Measles Containing Vaccines UNICEF/UN074464/Lister UNICEF Vaccine Industry Consultation 02 October 2018 UNICEF Supply Division
Outline Review of main consideration related to Measles and Measles-Rubella market and interrelations between the two markets. Measles vaccine Historical and forecasted procurement through UNICEF. Measles-Rubella vaccine Historical and forecasted procurement through UNICEF, including major Measles-Rubella vaccine introductions in the coming years. Measles-Mumps-Rubella vaccines Main considerations and review of historical and forecasted procurement.
Measles and MR Vaccines main considerations Demand Fluctuation Opportunities come with risks Measles and Rubella programme direction Funding Large portion of demand is for supplementary immunization activities (SIAs). Accurate monthly/operational forecasting of SIAs is challenged due to the difficulty in predicting the exact timing of countries SIAs and timing of MR introduction. Demand for Measles and MR vaccine is interconnected as countries switch from Measles to MR. Countries are typically introducing Rubella vaccine through wide age range catch up campaigns, targeting children aged 9m-14y. The inverse relationship is therefore not 1:1. Expansion of the supplier base is needed to stimulate development of a healthy market and to ensure continued vaccine security. With new entries into the market, there will be a need for balancing level of capacity in post 2022-2023 period when remaining major MR catch up campaigns are anticipated to be completed and demand pattern is anticipated to normalize and see less significant peaks. It is considered premature to set an eradication goal. The World Health Assembly is scheduled to consider a target date in May 2020. Potential eradication strategies may impact demand beyond 2020. Introduction of second dose of Measles Containing Vaccine ongoing. Demand for Measles Demand for MR Gavi Measles and Rubella strategy approved by Gavi board in 2015 comes with comprehensive support to Gavi countries Funding source of Measles/MR procured through UNICEF in % (GAVI/PS/UNICEF incl. MRI) Measles: 30/50/20 MR: 50/35/15 5 Dose vial Introduction of 5 dose vial presentation may have a potential of reaching more children and reducing open vial wastage rate.
Quantity in million of doses Weighted Average Price per dose (US$) Measles vaccine - Historical and forecasted procurement through UNICEF Supply Two WHO PQ-ed products. Supply meets demand, however planning needed. Anticipated pipeline. Demand 31 Countries. For routine, Supplementary activities and outbreaks. As countries introduce MR, reduction in demand for Measles. 2016- Between 2016 and present, UNICEF procured Measles vaccine for preventative campaigns in 17 countries. 2019-2020-2021: Measles campaigns in DRC, Nigeria, Ethiopia, Afghanistan. These are anticipated to be last Measles SIAs in these countries before they switch to MR. 300 Measles vaccine - Historical and forecasted procurement through UNICEF 0.40 250 200 0.222 0.236 0.236 0.246 0.252 0.277 0.279 0.271 0.307 0.301 0.287 0.35 0.30 0.25 150 0.20 100 0.15 0.10 50 0.05 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Actual procurement - Routine Immunization Actual procurement - Supplementary Immunization Activities WAP (US$/dose) 0.00
MR vaccine - Historical and forecasted procurement through UNICEF Quantity in millions of doses Weighted Average Price per dose (US$) Supply One WHO PQ-ed product. Supply meets demand, however planning needed. Unawarded quantities in 2019 & 2020 to enable anticipated pipeline. Demand 37 Countries. For routine, Supplementary activities and outbreaks. 2017-2018: MR Introduction in India and Indonesia. UNICEF procured ~ 173 mds (Gavi funded) for India. 2019-2020: MR introduction in Comoros, Uganda, DPRK, Sierra Leone. Large SIAs in Tanzania Bangladesh 2021-2022: MR introduction in Sudan, Niger, DR Congo, Ethiopia, Pakistan, Mali, Madagascar, Liberia. 300 0.75 250 0.62 0.615 0.644 0.656 0.656 0.7 0.65 200 150 0.489 0.505 0.497 0.527 0.55 0.6 0.55 0.5 100 0.45 50 0 0.359 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Actual procurement - Routine Immunization Actual procurement - Supplementary Immunization Activities WAP (US$/dose) 0.4 0.35 0.3
Quantity procured/forecast in doses Weighted average price, US$/dose Measles-Mumps-Rubella vaccine - Historical and forecasted procurement through UNICEF Main consideration Three (3) WHO PQ-ed MMR vaccine, (2xJL, 1xLZ) Demand primarily from Middle Income Countries with strong preference for specific Mumps strain 26 Countries regularly procure their MMR requirements UNICEF, valued at US$ 18 million (2017) Strict registration requirements, limiting flexibility of supply source Jeryl Lynn Quantity of doses Urabe Quantity of doses Leningrad Zagreb Quantity of doses 1-dose WAP 2-dose WAP 5-dose WAP 10-dose WAP 25,000,000 $4.74 $5.00 $4.47 $4.47 $4.50 $4.08 20,000,000 $4.00 $3.44 $3.25 $3.25 $3.25 $3.50 Demand for 2, 5 and 10 dose vial presentation driven by small number of large countries. The increase in demand seen in last 4 years is likely to stabilize 15,000,000 10,000,000 $2.29 $1.82 $2.90 $3.07 $2.27 $2.37 $2.85 $3.00 $2.50 $2.00 Countries with MR vaccine in their RI schedule may choose to introduce Mumps containing vaccine in the future, currently no indication of the timing of potential switch. 5,000,000 $1.13 $0.90 $0.96 $1.03 $1.06 $1.11 $1.15 $1.45 $1.27 $1.28 $1.50 $1.00 To suppliers: Challenges in facilitating timely availability of vaccine in response to recent surge in Measles outbreaks primarily in Europe. How can access for such unforeseen requests be improved? - 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 $0.50 $-
Summary Measles and MR market are interconnected. Demand is continuing to gradually switch from Measles to MR. Accurate monthly/operational forecasting of SIAs is challenged due to difficulty in predicting the exact timing of countries SIAs. Countries decision to postpone MR introduction has significant impact on accuracy of our forecasts communicated through tenders. With only one WHO PQ-ed MR vaccine, UNICEF encourages additional entries. At the same time, if major MR catch up campaigns materialize as currently forecasted during 2021-2023 and with that, demand pattern stabilizes, there will be a need for balancing level of capacity in post 2022-2023 period. Eradication strategies may have impact on demand pattern for Measles/MR beyond 2020. MMR demand has been increasing in the last 5 years, however it is now anticipated to stabilize. Challenge in accessing MMR vaccine in response to outbreaks in countries not usually served through UNICEF calls for input from suppliers on how access especially to Jeryl-Lynn mumps strain for unforeseen ad hoc demand can be improved. Next multi-year tender: First half of 2020