Vaccine Investment Strategy Aurélia Nguyen, Judith Kallenberg GAVI Alliance Board meeting Geneva, Switzerland, 11-12 June 2013
Strategy process Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Analysis In-depth analysis of shortlisted vaccines Analysis of WHO landscape and development of recommendations vaccines for initial prioritisation Governance 27-28 Mar: 30 Apr: 11-12 June: 19-20 Aug: External PPC review 8-9 Oct: 21 Nov: Board External Expert Review prioritisation PPC review Board to decision Expert Review vaccine approach VIS finalise shortlist review VIS analyses and shortlist Consultations Phase I stakeholder consultations Phase II stakeholder consultations Technical Consultation Group Technical Consultation Group Phase II Phase I GAVI Alliance Board meeting 1 11-12 June 2013 1
Scope of vaccines for consideration Landscape: WHO analysis: VIS phase I: VIS phase II: 60+ vaccines VIS candidates (15) shortlist (6) (?) Inclusion criterion: anticipated licensure by 2019 Out of scope: vaccines primarily indicated for emergency response or biosecurity purposes 15 vaccine candidates for VIS review: ‘Pipeline’ Potential expansion of Existing vaccines not GAVI vaccine support supported by GAVI vaccines DTP (booster) Cholera Malaria Hepatitis B (birth dose) Hepatitis A Dengue Measles (additional campaigns) Hepatitis E Enterovirus 71 Meningococcal (additional serotypes) Influenza Yellow Fever (additional campaigns) Mumps Poliomyelitis Rabies GAVI Alliance Board meeting 11-12 June 2013 2
Methodology for vaccine evaluation 1. Identify vaccination scenarios CONFIDENTIAL DRAFT Malaria: modelled vaccination scenarios Doses Routine target Catch-up target Legend population population 2. Develop demand forecast Base case Alternative scenario CONFIDENTIAL DRAFT Excluded because 6 weeks old 5 to <18M less attractive / not Vaccine demand for yellow fever campaigns in feasible high risk countries estimated to total ~67M doses 3 dose course in 1 month intervals 5 to < 18M N/A Demand (M doses) 20 15 PPC_Malaria 10 10 17 16 12 5 7 7 6 2 0 0 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 GAVI financed PPC_Yellow Fever GAVI Alliance Board meeting 11-12 June 2013 3
Methodology for vaccine evaluation CONFIDENTIAL DRAFT Modelled vaccination scenarios 1. Identify vaccination scenarios CONFIDENTIAL DRAFT Doses Routine target Catch-up target Legend population population Cumulative GAVI demand estimated to be Base case 2. Develop demand forecast ~610M doses through 2030 Alternative scenario Excluded because 6 weeks old 5 to <18M less attractive / not Demand (M doses) feasible 200 1 0 3 dose course in 1 month intervals 0 0 150 5 to < 18M N/A 100 198 3. Develop impact estimates 152 2 0 50 1 0 60 3 0 3 0 4 0 4 1 5 1 6 1 41 0 0 21 20 20 19 PPC_Malaria 12 10 18 16 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 4. Develop cost estimates 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 GAVI financed Country co-financed Graduated country financed Note: Includes demand from countries that graduate from GAVI support during 2015-2030 (following GAVI supported introduction) Flu for IEC_March 15 v3.pptx PPC_Dengue 15 5. Assess other disease/ vaccine features GAVI Alliance Board meeting 11-12 June 2013 4
Methodology for vaccine prioritisation CONFIDENTIAL DRAFT 6. Populate scorecards Rabies Phase I Scorecard Modelled scenario: supplement current country funding for post-exposure prophylaxis vaccines • Health impact Phase I Category VIS Criteria Phase I Indicator Evaluation • Cost ~36,000 future deaths averted, 2015 – 2030 Impact on child mortality ~600 U5 future deaths averted per 100K vaccinated population ~210,000 total future deaths averted, 2015 – 2030 • Implementation feasibility Health Impact on overall mortality ~3500 future deaths averted per 100K vaccinated population impact ~210,000 Total future cases averted, 2015 – 2030 Impact on overall morbidity ~3500 future cases averted per 100K vaccinated population • Other considerations No long term sequelae; rabies is 100% fatal Epidemic potential No epidemic potential Global / regional public health priority Elimination goals in Latin America and Asia Additional Herd immunity No herd immunity impact Availability of alternative interventions Cost-effective prevention can be achieved through mass dog vaccination consid- erations Socio-economic inequity Access to treatment can be more difficult for low income / isolated populations Gender inequity Disproportionately impacts boys Disease of regional importance Rabies prevalent across most GAVI countries Capacity and supplier base 11+ manufacturers, significant supply available to meet global demand Comparison of total future deaths averted GAVI market shaping potential GAVI market would be less than 10% of global market Imple- Ease of supply chain integration Intradermal packed volume of ~4 cc / dose mentation feasibility Not aligned with other schedules; change in health worker practices required for Ease of programmatic integration intradermal administration Vaccine efficacy and safety ~100% efficacy; some evidence of causal link to serious adverse events Vaccine procurement cost 1 ~$75M total procurement cost to GAVI and countries, 2015 - 2030 Cost and value for In-country operational cost Low incremental burden: 4 visits (reactive vaccination), no campaign required Total future deaths averted, 2015-2030 ('000) money Procurement cost per event averted 2 $350 per future death averted, $350 per future case averted 600 Threshold 1. Procurement cost includes vaccine, syringe, safety box, and freight 2. Scoring based on cost per future death averted 440 PPC_Rabies 7 <70 400 70-140 210 200 200 120 140+ 110 77 32 20 12 5 1 N/A Outliers = malaria 7. Compare vaccines against 0 Malaria Rabies Influenza Cholera Hep B Yellow Mening Hep E Measles Dengue Hep A IPV fever selected criteria Total future deaths averted per 100K vaccinated, 2015-2030 3,600 • Health impact (mortality and Threshold 3,500 200 <70 200 morbidity) most important 70-140 130 100 140+ 75 56 38 37 • 12 Outliers = rabies Also consider epidemic 7 3 2 N/A 0 Rabies Malaria Yellow Hep B Influenza Hep E Cholera Mening Hep A Dengue Measles IPV fever diseases and value for money Note: impact estimates based on modeled strategies 9 GAVI Alliance Board meeting 11-12 June 2013 5
Phase I outcome: five vaccines prioritised for further analysis + IPV Landscape: WHO analysis: VIS phase I: VIS phase II: 60+ vaccines VIS candidates (15) shortlist (6) (?) Health Epidemic Phase I assessment and expert guidance impact potential • High impact on mortality and morbidity Malaria • Major public health priority • Impact on maternal and child mortality Influenza • Opportunity to strengthen antenatal contact point (maternal) • Mortality impact + prevents epidemics; pro-poor Cholera • Oral vaccine with strong herd effects • Reduce epidemics; no alternative intervention Yellow Fever • Regional importance; small overall investment (mass campaigns) • Prevents mortality of suspected cases Rabies • Pro-poor; Asia elimination goal; small overall investment (Post-Exposure) • Major global public health agenda Special case: opportunity Polio (IPV) • Time-sensitive decision to contribute to eradication GAVI Alliance Board meeting 11-12 June 2013 6
Next steps in phase II and expected outcomes Landscape: WHO analysis: VIS phase I: VIS phase II: 60+ vaccines VIS candidates (15) shortlist (6) (?) Next steps: Consultations Updated and integrated demand forecasts and impact estimates Implementation feasibility and operational costs review Benchmark against current GAVI vaccines Expected outcomes: November recommendation: future vaccine priorities Considerations for implementation GAVI application process 2018: re-evaluate vaccine landscape GAVI Alliance Board meeting 11-12 June 2013 7
GAVI Alliance Board meeting 11-12 June 2013 8
Recommend
More recommend
