1. K. Luthra1, A. Zimmermann Jin2,3, P. Vasudevan1, L. Privor-Dumm1
PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION AND UPTAKE TIMELINES FOR GAVI-SUPPORTED COUNTRIES
K. Luthra1, A. Zimmermann Jin2,3, P. Vasudevan1, L. Privor-Dumm1
1International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2Skoll Foundation, Palo Alto, CA, USA, 3Strategic Decisions Group, San Mateo, CA, USA
ISPPD-0361
BACKGROUND & AIMS
FIGURE 3A: Uptake from 1st Licensure
The introduction of pneumococcal conjugate vaccines (PCV) into low and middle-income countries has been described as a success in accelerating vaccine access. Analyzing introduction timelines provides an objective review of the performance of countries and international organizations. It also helps identify ways to accelerate access and pinpoint bottlenecks or potential barriers to PCV or other new vaccine introductions and uptake. In addition, comparing the timelines of different PCV products allows for analysis of how the product profile may impact timelines.
METHODS
We measured timelines from 1996 through 2017 for vaccine introduction milestones from first licensure through country uptake for PCV and five other vaccine preventable diseases (VPDs) across 45 vaccine products, three delivery platforms, and 73 Gavi-supported countries. VPD milestones included first product licensure, first WHO prequalification (PQ), first SAGE recommendation, Gavi Board Approval for support, UNICEF tender issued, and first Gavi-supported introduction. Vaccine product milestones include WHO PQ dossier submission and approval. Country-level milestones included Gavi application submitted, Gavi application approved, Gavi-supported introduction in country, and 50% and 100% target coverage rate achieved. We calculated the median times between milestones within each VPD, and across VPDs, vaccine products, and countries. Results are presented for all licensed PCV vaccines (PCV7, PCV10, PCV13) and next generation vaccines only (PCV10, PCV13).
FIGURE 3B: Uptake from 1st WHO PQ
FIGURE 1: 1st Licensure to 1st Gavi-Supported Intro.
FIGURE 3C: Uptake from 1st Gavi-Supported Intro.
FIGURE 2: Vaccine Licensure to WHO PQ Approval*
product licensure. 96.5% of PCV introductions (n=57) were delayed, which was more often than all other VPDs except one (Meningitis A (RI), 100%, n=7). Median introduction delay for PCV was 1.3 years (n=58) compared to a median time of 0.5 years across all VPDs and countries (n= 285). Uptake of PCV from time of first licensure lags behind other routine immunization (RI) vaccines when considering all PCV products, but is fastest when considering only PCV10/PCV13 (Figure 3a). From time of first WHO PQ product, PCVs have outpaced other RI vaccines, reaching 50% of the Gavi-cohort of surviving infants in 7.2 years (11.1 years across all VPDs, n=3) (Figure 3b). Only IPVs had faster uptake to 50% target coverage (2.1 years) than PCVs (6.1 years) when considering time from first Gavi-supported introduction (Figure 3c).
*WHO PQ data is through 2015
RESULTS
CONCLUSION
PCV had been introduced in 58 of 73 Gavi-supported countries analyzed. Time from first product licensure to first Gavi-supported country introduction was slower for PCV (including PCV 7, 10.8 years) than the median time across all VPDs (5.4 years, n=6), but faster if considering only PCV10/PCV13 (2.0 years) (Figure 1). This time decreased to 9.2 years to first introduction of PCV (including PCV7) if including non-Gavi supported introductions. Median time from vaccine licensure to WHO PQ approval was faster for PCV than all vaccines but one, and the range decreased considerably when considering only PCV10/PCV13 (Figure 2). Median time from vaccine licensure to WHO PQ dossier submission was faster for PCV than other VPDs when considering only PCV10/PCV13 (-0.9 years, n=3); however, median time to submission of WHO PQ dossier for PCV7 (7.7 years, n=2) was slower than other vaccines, except for older IPV products. Time from first licensure to first country introduction was accelerated across all VPDs when first SAGE recommendation and/or Gavi Board approval occurred prior to first
PCV introductions are accelerated compared to other VPDs if considering only PCV10/ PCV13 timelines. This analysis highlights that the right target product profile and early achievement of major introduction milestones prior to licensure can fast-track new vaccine introductions and uptake.
ACKNOWLEDGEMENTS
This work was funded by the Bill & Melinda Gates Foundation. We also thank Carol Marzetta (SDG), Helen Matzger (Bill & Melinda Gates Foundation), Karen Kirk (JHSPH), Kate O’Brien (IVAC), Gavi, The Vaccine Alliance (Country Programmes), UNICEF Supply Division, and the WHO (PQ and IVB teams) for their input and providing data.
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