1. Pre Tender Meeting UNICEF Supply Division Copenhagen 10-11th December 2008 Siri Bjornstad Yellow Fever Vaccine Tender 2010- 2012

2. Assessment of effectiveness of vaccine procurement Principles & Objectives Objective 1. Continued, sustainable supply 2. Quality vaccines (WHO pre- qualification) 3. Multiple manufacturers per vaccine 4. Affordable prices Assessment (2001-2007) 1. Progress, but reliability still needs improvement & insufficient global availability 2. No major recall or vaccine- caused AEFI 3. Three manufacturers 4. Change of presentations influenced price increases. Expectation is that prices will stabilize

3. Yellow Fever supply market Maturing, yet fragile market 3 manufacturers currently supplying WHO pre-qualified products 5, 10, 20 and 50 dose presentations WHO pre-qualified products More manufacturers seeking WHO pre-qualification Since mid 2007 demand has exceeded supply, and supply issues have decreased and delayed availability In 2008 high number and size of YF outbreaks contributed to strained supply situation

4. Yellow Fever demand profile Routine: Yellow fever belt in Africa Country driven demand, GAVI approvals per country 5 and 10 dose presentation preferred Stable demand with slight annual increase Campaigns (preventive and emergency outbreak): Preventive campaigns in 12 West African countries + annual emergency stockpile (global) Demand supported by GAVI financed Investment Case; Programme (ICG) approves request for vaccine 10 and 20 dose presentation preferred, 50 dose presentation acceptable to certain extent Preventive campaign demand higher than anticipated, increasing Emergency outbreak response – urgency and need for stand-by capacity, unpredictable demand Demand for routine and campaigns have historically been tendered separately and have been contracted under separate LTAs due to different demand drivers:

5. YF routine: delivered and forecasted Increase with GAVI support from 2003 Nigeria make up 45% of demand (forecast 2009) 3 largest countries (Nigeria, DRC, and Ghana) make up 70% of demand (forecast 2009) Routine vaccine is 60% GAVI financed. Remaining 40% is government co-financing or government funded GAVI funding approved through 2010-12 tender period, but co- financing introduces some uncertainty Forecast trend shows stable demand 2007-2009 LTAs in place=> slight adjustment in quantity and presentation. 2010-2012 demand to be included in upcoming Yellow Fever Tender

6. YF routine: Historic forecast accuracy Change in 1 country demand decreased qty in 2005 and 2006 (Nigeria and GAVI approval) Supply shortage decreased quantity procured in 2007 and 2008 2009-2012 forecast figures based on UNICEF 2009 Country Forecasts and GAVI approvals

7. Evolution of funding for Emergency response and Preventive campaigns 2003 - 2006: Annual emergency stockpiles Annual GAVI financed stockpiles of 6 mio ds for outbreak response from 2003 Quantity not used for outbreaks was delivered for preventive campaigns the following year Firm, 1 year contracts 2007 - 2009: Emergency Stockpile and Preventive Campaigns 6 mio dose stockpile continued Preventive campaigns for W. Africa countries begin GAVI funded under YF Investment Case 2010- 2012: Emergency Stockpile and Preventive Campaigns Extension of GAVI YF Investment Case not approved in full in October Board. Additional 2009 + 2010 approved and decision for 2011-2012 deferred. Preventive+stockpile quantities for 2010-2012 to be tendered for in upcoming tender (January 2009)

8. YF Stockpile and YF IC deliveries 2007: 2.1 mio ds outbreak response 14.2 mio ds preventive 2008: 9.5 mio ds outbreak response 10 mio ds preventive (assuming no further outbreaks in 2008) Emergency stockpile to be available per 1 January each year Carry over unused emergency stockpile quantities from one year to preventive campaigns the following year

9. Emergency Stockpile and Preventive Campaigns 2009-2010 demand scenario, based on current approved funding Additional 2009 qty’s due to funding approval following GAVI Board meeting in Oct-08 to be requested under RFP 500277=> 8-9 million doses, 10 and 20 dose preferred, 50 dose acceptable GAVI has approved funding for preventive campaigns and emergency stockpiles for 2009 and 2010

10. Emergency Stockpile and Preventive Campaigns 2009-2010 demand scenario, based on current approved funding 2010 qty’s for both routine, emergency stockpile and preventive campaigns will be included in upcoming tender GAVI has approved funding for preventive campaigns and emergency stockpiles for 2009 and 2010 Upcoming Tender Period

11. Emergency Stockpiles and Preventive Campaigns 2011-2012 demand scenario, as per programmatic plans in the GAVI Investment Case Funding for 2011 and 2012 emergency and preventive campaign quantities are not yet approved by GAVI 2010-2012 emergency stockpile + preventive campaign qty’s will be included in requested quantities in upcoming tender For 2011 and 2012 qty’s, timing of award and final award qty’s will depend on funding status Upcoming Tender Period

12. Table of tender quantities 2010-2012 Vaccine demand quantities for both Routine, Emergency, and Preventive will be included in the 2010-2012 Yellow Fever Vaccine Tender One set of resulting LTAs will be established with manufacturers

13. UNICEF VACCINES Thank You!

14. Total tender quantities 2010-2012