Aurelia Nguyen
Update from GAVI
Vaccine Industry Consultation
(Copenhagen, Denmark, 27 June 2012)
Vaccine Industry Consultation
Copenhagen, 27 June 2012
GAVI vaccine support
Currently supported vaccines: pentavalent,
pneumococcal, rotavirus, meningitis A, human
papillomavirus (HPV), rubella, yellow fever and
measles second dose and selected campaigns
Also: meningitis and yellow fever vaccine stockpiles
Prioritised for future support: Japanese encephalitis
(c.2015) and typhoid (c.2017) vaccines
Monitoring development: malaria (c.2016), dengue
(c.2017)
New options: cholera and polio IPV
(year of potential first introduction)
Vaccine Industry Consultation
Copenhagen, 27 June 2012
June Board update: Outlook through 2020
(current portfolio)
(current portfolio)
3
Includes the new
vaccine windows
(MR, HPV, JE, typhoid)
Prior to any other
new vaccines (and
measles option)
2011-15: $8.0 bn
2016-20: $7.9 bn Indicative
Vaccine Industry Consultation
Copenhagen, 27 June 2012
GAVI Alliance Board update
Rotavirus and pneumococcal supply constraints
Enhancing GAVI‟s investment in measles prevention
Vaccine introduction grant and operational support for
campaigns
Polio
Cholera
Lower Middle Income Countries
Rotavirus forecast v 5.0 unconstrained
3 1 1 8 15
5
9 8
0
10
20
30
2009 2010 2011 2012 2013 2014 2015
* Source demand forecast v5.0
Number of
Countries per
year
Forecast
Introduced
Approved
Sudan
Nicaragua
Honduras
Guyana
Bolivia
Burundi
Djibouti
Zimbabwe
Zambia
Togo
Tanzania
Sierra Leone
Niger
Madagascar
Haiti
Guinea-Bissau
Congo Republic
Cen. Afr. Rep.
Cameroon
Angola
Rota: supply constrained annual introductions
* Source demand forecast v5.0
Number of
Countries per
year
Forecast
Introduced
Approved
Sudan
Nicaragua
Honduras
Guyana
Bolivia
Burundi
Djibouti
Zimbabwe
Zambia
Togo
Tanzania
Sierra Leone
Niger
Madagascar
Haiti
Guinea-Bissau
Congo Republic
Cen. Afr. Rep.
Cameroon
Angola
3 1 1 3
5 5
13 18
0
10
20
30
2009 2010 2011 2012 2013 2014 2015
Pneumo demand v 5.0 unconstrained
introductions
16 14
5
2 1
13 16
19
5 2
0
10
20
30
2009 2010 2011 2012 2013 2014 2015
Number of
Countries per
year
Forecast
Introduced
Approved
Democratic
Republic of
the Congo
Gambia
Mali
Sierra Leone
Burundi
Benin
CAR Ethiopia
Guyana
Honduras
Nicaragua
Rwanda
Yemen
Kenya
Malawi
Cameroon
Pakistan
Madagascar
Ghana
Georgia
Moldova
Armenia Azerbaijan
Sudan
Zimbabwe Mozambique
Angola
Tanzania
Zambia
Niger Senegal
Bolivia
Sao Tome
Djibouti
Kiribati.
Bangladesh
Guinea Bissau
Haiti
Lao PDR
Lesotho
Mauritania
Nigeria
Togo
Papua New
Guinea
Uganda
* Source forecast based on SDF v5.0
Pneumo: supply constrained annual
introductions
Number of
Countries per
year
Forecast
Introduced
Approved
Democratic
Republic of
the Congo
Gambia
Mali
Sierra Leone
Burundi
Benin
CAR Ethiopia
Guyana
Honduras
Nicaragua
Rwanda
Yemen
Kenya
Malawi
Cameroon
Pakistan
Madagascar
Ghana
Georgia
Moldova
Armenia Azerbaijan
Sudan
Zimbabwe Mozambique
Angola
Tanzania
Zambia
Niger Senegal
Bolivia
Sao Tome
Djibouti
Kiribati.
Bangladesh
Guinea Bissau
Haiti
Lao PDR
Lesotho
Mauritania
Nigeria
Togo
Papua New
Guinea
Uganda
* Source forecast based on SDF v5.0
2 1
13 10 5
12 17
0
10
20
30
2009 2010 2011 2012 2013 2014 2015
Vaccine Industry Consultation
Copenhagen, 27 June 2012
GAVI‟s commitments strengthen measles
control
$197M since 2004, primarily to the
Measles Initiative for campaigns
Routine second dose of measles
Investments in health systems and
improving immunization coverage
Support for measles-rubella through wide-
age campaigns
Performance-based funding mechanism
includes measles coverage indicator
9
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Enhanced support
Six large countries estimated by WHO at high
risk of outbreaks prior to introducing MR
vaccine
10
Country DTP3
(2010)
Measles1
(2010)
Afghanistan 66 62
DR Congo 63 68
Chad 59 46
Ethiopia 86 81
Nigeria 69 71
Pakistan 88 86
Response to outbreaks and emerging needs
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Projected Cost Estimates (US$ millions)
11
2012 2013 2014 2015 2016 2017 Total
Outbreak funds - Pass
to MR Initiative
5 10 10 10 10 10 55
Funds for vaccines by
proposals – up to 6
countries ($0.42/dose)
0 21 3 17 1 - 42
Funds for operational
costs – up to 6
countries
($0.65/person)
0 33 4 26 1 - 65
Total potential
commitment by year
5 65 17 53 12 10 162
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Vaccine introduction grant and operational
support for campaigns
12
Objective
Facilitate timely, effective implementation of critical activities:
Before new vaccine introductions
For delivery during campaigns
One-time investments, covering a share of the cost
Scope
All new GAVI-supported vaccines
Activities driven by country needs
Does not cover recurrent costs
Operating guidelines
Flexible, timely, simple, separate from other cash support, not
used for co-financing
Vaccine Industry Consultation
Copenhagen, 27 June 2012
$0.0
$0.6
$1.2
$1.8
$2.4
$3.0
Infantvaccines
HPVvaccines
Operational supportcampaigns
x
New policy: what has changed?
13
Total cost estimate:
80% 80%
80%
New policy
GAVI support:
x
Current policy
New policy
Current policy
(per child) (per girl) (per target)
Vaccine Industry Consultation
Copenhagen, 27 June 2012
New policy: funding levels
14
1. Vaccine introduction grants:
Vaccines delivered to infants: US$ 0.80 per child in birth cohort
(min. US$ 100,000)
HPV vaccines delivered to adolescent girls: US$ 2.40 per girl
in target population (min. US$ 100,000)
2. Operational support for campaigns:
US$ 0.65 per individual in target population
3. Product switches after first introduction:
One third of full grant for transition to new product, provided
criteria are met
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Polio
GAVI support to polio efforts - investment case providing
financing for operational costs and stockpiling of vaccines
Intensify support to health systems strengthening in polio-
affected countries
Potential role for GAVI to play to support the new polio “end-
game” strategy
IPV funding in the context of a tOPV to bOPV switch
Update to Board and review following November SAGE
meeting
Major cholera outbreaks & hotspots, 2005-2011
2005 West Africa
> 76 000 cases 2006 /07 Angola
> 86 000 cases
2008/09 Zimbabwe
> 98 000 cases
2006 / 07
Horn of Africa
> 130 000 cases
2005 Afghanistan
> 155 000 cases
annually :
Bangladesh
100 - 300 000
cases
India? Pakistan?
2007 / 08 Iraq
> 4700 cases + AWD
Oct 2010 - Dec 2011 Haiti
500 000 cases
2009/10
Papua New Guinea
> 10 000 cases
Nov 2009 - Dec 2011
Central Africa
> 129 000 cases
annually: DRC
13 000 – 30 000 cases
Areas reporting cholera outbreaks, 2010-2011
Source: Global Task Force on Cholera Control, WHO
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Estimated size and cost of a potential cholera
vaccine stockpile
2013 -2014 2015-2016 2017-2020 Total (2012-2020)
Doses in
stockpile 2 m/year 5 m/year 10 m/year 54 million
Cost $5.5
m/year $13.6
m/year $23-27
m/year ~ $138 million
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Low- and Lower Middle-Income countries
and GAVI support
36
21
1421
0
20
40
60
GAVIeligible
GAVIgraduating
Not supportedLMICs
Nu
mb
er
of
cou
ntr
ies
Low income and Lower-middle income countries & GAVI support
Lower-middle-income countries (n=56)Low income countries (n=36)
Vaccine Industry Consultation
Copenhagen, 27 June 2012
Vaccine Industry Consultation
Copenhagen, 27 June 2012
2012-2013: 94 introductions versus 50 in the
business plan - an increase of 88%
14
Pneumo, 37
Rota, 19
Rota, 30
Penta, 4
Penta, 7
Rubella, 2
Rubella, 9
JE, 2
JE, 3
MenA, 8
MenA, 6
0
10
20
30
40
50
60
70
80
90
100
v2 v4
MenA
JE
Rubella
HPV
Penta
Rota
Pneumo
No.
of countr
ies
21
8 roll outs in 2012
Currently predict 2-5 will
introduce in 2013
2014-15 will see intro‟s back
on track
Up to 9 approved countries
delayed for a year
Future bottleneck „readiness‟
Rota: cumulative introductions –
versus business plan
4 5
16
23 28
33
4 5
13
18
31
49
40
0
10
20
30
40
50
60
70
B-Line 2011 2012 2013 2014 2015
Business Plan
Actual and Supply Constraint Adjusted SDF v5.0
Pneumo: cumulative introductions –
versus business plan
22
16 roll outs in 2011
10 roll outs in 2012
Currently predict 5 will
introduce in 2013
2014-15 will see intro‟s back
on track
Delays of a year effecting up
to15 countries
„Readiness‟ is the future
bottleneck 3
19
32 35
36
45
3
16
26
31
43
60
50
0
10
20
30
40
50
60
70
B-Line 2011 2012 2013 2014 2015
Business Plan
SDF v5.0 supply constrained
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