GAVI: Reducing Prices To Immunise 250 Million Children By 2015

The GAVI Alliance launched a mid-term report this week showing that the public-private partnership is on track to immunise more than 250 million children by 2015 and prevent some four million deaths. GAVI’s CEO said it uses multiple tools to help reduce prices of vaccine and that intellectual property rights do not pose a serious threat to its success.

Seth Berkley, chief executive officer of the Geneva-based GAVI Alliance, said at a 14 October press briefing that the Alliance chose to limit the print version of the report but that the website’s interactive version allows further exploration of the data behind the report. It also allows access to an interactive map of “real life stories from the frontlines of immunisation.”

The report will be presented on 30 October during the GAVI Alliance Mid-Term Review meeting in Stockholm, “which will assess the Alliance’s progress in delivering on the goals set at the 2011 Pledging Conference,” according to the conference webpage.

GAVI’s role is to try to accelerate the introduction of vaccines in the world’s poorest countries, Berkley said. By 2014, all of 73 GAVI-supported countries will have introduced 5-in-1 pentavalent vaccines, according to a GAVI release. Pentavalent vaccines are combination vaccines designed to protect children from five diseases.

In June 2011, Berkley said, the Alliance set an ambitious target to immunise 243 million children between 2011 and 2015, and avert some four million future deaths in the same period. “We are on track on meeting these targets,” he said, and moving to close the gap between wealthy and poor countries.

GAVI has made significant progress towards achieving its goals, he said. One of those goals is to accelerate the diffusion of vaccine. In its 12 first years, GAVI distributed about 1 billion vaccines, he said, but in 2013 alone, it is expected that GAVI will distribute more than 600 million doses, with an extended number of vaccines.

Another goal is to bring countries to co-finance vaccines. This is a big innovation, he said. “We ask that 100 percent of our countries co-finance their vaccines,” he added. Between 85 and 95 percent of GAVI-supported countries are currently co-financing their vaccines, he said. As of August, co-financing countries had raised about 8 percent of GAVI’s total support of these countries, to an amount of US$125 million, he said.

This is important, he explained, as countries are now putting vaccines in their national budget. Ministers of finance are engaged in the process, he said, and “they are working towards building this as their economies grow, having a line item that will allow them to finance these activities.”

Reducing Prices

GAVI has numerous ways to reduce prices for vaccines, said Berkley. One of them is to create long-term demand forecasts. In the past, developing countries and least-developed countries, which have the highest disease burden, had difficulty purchasing vaccines. They did not know what capacity they would have, or whether funding was available, he said.

The pharmaceutical industry, from the business point of view, found it very difficult to make predictions and produce adequate quantities. “We calculate how many doses are needed for these countries,” he said. The exercise is run twice a year and those data are given to all manufacturers, which allows them to plan ahead, build plants for the appropriate size, and scale up appropriately. “This made a huge difference in their ability to reduce prices,” he said.

GAVI is also purchasing for 60 percent of the world’s children, he said, and as such contributed to growing the size of the market, which over time increased efficiency and contributed to bring down prices.

Another tool is to create “healthy competition,” he said, adding, “By creating a marketplace, we brought many more manufacturers.” When GAVI began, there were five manufacturers in a few countries. Now there are over 12 manufacturers across the world, he said, and those are expanding.

Berkley noted that last week, a Chinese manufacturer received pre-qualification from the World Health Organization for a vaccine against Japanese encephalitis. This was the first time a Chinese manufacturer has been pre-qualified for a vaccine, he said. GAVI will begin to purchase that vaccine in the future. Having many different manufacturers creates competition and allows prices to drop, he said.

Finally, he said, another tool is to give long-term purchase guaranties with some manufacturers where GAVI buys for multiple years and sometime pre-pays “if that makes a difference for companies.”

Intellectual property rights are not as much of a problem for vaccines as it might be with drugs, according to Berkley. There have been issues, he said, but relating to research and development (R&D), such as in the case of hepatitis C, where a number of countries were reluctant to share their key discoveries so that many of the smaller companies, which carry out a lot of the R&D, could not develop vaccines. However, the situation found a remedy with companies providing research licences, he said. Problems are more in relation to know-how and are often process-related, he said.

However, some challenges persist, according to Berkley, particularly in a number of “fragile and difficult” countries. There are important inequities within countries, he added, and improvements have to be made around vaccines supply chain.

Looking Ahead, Need for Renewed Funding

The Stockholm conference will assess the Alliance’s progress in delivering on the goals set in 2011, according to GAVI. Some 150 participants are expected to gather, including the GAVI Alliance partners: WHO, UNICEF, the World Bank, and the Bill & Melinda Gates Foundation. Also invited are donors and potential donors, implementing countries, the private sector, civil society, and vaccine manufacturers, the conference website says.

After the mid-term review, GAVI will begin to work on its 2016-2020 strategy, named GAVI4.0, and move to the next replenishment of its funding, Berkley said.

Vaccines are the most cost-effective interventions in terms of health, he said. With only five percent of the world’s children being fully vaccinated with all of the 11 vaccines recommended by WHO, he said GAVI expects to extend coverage to many more children.