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Upcoming MSF Report: The Price of Immunisation. Julia Hill 13 November 2011 GAVI CSO SC Meeting Dhaka, Bangladesh. Why focus on pricing?. Release of UNICEF data: opportunity to evaluate factors influencing price MSF programmatic challenges to vaccination: need for better tools in the field

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upcoming msf report the price of immunisation

Upcoming MSF Report: The Price of Immunisation

Julia Hill

13 November 2011

GAVI CSO SC Meeting

Dhaka, Bangladesh

why focus on pricing
Why focus on pricing?
  • Release of UNICEF data: opportunity to evaluate factors influencing price
  • MSF programmatic challenges to vaccination: need for better tools in the field
  • Report examines both price and access issues—how can we get vaccines that are both affordable, and also adapted to help in reaching the 5th child? How do we balance vaccine cost with programmatic cost?
session overview
Session Overview
  • Factors influencing price of vaccination:
    • Vaccines
    • Programmes
  • Vaccine-specific case studies
  • Conclusions
  • Discussion & Questions
cost implications go beyond gavi
Cost implications go beyond GAVI
  • Countries graduate—16 countries in 2015
  • Middle-Income Countries outside pooled procurement mechanisms pay disproportionately high prices:
    • South Africa vs. PAHO & GAVI:
what affects supplier prices
What affects supplier prices?
  • Production costs (generally fixed)
    • Vaccine technology
    • Presentation (doses/vial, liquid v. lyo)
    • Location of production manufacturer
  • Economies of scale
    • Volumes purchased
    • Length of contract/options
  • Market dynamics
    • # producers in market
    • Length of time vaccine on the market (ROI)
    • Sales potential of vaccine in industrialised countries
  • Others…
vaccine price not the only factor
Vaccine price not the only factor
  • Measles vaccine: maximum price is $0.30/dose (UNICEF)
  • In 2010, 28 countries experienced measles outbreaks
    • 223,000 reported cases and 1200 deaths (WHO)
    • MSF vaccinated over 3 million in DRC alone (2011)
  • Why aren’t affordable vaccines reaching children?
    • Weak systems, lack of political will
    • Ill-adapted tools
  • MSF desire to decentralize care
    • VVM 14 and cold chain
    • Dosing schedules and burden of disease
    • Adapted products in pipeline could prove useful: inhalation or wet mist delivery
what affects programmatic cost of a vaccine
What affects programmatic “cost” of a vaccine?
  • Costs associated with product characteristics:
    • Volume
    • Heat stability – need for cold chain
    • Doses per vial (delivery & wastage concerns)
    • Delivery method (needle vs. oral, micro-needle, inhalation, etc.)
    • Number of doses per course (overlapping schedules)
    • Dosing schedule (usable over broad age range)
    • Others…
vaccine specific case studies
Vaccine-specific Case Studies
  • DTP combos with HepB and Hib
  • Measles
  • Meningitis Polysaccharides and Conjugates
  • PCV
  • Rotavirus
dtp combos w hepb hib
DTP Combos w/ HepB & Hib
  • Same antigens, but different vaccine presentations than U.S./Europe: DTwP, pentavalent combinations
  • Expected ease of delivery took time to evolve:
    • Penta cold chain volume vs. DTP or DTP-HepB
    • Presentation: liquid vs. lyophilised
    • HepB birth dose issue still not resolved through use of penta (decentralisation?)
  • Entrance of new suppliers has brought down price (more doses/vial)
    • Strengthens argument for encouraging competition
    • Any new combos should also consider program challenges
menafrivac vs amc for pcv
MenAfriVac vs. AMC for PCV
  • MenAfriVac: New vaccine developed with TPP and target price in mind after demand identified
    • WHO had been key in ensuring needs of developing countries were met. Utilised developing country supplier through tech transfer to meet need
    • Introduced at $0.40 a dose by single supplier
    • Will it meet serotype needs?
  • AMC for PCV: newer vaccine for U.S. and Europe close to coming on the market
    • Two Northern manufacturers selling same vaccine in wealthy markets
    • High absolute price for LDCs—because cost structures set & harder to negotiate?
    • Market segmentation by current suppliers reiterates GAVI market not top priority for product (presentations not ideal)
rotavirus
Rotavirus
  • Like PCV, GAVI uses same products as sold in U.S. and Europe
  • Unlike PCV, Northern suppliers did not need an AMC to offer price reductions and increase supply.
    • Price reductions closely followed increased price transparency
  • Still significant need for product adaptation
    • Cold chain volume
    • Heat stability
    • Dosing schedules
  • Ability to set fair price targets for adapted products?
conclusions
Conclusions
  • Price and product profiles should both be included in TPPs
  • Development/incentive models matter: should consider ûtilising suppliers in emerging markets for production of more affordable vaccines
    • Facilitation of tech transfer, overcoming IP barriers
  • Possible addition of “sub-markets” to improve reach of immunisation
    • Products that allow for decentralisation, flexibility of delivery
    • May require paying more for specialised vaccine presentations, but could be re-gained in reduced program costs
      • Cost to GAVI could be offset by country co-payments linked to product price/program cost savings?
      • more research needed into program cost savings
discussion and questions
Discussion and Questions
  • How this could influence GAVI Supply & Procurement Strategy, vaccine roadmaps
    • Willingness to pay more for “sub-markets” to reach more children?
    • Likely requires signalling to manufacturers, strong involvement in setting TPPs and facilitating tech transfer
  • What it could mean for GAVI-CSO interaction
    • How to improve discussion and communication on needed Target Product Profiles with all actors—SG2112 activities, Francophone platform?
    • Discussions needed on appropriate product mix
    • Advocacy to help countries gain awareness about relationship between vaccine costs & program costs
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