[French]
  • The Vaccine Alliance Progress Report 2014: Summary

    Q&A WITH GAVI'S EXECUTIVE LEADERS

    Gavi CEO Seth Berkley and Board Chair Dagfinn Høybråten look back on one of the most significant years in Gavi’s 15-year history, including the highs of the Berlin Pledging Conference and reaching our vaccine introduction targets and the challenge of the Ebola emergency.

    What was the highlight of the year? 

    Seth: For me polio was one of the biggest highlights of 2014. Having been in New Delhi in January just before India celebrated three years since its last case of wild polio, a truly historic milestone in the eradication of this disease, and then later in the same year we had the first Gavi-supported launch of the inactivated polio vaccine (IPV) in Nepal. By the end of the year 64 countries had applied for IPV support from Gavi. This is important, not just in terms of rising to the challenge of the Polio Endgame – and having at least one dose of IPV introduced into immunisation programmes in all Gavi- supported countries – but also because it is likely to have a broader positive impact on coverage by helping to increase access to routine immunisation.

    Dagfinn: With IPV we collectively took a new step towards polio eradication. However it was not the only new vaccine. In 2014 we also saw for the first time Gavi offering support for Japanese encephalitis and cholera vaccines. In fact it proved to be another record- breaking year in terms of the number of launches, with on average one launch per week. Within the space of a week we met our introduction targets for both pneumococcal and rotavirus vaccines, and in July, despite major internal conflicts, South Sudan became the 73rd and final Gavi-supported country to introduce the 5-in-1 pentavalent vaccine. So many highlights!

    THE GAVI MODEL AT WORK

    Saving lives, improving health, strengthening economies

    Gavi, the Vaccine Alliance is a global partnership bringing together public and private sectors with the shared goal of creating equal access to vaccines for all children.

     

    Drawing on the individual strengths of its members, Gavi pools country demand, guarantees long-term, predictable funding and brings down prices, helping to ensure that generations of children in poor countries do not miss out on life-saving vaccines.

     
  • Our Mission

    → Ahead of all three targets
    Gavi is on track to achieve or surpass its 2015 mission goals

     

    Gavi relies on three indicators, each with specific targets, to measure progress towards fulfilling our 2011–2015 mission.

    With just 12 months to go until the end of our strategic period, check each graph and its analysis to see how we are performing against our three mission goals.

    Read more detail in full version → 

    Our mission indicators: click to view

    Reduced child mortality

    Child mortality in Gavi-supported countries fell from 77 to 69 deaths per 1,000 live births between 2010 and 2013, with vaccines responsible for reducing mortality from vaccine- preventable diseases. The acceleration in the number of new vaccine introductions in recent years has made a major contribution to the unprecedented rate of reduction in under-five mortality.

    Read updates on the Gavi mission in the full version →  

    Under-five mortality rate

    In Gavi-eligible countries (per 1,000 live births)

    KPI  

    Source: The United Nations Inter-agency Group for Child Mortality Estimation, United Nations Population Division; World Population Prospects

    Future deaths averted

    It is estimated that in the four-year period from the start of 2011 to the end of 2014, use of Gavi-supported vaccines will have averted approximately 3.1 million future deaths. The Vaccine Alliance expects to meet its target of helping to avert 3.9 million future deaths from the beginning of 2011 to the end of 2015. Gavi-funded measles vaccine campaigns conducted between 2013 and 2015 are projected to avert an additional 500,000 future deaths.

    Number of future deaths averted

    (millions)

    KPI  

    Source: Joint impact modelling by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation

    Children immunised

    Relative to the number in 2010, an additional 207 million children have been immunised with Gavi-supported vaccines (by the end of 2014). Gavi expects to meet its target of immunising an additional 243 million children by the end of 2015 across all of its approved vaccine programmes.

    Number of children immunised

    (millions)

    KPI  

    Source: WHO/UNICEF National Immunization Coverage estimates, United Nations Population Division; World Population Prospects

  • The Vaccine Goal

    → Gavi surpasses vaccine introduction targets for 2015 ahead of schedule
    Pentavalent vaccine introduced in all 73 Gavi countries

    → Vaccine Alliance starts support for three new vaccines
    Inactivated polio vaccine (IPV), Japanese encephalitis vaccine, oral cholera vaccine stockpile

    → Alliance fast tracks IPV programme
    64 countries have applied for Gavi support in 12 months

     

    Gavi, the Vaccine Alliance continues to respond to sustained demand for vaccines from developing countries. In a third successive year of record-breaking numbers, our partners supported nearly one vaccine introduction every week.

    The trend ensured that we surpassed our 2015 introduction targets for pentavalent, pneumococcal and rotavirus vaccines more than one year in advance. The high level of country introductions will continue apace next year after the majority of Gavi-supported countries applied to introduce inactivated polio vaccine (IPV) by the end of 2015 – as recommended under the Polio Eradication and Endgame Strategic Plan.

    In this section, we provide updates on all 11 new and underused vaccines included in the Gavi portfolio, including the first year of support for IPV, Japanese ncephalitis and oral cholera vaccines.

    As we start to focus on ensuring all 11 WHO-recommended vaccines reach every child, we also look at challenges to increasing coverage and how introducing state-of-the-art vaccines is driving improvements in the management of national immunisation programmes.

    Read more about the Vaccine Goal in the full report →  

    Gavi-supported vaccine launches and new campaigns in 2014

    Source: Gavi, the Vaccine Alliance, 2014, United Nations Population Division, Department of Economic & Social Affairs, World Population Prospects

    Measuring our progress : vaccine goal indicators

    Pneumococcal vaccine

    In 2014, country demand for pneumococcal vaccine continued to increase rapidly with eight countries introducing the vaccine. When Georgia added the vaccine to its routine immunisation schedule in November, Gavi met its 2015 target of supporting 45 introductions – 13 months ahead of schedule.

    Close cooperation among our partners ensured that Nigeria was ready to introduce the pneumococcal vaccine before the end of 2014, pushing the total number of Gavi-supported launches up to 46. WHO estimates that to date 47 million children have been protected against pneumococcal disease with Gavi support. The disease claims the lives of more than half a million children under five each year.

    As Gavi-supported countries continued to roll out the pneumococcal vaccine, coverage levels increased to 28% in 2014. However, coverage is still falling behind annual targets for the 2011–2015 period, largely as a result of supply issues in the early years of the programme and delayed introductions in countries with large populations.

    Vaccine Alliance partners are working to ensure that supply remains stable, that adequate support is provided for remaining introductions and that coverage is sustained over the long term. In most countries, pneumococcal vaccine coverage reaches the same level as pentavalent coverage rates within two years of its introduction.

    Number of country introductions

    Pneumococcal vaccine

    KPI  

    Source: Gavi, the Vaccine Alliance, 2014

    Coverage (%)

    Pneumococcal vaccine, 3rd dose

    KPI  

    Source: WHO/UNICEF Estimates of National Immunization Coverage, 2015

    Pentavalent vaccine

    In July, South Sudan became the 73rd and final Gavi-supported country to introduce the five-in-one pentavalent vaccine. In 2000, fewer than 10% of low- income countries had introduced hepatitis B vaccine into their national immunisation schedules while less than 5% had added the Hib vaccine.

    Fifteen years later, our partners have exceeded one of the Vaccine Alliance’s original objectives and achieved our goal to ensure all poor countries have access to these life-saving vaccines as part of the pentavalent vaccine. Hepatitis B infection causes hundreds of thousands of deaths every year through acute and chronic illnesses, including liver cancer and cirrhosis, while the Hib bacterium causes meningitis, pneumonia and septicaemia.

    The pentavalent success story reflects the strengths of our public-private partnership model. UNICEF’s Supply Division has met demand for over one billion doses. WHO and UNICEF have helped countries make informed decisions about when and how to introduce the vaccine. Industry has increased annual global production capacity from 20 to 400 million doses. Innovation in improved formulation and packaging of the five-in-one vaccine has significantly reduced the strain on poor countries’ immunisation cold chains.

    This is especially important in conflict-affected and fragile countries such as the Democratic People’s Republic of Korea, DRC and Somalia, where the capacity of health systems is often limited. Even as we approached the introduction target for pentavalent, we had already started to shift our attention to improving coverage. This is estimated at 57% for 2014, below our 77% target for the end of 2015. Progress depends mainly on the successful completion of pentavalent’s introduction in India, which accounts for 26 million newborns each year. The roll-out is expected to be completed by early 2016.

    Number of country introductions

    Pentavalent vaccine

    KPI  

    Source: Gavi, the Vaccine Alliance, 2014

    Coverage (%)

    Pentavalent vaccine, 3rd dose

    KPI  

    Source: WHO/UNICEF Estimates of National Immunization Coverage, 2015

    Rotavirus vaccine

    Recognising the importance of rotavirus vaccine in preventing diarrhoeal deaths in young children, more countries (16) introduced this life-saving intervention in 2014 than ever before. It represented the largest number of introductions of a single vaccine in a calendar year in Gavi’s history and meant we surpassed our 2015 target of 33 introductions.

    Both Niger and Togo added to the momentum with simultaneous introductions of rotavirus and pneumococcal vaccines, an approach pioneered by Ghana in 2012.

    The large number of countries introducing rotavirus vaccine in 2014 meant coverage levels more than doubled compared with 2013. However, Gavi is still behind its 2011–2015 annual coverage targets due to a lack of introductions in highly-populated countries. As many large countries plan to roll out the vaccine in the near future, the Vaccine Alliance continues to work with

    Number of country introductions

    Rotavirus vaccine

    KPI  

    Source: Gavi, the Vaccine Alliance, 2014

    Coverage (%)

    Rotavirus vaccine, 3rd dose

    KPI  

    Source: WHO/UNICEF Estimates of National Immunization Coverage, 2015

    Q&A

    Michel Zaffran, Coordinator, Expanded Programme on Immunization, WHO

     

    What are the advantages for WHO of working as part of Gavi?  

    WHO is one of the founding partners of Gavi. The need to establish an alliance of partners became very obvious in the late 1990s, to rejuvenate efforts to strengthen immunisation and fill the gaps existing at that time. Most low-income countries lacked access to new vaccines, and over 20 million children every year were not being reached by routine immunisation services. The combined efforts of Vaccine Alliance partners through a strongly coordinated action plan have helped to ensure that available resources are used efficiently to meet immunisation goals at global and country levels. In addition, working as an alliance allows for innovative approaches to tackle challenges.

    What can WHO achieve as part of the Vaccine Alliance that you could not do alone?  

    Gavi has been able to generate donor support for countries and partner agencies that WHO alone could not have secured. As a result, WHO has boosted its technical assistance to countries and its ability to more rapidly prequalify vaccines for use in Gavi-funded programmes. We have also been able to develop policy, strategy and technical guidance in areas such as new vaccine introduction, vaccine management, surveillance, programme evaluation and monitoring.

     

    Can you give an example of how Gavi has contributed to accelerating access to vaccines?  

    Before Gavi was created, newly licensed vaccines (such as hepatitis B and Hib) would take 10 to 15 years before they became affordable and accessible for lower income countries. The establishment of Gavi and its ability to finance procurement of new vaccines and drive prices down has had a major impact on this time lag. The Gavi Board endorsed support for rotavirus and pneumococcal vaccines in December 2006, just a couple of years after these vaccines were licensed for use in industrialised countries.

    What was the main success story of 2014?  

    Gavi’s contribution to the 2013–2018 Polio Eradication and Endgame Strategic Plan - supporting the introduction of IPV in all Gavi countries - has been extraordinary. Without the Vaccine Alliance and its established mechanisms for new vaccine introduction, the world would not have been able to roll out IPV so rapidly in so many countries.

  • The Health Systems Goal

    → Health system strengthening support continues to increase
    Support increasingly tailored to address specific country challenges

    → Partners help countries modernise supply chains
    Increasing volumes of vaccines put strain on outdated systems and equipment

    → Gavi continues to monitor, evaluate and learn from health system strengthening grants
    Revisions to grant management process include use of intermediate indicators

     

    While strong health systems are essential for successful vaccine introductions, they are even more critical for sustaining immunisation coverage and ensuring equity.

    Strong infrastructure – quality services, availability of trained managers and health workers, good information and data systems, and supply chains – is needed to work with communities and parents to protect the gains of the first 15 years of Gavi’s work. It holds the key to reaching the one in five children still missing out on the basic package of childhood vaccines, and the 95% who do not yet have access to all 11 vaccines recommended by WHO for infants in all countries.

    The 2014 immunisation coverage rates suggest that Gavi’s and other partners’ investments in health systems are starting to yield results. More and more children are being vaccinated and have regular contact with health services in their fragile first year of life.

    This section provides an update on Gavi’s health system strengthening (HSS) support – our main approach to increasing the capacity of health systems to deliver immunisation – with a special focus on the Vaccine Alliance’s Supply Chain Strategy. We also look at how Gavi monitors and learns from the impact of its HSS programmes to improve future grants.

    Read more detail on Gavi's Health Systems Goal → 

    Gavi’s approach to health system strengthening

     
    Health system goal indicators

    DTP3 coverage (%)

    Coverage with three doses of diphtheria-tetanus- pertussis (DTP3) is a standard indicator of the reach of national immunisation programmes. In 2014, DTP3 coverage in Gavi-supported countries reached its highest-ever level (81%); it is the first time this figure has exceeded 80% in these countries. The vast majority of children in Gavi-supported countries receive DTP as part of the pentavalent vaccine.

    KPI  

    Source: WHO/UNICEF Estimates of Immunization Coverage, 2015

    Equity in immunisation coverage (%)

    By comparing DTP3 coverage for the poorest 20% of the population in Gavi countries with the richest 20%, this indicator measures the extent to which poverty plays a role in determining whether a child is immunised. The percentage of countries meeting the minimum equity benchmark has increased from 51% in 2010 to 57% in 2014.

    KPI  

    Source: DHS and MICS; other surveys that use comparable methods may be used where no DHS or MICS is conducted

    Percentage point difference between DTP1 and DTP3

    This indicator measures the percentage of children that receive the first but not the third dose of DTP-containing vaccines. Weaker health systems may not be able to reach a child with a full course of DTP rather than just the first dose. In 2014, the difference between DTP1 coverage and DTP3 coverage in Gavi-supported countries fell to seven percentage points, confirming that countries are increasingly able to deliver a full course of the vaccine.

    KPI  

    Source: WHO/UNICEF Estimates of Immunization Coverage, 2015

    First dose of measles coverage (%)

    Children are immunised against measles later than DTP3 but still within the first year of their life. Measles first dose coverage, which Gavi does not support, gauges the ability of health services to vaccinate children beyond three months of age. While DTP3 coverage has increased in recent years, coverage with routine measles first dose has stagnated at 78% for five years in a row.

    KPI  

    Source: WHO/UNICEF Estimates of Immunization Coverage, 2015

    Q&A

    Henri van den Hombergh, Senior Advisor, Immunization and Health Systems Strengthening, UNICEF

     

    How does UNICEF work as a partner of Gavi, the Vaccine Alliance?  

    As a founding partner of Gavi, UNICEF works to improve immunisation through policy work, country offices and support from our Supply Division.

    We use our presence at all levels in priority countries to deliver change in critical areas. We analyse obstacles to coverage and equity for children and their caretakers in their efforts to access immunisation and other essential health services. We work with partners to develop proof of concept and implement the joint WHO-UNICEF approach. Bottlenecks are often related to how immunisation financing is managed, from the national level down.

    We work with WHO at country, regional and headquarters levels to support health system strengthening (HSS) grant applications and implementation. UNICEF applies social and behavioural insights for demand generation and to develop introduction plans, including communication and social mobilisation, to promote and sustain demand for vaccination services.

    In 2014, UNICEF facilitated the development of 24 government-endorsed plans to support new vaccine introductions and/or routine immunisation programmes. Our staff also work on all aspects of the polio eradication endgame, from technical implementation to logistics and supply. Gavi plays an important role as a convergence platform. Gavi policies and strategies and their implementation rely on good data. UNICEF works with WHO to develop annual joint estimates and on the compilation and analysis of the Joint Reporting Format (JRF).

     

    What can you achieve additionally through the Vaccine Alliance that you would not be able to do alone?  

    An excellent example of how much more we can achieve by working together is the Gavi Immunisation Supply Chain Strategy. The strategy is focused on helping countries to put in place the building blocks for improved immunisation supply chains. It takes an end-to-end perspective on the supply chain, all the way from the manufacturer to the health worker. This important, cross-cutting piece of work was developed by and is being implemented by Vaccine Alliance partners.

    Can you give an example of what you have been able to achieve in this area?  

    Together with WHO, we have developed and implemented the Effective Vaccine Management tool. This tool has become a globally accepted standard for assessing vaccine management and allowing trend analysis and improvement plan development within countries, as well as comparison between countries. It is used as an important tool for Gavi HSS grant applications, and for development of annual immunisation work plans.

    What was the main success story for UNICEF in this area in 2014?  

    One example where we were able to have a substantial impact on equity in immunisation was in Madagascar, one of the least developed countries in the world. UNICEF worked with the government to develop a new strategy to address inequities. By helping to identify and analyse obstacles at national and local levels, including barriers to access for disadvantaged populations, we helped to develop and implement a new strategy as part of a national Expanded Programme on Immunization (EPI).

  • The Financing Goal

    → Assessment missions prepare the ground for countries to graduate from Gavi support
    Four countries – Bhutan, Honduras, Mongolia and Sri Lanka – on track to self-finance immunisation programmes from 2016

    → Full funding secured for the 2011-2015 strategic period
    100% of donor pledges signed as formal grant agreements

    → Private sector ranks among top 15 Gavi donors
    In-kind support delivers advocacy and operational expertise

     

    By the end of 2014, just six years after countries made their first co-financing contributions towards Gavi-supported vaccines, there is growing evidence that our funding model is working.

    Over 20 countries are preparing to graduate from Gavi support. The first four – Bhutan, Honduras, Mongolia and Sri Lanka – are expected to start fully financing their immunisation programmes in 2016. From Gavi’s inception, our funding model has been designed to increase countries’ investment in their immunisation programmes. The aim is to encourage national ownership and ensure programmes are financially sustainable after Gavi support ends.

    Predictable, long-term donor contributions give countries the confidence to introduce new vaccines. Aggregating demand forecast from developing countries enables manufacturers to plan production and supply vaccines at more affordable prices. Greater levels of immunisation lead to healthier, more productive populations, and in turn increase national prosperity. This in turn helps countries move towards full financing of their immunisation programmes.

    More information on the Financing Goal → 

    Gavi: a dynamic resource mobilisation model

     
    Financing goal indicators:

    Co-financing: countries keep up with rising number of vaccine programmes

    As the strategic goal indicator on the right shows, countries continue to invest in vaccines, with the amount spent per child increasing from US$ 3.80 in 2010 to US$ 4.3 in 2013. The drop in average expenditure observed in 2013 is a result of the influence of reduced investment per child in three countries with large birth cohorts (Indonesia, Nigeria and Pakistan); elsewhere, relative to 2012, spend per child either increased or remained stable in 2013.

    Our co-financing approach is a key driver for country investment in immunisation with US$ 69 million paid on time in 2014 – a 9% increase on 2013. The number of vaccine programmes paid on schedule also increased, from 111 in 2013 to 116 in 2014. Since the first co- financing contribution was made in 2008, countries have made payments totalling US$ 356 million.

    However, while countries are co-financing more vaccines, the proportion making timely co-financing payments remained similar to 2013 – 75% in 2014 compared with 79% in 2013. This is a reflection of the rapidly increasing number of Gavi-funded vaccine programmes which rose by more than 20% from 2013 to 2014.

    Of the 70 countries co-financing in 2014, 51 fulfilled their commitments on schedule. Although 17 countries defaulted, only five made no contribution – Djibouti, Guinea-Bissau, Haiti, Lesotho and South Sudan. Another two, Guinea and Sierra Leone, were suffering the consequences of the Ebola epidemic and were granted a waiver by the Gavi Board. The others made partial payments or paid off their 2013 arrears.

    By mid-2015, 11 of the 17 defaulting countries had already paid off their 2014 arrears, bringing the total contribution through co-financing in 2014 to US$ 84 million.

    In 2014, we started a review of our co-financing policy to assess whether the mechanism requires adjustment to help consistently defaulting countries like the Central African Republic. Although it failed to meet its commitments in 2008, the Central African Republic has since regularly paid its annual contribution, just one year late. Nevertheless, under our current co-financing policy, the Central African Republic is listed as defaulting every year. The review recommended a change to the policy to ensure countries in similar situations are more closely monitored with a payment plan to enable them not to be listed as defaulting.

    Read updates on all Gavi-supported programmes in the full version  

    Country investment in vaccine per child

    Average expenditure per child (US$)

    KPI

    Source: WHO/UNICEF Joint Reporting Form; Gavi Annual Progress Reports; Gavi’s Adjusted Demand Forecast; UNPD data.

    Timely fulfilment of co-financing

    Percentage of countries

    KPI

    Source: UNICEF Supply Division and the PAHO Revolving Fund.

    Our donor funding base: predictable, long-term funding commitments

    Developing countries assessing whether to adopt a new vaccine look for assurance that programme support will continue until they can take over full financing. Likewise, vaccine manufacturers investing in new or expanded production that can take several years of lead time need confidence that there is guaranteed demand. This means that direct funding agreements, the International Finance Facility for Immunisation (IFFIm) and the Advance Market Commitment (AMC) lie at the core of the long-term, predictable funding required to support Gavi programmes.

    In 2014, total donor funding, mainly in the form of multi-year agreements, amounted to US$ 1.6 billion, meaning Gavi is on track to securing full funding for the 2011–2015 strategic period. Cumulative funds received by Gavi since its inception in 2000 total US$ 10 billion.

    Contributions pledged to Gavi and IFFIm

    (US$ millions)

    KPI

    Source: Gavi, 2014.

    Direct contributions: all pledges for 2011–2015 signed as grant agreements

    By the end of 2014, 100% of donor pledges made for the period 2011–2015 had been signed as formal grant agreements, mainly in the form of multi-year agreements (see below). In total, we received US$ 888 million in direct contributions from 14 donor governments: Australia, Canada, France, Germany, India, Ireland, Japan, Luxembourg, the Netherlands, Norway, the Republic of Korea, Sweden, the United Kingdom (UK) and the United States.

    The cumulative value of direct contributions received from national governments and the European Commission since Gavi’s foundation in 2000 amounts to US$ 5.1 billion.

    Signed grant agreements versus total pledges

    (US$ millions)

    KPI

    Source: Gavi, 2014.

    Q&A

    Rama Lakshminarayanan, Senior specialist on Health, Nutrition & Population and Gavi Alternate Board member

     

    What are the advantages for the World Bank of working as part of Gavi, the Vaccine Alliance?  

    The World Bank is a founding partner and active Board member of Gavi, which has given us the ability to engage in important policy discussions and decisions. We cannot overstate the importance of Board membership, which helps to keep us fully engaged with Gavi’s thinking and strategy. At country level, Gavi is a key financial supporter of immunisation, whose interests coincide closely with those of the Bank. Immunisation is one of the most effective health interventions, as well as one of the most cost-effective. Gavi and the Bank are both working to increase coverage rates. On health system strengthening, Gavi’s investments and interests overlap with the Bank’s. For us, it is also important to focus on financial sustainability, so that resources are mobilised to continue support for immunisation.

    What can the World Bank achieve as part of Gavi that you could not do alone?  

    Our work in health focuses on the Universal Health Coverage (UHC) agenda. For countries to reach this ambitious but achievable goal, they and the Bank need to align closely with financing institutions like Gavi. We have also worked to align the objectives of the International Development Association (IDA) with Gavi – to advance the UHC agenda in the poorest countries. And finally, the newly launched Global Financing Facility (GFF) can only attain its goals for Reproductive, Maternal and Child Health through close collaboration with Gavi.

     

    Can you give an example of how Gavi has contributed to sustainability?  

    Gavi has recently worked to evaluate new evidence and re-examine its approach to policies on co- financing and sustainability. By helping countries to prepare earlier for transition from Gavi support, investing in health systems strengthening, institutional sustainability and technical support, countries can plan for this transition and minimise volatility. This new approach is critical for future sustainability.

    What was the main success story for the World Bank in the area of sustainability for immunisation in 2014? What was your most significant challenge in this area?  

    Building the financial and institutional capacity of countries is critical for sustainability. Our engagement with Gavi, including the recent partners framework agreement, will help to hone the Bank’s engagement in immunisation. This is a good foundation for us to help countries to sustain their immunisation programmes. We are also collaborating with Gavi on the Global Financing Facility.

    Our joint challenge is to ensure sufficient government spending to maintain immunisation coverage. Health investments are particularly at risk when countries transition from lower to middle income and these vulnerabilities need to be addressed.

  • The Market Shaping Goal

    → Supply secured for three new vaccines
    Cholera, inactivated polio and Japanese encephalitis (JE) vaccines

    → Low prices achieved for inactivated polio vaccines
    Prices starting from as low as €0.75 per dose

    → Four new vaccine roadmaps to guide Gavi’s market shaping efforts
    Roadmaps developed for cholera, Japanese encephalitis, measles-rubella and pneumococcal vaccines

     

    Fostering healthy vaccine markets, with adequate, secure supply of quality vaccines at low and sustainable prices, is at the core of the Gavi business model.

    As Gavi’s vaccine portfolio was expanded in 2014 to include cholera, inactivated polio (IPV) and Japanese encephalitis (JE) vaccines, we worked to ensure that countries have access to sufficient supply of these new vaccines.

    By working with our partners, we successfully secured prices as low as €0.75 (approximately US$ 1) per dose for IPV.

    Vaccine roadmaps help to guide our market shaping efforts by analysing the dynamics of each market, prioritising our objectives and establishing a way forward to achieve them. In 2014 we developed roadmaps for cholera, JE, measles-rubella and pneumococcal vaccines, and updated the roadmap for pentavalent vaccine.

    Fuller information on Market Shaping 

    How Gavi’s supply and procurement strategy works

     

    Market shaping goal indicators

    More manufacturers, increased supply security

    Efforts to improve vaccine markets have led to increased competition and diversification of the manufacturing base. In 2001, there were just 5 Gavi vaccine suppliers; by the end of 2014, 16 manufacturers were producing prequalified vaccines suited to the needs of Gavi-supported countries.

    By tracking the number of products offered in response to tenders for Gavi-supported vaccines, we can measure vaccine supply security. The number of products offered as a percentage of the 2015 target increased to 88% in 2014, from 79% in 2013. Since 2010, it has increased from 54%. Gavi remains on track to meet the 2015 target for the number of products offered.

    Security of supply

    Number of products offered as % of 5-year target

    KPI  

    Source: UNICEF Supply Division.

    Minimised costs

    Together with our partners we managed to secure appropriate prices in all of our 2014 tenders.

    Following the tender for IPV, the vaccine will be available to Gavi-supported countries from as little as €0.75 (approximately US$ 1) per dose. Middle-income countries will be able to buy the vaccine through UNICEF for between €1.49 and €2.40 (approximately US$ 2.04–3.28) per dose.

    The weighted average price that Gavi pays for pentavalent vaccine fell from US$ 2.04 in 2013 to US$ 1.90 in 2014. The total cost of fully immunising a child with pentavalent, pneumococcal and rotavirus vaccines, which is one of our key indicators, went down from US$ 35 in 2010 to US$ 22 in 2014.

    Total cost to fully immunise a child with pentavalent, pneumococcal and rotavirus vaccines

    elected vaccine package price (US$)

    KPI  

    Source: Procurement partner manufacturer offers

    Q&A

    Dr Orin Levine, Director, Vaccine Delivery, Bill & Melinda Gates Foundation

     

    What are the advantages for the Gates Foundation of working as part of the Vaccine Alliance on market shaping?  

    First, we have access to thought partners in the Gavi Secretariat and UNICEF Supply Division. Sometimes we have different views, but this challenges us to be more robust and clear in our analysis and recommendations, and improves the overall effectiveness of our efforts. Also, each institution has access to different information and different perspectives, so together we can get to the best collective perspectives on issues. The Gavi Secretariat leads development and partner alignment on the vaccine roadmaps, which are our most important tools for harnessing the benefits of working together. It also develops the Strategic Demand Forecasts (SDF), which we then use for our own market analysis.

    What can the Gates Foundation achieve as part of the Vaccine Alliance that you would not be able to do alone?  

    We dedicate more of our own internal resources (time and people) to novel, innovative projects because Gavi takes care of important inputs for market shaping, like roadmaps and SDFs. Our partnership with Gavi is based on sharing information, which enables all partners to access critical information we might not otherwise have. Lastly, by working within a coordinated Gavi effort, our voice gains impact and legitimacy as compared to working alone.

     

    Please give an example of an outcome that resulted from the Vaccine Alliance’s work?  

    By leading development of the vaccine roadmaps, and gaining input and alignment with UNICEF’s Supply Division and the Gates Foundation, we have more impact on supply and pricing. The roadmaps require alignment on market strategies and action plans which focuses everyone’s efforts on defining and working toward the same goals. Alignment is not always perfect, but the roadmap approach is definitely an improvement and positions us for further improvement.

    What was the main success for the Gates Foundation in the area of market shaping in 2014?  

    The biggest success story in market shaping was the Sanofi IPV investment to reach US$ 1.00 per dose to remove cost as a barrier to rapid IPV introduction and uptake for polio eradication.

    Another major success was bolstering our ability and information base for market strategies and investment decisions. We solidified our approach to market analysis and action plans, improved our production economics data (how we collect it and use it in a more dynamic way), and developed a framework for assessing total systems costs and identifying goals around product innovation.

close icon

modal window here