Vaccine Pricing: Gavi Fully Self-financing & Accelerated Transition Countries Manufacturer commitments presented in this document – provided solely for the purpose of helping Gavi fully self-financing and accelerated transition countries to plan and budget adequately for self-financing – are not legally binding; they do not represent contractual obligations between sellers and countries and as such are not a guarantee of price, eligibility criteria or duration. All commitments are subject to supply availability. The Gavi product menu This document intends to address questions that procurement officials with information on product availability is provided by UNICEF at https:// and immunisation stakeholders www.unicef.org/supply/index_gavi.html (within Ministry of Health and Ministry of Finance, among others) This document reflects 2018 prices and will be updated annually. may have about vaccine pricing in countries that are transitioning or have transitioned out of Gavi support. These are countries that have surpassed or will surpass the Gavi Gross National Income (GNI) Summary eligibility threshold and therefore are no longer eligible for Gavi support As of November 2018, nine countries are in a state of accelerated (including co-financing of vaccine transition from Gavi support to self-financing1, and 16 countries have procurement). transitioned out of Gavi support2. These countries have requested WHO In particular, the document aims to provide more visibility on their vaccine purchase price prospects, for to provide information on public sector vaccine prices that can both the proper budgeting of ongoing vaccination programs and the assist Gavi-transitioning countries’ introduction of new vaccines. financial planners in establishing appropriate budgets when countries Three manufacturers – GSK, Merck and Pfizer – have committed to assume full self-financing of previously Gavi-supported vaccines. continue providing countries that transition out of Gavi support with Importantly, this document can access to prices similar to those offered to Gavi-supported countries, or also provide crucial information to to maintain the prices that these countries are currently paying for certain countries contemplating new vaccine vaccines, for a certain period of time, depending on commitment terms. introductions. These commitments apply to: This is one of several tools available to Gavi-transitioning countries on • human papillomavirus vaccine (HPV) the MI4A website. MI4A has vaccine price and procurement data from • pneumococcal conjugate vaccine (PCV) 151 countries. The database, as well as documents on vaccine pricing, • rotavirus vaccine (Rota)3 are available on the MI4A website: http://www.who.int/immunization/ MI4A Information for Gavi-transitioning countries is also available on the Gavi website: http://www.gavi.org/ support/sustainability/transition- process/ UNICEF vaccine price data is available: https://www.unicef.org/ supply/index_57476.html This document has been prepared by the Expanded Programme on Immunization (EPI) of the Department of Immunization, Vaccines and Biologicals. This version is up to date as of 1India, Lao PDR, Nicaragua, Nigeria, Papua New Guinea, Sao Tome and Principe, Solomon Islands, Uzbekistan, November 2018. Vietnam. For more information on this 2Angola, Armenia, Azerbaijan, Bhutan, Bolivia, Congo, Cuba, Georgia, Guyana, Honduras, Indonesia, Kiribati, document or on vaccine price and Moldova, Mongolia, Sri Lanka, Timor-Leste, Ukraine. procurement, please email MI4A@ 3 Manufacturers have also made commitments for Gavi-transitioning countries for pentavalent vaccines. who.int However, as of 2017, all UNICEF suppliers of pentavalent vaccine are offering the same price to all countries buying through UNICEF, irrespective of their Gavi status. Therefore, information on pentavalent prices is not covered in this fact sheet, but is available from UNICEF at: https://www.unicef.org/supply/files/Penta_Price_ Update_17_10_06.pdf November 2018 | 1 The GAVI Framework for Transitioning Details of Manufacturer Commitments Countries Three vaccine manufacturers have committed to The aim of the Transition Policy is to contribute to continue to offer PCV, Rota, and HPV vaccines (specific the vision that, when countries transition out of Gavi presentations) to countries that transition out of support, they have successfully expanded their national Gavi support at prices similar to those paid by Gavi- immunisation programmes with vaccines of public supported countries or to maintain fixed prices for a health importance and sustain these vaccines post- certain period of time and under specific conditions transition with high and equitable coverage of target terms. For most manufacturers, procurement must be populations, while having robust systems and decision- through UNICEF.8 Additionally, GSK has allowed for making processes in place to support the introduction the possibility of self-procurement for any of their price of future vaccines (see the Gavi website at: http:// commitments; countries should contact GSK to check www.gavi.org/about/programme-policies/eligibility- for availability. and-transition/ and http://www.gavi.org/support/ The product-specific price commitments announced sustainability/transition-process/). Low vaccine prices by vaccine manufacturers are summarised in Tables (in addition to a variety of other factors) are necessary 1–3 for ease of reference. Commitment prices for for supporting countries to sustain immunization 2018 are listed for each product. This commitment programmes and introduce new vaccines after they price only applies to countries that are transitioning no longer receive Gavi financial support. Per the Gavi in 2018 and may not apply for countries transitioning website, “fully self-financing countries can no longer at a later date due to possible long-term agreement access new financial support from Gavi. However, (LTA) price changes (this is not applicable to fixed several manufacturers have made commitments to price commitments). More information is available on continue providing these countries with access to prices the Gavi website at: http://www.gavi.org/library/gavi- similar to those Gavi pays, under specific circumstances documents/supply-procurement/. and for a specified time period”.4 It is important for countries to note that since the price In 2019, 14 countries will be in the “preparatory commitments were made in 2015, there have been transition” phase5, 9 in the “accelerated transition” 6 7 pricing evolutions for some vaccines and countries can phase , and 16 in the “fully self-financing” phase . In all, now access lower prices through UNICEF. The current 25 countries are expected to be fully self-financing by (2018) UNICEF LTA prices for two products are lower 2025. than the manufacturer commitment prices: • Pfizer 4-dose PCV is now offered via UNICEF procurement at $2.95 • Merck 1-dose Rota is now offered via UNICEF procurement at $3.20 Prices shown are either price freezes based on UNICEF LTA or supply agreement prices or fixed prices stated within the commitment terms. Prices shown are indicative only and are not a guarantee of price. 4 https://www.gavi.org/about/programme-policies/eligibility-and-transition/ 5 Bangladesh, Cambodia, Cameroon, Cote d'Ivoire, Djibouti, Ghana, Kenya, Kyrgyzstan, Lesotho, Mauritania, Myanmar, Pakistan, Sudan, Zambia 6 India, Lao PDR, Nicaragua, Nigeria, Papua New Guinea, Sao Tome and Principe, Solomon Islands, Uzbekistan, Vietnam. 7 Angola, Armenia, Azerbaijan, Bhutan, Bolivia, Congo, Cuba, Georgia, Guyana, Honduras, Indonesia, Kiribati, Moldova, Mongolia, Sri Lanka, Timor-Leste, Ukraine. 8 Self-procuring countries should contact manufacturers to check for eligibility. November 2018 | 2 Human Papillomavirus Vaccine Table 1. Price commitments, for HPV, to fully self-financing Gavi countries procuring through UNICEF SD*, 2018 Manufacturer Presentation Conditions of Price Commitment Commitment Commitment Size (form) Duration Prices (2018) GSK 2-dose (liq) Fully self-financing countries are eligible at the current commitment 10 years $4.60 price of $4.60 per dose. Countries that transition in the future will be from date of eligible for the price at time of transition. transition to Countries that had not applied for Gavi support at the time of full fully self- transition, the same price commitment will be made provided that: financing** • A supply agreement for an immunization program is entered on or before 31 December 2017 • The price freeze offer will apply for 10 years from the effective date of such supply agreement and will take the form of an initial five-year contract, renewable once for an additional period of five years • The price will be the same as the price last offered to the Gavi Alliance at the effective date of such agreement. Not valid if a country has introduced an HPV vaccine programme under Gavi support using a different manufacturer’s product and wishes to switch after transition. Merck 1-dose (liq) Commitment of $4.50 per dose is at the 2015 price, regardless of Until end of $4.50 subsequent UNICEF LTA price changes that may occur. 2025 Applies to: 1. Gavi accelerated transition or fully self-financing countries with a GNI per capita ≤ US$3,200 in 2013 (World Bank, 2014) that wish to introduce HPV4 or to continue an existing HPV vaccination program 2. Gavi accelerated transition or fully self-financing countries with a GNI per capita > US$3,200 that meet Gavi’s Exceptional Opportunity criteria in 2016, for introduction