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. WORKING DOCUMENT • November 2017 | 1 EUR 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 WORKING DOCUMENT • November 2017 | 2 EUR 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. WORKING DOCUMENT • November 2017 | 3 EUR 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 WORKING DOCUMENT • November 2017 | 4 EUR Table 2. Vaccine manufacturers reported by EUR countries, and additional manufacturers reported from other regions but not from EUR.