of all vaccine volumes reported to V3P in 2015 All purchases of apcontaining vaccines amounted to over 26 million doses (worth about $314.4 million), or about 4% of all vaccine doses reported in apcontaining vaccines were only procured in singledose presentation through selfprocurement In 2015, apcontaining vaccines were not available for procurement through UNICEF and all countries reporting to V3P selfprocured their vaccines. The vaccines were not available in multidose presentations, given the preference for singledose presentations in higher income markets, primary targets of these vaccines. Countries reported purchasing from only two suppliers: GSK and Sanofi Pasteur Both manufacturers of apcontaining vaccines supplied and non countries alike. Pneumococcal conjugate vaccine (PCV) The V3P purchase data for PCV for 2015 is shown in Table 4. The majority of PCV procuring countries were non countries 23 of 35 (66%) countries reporting to V3P and procuring PCV in 2015 were non countries. PCV procurement represented about 9% of all vaccine volumes reported to V3P in 2015 All purchases of PCV vaccines amounted to almost 55 million doses (worth about $882.1 million), or about 9% of all vaccine doses reported in Page 10 of 34 V3P Price Digest 2016 edition

11 All countries procured PCV through UNICEF whereas the great majority of non countries selfprocured the vaccine Of the 23 non countries registered in the V3P database, 22 selfprocured the vaccine and only one procured it through UNICEF. Both suppliers of PCV vaccine supplied and non countries alike There are only 2 suppliers of PCV: GlaxoSmithKline (GSK, producing PCV10) and Pfizer (producing PCV13). They supply countries in all WHO regions across all income levels. Overall Pfizer was the most frequent supplier, and Pfizer was the most frequent supplier to countries and the EUR region. In 2015, PCV10 existed in single and 2dose presentations. The 2dose presentation was exclusively sold to countries. PCV13 only existed in single dose presentation. Rotavirus vaccine (Rota) The V3P purchase data for Rota for 2015 is shown in Table 5. Slightly more than half of Rota vaccine procuring countries were non countries 11 of 19 (58%) Rota vaccine procuring countries were non countries. Rota vaccine procurement represented about 2% of all vaccine volumes reported to V3P in 2015 All purchases of Rota vaccines amounted to slightly over 13 million doses (worth about 44.1 million) or about 2% of all vaccine doses reported in All countries procured Rota vaccine through UNICEF whereas all non countries selfprocured the vaccine GSK was the most frequent supplier of Rota vaccines reported to the V3P database in 2015 There are only 2 suppliers of Rota vaccines (GSK producing Rotarix and Merck producing Rotateq) but GSK was by far the most frequent supplier of this vaccine (95% of countries) with Merck supplying only 1 reporting country. The presentation size for all Rota vaccine is the same (single dose), but the number of doses for a full course varies between the two suppliers, with GSK Rotarix requiring a 2dose schedule, while Merck Rotateq requires 3 doses. Human papilloma virus vaccine (HPV) The V3P purchase data for HPV for 2015 is shown in Table 6. The vast majority of HPV procuring countries were non Out of 15 countries procuring HPV vaccine, only 1 was a country (7%). HPV vaccine procurement represented about 0.3% of all vaccine volumes reported to V3P in 2015 All purchases of HPV vaccine amounted to less than 2 million doses (worth about $27.2 million), or about 0.3% of all vaccine doses reported in Page 11 of 34 V3P Price Digest 2016 edition

12 The sole country procured HPV through UNICEF whereas all non countries selfprocured Both suppliers of HPV vaccine supplied and non countries alike The only 2 manufacturerss of HPV (GSK producing bivalent Cervarix and Merck producing quadrivalent Gardasil) supply to countries in all WHO regions across all income levels. Overall, the GSK vaccine had a slightly higher frequency of procurement than the Merck vaccine in the countries reporting data. GSK Cervarix exists in single and 2dose presentations while Merck Gardasil only exists in single dose presentation. The 2dose presentation is only used in countries. As almost all countries in the V3P database reporting data for HPV were not eligible, only single dose presentations were reported. Inactivated Polio Vaccine (IPV) The V3P purchase data for IPV for 2015 is shown in Table 7. The majority of IPV procuring countries were non countries 18 of 22 (82%) countries procuring standalone IPV are not eligible. IPV procurement represented about 1% of all vaccine volumes reported to V3P in 2015 All purchases of IPV vaccine amounted to almost 55 million doses (worth about $23 million), or about 1% of all vaccine doses reported in All countries procured IPV through UNICEF whereas the vast majority of non countries selfprocured the vaccine All countries and 4 of 18 non countries (22%) purchased through UNICEF. The three suppliers of IPV do not supply the same markets There are 3 suppliers of IPV registered in the V3P database: GSK, Sanofi Pasteur and Bilthoven Biologicals. countries purchased mainly GSK and Sanofi Pasteur s IPV (15 of 18 countries, 83%), while 3 of 4 (75%) countries purchased IPV from Bilthoven Biologicals. Overall, Sanofi Pasteur was the most frequent supplier. The most frequently procured presentation overall was single dose There are 3 different presentation sizes of standalone IPV procured by countries reporting data to V3P (1, 5, and 10doses). The predominant presentation size procured was the single dose, particularly in the European region, where 8 of the 9 countries (89%) purchasing standalone IPV purchased in singledose presentation. Of note is that several s and MICs do not use standalone IPV but instead use IPVcontaining combination vaccines, such as DTaPIPV, DTaPHibIPV or DTaPHepBHibIPV. Of the 15 s in the database reporting using IPV, only 7 (47%) purchased standalone IPV. Of these 7 countries, 6 countries purchased standalone IPV, usually in limited amount, as a complement to the purchase of other IPVcontaining combination vaccines. Page 12 of 34 V3P Price Digest 2016 edition

13 II. VACCINE PRICE ANALYSIS This section is intended to provide countries, and particularly MICs, with price ranges for specific vaccines from all countries reporting to the V3P database. Key findings by vaccine, 2015 This subsection presents the findings of purchase analyses for specific vaccines procured by countries participating in the V3P database in 2016 and reporting 2015 data (50 countries). Vaccines presented here are: DTwPHepBHib, PCV, Rota, HPV, and IPV. Select acellular pertussiscontaining combinations were also analysed because of their potential interest to non MICs. Wholecell pertussiscontaining pentavalent vaccine (DTwPHepBHib) With the increased uptake of pentavalent vaccine in low and middleincome countries, and an increase in the number of manufacturers, since the launch of in 2000, the price of the wholecell pertussiscontaining pentavalent vaccine fell from $3.5 in 2001 to as little as $ 1.19 a dose in 2015 to UNICEF for countries. This price will lower further to $0.68 by 2017 for all countries procuring through UNICEF. 5,6 The 2015 price ranges, as available in the V3P database, for pentavalent vaccines from 5 manufacturers, in 3 presentation sizes, are shown in Table 8. For 2015, there were a total of 30 procurement transactions for DTwPHepBHib vaccine reported from 25 countries (16 and 9 non countries). The price range is narrow for the single dose and even narrower for the 10dose presentation In singledose presentation, the maximum price registered was 4.2 times higher than the minimum price for this vaccine, across all manufacturers. In 10dose presentation, the maximum price registered was 1.9 times higher than the minimum price for this vaccine, across all manufacturers. Presentation size impacted price The median price of the 10dose presentation was 1.3 to 1.6 times lower than the median price of the single dose presentation, for UMICs and LMICs respectively. Income level and eligibility had a limited impact on price The median price paid in countries was the same as the median price paid in non MICs. The median prices for the vaccine in a same presentation size were slightly lower countries and non LMICs than for UMICS. However, when breaking down the data by procurement mechanism, it appeared that countries paying the lowest prices, regardless of their income levels, were procuring through UNICEF. Page 13 of 34 V3P Price Digest 2016 edition

14 Acellular pertussiscontaining combination vaccines Most s use acellular pertussiscontaining pentavalent vaccines, and several MICs have begun to introduce acellular pertussis containing combinations. Acellular pertussis (ap) combination vaccines not only carry a higher price that the corresponding wholecell combination, but they also tend to be substantially more price differentiated between income groups than wholecell combinations are. The 2015 price ranges, as available in the V3P database, for a selection of apcontaining vaccines (DTaPIPV, DTaPHibIPV and DTaPHepBHibIPV) from 2 manufacturers are shown in Table 9. For 2015, there were a total of 49 procurement transactions for apcontaining vaccines reported from 22 countries (1 country and 21 non countries). The price range is narrow for all apcontaining combination vaccines For all three apcontaining combination vaccines analysed here, the maximum price registered was 4 to 4.3 times higher than the minimum price registered for the same combination vaccine, across the two manufacturers and across income groups. In 2015, apcontaining vaccines were not supported by. For these vaccines, there is therefore no distinct and prenegotiated prices for countries eligible for support. The narrow price range was certainly supported by the fact that only countries with higher income procured apcontaining vaccines in Income level impacted price In the V3P database, all procurement of apcontaining vaccines was done by UMICs and s. Median prices for apcontaining vaccines were consistently lower for UMICs than for s. Across all three combination vaccines, the median price in UMICs was about 40% lower than the median price in s. Pneumococcal conjugate vaccine (PCV) PCV was introduced into several countries through a mechanism called the Advance Market Commitment (AMC) in 2010, through which the price of pneumococcal vaccine was negotiated at a lower price for countries compared to other buyers like PAHO, or high income countries like the 7,8,9 United States. The 2015 price ranges, as available in the V3P database, for PCV vaccines from the 2 manufacturers, in the 1dose and 2dose presentation sizes are shown in Table 10. In 2015, there were a total of 42 procurement transactions for PCV reported from 35 countries (12 and 23 non). The price range for PCV is wide The maximum price registered was 18 times higher than the minimum price for the 1dose presentation, across the two manufacturers and across income groups: countries benefit from a vaccine price of $3.30$3.50 in 2015, while the vaccine was priced high in high income markets ($48.2$60.1 price range in s). Page 14 of 34 V3P Price Digest 2016 edition

15 Income level impacted price, particularly for s. eligibility impacted price for MICs The median price paid in countries was about 4.5 times lower than the median price paid in non MICs. Across manufacturers, the median price for PCV increased with the income group. In non countries, the median price for PCV increased by 10% between LMICs and UMICs and by 158% between UMICs and s. Rotavirus vaccine (Rota) The price of Rota to countries is at or under $3.50 (support initiated in 2007), less than half the price available to PAHO when they introduced the vaccine, and much lower than the $76 average price in the UnitedStates. 8,9,10. The 2015 price ranges, as available in the V3P database, for Rota vaccines from 2 manufacturers, in single dose presentation size, are shown in Table 11. There were a total of 21 procurement transactions for Rota reported from 19 countries (8 and 11 non). The price range for Rota is very wide The maximum price of Rota was 30 times higher than the minimum price registered, across the two manufacturers and across income groups: countries benefit from a vaccine price of $2.08$3.50 in 2015, while the vaccine was priced high in high income markets ($16.7$61 price range in s). Price ranges were wider in higher income groups, and highest in s. Income level impacted price The median price paid in countries was about 4 times lower than the median price paid in non MICs. Across manufacturers, the median price for Rota increased with the income group. In non countries, the median price for Rota increased by 39% between LMICs and UMICs and by 135% between UMICs and s. Human papilloma virus vaccine (HPV) HPV vaccine is available to countries at the lowest international price of $ 4.50$4.60 per dose (support initiated in 2013). The previous lowest public sector price to the PAHO Revolving Fund was $ 13.5 per dose ii at the time and in the UnitedStates the vaccine was priced at around $ ,9,11 The 2015 price ranges, as available in the V3P database, for HPV vaccines from 2 manufacturers, in single dose presentation size, are shown in Table 12. There were a total of 15 procurement transactions for HPV reported from 15 countries (1 and 14 non). ii By 2016, PAHO had managed to lower this price to $8.50 for the bivalent HPV vaccine. Page 15 of 34 V3P Price Digest 2016 edition

16 The price range for HPV is wide The maximum price of HPV was about 9 times higher than the minimum price registered in the V3P database, across the two manufacturers and across income groups. We observe that one LMIC in the database reports paying a low price ($6) close to the price for countries of $4.50 in 2015 for the single dose presentation and a maximum price of $55.45 is registered in a. Price ranges were wider in higher income groups, and highest in s ($8.98 $55.45), with one outlier country paying a much higher price than other s. The average price for each of the two vaccines is similar In non countries, the average price of the two HPV vaccines was similar, at $23.6 for the GSK product and $26.6 the Merck product. Income level impacted price The price at which HPV was available to countries was about 3 times lower than the median price paid in non MICs. Across manufacturers, the median price for HPV increased with the income group. In non countries, the median price for HPV increased by 50% between LMICs and UMICs and by 102% between UMICs and s. Inactivated polio vaccine (IPV) Through the Global Polio Eradication Initiative (GPEI) to eradicate polio, UNICEF tenders secured the lowest price of 0.75 per dose for countries in The previous lowest public sector price to the PAHO Revolving Fund was $ 2.9 per dose. 8, 13 Price comparison of standalone IPV with s is not recommended, given the procurement specificities for this vaccine in s (see previous chapter on vaccine purchase analysis). The 2015 price ranges, as available in the V3P database, for IPV vaccines from 3 manufacturers, in 3 presentation sizes (1, 5 and 10doses), are shown in Table 13. There were a total of 25 procurement transactions for IPV vaccine reported from 22 countries (4 countries and 18 non countries). The price range for IPV is wide Excluding the 6 s that purchase IPV standalone in complement to other IPVcontaining vaccines, the maximum price of IPV is 9 times higher than the minimum price registered in the V3P database, across the two manufacturers and across all groups. (Note: including all s, including those procuring a limited number of doses to supplement other IPVcontaining vaccine purchases, the maximum price of IPV was about 56 times higher than the minimum price registered.) countries are getting lower prices for the vaccine, particularly for the 10dose vial of IPV ($0.83) while non eligible countries procuring single dose IPV paid higher prices (up to $7.00). s purchasing only a small amount of standalone IPV while purchasing other IPVcontaining vaccines paid the highest prices (up to $42.18). Page 16 of 34 V3P Price Digest 2016 edition

17 Presentation size seemed to have more impact on price than income level Excluding the 6 s that purchase other IPVcontaining vaccines, the median price of the 5 dose presentation was 2.3 times lower than the median price of the single dose presentation, and even slightly lower than the 10dose presentation. Price difference varied more by presentation size than by income level, highlighting different pricing strategies for these products. For the 5dose presentation, produced by Bilthoven Biologicals, all countries were paying the same price of $1.90, regardless of their income group or eligibility status. For the 10dose presentation, produced by Sanofi Pasteur, prices clearly followed a tiered pricing approach linked to income level and eligibility: $0.83 for countries, $1.65 $2.24 for LMICs and $2.72 $3.33 for UMICs. The single dose presentation was mainly sold to s and UMICs, at higher prices than multidose presentations, and without a clear price difference between UMICs and s (when excluding s purchasing small amounts of standalone IPV at high prices). Page 17 of 34 V3P Price Digest 2016 edition

18 number of suppliers most frequently procured vaccine type (frequency) number of vaccine types procured Proportion of UNICEF procuring* countries (%) Doses of all vaccines procured Countries reporting Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global III. TABLES Table 1. Purchase characteristics, for all vaccines, by income group and WHO region, in 2015 Non Non LIC, LMIC(13), LMIC UMICs s Total LIC, LMIC(13), 29,559, ,976,750 48,785,055 1,223, ,544,949 LMIC 835,400 40,371,516 11,320,900 52,527,816 UMICs 256,192,163 34,967, ,295 22,040, ,873,508 29,699,339 58,428 15,972,574 45,730,341 Total 315,451, ,837, ,803,440 23,263,414 11,320, ,676,614 Non Non Non LIC, LMIC(13), 7 / 7 (100%) 5 / 5 (100%) 2 / 3 (67%) 1 / 1 (100%) 15 / 16 (94%) LMIC 0 / 1 (0%) 1 / 1 (100%) 1 / 1 (100%) 2 / 3 (67%) UMICs 2 /10 (20%) 0 / 4 (0%) 1 / 1 (100%) 0 / 1 (0%) 3 / 16 (19%) s 0 / 12 (0%) 1 / 1 (100%) 0 / 2 (0%) 1 / 15 (7%) Total 9 / 29 (31%) 1 / 11 (55%) 4 / 7 (57%) 1 / 2 (50%) 1 / 1 (100%) 21 / 50 (42%) LIC, LMIC(13), Total (not additive) LMIC UMICs s LIC, LMIC(13), DTwPHepB Hib (10) topv (7) BCG / DTwP HepBHib / HepB (ped) / MR / topv /TT (3) LMIC UMICs s Total (not additive) LIC, LMIC(13), BCG (13) MMR (13) BCG (33) BCG (5) BCG / DTwP HepBHib / MMR / TT (2) BCG (13) Influenza (seasonaladult) (4) BCG / HepB (ped) (7) JE (3) BCG (2) JE (3) BCG / IPV (2) DTwPHepBHib (20) BCG (4) BCG (20) MMR (18) BCG (57) Non LMIC UMICs s Page 18 of 34 V3P Price Digest 2016 edition

19 most frequent presentation size procured (number of records) number of presentation sizes most frequent supplier (number of records) Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Total (not additive) Non LIC, LMIC(13), GSK (21) LMIC UMICs s Total (not additive) LIC, LMIC(13), Microgen (24) GSK (76) GSK (118) Serum Institute of India (14) Serum Institute of India (5) Sanofi Pasteur / Serum Institute of India (16) Serum Institute of India (7) Serum Institute of India (42) Serum Institute of India (9) Serum Institute of India (6) GSK (4) Sanofi Pasteur (12) Serum Institute of India (17) BioFarma (2) GPO Thailand / Serum Institute of India (3) Serum Institute of India (3) Serum Institute of India (4) Serum Institute of India (3) Serum Institute of India (39) Serum Institute of India (14) Sanofi Pasteur (39) GSK (86) GSK (152) Non LMIC UMICs s Total (not additive) Non LIC, LMIC(13), Total * in whole or in part Source: V3P Database dose (39) LMIC UMICs s 1 dose (72) 1 dose (154) 1 dose (265) 10 dose (21) 10 doses (5) 1 dose (23) 1 dose (6) 10 dose (52) 10 dose (12) 1 dose / 10 dose (4) 1 dose (5) 1 dose (31) 1 dose (47) 1 dose / 10 dose (3) 10 dose (5) 10 doses (5) 10 dose (8) 10 dose (5) 10 dose (64) 10 dose (14) 1 dose (103) 1 dose (191) 1 dose (359) Page 19 of 34 V3P Price Digest 2016 edition

20 most frequent presentation size procured (number of records) number of presentation sizes most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses procured Countries purchasing Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Table 2. Purchase characteristics for DTwPHepBHib vaccine by income group and WHO region, in 2015 LIC, LMIC(13), LMIC UMICs s 1 1 Total LIC, LMIC(13), 4,229,780 11,724,100 2,212,615 49,294 18,215,789 LMIC 103,400 8,808,696 1,700,000 10,508,696 UMICs 555, ,000 32,800 1,188,500 10,168 10,168 Total 4,785,480 12,437,668 11,054,111 49,294 1,700,000 30,026,553 LIC, LMIC(13), Total 7/ 7 (100%) 5 / 5 (100%) 2 / 3 (67%) 1 / 1 (100%) LMIC 0 / 1 (0%) 0 / 1 (0%) UMICs 2 / 2 (100%) s 9 / 9 (100%) 15 / 16 (94%) 1 / 1 (100%) 1 / 3 (33%) 0 / 2 (0%) 1 / 1 (100% 3 / 5 (60%) 1 / 1 (100%) 6 / 9 (67%) 3 / 5 (60%) 1 / 1 (100%) 1 / 1 (100%) 1 / 1 (100%) 20 / 25 (80%) LIC, LMIC(13), LMIC UMICs s 1 1 Total (not additive) LIC, LMIC(13), Janssen Janssen Janssen SII (4) (6) (8) LMIC SII SII SII SII (3) Janssen Biological E SII / Janssen UMICs SII (2) (2) (2) s SII (2) SII (2) Total (not additive) Janssen (8) SII (9) Biological E / SII (2) Janssen SII SII (14) LIC, LMIC(13), LMIC UMICs s 1 Total (not additive) LIC, LMIC(13), 1 dose (8) 10 dose (5) 1 dose (3) 1 dose 1 1 dose (13) LMIC 1 dose 1 dose 10 dose 1 dose (2) UMICs 1 dose (2) 1 dose 1 dose (4) s 1 dose (2) 1 dose (2) Note: SII = Serum Institute of India Source: V3P Database. 14 Total 1 dose (10) 10 dose (6) 1 dose (5) 1 dose 10 dose 1 dose (21) Page 20 of 34 V3P Price Digest 2016 edition

21 most frequent presentation size procured (number of records) number of presentation sizes most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses procured Countries purchasing Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Table 3. Purchase characteristics for DTaPIPV, DTaPHibIPV and DTaPHepBHibIPV vaccines by income group and WHO region, in 2015 UMIC 1 1 LMIC UMICs s Total UMIC 110, ,000 LMIC UMICs 18,405,604 3,804,270 22,209,874 3,361, ,232 4,052,258 Total 21,876,630 3,804, ,232 26,372,132 UMIC LMIC UMICs s Total not procured by Unicef UMIC 1 1 LMIC UMICs s Total (not additive) UMIC Sanofi Pasteur Sanofi Pasteur LMIC UMICs s Sanofi Pasteur (10) Sanofi Pasteur (16) Sanofi Pasteur (2) Sanofi Pasteur (12) GSK (3) Sanofi Pasteur (16) Total (not additive) Sanofi Pasteur (27) Sanofi Pasteur (2) GSK (3) Sanofi Pasteur (29) UMIC 1 1 LMIC UMICs s Total (not additive) UMIC 1 dose 1 dose LMIC UMICs 1 dose (6) 1 dose 1 dose (7) s 1 dose (12) 1 dose (2) 1 dose (14) Total 1 dose (19) 1 dose 1 dose (2) 1 dose (22) Source: V3P Database. 14 Page 21 of 34 V3P Price Digest 2016 edition

22 most frequent presentation size procured (number of records) number of presentation sizes most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses purchased Countries purchasing Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Table 4. Purchase characteristics for PCV vaccine by income group and WHO region, in 2015 LMIC(10), LMIC UMICs s Total LMIC(10), 2,006,200 16,042,790 1,179,493 19,228,453 LMIC 103,400 2,008,125 2,000,000 4,111,525 UMICs 25,153,053 3,340,840 63,300 28,557, ,695 2,465,282 2,951,977 Total 27,646, ,87,030 5,716,200 2,000,000 54,849,448 LMIC(10), 12 / 12 6 / 6 (100%) 4 / 4 (100%) 2 / 2 (100%) (100%) LMIC 0 / 1 (0%) 0 / 1 (0%) 0 / 1 (0%) 0 / 3 (0%) UMICs 1 / 6 (17%) 0 / 3 (0%) 0 / 1 (0%) 1 / 10 (10%) s 0 / 9 (0%) 0 / 1 (0%) 0 / 10 (0%) Total 7 / 21 (33%) 4 / 8 (50%) 2 / 6 (33%) 0 / 1 (0%) 13 / 35 (37%) LMIC(10), LMIC UMICs s Total (not additive) LMIC(10), Pfizer (5) GSK / Pfizer (2) GSK / Pfizer Pfizer (8) LMIC Pfizer Pfizer GSK Pfizer (2) UMICs GSK / Pfizer (3) Pfizer (3) GSK Pfizer (6) GSK / Pfizer s GSK / Pfizer (6) GSK / Pfizer (7) Total (not additive) Pfizer (14) Pfizer (6) GSK / Pfizer (3) GSK Pfizer (23) LMIC(10), LMIC UMICs s Total (not additive) LMIC(10), 1 dose (5) 1 dose / 2 dose (2) 1 dose (2) 1 dose (9) LMIC 1 dose 1 dose 1 dose 1 dose (3) UMICs 1 dose (6) 1 dose (3) 1 dose 1 dose (10) s 1 dose (12) 1 dose (2) 1 dose (14) Total 1 dose (23) 1 dose (6) 1 dose (6) 1 dose 1 dose (36) Source: V3P Database. 14 Page 22 of 34 V3P Price Digest 2016 edition

23 most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses purchased Countries purchasing Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Table 5. Purchase characteristics for Rota vaccine by income group and WHO region, in 2015 LMIC(7), UMIC LMIC UMICs s 4 4 Total LMIC(7), UMIC 2,094,000 6,548,340 8,642,340 LMIC ,980,000 2,057,400 UMICs 2,432,590 42,200 2,474,790 85,470 85,470 Total 2,179,470 9,058,330 42,200 1,980,000 13,260,000 LMIC(7), UMIC 5 / 5 (100%) 3 / 3 (100%) 8 / 8 (100%) LMIC 0 / 1 (0%) 0 / 1 (0%) 0 / 2 (0%) UMICs 0 / 4 (0%) 0 / 1 (0%) 0 / 5 (0%) s 0 / 4 (0%) 0 / 4 (0%) Total 5 / 9 (56%) 3 / 8 (38%) 0 / 1 (0%) 0 / 1 (0%) 8 / 19 (42%) LMIC(7), UMIC LMIC UMICs s 1 Total (not additive) LMIC(7), UMIC GSK (7) GSK (3) GSK (10) LMIC GSK Merck GSK / Merck UMICs GSK (4) GSK GSK (5) s GSK (4) GSK (4) Source: V3P Database. 14 Total (not additive) GSK (11) GSK (8) GSK Merck GSK (20) Page 23 of 34 V3P Price Digest 2016 edition

24 most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses purchased Countries purchasing Purchase characteristics Funding support Income group EUR AFR WPR SEAR EMR Global Table 6. Purchase characteristics for HPV vaccine by income group and WHO region, in 2015 LMIC 1 1 LMIC 1 1 UMICs s 8 8 Total LMIC 25,020 25,020 LMIC 300, ,000 UMICs 20, ,401 26, , , ,125 Total 486, , ,000 25,020 1,784,546 LMIC 1 / 1 (100%) 1 / 1 (100%) LMIC 0 / 1 (0%) 0 / 1 (0%) UMICs 0 / 1 (0%) 0 / 3 (0%) 0 / 1 (0%) 0 / 5 (0%) s 0 / 8 (0%) 0 / 8 (0%) Total 0 / 9 (0%) 0 / 3 (0%) 0 / 2 (0%) 1 / 1 (100%) 1 / 15 (7%) LMIC 1 1 LMIC 1 1 UMICs s 2 2 Total (not additive) LMIC Merck Merck LMIC Merck Merck UMICs GSK GSK (2) GSK GSK (4) s GSK (5) GSK (5) Source: V3P Database. 14 Total (not additive) GSK (6) GSK (2) GSK / Merck Merck GSK (9) Page 24 of 34 V3P Price Digest 2016 edition

25 most frequent presentation size (number of records) number of presentation sizes most frequent supplier (number of records) number of suppliers Proportion of UNICEF procuring* countries (%) Doses purchased Countries purchasing Purchase characteristi cs Funding support Income group EUR AFR WPR SEAR EMR Global Table 7. Purchase characteristics for IPV vaccine by income group and WHO region, in 2015 LIC LMIC(3) LMIC UMICs s Total LIC LMIC(3) 1,275, ,625 9,100 1,491,250 LMIC 941,176 1,080,900 2,022,076 UMICs 3,276,564 84,000 34,995 1,400,000 4,795, ,591 1, , ,290 Total 3,388,155 1,361,325 1,442,695 1,409,100 1,080,900 8,682,175 LIC LMIC(3) 2 / 2 (100%) 1 / 1 (100% 1 / 1 (100%) 4 / 4 (100%) LMIC 0 / 1 (0%) 1 / 1 (100%) 1 / 2 (50%) UMICs 1 / 5 (20%) 0 / 2 (0%) 1 / 1 (100%) 0 / 1 (0%) 2 / 9 (22%) s 0 / 4 (0%) 1 / 1 (100%) 0 / 2 (0%) 1 / 7 (14%) Total 1 / 9 (11%) 3 / 5 (60%) 2 / 5 (40%) 1 / 2 (50%) 1 / 1 (100%) 8 / 22 (36%) Total (not additive) LIC LMIC(3) LMIC UMICs s LIC LMIC(3) Bilthoven / Sanofi Pasteur LMIC UMICs s Total (not additive) Sanofi Pasteur (4) Sanofi Pasteur (4) Sanofi Pasteur (8) GSK / Sanofi Pasteur Sanofi Pasteur Sanofi Pasteur (3) Bilthoven Bilthoven Bilthoven (3) Sanofi Pasteur Bilthoven Sanofi Pasteur (2) Sanofi Pasteur (3) Sanofi Pasteur Bilthoven / Sanofi Pasteur Bilthoven / Sanofi Pasteur Bilthoven / Sanofi Pasteur Sanofi Pasteur (2) Sanofi Pasteur (6) Sanofi Pasteur (7) Sanofi Pasteur (16) LIC LMIC(3) LMIC UMICs s Total (not additive) LIC 5 dose / 10 LMIC(3) dose 5 dose 1 dose 5 dose (2) Total Source: V3P Database. 14 LMIC 10 dose UMICs 1 dose (4) 1 dose / 10 dose s 1 dose (5) 1 dose 1 dose (9) 1 dose / 10 dose (2) 5 dose / 10 dose 10 dose (2) 5 dose 10 dose 1 dose (5) 1 dose / 10 dose 5 dose / 10 dose (2) 1 dose (7) 1 dose / 10 dose 5 dose / 10 dose 1 dose(13) Page 25 of 34 V3P Price Digest 2016 edition

26 Table 8. Price ranges of DTwPHepBHib vaccines by manufacturer, by presentation size, and by income level, in 2015 Price characteristics All manufacturers, presentations, and income levels All presentation sizes and income levels by manufacturer Price range by manufacturer, presentation size and income level Source: V3P Database. 14 Funding support and and and Income level UMIC, UMIC, UMIC, UMIC LMIC UMIC (freq) $ US Price range (n) (30) MIN 1.19 MED 2.36 MAX 5.10 Serum Crucell/ Institute of Janssen India Biological E LG Shantha (n) (14) (10) (4) MIN MED MAX dose (n) (8) (6) (10) (3) MIN MED MAX (n) (3) (4) (9) (2) MIN MED MAX (n) (2) MIN MED MAX (n) (2) MIN MED MAX (n) (2) MIN 2.49 MED 3.10 MAX 3.70 Page 26 of 34 V3P Price Digest 2016 edition

27 Table 9. Price ranges of acellular pertussiscontaining combination vaccines by manufacturer in single dose presentation*, by income level, in 2015 Price characteristics Price range by manufacturer, presentation size and income level Funding support Income level Vaccine combination DTaPIPV DTaPHibIPV Vaccine manufacturer and UMIC, UMIC LMIC UMIC (freq) $ US Price range DTaPHepB HibIPV Sanofi Sanofi Sanofi GSK GSK Pasteur Pasteur Pasteur GSK (n) (9) (4) (13) (4) (7) (7) MIN MED MAX (n) (0) (0) (0) (0) (0) MIN MED MAX (n) (0) (0) (0) (0) (0) (0) MIN MED MAX (n) (3) (0) (5) (0) (3) MIN MED MAX (n) (6) (4) (8) (4) (3) (6) MIN MED MAX * Note: all apcontaining vaccines reported by countries to the V3P database for 2015 were in singledose presentation. Source: V3P Database. 14 Page 27 of 34 V3P Price Digest 2016 edition

28 Table 10. Price ranges of PCV vaccines by manufacturer, by presentation size, and by income level, in 2015 Price characteristics All manufacturers, presentations, and income levels All presentation sizes and income levels by manufacturer Price range by manufacturer, presentation size and income level Source: V3P Database. 14 Funding support and and and Income level UMIC, UMIC, UMIC, UMIC LMIC UMIC (freq) $ US Price range (n) (42) MIN 3.30 MED MAX GSK Pfizer (n) (19) (23) MIN MED MAX dose (n) (13) (6) (23) MIN MED MAX (n) (6) (8) MIN MED MAX (n) (0) (2) MIN MED MAX (n) (4) (0) (6) MIN MED MAX (n) (7) (0) (7) MIN MED MAX Page 28 of 34 V3P Price Digest 2016 edition

29 Table 11. Price ranges of Rotavirus vaccines by manufacturer, in single dose presentation, by income level, in 2015 Price characteristics All manufacturers, presentations, and income levels Price range by manufacturer, presentation size and income level Source: V3P Database. 14 Funding support and and Income level UMIC, UMIC, UMIC LMIC UMIC (freq) $ US Price range (n) (21) MIN 2.06 MED 3.70 MAX GSK Merck (n) (20) MIN MED MAX (n) (10) (0) MIN 2.06 MED 2.14 MAX 2.53 (n) MIN MED MAX (n) (5) (0) MIN 6.25 MED 8.15 MAX (n) (4) (0) MIN MED MAX Page 29 of 34 V3P Price Digest 2016 edition

30 Table 12. Price ranges of HPV vaccines by manufacturer, in single dose presentation*, and by income level, in 2015 Price characteristics All manufacturers, presentations, and income levels Price range by manufacturer, presentation size and income level Funding support and and * Note: GSK offers a 2dose presentation to eligible countries. Source: V3P Database. 14 Income level UMIC, UMIC, UMIC LMIC UMIC (freq) $ US Price range (n) (15) MIN 6.00 MED MAX GSK* Merck (n) (9) (6) MIN MED MAX (n) (0) MIN 6.00 MED 6.00 MAX 6.00 (n) (0) MIN MED MAX (n) (4) MIN MED MAX (n) (5) (3) MIN MED MAX Page 30 of 34 V3P Price Digest 2016 edition

31 Table 13. Price ranges of IPV vaccines by manufacturer, by presentation size, and by income level, in 2015 Price characteristics All manufacturers, presentations, and income levels All presentation sizes and income levels by manufacturer Price range by manufacturer and presentation size Source: V3P Database. 14 Funding support and and and Income level UMIC, UMIC, UMIC, UMIC LMIC UMIC (freq) $ US Price range (n) (24) MIN 0.83 MED 3.43 MAX Sanofi Pasteur GSK Bilthoven (n) (16) (3) (5) MIN MED MAX dose (n) (9) (7) (3) (4) MIN MED MAX (n) (0) (0) (2) MIN MED MAX (n) (0) (2) (0) (0) MIN MED MAX (n) (3) (3) (2) (0) MIN MED MAX (n) (6) (0) (0) MIN MED MAX Page 31 of 34 V3P Price Digest 2016 edition

32 REFERENCES 1 PAHO. Revolving Fund Prices. Available at: 2 World Bank. Country Classifications July Available at: 3. Countries eligible for support. Available at: 4 World Bank. Official exchange rate. Available at: 5. Pentavalent vaccine support. Available at: 6 UNICEF Supply Division. Vaccine Price data for DTwPHepBHib. Available at: 7. Pneumococcal vaccine support. Available at: 8 PAHO: Revolving Fund prices. Available at: 9 CDC. Vaccines for Children Program. CDC vaccine price list. Available at: Rotavirus vaccine support. Available at: Human papillomavirus vaccine support. Available at: 12 UNICEF. Joint GPEIGAVI Statement on the Availability and Price of Inactivated Polio Vaccine. 28 February Available at: Inactivated polio vaccine support. Available at: 14 WHO. Vaccine Product, Price and Procurement (V3P) Web Platform. Available at: Page 32 of 34 V3P Price Digest 2016 edition

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