WHA68: Global Vaccine Plan Lagging; New Proposal To Lower Prices

An assessment of the World Health Organization Global Vaccine Action Plan (GVAP) aimed at delivering vaccination to all and boosting research into new vaccines has found implementation to be “far off-track” in some areas. Today at the World Health Assembly, Libya put forward a new proposal at the Assembly to reduce vaccine prices and increase availability in developing countries.

The annual World Health Assembly is meeting from 18-26 May. The vaccine issue, agenda item 16.4, came up briefly in WHA Committee A today. It was suspended and it is not clear when it will come up again.

Key components of the new proposed draft resolution are to make global pricing data public, encourage competition, take steps to boost manufacturing in developing countries, and develop strategies for middle-income countries.

Libya’s proposed draft resolution was made available today (A68/A/CONF./4 [pdf]).

[Update:] In committee today, several delegations spoke on the GVAP issue. Libya mentioned its proposal, and noted the need to extend the action plan to include growing refugee populations. The Libyan delegate said WHO should increase its efforts to help countries with vaccination, and that governments have said affordability of vaccines is a challenge, especially the newest vaccines.

Governments which do not benefit from donor support bear a particular burden, the delegate said, making pooled procurement, and a healthy, competitive market essential. It is in the interest of all governments to foster the supply of vaccines, he said.

Iceland, on behalf of a range of Scandinavian region countries, noted with concern that one in five children are still not getting vaccinated. “We expect the director general to give high priority to overcome these areas,” it said.

Member states have a responsibility to ensure all relevant information is available and that healthcare workers understand risks. Iceland highlighted the need to counter “myths” around vaccination, and emphasised families. It did not mention cost or affordability issues.

Panama on behalf of the Americas region said vaccination is key and said, “We do urge the international community to bring down the cost of vaccines.” If they are affordable, “then we can really make progress,” he said. Also important are databases to exchange information about prices, and more needs to be done to strengthen alliances in order to bring down the financial burden.

Chile endorsed the regional statement and highlighted steps such as buying vaccines in bulk, and countries should share pricing information. It is extremely important, it said, that WHO step up the ability to counter information that may be intended to promote products trying to gain markets but which undermines vaccine campaigns.

Australia welcomed the draft resolution, saying it shares the concern about vaccine expense for countries graduating from donor support. But, it said, it would not be able to support the call to share pricing information publicly, “due to contractual constraints with our national suppliers.” [end update]

Global Vaccine Action Plan

The Global Vaccine Action Plan (GVAP) was endorsed by the 65^th World Health Assembly in May 2012.

The GVAP has two goals “to make 2011-2020 the Decade of Vaccines,” as declared by computer company executive Bill Gates of the Bill and Melinda Gates Foundation, which has donated significant funds to the WHO.

The first of the two goals, according to a “Summary of the 2014 Assessment Report” of the GVAP by the Strategic Advisory Group of Experts on Immunization, is: to “deliver vaccination to all – and through this: to end inequity in vaccination, eradicate polio globally, eliminate maternal and neonatal tetanus globally, and eliminate (guided by regional targets) measles and rubella.”

The second goal is to “unleash vaccines’ vast future potential – because their impressive history is nothing in comparison to what they could achieve.”

The assessment report summary states that there “has been success” in introducing new vaccines, and positive achievements in numerous countries, but that “progress is far off-track.” Five of the six goals set by the GVAP to be met by end of 2014 or 2015 “still require substantial progress.”

“Indeed,” the summary added, “most have seen very little progress. Some have been missed multiple times before.”

Three years after its start date, implementation of the GVAP “is patchy and slow,” said the summary.

A set of recommendations is set out in the document. Among these are a variety of actions by partners, efforts at country level to improve data quality and use, and “urgently examine” the affordability and supply of vaccines.

The summary calls on countries to “change the rules of the game on vaccine affordability, to create transparency which is in their interest. They can do this by making pricing information publicly available, and by collaborating with WHO and all technical agencies to develop solutions.”

Proposed Draft Resolution

The Libyan proposed draft resolution sets out steps to address some of these recommendations raised by the expert group.

Member States

Specifically, it would call on member states:

(1) to allocate adequate financial and human resources for introduction of life-saving vaccines into national immunization schedules and sustaining strong immunization programmes in accordance with national priorities;

(2) to strengthen efforts for pooling vaccine volumes in regional and interregional or other groupings as appropriate that will increase affordability by leveraging economies of scale;

(3) to consider providing timely vaccine price data to WHO for publication, with the goal of increasing affordability through improved price transparency, particularly for the new vaccines;

(4) to seek opportunities for establishing national and regional vaccine manufacturing capacity, in accordance with national priorities, that can produce to the standards required for WHO-prequalification;

(5) to create norms and mechanisms to increase available information on government funding to vaccine development and ensure that government investments in vaccine development be put towards improving the public’s health through affordable vaccine prices;

(6) to support the ongoing efforts of various partners coordinated by WHO to design and implement the strategies to address the vaccines and immunization gaps faced by the middle-income countries.

Secretariat

And for the WHO secretariat, it requests the director general:

(7) to secure funding to fully implement collaborative efforts with international partners, donors, and vaccine manufacturers to support low-and middle-income countries in accessing affordable vaccines of assured-quality in adequate supply;

(8) to continue developing and adequately managing publically available vaccine price databases, like the WHO Vaccine Product, Price and Procurement project, working with Member States to increase availability of price information;

(9) to monitor vaccine prices through annual reporting of the Global Vaccine Action Plan;

(10) to provide technical support and facilitate financial resources for establishing pooled procurement mechanisms where appropriate for use by Member States;

(11) to strengthen the WHO prequalification programme and provide technical assistance to support capacity building for research and development, technology transfer, and other relevant strategies, to enable the entrance of vaccine manufacturers in developing countries that can produce to the standards required for WHO-prequalification;

(12) to report upon technical and legal barriers, including regulatory and intellectual property barriers, that may undermine robust competition that can enable price reductions for new vaccines;

(13) to call on Member States to finance a coordinated strategy to provide relevant technical support needed by low and middle-income Member States.

Libya: Inequities Due to Cost

Libya’s draft resolution says there is concern that “inequities between Member States are growing due to the increased financial burden of new vaccines and based upon those that are eligible or ineligible for financial and technical support from global partners; and that mechanisms which lower the price of vaccines are not accessible to developing and middle-income Member States.”

It also cited concern that “many developing countries are not able to access life-saving new vaccines particularly because of the costs related to procurement and introduction of these vaccines; and concerned of the increase of costs of overall immunization programmes because of the increase in price of the WHO recommended vaccines.”

It further said that publicly available data on vaccine prices is “scarce” and that it is important for “facilitating Member States’ efforts towards introduction of new vaccines.” And it mentions the importance of competition for reducing prices and expanding the number of manufacturers, particularly in developing countries.

Médecins Sans Frontières

Public health advocates Médecins Sans Frontières (MSF, Doctors without Borders) is encouraging member states to support the Libyan proposal. It says action is needed for more affordable vaccines for all countries, including by manufacturers and governments making the prices they negotiate public. Also, MSF said in a document, governments should combine their vaccine orders (pooled procurement) with other countries, monitoring of vaccine prices should be reinforced, and the entry of new manufacturers needs to be accelerated.