2. TT

3. TT Procured by UNICEF 2001 - 08

4. TT historical demand and forecast overview Upcoming Tender Period

5. Trends in TT vaccine offered to UNICEF Good supplier base but still high dependency on one source One new supplier obtained WHO prequalification in end 2007, enhancing supply availability and vaccine security

6. Summary Elimination by 2012 MNT Investment Case (2007-2009) has given campaigns and routine program a boost. Funds through IFFIM IC for vaccines are fully utilized Active fund raising for SIAs beyond 2009 Routine demand for most part is funded through country financial resources

7. TT Tender quantities 2010-12 Upcoming Tender Period

8. MEASLES

9. Measles procured by UNICEF 2001-2008

10. Historically demand has been mainly driven by campaigns Large catch up campaigns in 2006-07 and some in 2008 2009-2010 Quantities do not include potential demand for India SIA Measles – Procurement Overview & Future demand Upcoming Tender Period

11. Trends in Measles vaccines offered to UNICEF- availability Drastic reduction in the number of suppliers offering WHO pre-qualified vaccine to UNICEF over the past 10 years High dependency on one manufacturer Measles containing vaccines are classified as high priority for WHO PQ

12. Mixed results in terms of affordability Weighted Average Prices for Vaccines BCG –stable demand, 4 suppliers, stable pricing DTP, declining demand, 2 suppliers per presentation, increasing prices TT – growing demand, 4 suppliers, adjusted prices, now stable Measles – growing demand, 3 suppliers, increasing prices

13. Summary… Global Measles mortality reduction by 74% need to Sustain achievement Expect stabilized demand with; Increased routine, including 2 dose as per SAGE recommendation, will add to routine demand. Sustained follow-up campaigns, intervals based on 1 st dose coverage, but average every 3 years * Both posing future funding challenges for countries Measles campaign is often use as the main vehicle for integrated campaigns Continued monovalent measles vaccine supply needed in the future

14. Measles Tender quantities 2010-12 Upcoming Tender Period

15. MMR

16. MMR Historical demand and forecast overview The main increase in 2009-12 demand is for 1 one country, introducing MMR in their routine program as of 2009, therefore demand picture can change substantially Increased quantity only partially due to MR campaigns in 2007 Upcoming Tender Period

17. Summary Very limited availability / long lead-time for unplanned demand Countries are strain aware / sensitive -There is strong strain preference from countries -At times the preference been influenced / diverted based on price and availability Large price differences between different products Limited sustainable external funding available – countries need to include in their own budget The projection / scenario for MR will not impact the MMR demand

18. MMR Tender quantities 2010-12 Upcoming Tender Period

19. MR

20. MR – Procurement Overview - Future Currently 2 WHO pre-qualified suppliers, high dependency on one Substantial portion of the demand in 2009 is for one country campaign Upcoming Tender Period

21. MR Tender quantities 2010-12 Upcoming Tender Period

22. June, 2008: Rubella as part of GAVI investment strategy introduced to GAVI the Board (for endorsement, not financial decision) Rubella: cause of congenital rubella syndrome (CRS) when infected in early pregnancy It is estimated that there are 110,000 cases of CRS each year and poses high disease burden on poorest countries Future of MR vaccine?

23. October, 2008: Rubella part of the portfolio for GAVI to consider for future investments (HPV, JE, Rubella, Typhoid) at the October 08 Board Mindful of the current financial environment, the Board deferred any financial commitment related to the vaccine investment strategy for further review

24. MR VACCINE DEMAND GIVEN INTEGRATED ADOPTION FORECAST Rapid Impact http://www.gavialliance.org/vision/strategy/vaccine_investment/index.php * Source: Applied Strategy – Oct 27, 2008

25. MR INTEGRATED ADOPTION FORECAST * 14 GAVI countries have already adopted rubella; 12 are not expected to be eligible based on projected MCV coverage rates < 80% through 2020 Bangladesh Bhutan Cambodia Haiti India Mongolia Nepal Solomon Is Tajikistan Viet Nam Indonesia Korea, DPR Myanmar Yemen Burundi Eritrea Ghana Pakistan Rwanda São Tomé and Principe Uganda Malawi Zambia Cameroon Congo, DR Côte d'Ivoire Gambia Benin Burkina Faso Kenya Niger Senegal Togo Lesotho Mali Mozambique PNG Tanzania Timor-Leste Zimbabwe Afghanistan Comoros Djibouti Congo, Rep. Guinea Sierra Leone Vaccine Need: 72 VISP Scope: 46* * Source: Applied Strategy – Oct 27, 2008

26. Assumptions: Delay the introduction by 3 years compared to rapid impact plan Total 300 mil ds for 2013 - 2018 Distribute quantities throughout 5-6 years

27. Total tender quantities of Measles containing vaccines 2010 – 12

28. UNICEF VACCINES Thank You