10_dr moon_roundtable_towards a fair global system for vaccine pricing_how to address the mics chall
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TOWARDS A FAIR GLOBAL SYSTEM FOR VACCINE PRICING: HOW TO ADDRESS THE MICS CHALLENGE?
The best shot: reaching 22 million missed children
MSF seminar on accelerating access to vaccination Oslo, 14 October 2013
Suerie Moon, MPA, PhD Co-Director and Research Director, Forum on Global Governance for Health,
Harvard Global Health Institute and Harvard School of Public Health
Co-Director, Project on Innovation and Access to Technologies for Sustainable Development
Sustainability Science Program, Harvard Kennedy School of Government
Middle-income countries (MICs)
LIC 12%
LMC 35%
UMC 34%
HIC 19%
Population LIC 1%
LMIC 7%
UMIC 22%
HIC 70%
Global GDP (2010)
LIC 25%
LMIC 56%
UMIC 19%
Global Population <$2/day
MICs challenges
Rely less on aid (DAH)
Price negotiations
New vaccines
$-
$2
$4
$6
$8
$10
LIC LMIC UMIC
DAH per capita
Prices & GDP
$-
$10
$20
$30
$40
$50
$60
$70
$80
$90
$100
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
GAVI avg Macedonia South Africa PAHO avg Brazil US
Pneu
mo
vax
pric
e/do
se
GD
Ppc
(201
0)
GDPpc (2010) Pneumo prices
Tiered pricing: best strategy?
3 Major weaknesses:
a) Price: reductions not reliable, not lowest
b) Arbitrary: categories and price premiums
c) Responsibility: firms or governments?
Source: Moon S, Jambert E, Childs M, von Schoen-Angerer T. 2011. “A ‘win-win’ solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries.” Globalization and Health 7:39. doi:10.1186/1744-8603-7-39. Available: www.globalizationandhealth.com/content/7/1/39/abstract
Tiered prices respond to competition: Evidence from Malaria
Source: Moon, S., Pérez Casas, C., Kindermans, J., de Smet, M., & von Schoen-Angerer, T. (2009). Focusing on Quality Patient Care in the New Global Subsidy for Malaria Medicines. PLoS Medicine, 6(7), e1000106. doi:10.1371/jounal.pmd.1000106
Generic Competition and HIV Treatment Scale-Up
0
1
2
3
4
5
6
7
$0
$100
$200
$300
$400
$500
$600
$700
$800
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Mill
ions
People in LMICs on treatment Lowest generic price first line ARV regimen
Originator price of first-line ARVs
$10,400 $2700
Arbitrary: prices & categories
No norms, no transparent basis for pricing
Evidence from HIV: 33 ARVs with Category 1 (~LICs) and Category 2 (~MICs) prices Difference Cat 1 & 2 pricing: 20-1353 USD; 4.5% to 177% Wide variation classifications:
Per capita GNI (low vs middle-income countries)* Disease burden (eg HIV) UN-classified Least-Developed Countries Human Development Index Regions
Fair price? Which countries should pay more, how much more? On what grounds? Who decides?
Government responsibility: HICs vs LMICs
Government regulation (e.g. in HICs):
Reference pricing Reimbursement rates
Formulary Price controls Pooled procurement
Pharmacoeconomic assessments
Compulsory licensing
Tiered pricing, sellers decide : Price Which countries eligible
For how long Other conditions Criteria for decisions not
transparent
Towards a fair global pricing system
Principled objectives Affordability Security of supply Reward R&D Fair burden-sharing Public responsibility
Short-term Pooled procurement Forecasting Graded price premium… …transparent rationale, data & objective criteria Government engagement
Towards a fair global pricing system
Principled objectives Affordability Security of supply Reward R&D Fair burden-sharing Public responsibility
Mid-to-Long term Competition (tech transfer) Multisource supply Proportional contribution to transparent R&D costs Intergovernmentally agreed framework
0
10
20
30
40
50
60
70
Pric
e U
SD
Population (hundred millions)
Cost of goods Reward for innovation
LIC 1%
LMIC 7%
UMIC 22%
HIC 70%
Global GDP (2010)
A Fairer Global Vaccine Pricing System
Conclusions
1. Fair, politically-sustainable global system for vaccine pricing is in everyone’s interest
2. Pro-active interventions needed to fix a dysfunctional pricing ‘system’ to ensure access to vaccines for all
LIC 25%
LMIC 56%
UMIC 19%
Global Population <$2/day
Public responsibility
“Access to drugs cannot depend on the decisions of private companies but is also a government responsibility.” –WHO Commission on IPRs, Innovation and Public Health (2006)
“The primary obligation for implementing the right to health falls upon the national authorities in the State in question,” and “access to medicines forms an indispensable part of the right to the highest attainable standard of health.”
– Paul Hunt, UN Special Rapporteur for Health & Human Rights (2002-08)
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