6th Global Meeting on Implementing New and Under-utilized Vaccines, 15-17 May 2012
Workgroup 7 - Middle Income Countries (MIC)
The challenges and issues facing graduating and middle income countries (MIC) to achieve sustainable new vaccine introduction have been a feature of the NUVI work plan since its inception in 2008. Since that time the eligibility criteria for GAVI have been changed and a new group of 16 countries has been allocated to the GAVI Graduating Country group. These countries will progressively increase their co-financing of GAVI subsidized vaccines by 20% per annum until they are completely self-financing.
WHO hosted a meeting in March 2012 of a number of partners and stakeholders to consider the needs and activities in MIC. The outcome of the meeting was an agreement that WHO should facilitate the development of a discussion paper identifying the needs of the countries; consolidating evidence available from existing initiatives and describing a plan of action to strengthen the capacity of the MIC to make evidence based decisions on immunizations and to help MIC maintain and increase investment on immunizations.
Main topics of discussion
Presentations during the session helped to stimulate discussions. These included identifying some of the specificities of the 56 LMIC. Three countries (Moldova, Philippines and Morocco) discussed the challenges they face in new vaccine implementation and financial sustainability; and two partners UNICEF Supply Division and GAVI presented the strategies and activities being considered and conducted in GAVI graduating and Middle Income countries.
Middle income countries face uncertainty with regards to current and future pricing of new vaccines, as prices provided by manufacturers are not solely determined by the gross national income per capita (GNI) of the purchaser. However the price of the vaccines is not the only obstacle to sustainable implementation in MIC. MIC face many challenges some of which include; disease surveillance, gaining the necessary disease and cost data and information for appropriate decision making, political advocacy and budget prioritization, financial sustainability at a time when many donors in health are scaling back assistance, human resource capacity to deal with complexities of regulation, procurement, supply, and vaccine management.
The group discussed the opportunity created by the development of a companion paper for the Global Vaccine Action Plan to support the strategies of the Decade of Vaccines as they relate to MIC policy and strategy for coordination of activities.
The Middle Income Countries are not a homogenous group that can be characterized solely by their GNI level. They face varying challenges in relation to poverty, equity, infrastructures , governance, infant mortality and disease burden.
Currently available mechanisms and tools utilized in GAVI eligible countries could be used and adapted to meet the individual specific needs of GAVI graduating and MIC. On the other hand, some identified challenges are specific to MIC and new ideas and interventions need to be considered to address these.
Immunization partners are now considering issues in MIC and a number of the partner activities and projects, particularly those funded by the Bill and Melinda Gates Foundation have been extended to include a few of the GAVI graduating and MIC including projects such as SIVAC, SIF, ProVac, and OPTIMIZE .
UNICEF Supply Division is considering innovative strategies taking into account new context and differences of this group compared with its “usual clients”. UNICEF SD will be consulting with countries, industry and partners on these ideas and strategies to make available new options for supply in 2013.
Given that GAVI eligibility criteria will not change for now the immunization community will needto move forward to address the MIC issues in a different manner. Reviews conducted by GAVI and partners of the situation in GAVI graduating countries highlightthe fact that these countries face more than just the financial impacts of graduation. Targeted technical assistance to address these issues while working with each individual country will be required to ensure sustainability post graduation in 2015.
WHO is assessing country needs with partners through specific country assessments and action plan implementation. The Vaccine Product Price and Procurement (V3P project) identifies country needs in relation to the provision of objective and accurate data and information to assist countries in making appropriate decisions on sustainable new vaccine implementation.
With this increased focus and activities in some MIC there is a need for a clear policy and strategy to coordinate activities in an effective and efficient manner. There is an opportunity to operationalize this and move forward under the GVAP companion paper development process.
- A draft outline of the content and structure of the proposed paper was provided to the meeting and will be distributed more widely among partners for inputs and discussion.
- A virtual working group of interested partners will be formed to maintain a regular dialogue and to provide direct inputs to the paper content and to inform policy direction. WHO will co-ordinate the development of this paper and move forward with ensuring the paper and its policies are considered in the appropriate fora.
- A road map will be developed considering:
- the expansion and adaptation of available tools to meet the individual specific needs of GAVI graduating and MIC
- the revision and adjustment of certain mechanisms to better respond to GAVI graduating and MIC contexts
- the design and development of innovative mechanisms in line with the challenges faced GAVI graduating and MIC.