Vaccine Landscape Implications for 202X

May 2, 2011

1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s 2020s

Yellow Fever(1948)

BCG(1926)

IPV(1955)

OPV(1963)

Rabies(1880s) Measles

(1963)DTP(1948)

Rubella(1969)

Mumps(1967)

EPI Introduced(BCG, DTP, Measles, OPV)

(1974)

<5% of infants immunizedglobally each year

Vaccine Characteristics

• Relatively low price for most vaccines (<$1.00/treatment)

• Large multi-dose vial sizes (minimize cost/dose and immunization logistics impact)

• Typically high wastage (25 – 70%)

Vaccine Characteristics

• Relatively low price for most vaccines (<$1.00/treatment)

• Large multi-dose vial sizes (minimize cost/dose and immunization logistics impact)

• Typically high wastage (25 – 70%)

FIR

ST

Vx

LIC

EN

SU

RE

EPI catalyzed the strengthening of

country supply logistics systems

2

Smallpox(1903)

MMR(1971)

Vaccine Landscape (1920 – 1979)

1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s 2020s

Yellow Fever(1948)

BCG(1926)

IPV(1955)

OPV(1963)

Rabies(1880s) Measles

(1963)DTP(1948)

Rubella(1969)

Mumps(1967)

Vaccine Characteristics

• Hib 1st of the higher priced vaccines (>$3.00/dose)

• High wastage comes at a higher cost trend toward smaller multi-dose vials

• Shift to pentavalent combination vaccine

Vaccine Characteristics

• Hib 1st of the higher priced vaccines (>$3.00/dose)

• High wastage comes at a higher cost trend toward smaller multi-dose vials

• Shift to pentavalent combination vaccine

HepB(1981)

Hib(1988)

FIR

ST

Vx

LIC

EN

SU

RE

EPI Introduced(BCG, DTP, Measles, OPV)

(1974)

<5% of infants immunizedglobally each year

DTP-HepB+HibPentavalent

Vaccine(1998)

Smallpox(1903)

MMR(1971)

Vaccine Landscape (1980 – 1999)

3

Health Systems Investments (1980-1999)

Medical Products, Vaccines, and Technologies

HealthInformation

System

HealthService Delivery

Leadership and Governance

HealthFinancing

HealthWorkforce

1975 1980 1985 1990 1995 2000

CCL training modules

Equipment info sheets

WHO PQestablished

VVMs available

Joint statement on AD syringes

TechNet e-Forum

PAHORevolving Fund

established

UNICEF Vaccine Independence Initiative

established

WHO GAGestablished

SAGEestablished

TechNetestablished

Bu

ild

ing

Blo

ck

s o

f a

Hig

hly

Fu

nc

tio

na

l H

ea

lth

Sy

ste

m*

WHO standardized immunization schedules

BMGFestablished

EPIintroduced

GPVestablished

* Everybody’s Business: Strengthening Health System's to Improve Health Outcomes, WHO’s Framework for Action, 2007

4

Source: WHO Global Atlas http://apps.who.int/globalatlas/dataQuery/default.asp

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aver

age

% V

acci

ne C

over

age

Rate

s in

Low

& Lo

wer

Mid

dle

Inco

me

Coun

trie

s

Year

BCG DTP3 MCV Pol3

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

5

Investment = Impact (1980 – 2000)

1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s 2020s

Yellow Fever(1948)

BCG(1926)

HepB(1981)

Hib(1988)

IPV(1955)

OPV(1963)

Rabies(1880s)

Measles(1963)DTP

(1948)Rubella(1969)

Mumps(1967)

Cholera(2009)

MenA(2009)DTP-HepB+Hib

Pentavalent Vaccine(1998)

PCV7(2000)

Cervarix(2007)

PCV 10(2009)

Smallpox(1903)

PCV 13(2009)

MMR(1971)

6

Vaccine Landscape (2000 – 2010)

FIR

ST

Vx

LIC

EN

SU

RE

Vaccine Characteristics

• Multinational suppliers targeting low income markets earlier than in past

• Prices >$3.00 per dose becoming the norm

• Different product profiles for vaccines targeting the same disease

Vaccine Characteristics

• Multinational suppliers targeting low income markets earlier than in past

• Prices >$3.00 per dose becoming the norm

• Different product profiles for vaccines targeting the same disease

JE(2010)

RotaRix(2006)

Gardasil(2006)

RotaTeq(2006)

Medical Products, Vaccines, and Technologies

HealthInformation

System

HealthService Delivery

Leadership and Governance

HealthFinancing

HealthWorkforce

1980 1985 1990 1995 2000 2005 2010

Effective Vx Stores Mgmt

rollout

CCL training modules

WHO PQestablished

VVMs available

WHO PQS devices and equip specs

TechNet e-Forum

cMYP rollout

Effective Vx Mgmt rollout

CCEM rollout

GAVI ISS

GAVI HSS

Project Optimizeinitiated

PAHORevolving Fund

established

UNICEF Vaccine Independence Initiative

established

GAVI Allianceestablished

WHO GAGestablished

SAGEestablished

TechNetestablished

VPPAG established

CCLTask Force established

IPAC established

Bu

ild

ing

Blo

ck

s o

f a

Hig

hly

Fu

nc

tio

na

l H

ea

lth

Sy

ste

m*

WHO standardized immunization schedules

EPIintroduced

GPVestablished

FSP rollout

VMA rollout

UNICEF includesVVMs in tender &

bundles AD syringe for each dose

* Everybody’s Business: Strengthening Health System's to Improve Health Outcomes, WHO’s Framework for Action, 2007

7

Global Health Workforce Alliance

created

7

Health Systems Investments (2000 – 2010)

Equipment info sheets

Joint statement on AD syringes

BMGFestablished

8*2009 and 2010 forecasted data for Pol3 not available

8

Investment = Impact (2000-2010)

1920 – 1939: 1 vaccine1940 – 1959: 3 vaccines1960 – 1979: 4 vaccines1980 – 1999: 3 vaccines2000 – 2019: >13 vaccines 9

1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s 2020s

Yellow Fever(1948)

BCG(1926)

HepB(1981)

Hib(1988)

IPV(1955)

OPV(1963)

Rabies(1880s)

Measles(1963)DTP

(1948)

Rubella(1969)

Mumps(1967)

Rota(2006)

HPV(2006)

JE(2010)

Cholera(2009)

TyphoidConjugate(~2013)

Malaria(~2014-2016)

rBCG(~2014-2018)

MenA(2009)

Dengue(~2015-2016)

ETEC(~2013-2016)

Shigella(~2011-2015)

FIR

ST

Vx

LIC

EN

SU

RE

DTP-HepB+HibPentavalent

Vaccine(1998)

Pneumo(2000)

Smallpox(1903)

MMR(1971)

9

Vaccine Landscape (2000 – 2019)

TyphoidPS

(2011)

Leishmaniasis(~2016-2018)

Characteristic Change Implication

PriceMany have higher costs

(> $10/treatment)Impacts affordability &

vaccination sustainability

PresentationMany have smaller vial sizes

(1-2 dose vials)

Minimizes vaccine wastage, increases cold chain needs

& waste disposal costs

Target Population

Birth Doses, Infants, Adolescents, & Adults

More vaccines delivered outside the EPI system

Vaccination Strategy

Routine + catch-up, mass campaigns,

school-based routine, school-based mass campaigns

Significant immunizationlogistics implications

Product Profile

Not all vaccines the same – differ by dose schedule, serotypes, route of

administration, preservative use

Country preferences becomea greater factor, immunization logistics need to be managed

InterventionPortfolio

More interventions available at the same time than ever before

Country decision-making in face of much greater complexity

(which disease, which product, what timeframe, what trade-offs)

10

New Vaccine Characteristics

11

Currently At Scale

Being Scaled Up

Waiting for Scale Up

Currently Under Development

Licensed or WHO PQ’d prior to 2011 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Hib

Pneumo

Rotavirus

MenA

HPV

Cholera

Typhoid

Typhoidconjugate

JE

Pneumo(common protein)

Rotavirus (116E)

Pneumo(Killed whole cell)

Pneumo(conjugates)

Lowerpriced IPV

HexavalentDTwP-HepB-Hib-IPV

BCG

OPV

MCV

DTP-HepB

YF

Td / TT

Rotavirus(BRV)

Malaria(RTS,S)

Dengue

ETEC

Hookworm

BCG Boost

Shigella

Flu(Lentigen)

Leishmaniasis

11

CURRENT VACCINE LANDSCAPE

rBCG