2nd Global meeting on implementing new and under-utilized vaccines, 23-25 June 2008
Lower middle-income countries (LMICs)
Lower middle-income countries are those with a Gross National Income of between US$ 906 and US$ 3595 per capita. They total 55 in number and although most of them do not qualify for support from the GAVI Alliance, a small proportion of those with GNI per capita of between US$ 906 and US$ 1000 are eligible for GAVI support. With the exception of countries in the Americas, LMICs are beginning to lag behind GAVI-eligible countries in terms of new vaccine introduction.
The high price of many new vaccines is one obstacle being faced by LMICs. It is not, however, the only one. Other needs identified during discussions on this issue were that: national advisory groups need to be strengthened such that they can make more informed decisions; mechanisms leading to better pricing agreements with manufacturers need to be explored; and tools such as the comprehensive Multi-Year Plan (cMYP) need to be made available and adapted as necessary to help LMICs in their planning processes. There was consensus that solutions will need to be tailored to individual country situations.
Undertake country needs assessments with the primary objective to understand the needs of countries and challenges of vaccine introduction. All middle-income countries (MICs) — both struggling and successful — should be considered.
Step 1: Collate information from all partners on MICs.
Step 2: Develop a questionnaire to be completed for all countries. Partners to facilitate completion at country level. Regional meetings to be considered as a means of sensitizing countries.
Step 3: Develop a list of 6-10 priority countries for in-depth assessment.
Particular consideration should be given to LMICs which have successfully introduced new vaccines. Intercountry exchange mechanisms should be promoted and facilitated.
Undertake further global analysis in the following areas:
- Impact of introduction of new vaccines by all MICs — and in particular LMICs — on global demand and supply (with consideration of current and planned uptake levels, global demand forecast guidelines, updating of global supply assessment, vaccine pipeline status).
- Pricing policies and pricing assessment — with consideration of existing pricing policies and what countries are paying for new and underused vaccines.
- Assessment of current procurement and financing strategies.
- Identification of new procurement and financing options and their potential costs, and the impact on the global market.
- Adapt current planning tools — such as the cMYP — to LMIC situations to strengthen in-country planning processes.
- Conduct feasibility studies of pooled procurement mechanisms to move towards more affordable quality vaccines.
- Support national advisory bodies in their decision-making processes with advice and information on the value of the new vaccines, immunization in general, and other health interventions.
- Provide technical assistance on cost-effectiveness analysis, demand forecasting, vaccine procurement and management, regulation and financial sustainability.
- Designate a focal point/entity to coordinate activities with all concerned partners.
- Partners to collaborate closely and fund mutually-agreed tasks.
- Identify and mobilize additional funding.