Vaccines At WHA: Immunization Concerns, High Prices For Middle-Income Countries

Immunization coverage in many developing countries remains low and even shows a decrease in some cases, according to the report of a World Health Organization advisory group of experts, to be noted by this week’s World Health Assembly. A number of developing countries yesterday underlined the high cost of new vaccines and asked that the WHO help them campaign for lower prices.

Developing countries in a committee of the World Health Assembly raised issues preventing them from reaching adequate immunization coverage and meeting the goals of the Global Vaccine Action Plan (GVAP), which was endorsed in May 2012. The 67^th World Health Assembly is taking place from 19-24 May.

The document [pdf] presented to the WHA is a summary of the 2013 assessment report [pdf] of the Strategic Advisory Group of Experts on Immunization (SAGE), which was tasked with overseeing the review and the reporting of progress of the GVAP.

The report underlines several issues to be addressed, in particular data quality improvement. According to the report, “in many countries, the quality of currently available data are inadequate to inform the proper management of the immunization programmes.”

Recommendations to improve data quality made by the Advisory Group include that countries conduct regular, timely reviews of data, at all administrative levels; that countries establish systems to monitor subnational data, at the district level, and report subnational coverage estimates to the World Health Organization by 2015.

The report also draws a dim portrait of immunization coverage in developing countries. Many countries, in particular in the African, South-East Asia and Eastern Mediterranean regions, according to the report, “will not meet routine immunization coverage targets by 2015.

“Even more worrying is that immunization coverage has remained low, stagnant or even decreasing in several of these countries,” states the report, which calls for countries to intensify efforts to improve programme performance.

Hurdles for New Vaccines

Some countries underlined hurdles they are experiencing in the delivery of vaccines. Colombia mentioned the difficult access to remote areas, the necessity to have a cold chain, and beyond those barriers, the high prices of new vaccines which make them difficult to acquire for a developing country. A number of countries also stressed the shortage of the vaccine supply.

The high cost of new vaccines was in particular mentioned for the vaccine against human papillomavirus, which can lead to cervical cancer. Ecuador said it was concerned about “emerging trends seeking to limit access to vaccines through segmented prices.” He quoted WHO Director General Margaret Chan saying in her opening speech that, “We learned that markets cannot sell something to people who cannot pay.”

The issue of access to vaccines for middle-income countries, or countries not any longer eligible for the support of the GAVI Alliance, was also mentioned a number of times by countries such as Jamaica, Lebanon, Algeria, Barbados on behalf of the Caribbean Community (CARICOM), and Egypt.

Egypt asked that the WHO support a request to GAVI in reconsidering and reviewing its mechanism to support middle-income countries. South-Africa, Algeria and Iran asked that the WHO helps them strengthen the capacity of countries to produce their own vaccines. Mexico urged that technology transfer be provided so countries to promote the local production of vaccines and to guarantee sufficient supplies.

The African region underlined the need to establish a bottom-up approach and to address the inadequate resources of many countries for routine immunization. They called for all stakeholders to renew their commitment and invest more in immunization programmes.

UNASUR Revolving Fund; US Global Data Collection

The Union of South American Nations (UNASUR) cited the Revolving Fund of the Pan American Health Organization as a management model for the supply of vaccines. The Revolving Fund is a cooperation mechanism for the joint procurement of vaccines, syringes, and related supplies for the participating member states (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Surinam, Uruguay, and Venezuela).

According to Suriname, speaking on behalf of UNASUR, the Revolving Fund has been providing for over 30 years a continuous and timely supply of high quality vaccines at affordable prices. The introduction of new vaccines should be introduced on the basis of local scientific evidence, considering the benefits and and cost-effectiveness of this intervention, the delegate said.

A number of developing countries underlined the growing issue of vaccination resistance promoted by anti-vaccination groups. The issue of countries experiencing armed conflict was also mentioned by several delegates.

The need for innovative new vaccines was also mentioned by countries, as well as the need for WHO assistance in logistics and health system strengthening.

The United States said data collection is critical to monitor and evaluate progress, and proposed a global task force to monitor progress of key indicators across member countries. They encouraged the secretariat to be more ambitious on the target to develop new improved and underutilised vaccines and technologies by 2020. The US also encouraged enhanced attention to issues on costing, effective delivery and affordability of the entire vaccine package.

MSF Seeks Lower Prices; GAVI Pondering

According to Médecins Sans Frontières (MSF), the only data publicly available on a systematic basis are the prices paid by the Revolving Fund and UNICEF for GAVI-supported vaccines. “It is otherwise unclear what most countries pay for their vaccines,” they said.

When the GVAP was adopted, concerns were raised about vaccine affordability and the “extremely high prices paid by many middle-income countries,” the MSF representative said. “According to the lowestpublicly-published prices – which aren’t available to most countries in this room – the cost of fully vaccinating a child has increased by 2,700 percent over the last decade,” the representative said, adding that a large portion of the US$51 billion Decade of Vaccine is allocated to the cost of vaccines and thus prices should be monitored, in particular for countries that will lose GAVI support, and considering that middle-income countries are increasingly experiencing financial difficulty to meet the high costs of vaccines.

GAVI said 2013 was marked by an unprecedented acceleration in country demand for vaccines. The representative remarked on the number of countries concerned about GAVI eligible countries moving toward graduating out of GAVI support, and whether they will be able to continue to purchase vaccines at affordable prices to sustain their immunization programme.

A recent meeting of the GAVI Programme and Policy Committee addressed the question on how to help graduating countries, she said. A Decision of the November GAVI Board meeting requests the GAVI secretariat “to conduct analyses and consultations to develop and propose instruments to support access to affordable prices for all Lower Middle Income Countries (LMICs), including graduated countries and non-GAVI LMICs. Options would be brought to the Board for consideration in 2014.”

The WHO secretariat said the first report of a new pricing working group had been posted on the webpage of the Strategic Advisory Group of Experts on Immunization (SAGE). The secretariat is also setting a new vaccine, products, prices and procurement project which will provide publicly available, reliable, accurate and neutral information on vaccine prices and products, WHO said. The first results of this initiative should be available during the second half of 2014, the WHO official said. The working group report could not be found on the WHO website, and WHO did not answer inquiries by press time.

On the particular issue of middle-income countries, the WHO secretariat said that it is taking a five-pronged approach to deal with this issue with partner agencies. Additional and new analytical work will be carried out, the official said, to better understand the needs and challenges of such countries, in particular through market intelligence. New work on procurement mechanisms also will be undertaken, he said.