TT

TT Procured by UNICEF 2001 - 08

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

2001 2002 2003 2004 2005 2006 2007 2008

Routine SIA

TT historical demand and forecast overview

Upcoming Tender Period

Trends in TT vaccine offered to UNICEF

TT vaccine offered to UNICEF 1992-2009

0

50

100

150

200

250

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Mill

ion

s o

f d

os

es

•Good supplier base but still high dependency on one source•One new supplier obtained WHO prequalification in end 2007, enhancing supply availability and vaccine security

Summary

•Elimination by 2012

•MNT Investment Case (2007-2009) has given campaigns and routine program a boost.

•Funds through IFFIM IC for vaccines are fully utilized

•Active fund raising for SIAs beyond 2009

•Routine demand for most part is funded through country financial resources

TT

2009 2010 2011 2012Routine 106,500,000 130,000,000 135,000,000 140,000,000SIA 60,000,000 30,000,000 30,000,000 30,000,000Total 166,500,000 160,000,000 165,000,000 170,000,000

TT Tender quantities 2010-12

Upcoming Tender Period

MEASLES

Measles procured by UNICEF 2001-2008

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

2001 2002 2003 2004 2005 2006 2007 2008

Nu

mb

er o

f D

ose

s

Routine Supplementary

• Historically demand has been mainly driven by campaigns • Large catch up campaigns in 2006-07 and some in 2008• 2009-2010 Quantities do not include potential demand for India SIA

Measles – Procurement Overview & Future demand

Upcoming Tender Period

Measles vaccine offered to UNICEF 1992-2009

0

50

100

150

200

250

300

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Mill

ion

s o

f d

os

es

Trends in Measles vaccines offered to UNICEF- availability

Drastic reduction in the number of suppliers offering WHO pre-qualified vaccine to UNICEF over the past 10 years

High dependency on one manufacturerMeasles containing vaccines are classified as high priority for WHO PQ

Mixed results in terms of affordability

Weighted Average Prices for Vaccines

BCG –stable demand, 4 suppliers, stable pricingDTP, declining demand, 2 suppliers per presentation, increasing pricesTT – growing demand, 4 suppliers, adjusted prices, now stableMeasles – growing demand, 3 suppliers, increasing prices

Summary…

Global Measles mortality reduction by 74% need to Sustain achievement

Expect stabilized demand with; • Increased routine, including 2 dose as per SAGE recommendation,

will add to routine demand.• Sustained follow-up campaigns, intervals based on 1st dose

coverage, but average every 3 years

* Both posing future funding challenges for countries

Measles campaign is often use as the main vehicle for integrated campaigns

Continued monovalent measles vaccine supply needed in the future

Measles

2009 2010 2011 2012Routine 75,500,000 70,000,000 75,000,000 75,000,000SIA 79,800,000 95,000,000 70,000,000 50,000,000Total 155,300,000 165,000,000 145,000,000 125,000,000

Measles Tender quantities 2010-12

Upcoming Tender Period

MMR

MMR Historical demand and forecast overview

•The main increase in 2009-12 demand is for 1 one country, introducing MMR in their routine program as of 2009, therefore demand picture can change substantially•Increased quantity only partially due to MR campaigns in 2007

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Original Quantity on LTA Forecast to Suppliers at beginning of YearQuantity Procured Current Forecasted Quantity Current Tender Quantity

Upcoming Tender Period

Summary

• Very limited availability / long lead-time for unplanned demand

•Countries are strain aware / sensitive -There is strong strain preference from countries-At times the preference been influenced / diverted based on price and availability

• Large price differences between different products

• Limited sustainable external funding available – countries need to include in their own budget

The projection / scenario for MR will not impact the MMR demand

MMR Tender quantities 2010-12

MMR

2009 2010 2011 2012MMR 10 4,855,000 4,800,000 4,900,000 5,200,000MMR 1 795,000 1,000,000 1,000,000 1,000,000Total 5,650,000 5,800,000 5,900,000 6,200,000

Upcoming Tender Period

MR

MR – Procurement Overview - Future

•Currently 2 WHO pre-qualified suppliers, high dependency on one•Substantial portion of the demand in 2009 is for one country campaign

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Original Quantity on LTA Forecast to Suppliers at beginning of YearQuantity Procured Current Forecasted Quantity Current Tender Quantity

Upcoming Tender Period

MR

2009 2010 2011 2012Routine 1,351,623 1,700,000 1,700,000 1,700,000SIA 4,500,000 0 2,000,000 1,000,000Total 5,851,623 1,700,000 3,700,000 2,700,000

MR Tender quantities 2010-12

Upcoming Tender Period

June, 2008: Rubella as part of GAVI investment strategy introduced to GAVI the Board (for endorsement, not financial decision)

• Rubella: cause of congenital rubella syndrome (CRS) when infected in early pregnancy

• It is estimated that there are 110,000 cases of CRS each year and poses high disease burden on poorest countries

Future of MR vaccine?

Future of MR vaccine?

• October, 2008: Rubella part of the portfolio for GAVI to consider for future investments (HPV, JE, Rubella, Typhoid) at the October 08 Board

• Mindful of the current financial environment, the Board deferred any financial commitment related to the vaccine investment strategy for further review

MR VACCINE DEMAND GIVEN INTEGRATED ADOPTION FORECAST Rapid Impact

Vaccine Demand including Wastage2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Routine Vaccination 0 25 31 32 40 41 46 50 55 56 57 58Catch-up Campaign 0 406 88 4 106 14 50 53 53 15 0 9Periodic Campaign 0 119 26 1 22 2 10 9 10 3 0 2Boost Vaccination 0 0 0 0 23 28 29 36 37 41 45 49

Buffer Stock 0 6 1 0 2 0 1 1 1 0 0 0Stock Pile 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 556 147 37 193 86 135 149 155 116 102 119

0

100

200

300

400

500

600

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Dos

es (M

)

Vaccine Demand including Wastage

Routine Vaccination Catch-up Campaign Periodic Campaign Boost Vaccination Buffer Stock Stock Pile

http://www.gavialliance.org/vision/strategy/vaccine_investment/index.php* Source: Applied Strategy – Oct 27, 2008

0

5

10

15

20

25

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

# of

Cou

ntri

es A

dopti

ng V

acci

ne

Rubella

MR INTEGRATED ADOPTION FORECAST

* 14 GAVI countries have already adopted rubella; 12 are not expected to be eligible based on projected MCV coverage rates < 80% through 2020

Bangladesh

Bhutan

Cambodia

Haiti

India

Mongolia

Nepal

Solomon Is

Tajikistan

Viet Nam

Indonesia

Korea, DPR

Myanmar

Yemen

Burundi

Eritrea

Ghana

Pakistan

Rwanda

São Tomé and Principe

Uganda

Malawi

Zambia

Cameroon

Congo, DR

Côte d'Ivoire

Gambia

Benin

Burkina Faso

Kenya

Niger

Senegal

Togo

Lesotho

Mali

Mozambique

PNG

Tanzania

Timor-Leste

Zimbabwe

Afghanistan

Comoros

Djibouti

Congo, Rep.

Guinea

Sierra Leone

Vaccine Need: 72

VISP Scope: 46*

* Source: Applied Strategy – Oct 27, 2008

A PossiblePossible scenario for MR introduction through catch up campaigns…: 2013 - 18

Assumptions:

• Delay the introduction by 3 years compared to rapid impact plan

• Total 300 mil ds for 2013 - 2018

• Distribute quantities throughout 5-6 years

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

2013 2014 2015 2016 2017 2018

mil

ds

Total tender quantities of Measles containing vaccines 2010 – 12

Measles

2010 2011 2012Total 165,000,000 145,000,000 125,000,000

MR

2010 2011 2012Total 1,700,000 3,700,000 2,700,000

MMR

2010 2011 2012Total 5,800,000 5,900,000 6,200,000

UNICEF VACCINES

Thank You