GAVI Alliance Support for Access to Appropriate Pricing for GAVI Graduates and Other Lower Middle Income Countries Wilson Mok, Melissa Malhame, Santiago Cornejo, Paolo Sison, Robert Newman Technical Briefing Session for the GAVI Alliance Board Geneva, Switzerland, 17 June 2014
Purpose of technical briefing � Provide background and progress update on this work � Review outcome of PPC meeting and explain next steps � Address questions and receive any initial Board input GAVI Alliance Board Technical Briefing 17 June 2014 1
Problem statement and Board request � As countries graduate, critical they can sustain immunisation programmes begun with GAVI Alliance support and be able to introduce new life-saving vaccines � Alliance implementing comprehensive strategy to support countries to achieve successful graduation � Many countries concerned about increasing vaccine prices after graduation; asking for Alliance support to access appropriate, sustainable prices � In November 2013, GAVI Board requested the 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” GAVI Alliance Board Technical Briefing 17 June 2014 2
Context within GAVI Alliance strategy 2016-2020 Mission To save children’s lives and protect people’s health by increasing equitable use of vaccines in lower income countries � Integrated Principles � Country-led � Innovative � Community-owned � Collaborative � Globally engaged � Accountable � Catalytic & sustainable Increase effectiveness and efficiency of Accelerate equitable uptake and immunisation delivery as an integrated coverage of vaccines part of strengthened health systems � Coverage and equity � Integrated comprehensive immunisation systems 1 2 � Introduction and scale-up of new vaccines � Supply chains, health information systems, demand generation and gender sensitive approaches � Flexible response to special needs of fragile countries � Engagement of civil society, private sector and other Goals partners Improve sustainability of national 4 Shape markets for vaccines and other immunisation programmes immunisation products � National and sub-national political commitment � Adequate and secure supply 3 4 � Allocation and management of national human and � Appropriate and sustainable prices financial resources � Incentivise development of suitable and quality � Sustained performance after graduation products A) Country leadership management & coordination Strategic enablers B) Resource mobilisation C) Advocacy GAVI Alliance Board Technical Briefing D) Monitoring & Evaluation 17 June 2014 3
What happens to vaccine pricing after GAVI graduation? Source: GAVI Alliance 2014
Shifting global demographics highlights opportunity associated with supporting LMICs: share of poor people living in GAVI-supported countries decreasing People living with less than 1.25$ a day Ineligble and graduated Global distribution, all countries for which data GAVI graduating available Eligible for full GAVI support 100% 18% 5% No GAVI 54% support GAVI 13% support 77% phasing out Full GAVI 33% support 2012 2020 Sources: UN population division (2020 projections), Projections of future poverty rates based on World Bank latest available poverty rates, crossed with estimated future poverty rate changes for India and China illustrated in Chandy, Ledlie and Penciakova (Brookings Institution), The Final Countdown: Prospects for Ending Extreme Poverty by 2030, Brookings Policy paper 2013-04 (mid-point estimates (2014) applied to the period 2012-2020) GAVI Alliance Board Technical Briefing 17 June 2014 5
Approach � Identify specific challenges faced by countries Work to � Define range of potential options to support countries date – � Assess options and recommend range of options to “Phase 1” carry forward for further analysis � Conduct detailed analyses and consultations to To be identify optimal solution completed – � Define operating model for solution, including roles “Phase 2" and responsibilities of Alliance partners GAVI Alliance Board Technical Briefing 17 June 2014 6
Phase 1 process February March April Country gap analysis Identification and Development of initial assessment of potential recommendations options Individual expert consultations Discussion Technical consultation group at PPC GAVI Alliance Board Technical Briefing 17 June 2014 7
44 heterogeneous countries with a birth cohort of 54 million Currently graduating GAVI countries (n = 15) Non-GAVI LMICs (n = 11) GAVI-eligible entering graduation by 2020 (n = 10) PAHO LMICs (n = 8) GNI per capita (USD) 8,000 Azerbaijan Cuba Angola LMIC upper 4,000 Kosovo threshold Ukraine, IPV El Salvador Indonesia Guatemala Guyana Paraguay Congo, Rep. Morocco Syria Honduras Egypt, Arab Rep. Philippines Bolivia Ghana Uzbekistan 2,000 Vietnam Sudan Sri Lanka GAVI eligibility threshold Nicaragua Cote d’Ivoire Papua New Lao PDR West Bank and Gaza Nigeria Guinea India Zambia 0 0 1,000 2,000 26,000 Birth cohort (thousand people) Source: 2012 UN World Population Prospectus, World Bank 2012 GNI/capita Atlas method (extracted in Feb. Size of birth cohort 2014) GAVI Alliance Board Technical Briefing 17 June 2014 8
The number of countries would vary year-by-year as countries graduate from GAVI support and others meet a pre-defined exit criterion Annual birth cohort (Million) 50 46.1 46.1 46.1 46.1 46.1 45.6 45.6 45 41.7 40.8 40 38.2 36.8 35 30 25 20.5 20.5 20.5 20.5 20.5 20.0 20.0 20 16.1 15.3 15.2 14.2 14.3 15 12.6 11.2 9.5 10 5 0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 # of 28 30 31 34 36 28 28 29 31 30 29 29 29 27 27 countries India GAVI-eligible entering graduation by 2020 PAHO countries Non-GAVI LMICs Currently graduating GAVI countries Note: Exit criteria applied in this analysis is that countries exit when they reach UMIC status, but at the earliest 5 years after graduation for GAVI countries; all birth cohorts are from 2013, no projections GAVI Alliance Board Technical Briefing Source: GAVI projections of graduation and income status; World 17 June 2014 Bank; IMF GDP projections; UN World Population Prospectus 9
Country gap analysis performed along three dimensions: Pricing, Procurement, Payment • Current vaccine prices Methodology • Expected future prices • Link between price and country's ability to maintain vaccination programmes and/or new introductions • Fiscal space to accommodate vaccine • Procurement purchases mechanisms currently in • Access to hard currency use • Ability to make pre- • Procurement capabilities payments • Country's interest in self- • Credit worthiness vs. pooled-procurement • Obstacles to pooled GAVI Alliance Board Technical Briefing 17 June 2014 procurement 10
Country gap analysis performed along three dimensions: Pricing, Procurement, Payment • Without access to appropriate Findings prices, most countries likely to face challenges sustaining immunisation programmes and introducing new vaccines • Large majority of countries require support • Major needs observed • Insufficient information regarding ability to make on vaccines market pre-payments and access • Limited procurement hard currency capabilities • Low bargaining power GAVI Alliance Board Technical Briefing 17 June 2014 11
Countries can be grouped in clusters with common characteristics ~15 countries, ~3% of birth cohort 1 Small countries � Countries with small birth cohort, thus low bargaining power and procurement with long term needs capability; expected to face challenges for a long period ~10 countries, ~20% of birth cohort 1 � Low procurement capabilities or low ability to absorb large price increases Countries with variable needs without an external intervention; may eventually be able to procure self- sufficiently ~3 countries, ~30% of birth cohort 1 � Countries generally relying on their own production; may benefit from near Large countries term support as they transition to efficient local production of required vaccines with own production ~3 countries, ~40% of birth cohort 1 potential � Countries have manufacturing potential but currently lack capabilities; require support as they continue to plan Countries with ~5 countries, ~5% of birth cohort 1 � Countries likely to efficiently procure vaccines without any additional support less need 1. Analysis of 35 countries (current GAVI graduating; GAVI GAVI Alliance Board Technical Briefing eligible but projected to enter graduation by 2020; non- GAVI LMICs), excluding India and PAHO countries; 2013 17 June 2014 birth cohort 12
Recommend
More recommend
