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					          Measles Partnership Meeting

Yalda Momeni
September 23rd - WDC
Vaccines – a New Perspective

A commercially viable commodities to
 invest in….

…. not viewing vaccines as the life saving
interventions they are.

Essentially - the supply perspective
    Knowing the product profile from a supply
    perspective is key for supply planning
    Vaccines as Products
                                              How long does it take to make
  High Product Sensitivity                    vaccine?
    •Biological products requiring constant     •Production of a dose: 6 -24 months
    temperature control                         •Capacity Increase: 2-3 years
                                                •New Plant: 5-7 years
    •Significant risks of production failures
                                                •New regulatory requirements can
    •Highly regulated production environment    cause interruptions
    •Quality is the OVER-RIDING Criterion
    •Dependency on well functioning NRA
    •Limited Shelf life                      UNICEF Vaccine Procurement
    •Cold Chain from Manufacturer to Child     •No firm contracts for the majority of
                                               vaccines procured
                                               •40% volume, 5% value
  Very Limited Supply
                                               •Funding often less than 12 weeks
    •1- 5 suppliers per product                before delivery
    •High entry cost to manufacturers

Summary: manufacturer taking risk in low profit environment!
UNICEF has a significant role in the vaccine
market in terms of volumes but limited in terms
of value
Amounting to 40% of the in of 80 – 100procurement of the
Procuring the routine needs the overall but only annually,
With significant increasesglobal volumescountries 5%level over
 the past 10 procurement of vaccines for GAVI, the Measles
 Global valueyears
 alongside the
 Partnership and the Global Polio Eradication Program
 UNICEF represents an important buyer in
 terms of volume on the Measles market

                                   Data Sources:       Excl. self producing countries
                                   Population Data: ‘The State of the Worlds Children 2008’
                                   Procurement Coverage Data: UNICEF Vaccine Forecast 2008
                                   Income Classification: World Bank

Covering the vaccine procurement for ~ 70% of the
routine demand on the Global Market
In addition to procuring the vaccines on behalf of the
Measles Partnership
Over 200m doses per year average for the past 3 years
 However the picture is very different in the
 MR market

Covering the vaccine procurement for less than 10% of the
routine demand on the Global Market
In addition to procuring the vaccines on behalf of the
Measles Partnership
Under 20m doses per year average for the past 3 years
    In addition, Pricing trends within the vaccine
    markets are dependant on (i) levels of
    competition, (ii) demand profile within the market
                       Weighted Average Prices for Vaccines
                                                                                 Hep B – ‘High’
$0.2500                                                                          competition, declining
                                                                                 BCG – 4 suppliers, stable
                                                                                 Measles – high dependency
$0.1000                                                                          on 1 supplier, increasing
                                                                                 DTP, declining demand, 2
                                                                                 suppliers per presentation,
          2004         2005        2006        2007           2008        2009   increasing prices
                 BCG-20        DTP-10         DTP-20             Hep-10
                 Measles-10    TT-10          TT-20

    Within the MR market
    •Currently 2 WHO pre-qualified manufacturers
    •High dependence on one Manufacturer
Markets in Transition - Shifting the
demand profile

Recent experiences within the DTP
 markets highlight the market transition
 within different settings
Transition of DTP to STP-HepB/Hib demand
UNICEF large influence on market. GAVI supported, Routine demand
only - requiring individual country decisions to switch creating a level of
uncertainty, moving from an established market to new markets.
Rate of change gradual, longer timelines than anticipated.

The original forecastsacontained a ‘potential switcher’ category where the
Current trend shows clear preference and shift towards the combination
vaccine with the timelines to and dependant on individual country decision
actual demand was unknownshift being longer than anticipated
Even with funded demand, the Pentavalent market
took time to react
- healthy market, increased availability & evolving pipeline
- declining prices as new sources / products become available
- more significant price decreases expected in next tender round (2010-2012)

      Weighted average price                PQ products              Pipeline products
Lessons Learnt from prior experiences
• Market shifts require to be closely managed:
  •   It is not only the establishment/ enhancement of new markets but the
      maintenance of the older markets needs to be monitored
• ensuring an uninterrupted supply and balanced
  market requires multiple suppliers
  •   With only one or two manufacturers in the market, supply
      interruptions are a real risk that need to be managed while the
      market is developing
  •   The level of influence over the market is dependant on the level of
      availability versus demand, the market share both in terms of
      volumes and value.
• Adoption of new products require individual country approval
  •   the timelines for uptake are longer than global programme
• Sustainable demand is a key driver for manufacturers
  to engage in production
• Affordable prices:
  •   Healthy market (competition) needed before significant decreases
      in price can be expected
UNICEF Vaccine Procurement – focused on
achieving Vaccine Security - Ensuring the
uninterrupted, sustainable supply of affordable,
quality vaccines
                                3 Pillars of
                              Vaccine Security

        Accurate                   Firm funding          Appropriate
       Forecasting                                       Contracting
  The forecast is the         - contracting could not
  foundation of Vaccine                                 - to secure
                              occur without the         production
  security – it is the base
  upon which the              necessary funding in      - dependant on
  production quantities       place                     the individual
  are determined and                                    vaccine markets
  funding needs identified
Vaccine supply 2009 and beyond
• India Measles SIA and timing and volume
• CRS elimination strategy and Rubella vaccine

• Increase need for country generated funding

• Tender for EPI vaccines 2010-2012 in Q1 2009
• Supply arrangement in place 6 months prior to first
What do we need…..
 • Realistic demand
 • Program Planning with Realistic timelines in terms of
   vaccine availability
 • Long term plans and demand projection

Ensure uninterrupted, sustainable supply
     of affordable, quality vaccine!

Thank You

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