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Aurelia Nguyen

Update from GAVI

Vaccine Industry Consultation

(Copenhagen, Denmark, 27 June 2012)


Copenhagen, 27 June 2012

GAVI vaccine support

Currently supported vaccines: pentavalent,

pneumococcal, rotavirus, meningitis A, human

papillomavirus (HPV), rubella, yellow fever and

measles second dose and selected campaigns

Also: meningitis and yellow fever vaccine stockpiles

Prioritised for future support: Japanese encephalitis

(c.2015) and typhoid (c.2017) vaccines

Monitoring development: malaria (c.2016), dengue

(c.2017)

New options: cholera and polio IPV

(year of potential first introduction)



June Board update: Outlook through 2020

(current portfolio)

(current portfolio)

3

Includes the new

vaccine windows

(MR, HPV, JE, typhoid)

Prior to any other

new vaccines (and

measles option)

2011-15: $8.0 bn

2016-20: $7.9 bn Indicative



GAVI Alliance Board update

Rotavirus and pneumococcal supply constraints

Enhancing GAVI‟s investment in measles prevention

Vaccine introduction grant and operational support for

campaigns

Polio

Cholera

Lower Middle Income Countries

Rotavirus forecast v 5.0 unconstrained

3 1 1 8 15

5

9 8

0

10

20

30

2009 2010 2011 2012 2013 2014 2015

* Source demand forecast v5.0

Number of

Countries per

year

Forecast

Introduced

Approved

Sudan

Nicaragua

Honduras

Guyana

Bolivia

Burundi

Djibouti

Zimbabwe

Zambia

Togo

Tanzania

Sierra Leone

Niger

Madagascar

Haiti

Guinea-Bissau

Congo Republic

Cen. Afr. Rep.

Cameroon

Angola

Rota: supply constrained annual introductions

* Source demand forecast v5.0

Number of

Countries per

year

Forecast

Introduced

Approved

Sudan

Nicaragua

Honduras

Guyana

Bolivia

Burundi

Djibouti

Zimbabwe

Zambia

Togo

Tanzania

Sierra Leone

Niger

Madagascar

Haiti

Guinea-Bissau

Congo Republic

Cen. Afr. Rep.

Cameroon

Angola

3 1 1 3

5 5

13 18

0

10

20

30

2009 2010 2011 2012 2013 2014 2015

Pneumo demand v 5.0 unconstrained

introductions

16 14

5

2 1

13 16

19

5 2

0

10

20

30

2009 2010 2011 2012 2013 2014 2015

Number of

Countries per

year

Forecast

Introduced

Approved

Democratic

Republic of

the Congo

Gambia

Mali

Sierra Leone

Burundi

Benin

CAR Ethiopia

Guyana

Honduras

Nicaragua

Rwanda

Yemen

Kenya

Malawi

Cameroon

Pakistan

Madagascar

Ghana

Georgia

Moldova

Armenia Azerbaijan

Sudan

Zimbabwe Mozambique

Angola

Tanzania

Zambia

Niger Senegal

Bolivia

Sao Tome

Djibouti

Kiribati.

Bangladesh

Guinea Bissau

Haiti

Lao PDR

Lesotho

Mauritania

Nigeria

Togo

Papua New

Guinea

Uganda

* Source forecast based on SDF v5.0

Pneumo: supply constrained annual

introductions

Number of

Countries per

year

Forecast

Introduced

Approved

Democratic

Republic of

the Congo

Gambia

Mali

Sierra Leone

Burundi

Benin

CAR Ethiopia

Guyana

Honduras

Nicaragua

Rwanda

Yemen

Kenya

Malawi

Cameroon

Pakistan

Madagascar

Ghana

Georgia

Moldova

Armenia Azerbaijan

Sudan

Zimbabwe Mozambique

Angola

Tanzania

Zambia

Niger Senegal

Bolivia

Sao Tome

Djibouti

Kiribati.

Bangladesh

Guinea Bissau

Haiti

Lao PDR

Lesotho

Mauritania

Nigeria

Togo

Papua New

Guinea

Uganda

* Source forecast based on SDF v5.0

2 1

13 10 5

12 17

0

10

20

30

2009 2010 2011 2012 2013 2014 2015



GAVI‟s commitments strengthen measles

control

$197M since 2004, primarily to the

Measles Initiative for campaigns

Routine second dose of measles

Investments in health systems and

improving immunization coverage

Support for measles-rubella through wide-

age campaigns

Performance-based funding mechanism

includes measles coverage indicator

9



Enhanced support

Six large countries estimated by WHO at high

risk of outbreaks prior to introducing MR

vaccine

10

Country DTP3

(2010)

Measles1

(2010)

Afghanistan 66 62

DR Congo 63 68

Chad 59 46

Ethiopia 86 81

Nigeria 69 71

Pakistan 88 86

Response to outbreaks and emerging needs



Projected Cost Estimates (US$ millions)

11

2012 2013 2014 2015 2016 2017 Total

Outbreak funds - Pass

to MR Initiative

5 10 10 10 10 10 55

Funds for vaccines by

proposals – up to 6

countries ($0.42/dose)

0 21 3 17 1 - 42

Funds for operational

costs – up to 6

countries

($0.65/person)

0 33 4 26 1 - 65

Total potential

commitment by year

5 65 17 53 12 10 162



Vaccine introduction grant and operational

support for campaigns

12

Objective

Facilitate timely, effective implementation of critical activities:

Before new vaccine introductions

For delivery during campaigns

One-time investments, covering a share of the cost

Scope

All new GAVI-supported vaccines

Activities driven by country needs

Does not cover recurrent costs

Operating guidelines

Flexible, timely, simple, separate from other cash support, not

used for co-financing



$0.0

$0.6

$1.2

$1.8

$2.4

$3.0

Infantvaccines

HPVvaccines

Operational supportcampaigns

x

New policy: what has changed?

13

Total cost estimate:

80% 80%

80%

New policy

GAVI support:

x

Current policy

New policy

Current policy

(per child) (per girl) (per target)



New policy: funding levels

14

1. Vaccine introduction grants:

Vaccines delivered to infants: US$ 0.80 per child in birth cohort

(min. US$ 100,000)

HPV vaccines delivered to adolescent girls: US$ 2.40 per girl

in target population (min. US$ 100,000)

2. Operational support for campaigns:

US$ 0.65 per individual in target population

3. Product switches after first introduction:

One third of full grant for transition to new product, provided

criteria are met



Polio

GAVI support to polio efforts - investment case providing

financing for operational costs and stockpiling of vaccines

Intensify support to health systems strengthening in polio-

affected countries

Potential role for GAVI to play to support the new polio “end-

game” strategy

IPV funding in the context of a tOPV to bOPV switch

Update to Board and review following November SAGE

meeting

Major cholera outbreaks & hotspots, 2005-2011

2005 West Africa

> 76 000 cases 2006 /07 Angola

> 86 000 cases

2008/09 Zimbabwe

> 98 000 cases

2006 / 07

Horn of Africa

> 130 000 cases

2005 Afghanistan

> 155 000 cases

annually :

Bangladesh

100 - 300 000

cases

India? Pakistan?

2007 / 08 Iraq

> 4700 cases + AWD

Oct 2010 - Dec 2011 Haiti

500 000 cases

2009/10

Papua New Guinea

> 10 000 cases

Nov 2009 - Dec 2011

Central Africa

> 129 000 cases

annually: DRC

13 000 – 30 000 cases

Areas reporting cholera outbreaks, 2010-2011

Source: Global Task Force on Cholera Control, WHO



Estimated size and cost of a potential cholera

vaccine stockpile

2013 -2014 2015-2016 2017-2020 Total (2012-2020)

Doses in

stockpile 2 m/year 5 m/year 10 m/year 54 million

Cost $5.5

m/year $13.6

m/year $23-27

m/year ~ $138 million



Low- and Lower Middle-Income countries

and GAVI support

36

21

1421

0

20

40

60

GAVIeligible

GAVIgraduating

Not supportedLMICs

Nu

mb

er

of

cou

ntr

ies

Low income and Lower-middle income countries & GAVI support

Lower-middle-income countries (n=56)Low income countries (n=36)





2012-2013: 94 introductions versus 50 in the

business plan - an increase of 88%

14

Pneumo, 37

Rota, 19

Rota, 30

Penta, 4

Penta, 7

Rubella, 2

Rubella, 9

JE, 2

JE, 3

MenA, 8

MenA, 6

0

10

20

30

40

50

60

70

80

90

100

v2 v4

MenA

JE

Rubella

HPV

Penta

Rota

Pneumo

No.

of countr

ies

21

8 roll outs in 2012

Currently predict 2-5 will

introduce in 2013

2014-15 will see intro‟s back

on track

Up to 9 approved countries

delayed for a year

Future bottleneck „readiness‟

Rota: cumulative introductions –

versus business plan

4 5

16

23 28

33

4 5

13

18

31

49

40

0

10

20

30

40

50

60

70

B-Line 2011 2012 2013 2014 2015

Business Plan

Actual and Supply Constraint Adjusted SDF v5.0

Pneumo: cumulative introductions –

versus business plan

22

16 roll outs in 2011

10 roll outs in 2012

Currently predict 5 will

introduce in 2013

2014-15 will see intro‟s back

on track

Delays of a year effecting up

to15 countries

„Readiness‟ is the future

bottleneck 3

19

32 35

36

45

3

16

26

31

43

60

50

0

10

20

30

40

50

60

70

B-Line 2011 2012 2013 2014 2015

Business Plan

SDF v5.0 supply constrained