TT Procured by UNICEF

TT

TT Procured by UNICEF 2001-08 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000 0 2001 2002 2003 2004 2005 2006 2007 2008 Routine SIA

TT historical demand and forecast overview Upcoming Tender Period

Millions of doses Trends in TT vaccine offered to UNICEF TT vaccine offered to UNICEF 1992-2009 250 200 150 100 50 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 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

Summary Elimination by 2012 MNT Investment Case (2007-2009) 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

TT Tender quantities 2010-12 TT Upcoming Tender Period 2009 2010 2011 2012 Routine 106,500,000 130,000,000 135,000,000 140,000,000 SIA 60,000,000 30,000,000 30,000,000 30,000,000 Total 166,500,000 160,000,000 165,000,000 170,000,000

MEASLES

Number of Doses Measles procured by UNICEF 2001-2008 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000 0 2001 2002 2003 2004 2005 2006 2007 2008 Routine Supplementary

Measles Procurement Overview & Future demand Upcoming Tender Period Historically demand has been mainly driven by campaigns Large catch up campaigns in 2006-07 and some in 2008 2009-2010 Quantities do not include potential demand for India SIA

Millions of doses Trends in Measles vaccines offered to UNICEFavailability Measles vaccine offered to UNICEF 1992-2009 300 250 200 150 100 50 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 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

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

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

Measles Tender quantities 2010-12 Measles Upcoming Tender Period 2009 2010 2011 2012 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 155,300,000 165,000,000 145,000,000 125,000,000

MMR

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 1,000,000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Original Quantity on LTA Quantity Procured Current Tender Quantity Forecast to Suppliers at beginning of Year Current Forecasted Quantity The main increase in 2009-12 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

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

MMR Tender quantities 2010-12 MMR Upcoming Tender Period 2009 2010 2011 2012 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

MR

MR Procurement Overview - Future 30,000,000 25,000,000 Upcoming Tender Period 20,000,000 15,000,000 10,000,000 5,000,000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 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

MR Tender quantities 2010-12 MR Upcoming Tender Period 2009 2010 2011 2012 Routine 1,351,623 1,700,000 1,700,000 1,700,000 SIA 4,500,000 0 2,000,000 1,000,000 Total 5,851,623 1,700,000 3,700,000 2,700,000

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

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

Doses (M) MR VACCINE DEMAND GIVEN INTEGRATED ADOPTION FORECAST Rapid Impact 600 500 Vaccine Demand including Wastage 400 300 200 100 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Routine Vaccination Catch-up Campaign Periodic Campaign Boost Vaccination Buffer Stock Stock Pile Vaccine Demand including Wastage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Routine Vaccination 0 25 31 32 40 41 46 50 55 56 57 58 Catch-up Campaign 0 406 88 4 106 14 50 53 53 15 0 9 Periodic Campaign 0 119 26 1 22 2 10 9 10 3 0 2 Boost Vaccination 0 0 0 0 23 28 29 36 37 41 45 49 Buffer Stock 0 6 1 0 2 0 1 1 1 0 0 0 Stock Pile 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 556 147 37 193 86 135 149 155 116 102 119 * Source: Applied Strategy Oct 27, 2008 http://www.gavialliance.org/vision/strategy/vaccine_investment/index.php

# of Countries Adopting Vaccine MR INTEGRATED ADOPTION FORECAST Vaccine Need: 72 VISP Scope: 46* Rubella 25 20 15 10 5 0 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 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 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

mil ds A Possible scenario for MR introduction through catch up campaigns : 2013-18 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000,000 0 2013 2014 2015 2016 2017 2018 Assumptions: Delay the introduction by 3 years compared to rapid impact plan Total 300 mil ds for 2013-2018 Distribute quantities throughout 5-6 years

Total tender quantities of Measles containing vaccines 2010 12 Measles 2010 2011 2012 Total 165,000,000 145,000,000 125,000,000 MR 2010 2011 2012 Total 1,700,000 3,700,000 2,700,000 MMR 2010 2011 2012 Total 5,800,000 5,900,000 6,200,000

UNICEF VACCINES Thank You