V3P: Region Fact Sheet Highlights The 1 region market is 6% of the world market in volume and 6% in value. The regional vaccine procurement habits are different from the rest of the world in several ways, which may serve to inform sustainable supply strategies: higher number of vaccine types, with 12 vaccine types exclusive to ; higher use of single- versus multi-dose presentations; greater use of prefilled syringes than in the rest of the world (where single-dose presentations are more often in vials); the majority of countries are self-procuring; PCV and DTaP-HepB-Hib-IPV have a higher relative value in the market, while Rota and HPV have a higher relative value in the non- market; three of four vaccines analysed suggest that:»» WAPs in non-gavi MICs may be higher in than in non-gavi, non- PAHO MICs in the rest of the world;»» non-gavi MICs in may purchase in smaller volumes than non-gavi, non-paho MICs in the rest of the world. Vaccine Market For the data in the V3P database, the size of the vaccine market in is approximately 6% of the global market, by volume, and about 6% by value. However, a majority of HICs from Western Europe do not report price data to the V3P, so the relative size of the market is higher than reported. The global top 10 vaccines by value are PCV, HPV, Rota, Influenza (seasonal adult), Varicella, DTP-HepB-Hib, MenA,C,Y,W-135 conj, MenC, DTaP-HepB-Hib- IPV, and BCG, and these 10 account for about 55% of the value of the market in. The relative value of each vaccine type, in each market, is shown in Chart 1 (see page 2). Chart 1 also shows that one of the primary differences between the and non- markets are the greater relative values of DTaP-HepB-Hib-IPV and Varicella in the market. This regional fact sheet is intended for use by MoH and vaccine procurement staff. The regional fact sheet provides information on all vaccines procured by including analyses of: the presentations used in compared to the rest of the world; the procurement methods used in compared to the rest of the world; value to the market of the most frequently reported vaccines to the V3P from and the rest of the world; prices paid by, compared to rest of the world. Increased knowledge about several aspects of vaccine market and purchasing may help to inform the development of policies related to market shaping and vaccine access. The Vaccine Product Price & Procurement (V3P) initiative was launched to provide all countries with a platform for greater vaccine price & procurement transparency. The initiative collects data through the WHO and UNICEF Joint Reporting Form, and analyses and distributes information to relevant stakeholders to inform policy making and procurement processes. As of July 2017, the database contained data from 142 countries. The fact sheet is exclusively based on the data reported through the JRF & V3P initiative, as of July 2017. Pool-procurement refers to vaccines procured through UNICEF SD and the PAHO Revolving Fund. Readers may access additional vaccine price and procurement information from reporting countries and procurement agencies (UNICEF and PAHO) on the V3P website (http://www.who.int/immunization/ v3p) or by contacting v3p-project@ who.int. 1 countries contributing to the V3P: Albania, Andorra, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, France, Georgia, Hungary, Iceland, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Malta, Montenegro, Republic of Moldova, Romania, Russian Federation, San Marino, Slovakia, Slovenia, Sweden, Tajikistan, The Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan. countries not contributing to the V3P: Austria, Belgium, Denmark, Finland, Germany, Greece, Ireland, Israel, Italy, Luxembourg, Monaco, Netherlands, Norway, Poland, Portugal, Serbia, Spain, Switzerland, United Kingdom of Great Britain and Northern Ireland. WORKING DOCUMENT November 2017 1
Chart 1. The relative value of the global top 10 vaccines in the and non- markets. non- Products and Presentations uses the greatest number of vaccine types (50) compared to non- countries (46). Twelve vaccines are exclusive to : CCHF, Diphtheria, HepA-HepB, MM, Mumps, Plague, Rubella, TBE (ped and adult), Tdap-IPV, Td- IPV, and Tularemia. uses the same number of presentations (six) as the total for all other regions. However, an intranasal sprayer reported from is not used elsewhere, and Uniject, reported from non-, is not reported for. Both are reported at a frequency of <1%. There is, however, a much higher prevalence of prefilled syringes in than in non- countries (38% versus 10%). Chart 2 shows a greater predominance of single-dose presentations in compared to non- countries (71% versus 43%). Chart 2. Prevalence of presentation sizes in and non- countries. non- WORKING DOCUMENT November 2017 2
Procurement Method is predominantly self-procuring (67%), compared to non- regions, where pool procurement is more prevalent (63%). Mixed-procurement in is about half as prevalent as in non- countries. Vaccine Prices For non-gavi MICs, WAPs in are higher than WAPs in non-gavi, non- PAHO MICs in non-, for four out of six select vaccines for which comparator data is available. Minimum, maximum, and median prices for vaccines procured in are shown in Table 1 (see page 4). Chart 3. Prevalence of procurement method in and non- countries. non- Chart 4. WAPs for six select single-dose vaccines in self-procuring non-gavi MICs in and non-gavi, non-paho MICs in non-, in 2016 2. For non-gavi, non-paho MICs, WAPs for the newer vaccines, PCV and HPV, in single-dose, are 36 to 37% higher in than in non- countries. The WAP for Influenza (adult), on the other hand, is almost two times lower in countries. Vaccine Availability Reported manufacturers from and globally, for each vaccine type, are shown in Table 2 (see page 5). 2 Vaccines were selected based on sufficient data for analyses data for single-dose presentations from at least three countries in both and non-. WORKING DOCUMENT November 2017 3
Table 1. Proportion of countries self-procuring, minimum, median, and maximum prices, number of products, and number of manufacturers for each vaccine type reported from at least five countries, in 2016. Vaccine type (ranked by frequency of use) % of countries self-procuring in price (all procurement methods, all income groups): lowest (presentation size) / highest (presentation size) / median N different products in N manufacturers in N manufacturers reported globally MMR 69 $1.10 (5-dose) / $15.78 (1-dose) / $5.66 8 4 5 BCG 50 $0.06 (10-, 20-dose) / $2.77 (20-dose) / $0.46 11 8 16 HepB (ped) 54 $0.06 (10-dose) / $15.00 (10-dose) / $0.85 9 6 13 PCV 68 $3.14 (1-dose) / $77.59 (1-dose) / $31.24 5 2 2 Td 50 $0.06 (2-dose) / $10.07 (1-dose) / $0.18 11 8 13 DTaP-Hib-IPV 82 $13.76 (1-dose) / $41.89 (1-dose) / $22.19 4 3 3 DT 38 $0.11 (10-dose) / $7.24 (1-dose) / $0.15 8 6 11 DTaP-HepB-Hib-IPV 87 $17.70 (1-dose) / $78.85 (1-dose) / $39.71 3 2 2 Influenza (seasonal adult) 79 $1.01 (1-dose) / $7.92 (1-dose) / $4.65 7 6 11 bopv1,3 23 $0.14 (20-dose) / $1.86 (20-dose) / $0.18 4 3 10 HPV 92 $15.00 (1-dose) / $154.13 (1-dose) / $47.05 3 2 4 DTaP-IPV 92 $8.18 (1-dose) / $26.63 (1-dose) / $15.19 2 2 2 DTP 17 $0.13 (2-dose) / $3.01 (10-dose) / $0.21 5 4 8 HepB (adult) 75 $0.59 (1-dose) / $55.45 (1-dose) / $4.99 7 5 10 IPV 82 $1.97 (5-dose) / $13.42 (1-dose) / $4.71 5 3 7 Rabies 73 $5.69 (1-dose) / $50.25 (1-dose) / $13.31 6 6 7 TT 89 $0.06 (2-dose) / $6.77 (1-dose) / $2.09 6 5 14 Rota 22 $2.05 (1-dose) / $76.44 (1-dose) / $5.34 2 2 3 DTP-HepB-Hib 0 $1.57 (10-dose) / $2.82 (1-dose) / $2.35 4 3 11 Hib 88 $3.66 (1-dose) / $17.94 (1-dose) / $6.43 4 3 4 Varicella 86 $17.50 (1-dose) / $141.93 (1-dose) / $44.28 2 2 4 Pneumo ps 100 $11.09 (1-dose) / $59.35 (1-dose) / $16.92 2 2 2 DTaP 86 $9.52 (1-dose) / $27.92 (1-dose) / $15.46 3 2 3 HepA (adult) 100 $13.20 (1-dose) / $35.37 (1-dose) / $19.73 3 3 4 HepA (ped) 83 $7.50 (1-dose) / $24.73 (1-dose) / $17.08 3 3 9 Tdap 100 $8.53 (1-dose) / $16.64 (1-dose) / $14.95 3 2 4 Typhoid 100 $2.58 (1-dose) / $47.26 (1-dose) / $14.64 3 3 3 MenC 100 $16.35 (1-dose) / $37.09 (1-dose) / $23.84 2 2 3 WORKING DOCUMENT November 2017 4
Table 2. Vaccine manufacturers reported by countries, and additional manufacturers reported from other regions but not from. Vaccine type Manufacturers reported by countries Additional manufacturers not reported by BCG BB-NCIPD; Biomed Lublin; GreenSignal Bio Pharma Limited; InterVax; Japan BCG Laboratory; Mikrogen; Serum Institute of India; Torlak Institute of Virology, Vaccines and Sera AJ Vaccines A/S; China CNBG; FAP (Fundação Ataulpho de Paiva); Institut Pasteur Iran; Institut Pasteur Tunis; IVAC (Institute of Vaccines and Medical Biologicals); PT Bio Farma (Persero); Thai Red Cross Society bopv1,3 Bharat Biotech; GSK; Sanofi Pasteur Birmex; Boryung Biopharma; China CNBG; Haffkine Bio; PT Bio Farma (Persero); Razi Institute Iran; Serum Institute of India DT BB-NCIPD; InterVax; Mikrogen; Sanofi Pasteur; Serum Institute of India; Torlak Institute of Virology, Vaccines and Sera DTaP GSK; Sanofi Pasteur China CNBG DTaP-Hib-HepB-IPV GSK; Sanofi Pasteur None DTaP-Hib-IPV Farmeks; GSK; Sanofi Pasteur None DTaP-IPV GSK; Sanofi Pasteur None DTP Mikrogen; PT Bio Farma (Persero); Serum Institute of India; Torlak Institute of Virology, Vaccines and Sera Arabio; Biological E; China CNBG; PT Bio Farma (Persero); Razi Institute Iran Biological E; Boryung Biopharma; Butantan; IVAC (Institute of Vaccines and Medical Biologicals) DTP-HepB-Hib Janssen; LG Life Sciences; Serum Institute of India Arabio; Bharat Biotech; Biological E; Centro de Ingeniería Genética y Biotecnología; GSK; Panacea Biotec; PT Bio Farma (Persero); Shantha Biotechnics Private Limited HepA (adult) GSK; Sanofi Pasteur; Vector-BiAlgam Merck Vaccines HepA (ped) GSK; Merck Vaccines; Sanofi Pasteur Butantan; Changchun Changsheng Life Sciences Ltd.; China CNBG; Institute of Medical Biology Chinese Academy of Medical Sciences; Sinovac; Zhejiang Pukang HepB (adult) Centro de Ingeniería Genética y Biotecnología; GSK; LG Life Sciences; Merck Vaccines; Mikrogen Berna Biotech Korea; Institut Pasteur Iran; Janssen; Serum Institute of India; Shantha Biotechnics Private Limited HepB (ped) GSK; Janssen; LG Life Sciences; Mikrogen; Sanofi Pasteur MSD; Serum Institute of India Hib GSK; Sanofi Pasteur; Serum Institute of India Merck Vaccines HPV GSK; Merck Vaccines Butantan; Sinergium Influenza (adult) Abbott Biologicals B.V.; GSK; Hualan Biological Bacterin Co., Ltd; Mikrogen; Npo Petrovaks; Sanofi Pasteur Biokangtai; China CNBG; Dalian Hissen; Merck Vaccines; NCPC GeneTech; PT Bio Farma (Persero); VABIOTECH Butantan; GPO-MBP Co., Ltd.; Green Cross Corporation; Seqirus; Sinergium IPV Bilthoven Biologicals; GSK; Sanofi Pasteur Institute of Medical Biology Chinese Academy of Medical Sciences; PT Bio Farma (Persero); Serum Institute of India; Shantha Biotechnics Private Limited MenC GSK; Pfizer Funed (Fundação Ezequiel Dias) MMR GSK; Merck Vaccines; Sanofi Pasteur; Serum Institute of India China CNBG PCV GSK; Pfizer None Pneumo Ps Merck Vaccines; Sanofi Pasteur None Rabies Bharat Biotech; Chiron Behring Vaccines Private Ltd.; FSUE Chumakov; GSK; Novartis; Sanofi Pasteur Butantan Rotavirus GSK; Merck Vaccines Bharat Biotech Td BB-NCIPD; Biological E; GSK; InterVax; Mikrogen; Sanofi Pasteur; Serum Institute of India; Torlak Institute of Virology, Vaccines and Sera Tdap AJ Vaccines A/S; GSK Butantan; Sanofi Pasteur TT BB-NCIPD; GSK; Mikrogen; Sanofi Pasteur; Torlak Institute of Virology, Vaccines and Sera Typhoid Bharat Biotech; FSUE Chumakov; Sanofi Pasteur None Varicella GSK; Merck Vaccines Green Cross Corporation; Sinergium AJ Vaccines A/S; Boryung Biopharma; Butantan; PT Bio Farma (Persero); Razi Institute Iran Bharat Biotech; Biological E; Boryung Biopharma; Finlay; InterVax; IVAC (Institute of Vaccines and Medical Biologicals); PT Bio Farma (Persero); Serum Institute of India; Shantha Biotechnics Private Limited DISCLAIMER 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: (1) 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. WORKING DOCUMENT November 2017 5