V3P: Region Fact Sheet SEAR

Highlights The SEAR1 region market is 35% of the global market in volume and 8% in This regional fact sheet is intended value. The regional procurement habits are different from the rest for use by MoH and vaccine procurement staff. The regional of the world in several ways, which may serve to inform sustainable supply fact sheet provides information strategies: on all procured by SEAR • lower number of vaccine types, with 19 vaccine types compared to 58 including analyses of: reported from all other regions; • the presentations used in SEAR compared to the rest of the • higher use of multi- versus single-dose presentations; world; • lesser use of prefilled syringes than in the rest of the world; • the procurement methods used in SEAR compared to the rest of • an absence of mixed-procuring countries; the world; • very high relative value of BCG and DTP-HepB-Hib vaccines in SEAR, • value to the market of the most compared to the non-SEAR market; frequently reported vaccines to the V3P from SEAR and the rest • three vaccines analysed for price suggest that: of the world; »» WAPs in non-Gavi MICs may be lower in SEAR than in non-Gavi, non- • prices paid by SEAR, compared PAHO MICs in the rest of the world; to rest of the world. »» non-Gavi MICs in SEAR purchase in variable volumes compared to non- Increased knowledge about several aspects of vaccine market and Gavi, non-PAHO MICs in the rest of the world. purchasing may help to inform the development of policies related to market shaping and vaccine access.

Vaccine Market The Vaccine Product Price & For the data in the V3P database, the size of the vaccine market in SEAR Procurement (V3P) initiative was launched to provide all countries is 35% of the global market by volume, but only about 8% by value. This is with a platform for greater vaccine predominantly related to the overall size of the SEAR region, which is the most price & procurement transparency. populous of all regions. However, a majority of HICs from Western Europe do The initiative collects data through not report price data to the V3P, so the relative size of the global market is the WHO and UNICEF Joint higher. 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 49% of the value of the market contained data from 142 countries. in SEAR. 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 the primary differences between the SEAR and the as of July 2017. Pool-procurement non-SEAR markets are the greater relative values of BCG and DTP-HepB- refers to vaccines procured through Hib in the SEAR market. These two vaccines account for about 42% of the UNICEF SD and the PAHO Revolving Fund. Readers may access additional value of the top 10 vaccines. In the non-SEAR market, the value of the top 10 vaccine price and procurement vaccines is more equally distributed. 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.

1SEAR countries contributing to the V3P: Bangladesh, Bhutan, Democratic People's Republic of Korea, , , Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste.

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

SEAR non-SEAR

Products and Presentations SEAR uses a smaller number of vaccine types (19) than any much lower prevalence of prefilled syringes in SEAR than in other WHO region (58 in non-SEAR countries). No vaccines non-SEAR countries (1% versus 18%). are exclusive to SEAR. Chart 2 shows a greater predominance of multi-dose SEAR uses five out of six presentations reported by all other presentations in SEAR compared to non-SEAR countries regions (an intranasal sprayer is reported from non-SEAR (84% versus 48%), where 10-dose and 20-dose but at a frequency of <1% - not shown). However, there is a presentations account for 68% of all presentation sizes.

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

SEAR non-SEAR

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Procurement Method Chart 3. Prevalence of procurement method in SEAR and non-SEAR countries. Procurement in SEAR is split between self- procuring (45%) and pool-procurement SEAR non-SEAR (55%). The prevalence of pool-procurement in non-SEAR countries is similar (54%), but 16% of countries are mixed-procuring, which is absent in SEAR (see Chart 3).

Vaccine Prices There is very limited data for non-Gavi MICs in SEAR, but for three vaccines analysed, WAPs for these countries in SEAR were 23 to 50% lower than for the same single-dose vaccines in non-Gavi, non-PAHO MICs in the non-SEAR market (see Chart 4). Chart 4. WAPs for three select single-dose vaccines in self-procuring non-Gavi MICs in SEAR and non-Gavi, non-PAHO MICs in non-SEAR, in 20162. Minimum, maximum, and median prices for vaccines procured in SEAR are shown in Table 1 (see page 4).

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

2Vaccines were selected on the basis of sufficient data for analyses – data for the same presentations from at least two countries in both SEAR and non-SEAR.

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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 three SEAR countries, in 2016.

SEAR price (all procurement methods, all income Vaccine type (ranked by groups): lowest (presentation size) / highest

frequency of use) SEAR SEAR

(presentation size) / median in SEAR N different N different products in products % of countries % of self-procuring in self-procuring N manufacturers N manufacturers N manufacturers reported globally reported

bOPV1,3 45 $0.08 (20-dose) / $1.65 (10-dose) / $0.14 8 6 10 BCG 60 $0.05 (10-dose) / $4.96 (20-dose) / $0.14 9 7 16 IPV 38 $0.83 (10-dose) / $23.64 (5-dose) / $1.90 5 4 7 DTP-HepB-Hib 38 $0.77 (10-dose) / $6.31 (5-dose) / $1.50 5 5 11 HepB (ped) 20 $0.17 (1-dose) / $1.73 (1-dose) / $0.60 3 3 13 40 $0.17 (5-dose) / $2.33 (10-dose) / $0.28 3 2 5 MMR 50 $1.40 (10-dose) / $5.73 (2-dose) / $3.73 4 2 5 Td 50 $0.11 (10-dose) / $1.36 (10-dose) / $0.19 2 2 13 DTP 50 $0.17 (10-dose) / $0.41 (10-dose) / $0.21 3 3 8 JE 100 $0.45 (5-dose) / $7.86 (1-dose) / $0.70 3 2 5 TT 0 $0.79 (10-dose) / $0.79 (10-dose) / $0.79 1 1 14 DT 100 $0.19 (10-dose) / $1.47 (1-dose) / $0.32 2 2 11 MR 33 $0.58 (2-dose) / $0.62 (10-dose) / $0.61 1 1 3

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

Vaccine type Manufacturers reported by SEAR countries Additional manufacturers not reported by SEAR BCG BB-NCIPD; GreenSignal Bio Pharma Limited; InterVax; AJ Vaccines A/S; Biomed Lublin; China CNBG; FAP (Fundação Japan BCG Laboratory; PT Bio Farma (Persero); Serum Ataulpho de Paiva); Institut Pasteur Iran; Institut Pasteur Tunis; IVAC Institute of India; Thai Red Cross Society (Institute of Vaccines and Medical Biologicals); Mikrogen; Torlak Institute of Virology, Vaccines and Sera bOPV1,3 ; GSK; Haffkine Bio; PT Bio Farma Birmex; Boryung Biopharma; China CNBG; Razi Institute Iran (Persero); Sanofi Pasteur; Serum Institute of India DT PT Bio Farma (Persero); Serum Institute of India Arabio; BB-NCIPD; Biological E; China CNBG; InterVax; Mikrogen; Razi Institute Iran; Sanofi Pasteur; Torlak Institute of Virology, Vaccines and Sera DTP Biological E; PT Bio Farma (Persero); Serum Institute Boryung Biopharma; Butantan; IVAC (Institute of Vaccines and Medical of India Biologicals); Mikrogen; Torlak Institute of Virology, Vaccines and Sera DTP-HepB-Hib Biological E; Janssen; LG Life Sciences; PT Bio Farma Arabio; Bharat Biotech; Centro de Ingeniería Genética y Biotecnología; (Persero); Serum Institute of India GSK; Panacea Biotec; Shantha Biotechnics Private Limited HepB (ped) LG Life Sciences; PT Bio Farma (Persero); Serum Biokangtai; China CNBG; Dalian Hissen; GSK; Janssen; Merck Institute of India Vaccines; Mikrogen; NCPC GeneTech; Sanofi Pasteur MSD; VABIOTECH IPV Bilthoven Biologicals; PT Bio Farma (Persero); Sanofi GSK; Institute of Medical Biology – Chinese Academy of Medical Pasteur; Shantha Biotechnics Private Limited Sciences; Serum Institute of India JE Chengdu Institute of Biological Products Co., Ltd; GPO- China CNBG; Sanofi Pasteur; VABIOTECH MBP Co., Ltd. Measles PT Bio Farma (Persero); Serum Institute of India Biovac SA; Mikrogen; POLYVAC (Center for Research and Production of Vaccine and Biologicals) MMR GSK; Serum Institute of India China CNBG; Merck Vaccines; Sanofi Pasteur MR Serum Institute of India Beijing Minhai Biotech; China CNBG Td Sanofi Pasteur; PT Bio Farma (Persero) AJ Vaccines A/S; BB-NCIPD; Biological E; Boryung Biopharma; Butantan; GSK; InterVax; Mikrogen; Razi Institute Iran; Serum Institute of India; Torlak Institute of Virology, Vaccines and Sera TT Biological E BB-NCIPD; Bharat Biotech; Boryung Biopharma; Finlay; GSK; InterVax; IVAC (Institute of Vaccines and Medical Biologicals); Mikrogen; PT Bio Farma (Persero); Sanofi Pasteur; Serum Institute of India; Shantha Biotechnics Private Limited; Torlak Institute of Virology, Vaccines and Sera

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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