Iryna Mazur, Gavi, the Vaccine Alliance

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A rural vaccination session in DRC. Photo: Gavi/ Evelyn Hockstein.

This week a new approach to shaping vaccine markets was approved by Gavi, the Vaccine Alliance and its international partners. Aurelia Nguyen, Director of Policy and Market-Shaping, talked to Vaccines Work about the new strategic priorities and what they mean for immunising children around the world. 

Why is Gavi involved in the shaping of vaccine markets?

Aurelia: Since Gavi, the Vaccine Alliance was created in 2000, Gavi and partners have focused on improving availability of and access to vaccines for the countries we support. Since then, the approach has evolved from consolidating funding and demand for vaccines (2000-2010) to more proactively intervening in vaccine markets to improve supply, price, and innovation dynamics (2011-2015). These efforts resulted in a 39% decrease in the cost of immunising a child with three key vaccines and have contributed to the immunisation of 500 million children worldwide.

How is this strategy different from what came before?

Aurelia: The new Supply and Procurement Strategy is an exciting evolution of our approach to market-shaping.  We took a look at our work so far and realised that we had accomplished a lot in the past strategic period, but in order to improve in some areas, we have to expand our perspective.

The markets in which we operate are influenced by a lot of global factors, such as the increasing number of manufacturers and other stakeholders. The types of vaccines we procure are more and more diverse; not all vaccines are intended for routine immunisation for example, and vaccines without markets in high-income countries have specific challenges needing to be overcome. We already were wary of not applying a ‘one size fits all’ format to all vaccine markets, but need to step up how we work with vaccine manufacturers, donors, country governments, and other market-shaping actors who act as intermediaries between manufacturers and governments.

We identified three key priorities for our 2016-2020 strategy focusing on healthy markets, taking a long-term view, and innovating to suit country needs.

So what does a ‘healthy market’ look like?

Aurelia: One major shift in this new strategy is the use of the ‘healthy markets framework’, a tool that was developed to provide a more comprehensive way of thinking about healthy markets. The framework allows us to identify some common ‘building blocks’, such as whether countries’ preference for vaccine presentation is being met or a competitive market is being nurtured. Using the framework, we can identify which ‘blocks’ are most important within a specific market, and whether the market already includes those blocks. If it doesn’t, what will it take to add that block? What trade-offs will we need to consider, and what will it cost?  

We can then apply a tailored approach to each market, because what will work for the pentavalent vaccine market, for example, might not be the best approach in the rotavirus vaccine market. Or, we might want to have a larger number of manufacturers in one market, but it wouldn’t mean that we are targeting the same number in another market. The new strategy acknowledges the fact that markets are at different stages of health and often on different pathways to ‘optimal health’.

How does Gavi envision the future of how we secure and supply vaccines?

Aurelia: We need a longer-term view of the future of vaccine markets. Some objectives will take time to realise. We also recognise that as we become more active in shaping markets, our interventions have impact beyond the countries we support. Improving the overall supply landscape for non-Gavi countries through attracting more manufacturers is one way non-Gavi countries can benefit from our market-shaping activities. On the other hand, negotiating prices that are too low could result in manufacturers exiting the market. So we also need to be mindful of those externalities. We will be monitoring the wider consequences of our work for both positive and negative impact.

In 2016-2020, we will also see a large number of countries exiting Gavi support, which will be a new experience for us. Gavi will need to make sure that countries are ready for this transition in a number of ways, including that they can continue purchasing needed vaccines, and we’ll be doing so under our sustainability goal. At the same time, the markets, and other market-shaping partners, will also need to be ready for the changes in demand and supply dynamics that will occur as former Gavi-supported countries take up their own financing and procurement. We can support a smooth transition through strong collaboration with partners and other market-shaping intermediaries, including sharing some of our best practices.  

For 2016-2020, Gavi is focusing on immunising ‘the fifth child’. How can market-shaping support that?

Aurelia: Gavi’s overall strategy includes making sure that we reach every child with vaccines, in particular those who have historically been missed or under-immunised. For this we need to ensure that the products we procure are the right fit for individual countries and communities. This could include, for example, appropriate vaccine presentations for different settings, such as different vial sizes. It could also include novel delivery technologies that require less training or cold chain capacity. These innovations extend the reach of vaccines and improve their coverage.

At the same time, we also need to be clear on which innovations we think are most valuable, so that manufacturers and partners can invest appropriately. We will be bringing together the vaccine innovation community to think through some key issues and help develop some shared priorities.

One area of innovation that is of particular focus for us is cold chain equipment (CCE). CCE markets have some of the same issues that vaccine markets have, in terms of funding and demand fragmentation. Through our work in shaping CCE markets, higher-performing and more efficient products can be made available to countries, allowing them to upgrade their supply chains to improve vaccine delivery. We can apply some of the same successful market-shaping tools and principles from vaccine markets to CCE markets, but we will also have an opportunity to test-drive some novel ideas, such as new approaches to measuring cost.  

How will partners and countries be involved?

Aurelia: There are more players in the markets now – both manufacturers and intermediaries. Developing country governments are also taking up procurement and market-shaping activities. This means there will be more products on the market and more opportunities for targeted interventions, but it also means that we will need strong coordination and transparent sharing of information. Gavi is looking forward to bringing our partners and stakeholders together to collaborate on a sustainable future for vaccine markets.