V3P: Region Fact Sheet EUR

Highlights The EUR1 region market is 6% of the world market in volume and 6% in This regional fact sheet is intended value. The regional vaccine procurement habits are different from the rest for use by MoH and vaccine procurement staff. The regional fact of the world in several ways, which may serve to inform sustainable supply sheet provides information on all strategies: vaccines procured by EUR including • higher number of vaccine types, with 12 vaccine types exclusive to analyses of: EUR; • the presentations used in EUR compared to the rest of the • higher use of single- versus multi-dose presentations; world; • greater use of prefilled syringes than in the rest of the world (where • the procurement methods used single-dose presentations are more often in vials); in EUR compared to the rest of the world; • the majority of countries are self-procuring; • value to the market of the most • PCV and DTaP-HepB-Hib-IPV have a higher relative value in the EUR frequently reported vaccines to market, while Rota and HPV have a higher relative value in the non-EUR the V3P from EUR and the rest of the world; market; • prices paid by EUR, compared to • three of four vaccines analysed suggest that: rest of the world. »» WAPs in non-Gavi MICs may be higher in EUR than in non-Gavi, non- Increased knowledge about several PAHO MICs in the rest of the world; aspects of vaccine market and purchasing may help to inform the »» non-Gavi MICs in EUR may purchase in smaller volumes than non-Gavi, development of policies related to non-PAHO MICs in the rest of the world. market shaping and vaccine access.

The Vaccine Product Price & Procurement (V3P) initiative was Vaccine Market launched to provide all countries with a platform for greater vaccine For the data in the V3P database, the size of the vaccine market in EUR is price & procurement transparency. approximately 6% of the global market, by volume, and about 6% by value. The initiative collects data through However, a majority of HICs from Western Europe do not report price data to the WHO and UNICEF Joint the V3P, so the relative size of the EUR market is higher than reported. Reporting Form, and analyses and distributes information to relevant stakeholders to inform policy The global top 10 vaccines by value are PCV, HPV, Rota, Influenza (seasonal – making and procurement processes. adult), Varicella, DTP-HepB-Hib, MenA,C,Y,W-135 conj, MenC, DTaP-HepB-Hib- As of July 2017, the database IPV, and BCG, and these 10 account for about 55% of the value of the market contained data from 142 countries. in EUR. The relative value of each vaccine type, in each market, is shown in The fact sheet is exclusively Chart 1 (see page 2). based on the data reported through the JRF & V3P initiative, Chart 1 also shows that one of the primary differences between the EUR and as of July 2017. Pool-procurement non-EUR markets are the greater relative values of DTaP-HepB-Hib-IPV and refers to vaccines procured through Varicella in the EUR market. UNICEF SD and the PAHO Revolving Fund. Readers may access additional vaccine price and procurement information from reporting countries and procurement agencies (UNICEF and PAHO) on the V3P website (http://www.who.int/immunization/ v3p) or by contacting v3p-project@ who.int.

1EUR countries contributing to the V3P: Albania, Andorra, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, France, Georgia, Hungary, Iceland, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Malta, Montenegro, Republic of Moldova, Romania, Russian Federation, San Marino, Slovakia, Slovenia, Sweden, Tajikistan, The Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan. EUR countries not contributing to the V3P: Austria, Belgium, Denmark, Finland, Germany, Greece, Ireland, Israel, Italy, Luxembourg, Monaco, Netherlands, Norway, Poland, Portugal, Serbia, Spain, Switzerland, United Kingdom of Great Britain and Northern Ireland.

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Chart 1. The relative value of the global top 10 vaccines in the EUR and non-EUR markets.

EUR non-EUR

Products and Presentations EUR uses the greatest number of vaccine types (50) However, an intranasal sprayer reported from EUR is not compared to non-EUR countries (46). Twelve vaccines used elsewhere, and Uniject, reported from non-EUR, is not are exclusive to EUR: CCHF, Diphtheria, HepA-HepB, MM, reported for EUR. Both are reported at a frequency of <1%. Mumps, Plague, Rubella, TBE (ped and adult), Tdap-IPV, Td- There is, however, a much higher prevalence of prefilled IPV, and Tularemia. syringes in EUR than in non-EUR countries (38% versus 10%). EUR uses the same number of presentations (six) as the total for all other regions. Chart 2 shows a greater predominance of single-dose presentations in EUR compared to non-EUR countries (71% versus 43%).

Chart 2. Prevalence of presentation sizes in EUR and non-EUR countries.

EUR non-EUR

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Procurement Method Chart 3. Prevalence of procurement method in EUR and non-EUR countries. EUR is predominantly self-procuring (67%), compared to non-EUR regions, EUR non-EUR where pool procurement is more prevalent (63%). Mixed-procurement in EUR is about half as prevalent as in non- EUR countries.

Vaccine Prices For non-Gavi MICs, WAPs in EUR are higher than WAPs in non-Gavi, non- PAHO MICs in non-EUR, for four out of six select vaccines for which comparator data is available. Chart 4. WAPs for six select single-dose vaccines in self-procuring non-Gavi MICs in EUR and non-Gavi, non-PAHO MICs in non-EUR, in 20162. Minimum, maximum, and median prices for vaccines procured in EUR are shown in Table 1 (see page 4).

For non-Gavi, non-PAHO MICs, WAPs for the newer vaccines, PCV and HPV, in single-dose, are 36 to 37% higher in EUR than in non-EUR countries. The WAP for Influenza (adult), on the other hand, is almost two times lower in EUR countries.

Vaccine Availability Reported manufacturers from EUR and globally, for each vaccine type, are shown in Table 2 (see page 5).

2Vaccines were selected based on sufficient data for analyses – data for single-dose presentations from at least three countries in both EUR and non-EUR.

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Table 1. Proportion of countries self-procuring, minimum, median, and maximum prices, number of products, and number of manufacturers for each vaccine type reported from at least five EUR countries, in 2016.

EUR price (all procurement methods, all income Vaccine type (ranked by groups): lowest (presentation size) / highest frequency of use) EUR (presentation size) / median in EUR N different N different % of countries % of products in EUR products self-procuring in self-procuring N manufacturers N manufacturers N manufacturers reported globally reported

MMR 69 $1.10 (5-dose) / $15.78 (1-dose) / $5.66 8 4 5 BCG 50 $0.06 (10-, 20-dose) / $2.77 (20-dose) / $0.46 11 8 16 HepB (ped) 54 $0.06 (10-dose) / $15.00 (10-dose) / $0.85 9 6 13 PCV 68 $3.14 (1-dose) / $77.59 (1-dose) / $31.24 5 2 2 Td 50 $0.06 (2-dose) / $10.07 (1-dose) / $0.18 11 8 13 DTaP-Hib-IPV 82 $13.76 (1-dose) / $41.89 (1-dose) / $22.19 4 3 3 DT 38 $0.11 (10-dose) / $7.24 (1-dose) / $0.15 8 6 11 DTaP-HepB-Hib-IPV 87 $17.70 (1-dose) / $78.85 (1-dose) / $39.71 3 2 2 Influenza (seasonal – adult) 79 $1.01 (1-dose) / $7.92 (1-dose) / $4.65 7 6 11 bOPV1,3 23 $0.14 (20-dose) / $1.86 (20-dose) / $0.18 4 3 10 HPV 92 $15.00 (1-dose) / $154.13 (1-dose) / $47.05 3 2 4 DTaP-IPV 92 $8.18 (1-dose) / $26.63 (1-dose) / $15.19 2 2 2 DTP 17 $0.13 (2-dose) / $3.01 (10-dose) / $0.21 5 4 8 HepB (adult) 75 $0.59 (1-dose) / $55.45 (1-dose) / $4.99 7 5 10 IPV 82 $1.97 (5-dose) / $13.42 (1-dose) / $4.71 5 3 7 Rabies 73 $5.69 (1-dose) / $50.25 (1-dose) / $13.31 6 6 7 TT 89 $0.06 (2-dose) / $6.77 (1-dose) / $2.09 6 5 14 Rota 22 $2.05 (1-dose) / $76.44 (1-dose) / $5.34 2 2 3 DTP-HepB-Hib 0 $1.57 (10-dose) / $2.82 (1-dose) / $2.35 4 3 11 Hib 88 $3.66 (1-dose) / $17.94 (1-dose) / $6.43 4 3 4 Varicella 86 $17.50 (1-dose) / $141.93 (1-dose) / $44.28 2 2 4 Pneumo ps 100 $11.09 (1-dose) / $59.35 (1-dose) / $16.92 2 2 2 DTa P 86 $9.52 (1-dose) / $27.92 (1-dose) / $15.46 3 2 3 HepA (adult) 100 $13.20 (1-dose) / $35.37 (1-dose) / $19.73 3 3 4 HepA (ped) 83 $7.50 (1-dose) / $24.73 (1-dose) / $17.08 3 3 9 Tdap 100 $8.53 (1-dose) / $16.64 (1-dose) / $14.95 3 2 4 Typhoid 100 $2.58 (1-dose) / $47.26 (1-dose) / $14.64 3 3 3 MenC 100 $16.35 (1-dose) / $37.09 (1-dose) / $23.84 2 2 3

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Table 2. Vaccine manufacturers reported by EUR countries, and additional manufacturers reported from other regions but not from EUR.

Vaccine type Manufacturers reported by EUR countries Additional manufacturers not reported by EUR BCG BB-NCIPD; Biomed Lublin; GreenSignal Bio Pharma Limited; AJ Vaccines A/S; China CNBG; FAP (Fundação Ataulpho de Paiva); Institut Pasteur InterVax; Japan BCG Laboratory; Mikrogen; Serum Institute of India; Iran; Institut Pasteur Tunis; IVAC (Institute of Vaccines and Medical Biologicals); PT Bio Torlak Institute of Virology, Vaccines and Sera Farma (Persero); Thai Red Cross Society

bOPV1,3 Bharat Biotech; GSK; Sanofi Pasteur Birmex; Boryung Biopharma; China CNBG; Haffkine Bio; PT Bio Farma (Persero); Razi Institute Iran; Serum Institute of India

DT BB-NCIPD; InterVax; Mikrogen; Sanofi Pasteur; Serum Institute of Arabio; Biological E; China CNBG; PT Bio Farma (Persero); Razi Institute Iran India; Torlak Institute of Virology, Vaccines and Sera

DTa P GSK; Sanofi Pasteur China CNBG

DTaP-Hib-HepB-IPV GSK; Sanofi Pasteur None

DTaP-Hib-IPV Farmeks; GSK; Sanofi Pasteur None

DTaP-IPV GSK; Sanofi Pasteur None

DTP Mikrogen; PT Bio Farma (Persero); Serum Institute of India; Torlak Biological E; Boryung Biopharma; Butantan; IVAC (Institute of Vaccines and Medical Institute of Virology, Vaccines and Sera Biologicals)

DTP-HepB-Hib Janssen; LG Life Sciences; Serum Institute of India Arabio; Bharat Biotech; Biological E; Centro de Ingeniería Genética y Biotecnología; GSK; Panacea Biotec; PT Bio Farma (Persero); Shantha Biotechnics Private Limited

HepA (adult) GSK; Sanofi Pasteur; Vector-BiAlgam Merck Vaccines

HepA (ped) GSK; Merck Vaccines; Sanofi Pasteur Butantan; Changchun Changsheng Life Sciences Ltd.; China CNBG; Institute of Medical Biology – Chinese Academy of Medical Sciences; Sinovac; Zhejiang Pukang

HepB (adult) Centro de Ingeniería Genética y Biotecnología; GSK; LG Life Berna Biotech Korea; Institut Pasteur Iran; Janssen; Serum Institute of India; Shantha Sciences; Merck Vaccines; Mikrogen Biotechnics Private Limited

HepB (ped) GSK; Janssen; LG Life Sciences; Mikrogen; Sanofi Pasteur MSD; Biokangtai; China CNBG; Dalian Hissen; Merck Vaccines; NCPC GeneTech; PT Bio Serum Institute of India Farma (Persero); VABIOTECH

Hib GSK; Sanofi Pasteur; Serum Institute of India Merck Vaccines

HPV GSK; Merck Vaccines Butantan; Sinergium

Influenza (adult) Abbott Biologicals B.V.; GSK; Hualan Biological Bacterin Co., Ltd; Butantan; GPO-MBP Co., Ltd.; Green Cross Corporation; Seqirus; Sinergium Mikrogen; Npo Petrovaks; Sanofi Pasteur

IPV Bilthoven Biologicals; GSK; Sanofi Pasteur Institute of Medical Biology – Chinese Academy of Medical Sciences; PT Bio Farma (Persero); Serum Institute of India; Shantha Biotechnics Private Limited

MenC GSK; Pfizer Funed (Fundação Ezequiel Dias)

MMR GSK; Merck Vaccines; Sanofi Pasteur; Serum Institute of India China CNBG

PCV GSK; Pfizer None

Pneumo Ps Merck Vaccines; Sanofi Pasteur None

Rabies Bharat Biotech; Chiron Behring Vaccines Private Ltd.; FSUE Butantan Chumakov; GSK; Novartis; Sanofi Pasteur

Rotavirus GSK; Merck Vaccines Bharat Biotech

Td BB-NCIPD; Biological E; GSK; InterVax; Mikrogen; Sanofi Pasteur; AJ Vaccines A/S; Boryung Biopharma; Butantan; PT Bio Farma (Persero); Razi Institute Serum Institute of India; Torlak Institute of Virology, Vaccines and Iran Sera

Tdap AJ Vaccines A/S; GSK Butantan; Sanofi Pasteur

TT BB-NCIPD; GSK; Mikrogen; Sanofi Pasteur; Torlak Institute of Bharat Biotech; Biological E; Boryung Biopharma; Finlay; InterVax; IVAC (Institute of Virology, Vaccines and Sera Vaccines and Medical Biologicals); PT Bio Farma (Persero); Serum Institute of India; Shantha Biotechnics Private Limited

Typhoid Bharat Biotech; FSUE Chumakov; Sanofi Pasteur None

Varicella GSK; Merck Vaccines Green Cross Corporation; Sinergium

DISCLAIMER Information contained in the V3P database is provided by participating countries and/or organizations procuring on behalf of countries that have agreed to share vaccine price and procurement data with V3P. Participating countries are solely responsible for the accuracy of the data provided. The information contained in the V3P database does not in any way imply an endorsement, certification, warranty of fitness or recommendation by WHO of any company or product for any purpose, and does not imply preference over products of a similar nature that are not mentioned. WHO furthermore does not warrant that: (1) the information is complete and/or error free; and/or that (2) the products listed are of acceptable quality, have obtained regulatory approval in any country, or that their use is otherwise in accordance with the national laws and regulations of any country, including but not limited to patent laws. Inclusion of products in the database does not furthermore imply any approval by WHO of the products in question (which is the sole prerogative of national authorities). WHO will not accept any liability or responsibility whatsoever for any injury, death, loss, damage, or other prejudice of any kind that may arise as a result of, or in connection with the procurement, distribution and use of any product listed in the V3P database.

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