Traditional EPI: BCG, DTP, DT/Td, HepB, TT, Measles, MMR, MR, tender overview Pre-tender meeting UNICEF Supply Division, 11 December 2008 Katinka Rosenbom, Yalda Momeni

Assessment of traditional EPI vaccine procurement Principles & Objectives Objective 1. Continued, sustainable supply 2. Quality vaccines (WHO pre- qualification) 3. Multiple manufacturers per vaccine 4. Affordable prices Assessment ( ) 1. No major interruptions / sufficient to meet demand (with adjustments for some campaigns) 2. No major vaccine-caused AEFI 3. Achieved overall, except measles 4. Mixed, related to (3)

BCG – Procurement Overview – Historical Relatively stable demand, fluctuations occurring due to countries exiting or entering UNICEF Procurement 2008 reduced quantities due to Pakistan self procurement

Upcoming Tender Period Forecast remain stable during the next tender period Quantities based on demand from multiple countries BCG – Procurement Overview – Forecast

Summary of BCG tender quantities

DTP

Managing DTP based product transitions Demand The successful introduction of combination vaccines, needs careful transition management, and is impacting our forecast accuracy The tender aims at transparency on uncertainty by identifying known uncertain quantities due to product change (switchers) Funding When funding availability is a major determinant we share scenarios outlining the different demand profiles

Increasing quantities for all DTP-containing vaccines since 2001 Trend in shift to DTP-combination vaccines, primarily DTP-HepB/Hib, expected to continue in the next tender period

Steady decrease as countries shift to combination vaccines DTP – Procurement Overview – Historical

Upcoming Tender Period Steady decrease in demand as countries shift to combination vaccines DTP – Procurement Overview – Forecast

Upcoming Tender Period Additional countries likely to introduce combination vaccines during the tender period Potential switchers, notably Nigeria, Myanmar (GAVI) and Philippines (non-GAVI) DTP – Procurement Overview – Forecast, including potential switchers

Summary of DTP tender quantities

Summary of DT and Td tender quantities DT demand consists of small quantities from a number of countries. 75% of the Td demand is from one country only (Haiti).

HepB vaccines

On an aggregate level, there has been a steady increase in all HepB containing vaccines since 2001 GAVI support began in 2001 as well as introduction in non-GAVI supported countries Shifts between products, with trend towards combination vaccines HepB no longer supported by GAVI as a monovalent vaccine, no new countries to introduce

Remaining quantities dependant on a few large countries Demand decreasing as countries introduce combination vaccines HepB – Procurement Overview – Historical

Upcoming Tender Period HepB – Procurement Overview – Forecast Remaining quantities dependant on a few large countries Demand decreasing as countries introduce combination vaccines

Upcoming Tender Period Further decrease in demand expected as additional countries introduce combination vaccines, potential switchers (Nigeria & Philippines) Demand continues for HepB1 as countries introduce a birth dose (~2 m doses per year). HepB – Procurement Overview – Forecast, including potential switchers

Historically, majority of HepB demand has been supported by GAVI, but moving forward demand will be funded by different sources.

Summary of HepB tender quantities