Update from GAVI Aurelia Nguyen (Copenhagen, Denmark, 27 June 2012)
GAVI vaccine support Currently supported vaccines: pentavalent, pneumococcal, rotavirus, meningitis A, human papillomavirus (HPV), rubella, yellow fever and measles second dose and selected campaigns Also: meningitis and yellow fever vaccine stockpiles Prioritised for future support: Japanese encephalitis (c.2015) and typhoid (c.2017) vaccines Monitoring development: malaria (c.2016), dengue (c.2017) New options: cholera and polio IPV (year of potential first introduction)
June Board update: Outlook through 2020 (current portfolio) (current portfolio) 2011-15: $8.0 bn 2016-20: $7.9 bn Indicative Includes the new vaccine windows (MR, HPV, JE, typhoid) Prior to any other new vaccines (and measles option) 3
GAVI Alliance Board update Rotavirus and pneumococcal supply constraints Enhancing GAVI s investment in measles prevention Vaccine introduction grant and operational support for campaigns Polio Cholera Lower Middle Income Countries
Rotavirus forecast v 5.0 unconstrained Haiti Honduras Niger Sudan Nicaragua Guyana Guinea-Bissau Sierra Leone Togo Djibouti Cen. Afr. Rep. Cameroon Congo Republic Burundi Tanzania Bolivia Angola Zambia Madagascar Zimbabwe 30 Number of Countries per year 20 10 3 1 1 8 5 15 9 8 Introduced Approved 0 2009 2010 2011 2012 2013 2014 2015 Forecast * Source demand forecast v5.0
Rota: supply constrained annual introductions Haiti Honduras Niger Sudan Nicaragua Guyana Guinea-Bissau Sierra Leone Togo Djibouti Cen. Afr. Rep. Cameroon Congo Republic Burundi Tanzania Bolivia Angola Zambia Madagascar Zimbabwe 30 Number of Countries per year 20 10 0 3 1 1 5 3 2009 2010 2011 2012 2013 2014 2015 5 13 18 Introduced Approved Forecast * Source demand forecast v5.0
Pneumo demand v 5.0 unconstrained introductions Moldova Georgia Armenia Azerbaijan Pakistan Haiti Honduras Nicaragua Guyana Mauritania Senegal Gambia Guinea Bissau Sierra Leone Mali Niger Yemen Togo Sudan Djibouti Nigeria Ethiopia CAR Benin Ghana Cameroon Uganda Democratic Kenya Sao Tome Republic of Rwanda the Congo Burundi Tanzania Bangladesh Lao PDR Papua New Guinea Kiribati. Bolivia Angola Malawi Zambia Zimbabwe Mozambique Madagascar Lesotho 30 Number of Countries per year 20 10 0 19 16 13 5 2 16 14 5 1 2 2009 2010 2011 2012 2013 2014 2015 Introduced Approved Forecast * Source forecast based on SDF v5.0
Pneumo: supply constrained annual introductions Moldova Georgia Armenia Azerbaijan Pakistan Haiti Honduras Nicaragua Guyana Mauritania Senegal Gambia Guinea Bissau Sierra Leone Mali Niger Yemen Togo Sudan Djibouti Nigeria Ethiopia CAR Benin Ghana Cameroon Uganda Democratic Kenya Sao Tome Republic of Rwanda the Congo Burundi Tanzania Bangladesh Lao PDR Papua New Guinea Kiribati. Bolivia Angola Malawi Zambia Zimbabwe Mozambique Madagascar Lesotho 30 Number of Countries per year 20 10 0 2 1 17 13 10 12 5 2009 2010 2011 2012 2013 2014 2015 Introduced Approved Forecast * Source forecast based on SDF v5.0
GAVI s commitments strengthen measles control $197M since 2004, primarily to the Measles Initiative for campaigns Routine second dose of measles Investments in health systems and improving immunization coverage Support for measles-rubella through wideage campaigns Performance-based funding mechanism includes measles coverage indicator 9
Enhanced support Six large countries estimated by WHO at high risk of outbreaks prior to introducing MR vaccine Country DTP3 (2010) Measles1 (2010) Afghanistan 66 62 DR Congo 63 68 Chad 59 46 Ethiopia 86 81 Nigeria 69 71 Pakistan 88 86 Response to outbreaks and emerging needs 10
Projected Cost Estimates (US$ millions) Outbreak funds - Pass to MR Initiative 2012 2013 2014 2015 2016 2017 Total 5 10 10 10 10 10 55 Funds for vaccines by proposals up to 6 countries ($0.42/dose) Funds for operational costs up to 6 countries ($0.65/person) Total potential commitment by year 0 21 3 17 1-42 0 33 4 26 1-65 5 65 17 53 12 10 162 11
Vaccine introduction grant and operational support for campaigns Objective Facilitate timely, effective implementation of critical activities: Before new vaccine introductions For delivery during campaigns One-time investments, covering a share of the cost Scope All new GAVI-supported vaccines Activities driven by country needs Does not cover recurrent costs Operating guidelines Flexible, timely, simple, separate from other cash support, not used for co-financing 12
New policy: what has changed? $3.0 $2.4 $1.8 GAVI support: Current policy New policy $1.2 $0.6 $0.0 x 80% Infant vaccines 80% x HPV vaccines 13 80% Operational support campaigns (per child) (per girl) (per target) Total cost estimate: Current policy New policy
New policy: funding levels 1. Vaccine introduction grants: Vaccines delivered to infants: US$ 0.80 per child in birth cohort (min. US$ 100,000) HPV vaccines delivered to adolescent girls: US$ 2.40 per girl in target population (min. US$ 100,000) 2. Operational support for campaigns: US$ 0.65 per individual in target population 3. Product switches after first introduction: One third of full grant for transition to new product, provided criteria are met 14
Polio GAVI support to polio efforts - investment case providing financing for operational costs and stockpiling of vaccines Intensify support to health systems strengthening in polioaffected countries Potential role for GAVI to play to support the new polio endgame strategy IPV funding in the context of a topv to bopv switch Update to Board and review following November SAGE meeting
Major cholera outbreaks & hotspots, 2005-2011 Oct 2010 - Dec 2011 Haiti 500 000 cases Nov 2009 - Dec 2011 Central Africa > 129 000 cases 2009/10 Papua New Guinea > 10 000 cases annually : Bangladesh 100-300 000 cases India? Pakistan? 2008/09 Zimbabwe > 98 000 cases 2007 / 08 Iraq > 4700 cases + AWD 2006 / 07 Horn of Africa > 130 000 cases Areas reporting cholera outbreaks, 2010-2011 2006 /07 Angola > 86 000 cases 2005 Afghanistan > 155 000 cases 2005 West Africa > 76 000 cases annually: DRC 13 000 30 000 cases Source: Global Task Force on Cholera Control, WHO
Estimated size and cost of a potential cholera vaccine stockpile 2013-2014 2015-2016 2017-2020 Total (2012-2020) Doses in stockpile 2 m/year 5 m/year 10 m/year 54 million Cost $5.5 m/year $13.6 m/year $23-27 m/year ~ $138 million
Number of countries Low- and Lower Middle-Income countries and GAVI support Low income and Lower-middle income countries & GAVI support 60 40 21 Lower-middle-income countries (n=56) Low income countries (n=36) 20 0 36 GAVI eligible 14 GAVI graduating 21 Not supported LMICs
No. of countries 2012-2013: 94 introductions versus 50 in the business plan - an increase of 88% 100 90 80 70 60 50 40 30 20 10 0 MenA, 8 JE, 2 Rubella, 2 Penta, 4 Rota, 19 14 v2 MenA, 6 JE, 3 Rubella, 9 Penta, 7 Rota, 30 Pneumo, 37 v4 MenA JE Rubella HPV Penta Rota Pneumo
Rota: cumulative introductions versus business plan 70 60 50 40 30 20 Business Plan Actual and Supply Constraint Adjusted SDF v5.0 49 40 31 33 23 28 16 18 8 roll outs in 2012 Currently predict 2-5 will introduce in 2013 2014-15 will see intro s back on track Up to 9 approved countries delayed for a year Future bottleneck readiness 10 4 5 13 0 4 5 B-Line 2011 2012 2013 2014 2015 21
Pneumo: cumulative introductions versus business plan 70 60 50 40 30 20 10 0 Business Plan SDF v5.0 supply constrained 60 50 43 45 35 32 36 31 19 26 16 3 3 B-Line 2011 2012 2013 2014 2015 16 roll outs in 2011 10 roll outs in 2012 Currently predict 5 will introduce in 2013 2014-15 will see intro s back on track Delays of a year effecting up to15 countries Readiness is the future bottleneck 22