4th Global Meeting on Implementing New and Under-utilized Vaccines, 23-25 June 2010
Workgroup 2. New vaccine introduction in lower middle income countries
Background
Some of the Lower Middle Income Countries (LMICs) that are just above the GAVI threshold have been slower to adopt new vaccines than GAVI-supported countries. In addition, some countries will graduate from GAVI support in the coming years and move into the LMIC category. The Bill and Melinda Gates Foundation (BMGF) and WHO oversee a study implemented by Results for Development Institute in Washington, DC, which seeks to identify practical solutions at the global, regional, and country level to hasten new vaccine introduction by LMICs. This study began in October 2009 and benefits from advice from a multi-disciplinary Advisory Group that includes technical personnel, representatives of multilateral organizations concerned with new vaccine adoption and the vaccine industry. The study focuses on the Hib, pneumo, rota, and HPV vaccines and involves quantitative analysis, key informant interviews, visits to selected countries, and remote data collection from an additional seven countries.
This workshop reviewed preliminary findings and recommendations from the LMIC new vaccine adoption study, heard two country viewpoints (Armenia and Egypt) on new vaccine adoption, discussed the recent GAVI Board decision on AMC, and learned about the status of pooled vaccine procurement in EMR.
Main Topics of Discussion
The LMIC new vaccine adoption study is midway in data collection and anticipates collecting data from 15 countries, 9 of which have been visited. Interviews have been conducted with global vaccine experts and IFPMA and DCVMN firms. Analysis will include 1) regression analysis of quantifiable factors, 2) formulation and prioritization of practical recommendations for intervention at global, regional, and country level, and 3) modeling impact of interventions on vaccine adoption and effects on markets. The preliminary recommendations from those consulted are that LMICs would like
- Assistance with epidemiological and financial data collection and analysis
- To promote regional exchanges and collaboration on data and procurement
- Financial assistance to poorer of LMICs
- Access to GAVI-like prices
- Assistance with procurement, including access to UNICEF SD
- Creation of a source for vaccine market information
- To separate promotion of local vaccine production from the decision to introduce a new vaccine
- To integrate new vaccine decisions with insurance coverage development
Discussion on GAVI Board decision on AMC noted that some GAVI graduating countries have higher incomes than some LMICs, so AMC price to graduating countries only is inequitable.
The presentation on the status of pooled vaccine procurement in EMR reported that the region has had meetings and consultations involving CDC, UNICEF SD, PAHO, and countries, and various models are being considered for implementing the pooled vaccine procurement initiative. The initiative will focus on new vaccines and LMICs.
Recommendations
- Financing new vaccines is the critical issue
- Need donors to briefly pay for introduction in order to catalyze domestic budget allocation
- NonGAVI LMICs need access to GAVI-like prices
- Tier pricing of vaccines by manufacturers - What tier for LMICs?
- Role of partners (WHO, UNICEF, bilaterals)
- Currently not playing much role in immunization, but LMICs would value technical support for decision-making and procurement
- Unique situation: huge sector of the world not currently being addressed (not poorest of the poor), but could have huge impact at relatively low cost, so need to address LMICs issues. In addition, meeting LMIC needs would address public health and equity issues and provide the opportunity to enlarge the vaccine market.