Update from the GAVI Alliance - World Health Organization · 8 November 2011 Donors secured US$ 7.6...
Transcript of Update from the GAVI Alliance - World Health Organization · 8 November 2011 Donors secured US$ 7.6...
Seth Berkley, MD Chief Executive Officer
Update from the GAVI Alliance
SAGE meeting Geneva, 8-10 November 2011
SAGE Meeting 8 November 2011
Topics to cover
§ Update on new vaccine introduction § Introductions
§ New approvals
§ Co-financing
§ Success of the June pledging event § Money
§ Political commitment
§ Upcoming November board § Collaboration with SAGE
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Taking stock: the immunisation gap
136 million surviving newborns in 2010:
Source: Johns Hopkins Bloomberg School of Public Health; UN,DESA, Population Division; WHO/UNICEF
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Targeted vaccine support
• pentavalent, pneumococcal, rotavirus, meningitis A, yellow fever and measles (second opportunity) vaccines.
Currently supported:
• meningitis and yellow fever vaccine stockpiles, formerly contributions to measles and polio
Other investments:
• human papillomavirus (HPV), Japanese encephalitis, rubella and typhoid vaccines
Prioritised for future support:
• malaria, dengue, cholera, IPV
Monitoring development and use:
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Rotavirus mortality in children younger than 5 years, 2008 estimate 95% of deaths occur in GAVI eligible countries
Source:Tate J, Burton A, Boschi-Pinto C et al. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. The Lancet Infectious Diseases, Early Online Publication, 25 October 2011.
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Rotavirus vaccines: introduced, approved and forecast introductions
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3 1 1
8
22
7 4
0
10
20
30
2009 2010 2011 2012 2013 2014 2015
* Source demand forecast v4.0
Number of Countries per
year
Forecast
Introduced
Approved
Bolivia
Guyana
Nicaragua
Honduras N.Sudan
Tanzania
Madagascar
Angola
Republic of the Congo
Cameroon Ghana
Niger Yemen
Georgia Moldova
Armenia
Ethiopia
Djibouti
Malawi
Rwanda Burundi
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Pneumo: actual, recommended and forecast introductions
Burundi Benin
CAR Cameroon
DR Congo
Ethiopia Gambia
Guyana Honduras Kenya
Madagascar
Mali
Malawi Nicaragua
Pakistan
Rwanda Sierra Leone
Yemen
13 16
16 21
2 0
10
20
30
2009 2010 2011 2012 2013 2014 Forecast
Actual Recommended
Number of
Countries per year
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Yellow fever and Meningitis A
§ Yellow Fever § roll out continues with some supply challenges:
§ Ghana, Cote d’Ivoire (phase I completed, phase II 2012);
§ Sudan (planned for 2012)
§ Meningitis A § preventive campaigns (2010) in Burkina Faso, Mali
and Niger, reports of record low level of meningitis incidence;
§ Chad postponed;
§ Cameroon and Nigeria introduction beginning Dec 2011
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Co-financing
§ Countries are fulfilling their obligations § 50 (98%) countries met their commitments
§ 1 (2%) remain in default
§ 8 countries gave additional voluntary commitments
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Country demand: record number of applications
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Overview Top performer in UK Multilateral Aid Review March, 2011
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Donors secured US$ 7.6 billion for 2011-2015
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The US$ 7.6 billion in assured resources is comprised of US$ 7.3 billion in donor support and a further US$ 0.3 billion in investment income and cash and investment reserve drawdown. US$ 332 million of the US$ 7.3 billion in donor support is reserved to match new commitments by other donors after 13 June 2011.
Photo: Ben Fisher/GAVI/2011
Global leadership - GAVI pledging conference, London, 13 June 2011
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Reduced prices of life-saving vaccines
§ Two emerging market manufacturers committed to lower prices for pentavalent vaccine
§ Industrialised country manufacturers offered price reductions on rotavirus and HPV vaccines
§ Two firms will extend GAVI prices to countries graduating from GAVI support
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Next steps on resource mobilization efforts
§ Ensuring donors “make good” on pledges § GAVI matching fund for immunisation
supported by UK and BMGF § US to host potential high-level meeting on
immunisation in Q2 2012 § Mid-term accountability review to take
place in 2013
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Board meeting – Dhaka, Bangladesh Key issues for decision
§ Supply and procurement strategy § Performance based funding for cash support § New vaccine windows – HPV and rubella
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Vaccine Supply and Procurement Strategy
§ Balance supply and demand § Ensure sufficient uninterrupted supply
§ Vaccine prices § Minimise the cost
§ Appropriate products § Ensure appropriate, quality vaccines and foster
innovation
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GAVI Market Shaping
Short Term Price decreases • Pentavalent price
decreases to $1.75 from $3 two years ago
• 67% price reduction offer on rotavirus - $2.5/dose
• 67% price reduction offer on HPV - $5/dose
Medium Term New entrants • 3 potential new entrants
for rotavirus, yielding a further 40% price reduction target
• New entrants for pneumo, yielding a further price reduction of approx. 40%
• Graduating country price commitments
Long Term Innovation • Foster incremental
innovation for appropriate and affordable new and follow-on products
• Improvements in vaccine delivery mechanisms
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Performance based funding – programme design
§ GAVI’s cash support will be split into two different types of payments
§ % of funds provided as fixed payments depends on DTP3 coverage at baseline § Lower coverage = higher % of funds as fixed
§ Higher coverage = lower % of funds as fixed
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Fixed Fixed Performance
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Programme design: categories of countries
Category Fixed payment
Performance payment
A ≥90% DTP3
coverage
20% 40% for maintaining or increasing DTP3 coverage 40% for ensuring that 90% of districts have ≥80% DTP3 coverage
B 70-89% DTP3
coverage
40% $20 per additional child receiving DTP3 $20 per additional child receiving measles first dose
C <70% DTP3
coverage
60% $20 per additional child receiving DTP3 $20 per additional child receiving measles first dose
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Programme design: How payments would be made
Year of strategy
Payments
1 Countries receive all of their funds for the year up front as an investment in their National Health Strategy
2, 3, 4, 5...
Countries receive their fixed payment as well as additional funds based on performance
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If all minimum requirements are met, including TAP and financial controls:
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Opening the HPV window: Global disease burden
§ 275,000 deaths, most of which in developing world
§ Estimated 529,000 new cases of cervical cancer
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Sources: Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008; Cancer Incidence and Mortality Worldwide: IARC CancerBase No.10, Lyon France: International Agency for Research on Cancer; 2010, globocan.iarc.fr. Accessed October 5. 2010 Accessed from Cervical Cancer Action, 3 November 2011
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Source: Vynnycky , Adams et al (in preparation)
<10 10 - <100 100 - <1000 1000 - <10000 10,000 or more
Number of CRS cases
No data
Opening the Rubella window: Global disease burden
§ An estimated 112,000 CRS (Congenital Rubella Syndrome) cases occurs globally; 90,000 in GAVI eligible countries
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Number of CRS cases born in 2008
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Future opportunities: regional focus - Japanese Encephalitis
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Potential areas for engagement
§ Typhoid § Dengue § Malaria
§ IPV § Measles § Cholera
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GAVI collaboration with SAGE –moving forward
§ Safety monitoring and programmatic suitability
§ Strengthening and enhancing surveillance § Optimizing delivery and dosing schedules § Mission critical research questions
§ Review of serotype replacement § Estimating disease burden and impact § Reviewing target product profiles
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