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V3P: Region Fact Sheet

This regional fact sheet is intended for use by MoH and vaccine procurement staff. The regional fact sheet provides information on all vaccines procured by EMR including analyses of:

• the presentations used in EMR compared to the rest of the world;

• the procurement methods used in EMR compared to the rest of the world;

• value to the market of the most frequently reported vaccines to the V3P from EMR and the rest of the world;

• prices paid by EMR, compared to rest of the world.

Increased knowledge about several aspects of vaccine market and purchasing may help to inform the development of policies related to market shaping and vaccine access.

The Vaccine Product Price & Procurement (V3P) initiative was launched to provide all countries with a platform for greater vaccine price & procurement transparency. The initiative collects data through the WHO and UNICEF Joint Reporting Form, and analyses and distributes information to relevant stakeholders to inform policy making and procurement processes. As of July 2017, the database contained data from 142 countries.

The fact sheet is exclusively based on the data reported through the JRF & V3P initiative, as of July 2017. Pool-procurement refers to vaccines procured through 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.

EMR

1EMR countries contributing to the V3P: Afghanistan, Bahrain, Egypt, Iran, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Somalia, Sudan, Syrian Arab Republic, Tunisia, Yemen.EMR countries not contributing to the V3P: Djibouti, Kuwait, Libya, Saudi Arabia, United Arab Emirates.

HighlightsThe EMR1 region market is 13% of the global market in volume and 7% in value. The regional vaccine procurement habits are different from the rest of the world in several ways, which may serve to inform sustainable supply strategies:

• slightly less use of prefilled syringes than in the rest of the world;• a predominance of mixed-procurement, compared to non-EMR

countries where pool-procurement is more prevalent;• PCV, DTP-HepB-Hib, and DTaP-HepB-Hib-IPV have a higher relative

value in the EMR market and account for more than half (57%) of the value;

• Four vaccines analysed for price suggest that WAPs for three of four vaccines in non-Gavi MICs in EMR are 18% to 30% higher than in non-GAVI, non-PAHO MICs not in EMR.

Vaccine MarketFor the data in the V3P database, the size of the vaccine market in EMR is approximately 13% of the non-EMR market, by volume, and about 7% by value. However, a majority of HICs from Western Europe do not report price data to the V3P, so the relative size of the global market is higher than reported.

The global top 10 vaccines by value are PCV, HPV, Rota, Influenza (seasonal – adult), Varicella, DTP-HepB-Hib, MenA,C,Y,W-135 conj, MenC, DTaP-HepB-Hib-IPV, and BCG, and these 10 account for about 68% of the value of the market in EMR. The relative value of each vaccine type, in each market, is shown in Chart 1 (see page 2).

Chart 1 also shows that the primary differences between the EMR and non-EMR markets are the greater relative values of PCV, DTP-HepB-Hib, and DTaP-HepB-Hib-IPV in the EMR market. These vaccines account for 57% of the value of the vaccine market in EMR versus 29% in the rest of the world.

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EMR

Products and PresentationsEMR uses 34 vaccine types out of a total of 58 reported from all regions. No vaccine type is exclusive to EMR.

EMR uses five of the seven presentations reported from all regions combined (Uniject and an intranasal sprayer are reported from non-EMR but at a frequency of <1% - not shown). There is a near equal distribution of presentation types between EMR and non-EMR countries, with only slightly lower prevalence of pfs in EMR (15% versus 17%).

Chart 2 shows a nearly equal distribution of single-dose presentations in EMR compared to non-EUR countries (49% versus 50%). The distribution of multi-dose presentations in EMR is also nearly equal to the distribution in non-EMR countries.

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

EMR non-EMR

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

EMR non-EMR

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Procurement MethodEMR is predominantly mixed-procuring (44%), compared to non-EMR regions where mixed-procuring is less prevalent (11%) (see Chart 3). Pool-procurement in EMR is about half as prevalent as in non-EMR countries.

Vaccine PricesThere are few data points for non-Gavi MICs in EMR. For these countries, WAPs in EMR are comparable to WAPs for non-Gavi, non-PAHO MICs in non-EMR, for PCV, but lower for single-dose MMR and Influenza (adult) based on a single reporting country from EMR for each of the two vaccines (see Chart 4). Minimum, maximum, and median prices for vaccines procured in EMR are shown in Table 1 (see page 4).

For Rota, HepB (adult), and HepB (ped), WAPs in EMR were 18 to 30% higher than in the same income group in non-EMR countries. WAP for IPV was about 5% lower in EMR than in non-EMR MICs.

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

Chart 4. WAPs for four select single-dose vaccines in self-procuring non-Gavi MICs in EMR and non-Gavi, non-PAHO MICs in non-EMR, in 20162.

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

EMR

Chart 3. Prevalence of procurement method in EMR and non-EMR countries.

EMR non-EMR

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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 EMR countries, in 2016.

Vaccine type (ranked by frequency of use)

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EMR EMR price (all procurement methods, all income

groups): lowest (presentation size) / highest (presentation size) / median N

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N m

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bOPV1,3 50 $0.11 (10-dose) / $2.02 (20-dose) / $0.19 8 7 10

IPV 43 $0.83 (10-dose) / $11.27 (1-dose) / $2.80 4 2 6

BCG 43 $0.06 (10-dose) / $0.77 (20-dose) / $0.16 8 7 16

DTP-HepB-Hib 36 $0.29 (1-dose) / $4.98 (10-dose) / $0.16 10 8 11

HepB (ped) 55 $0.17 (10-dose) / $3.62 (1-dose) / $0.49 5 3 13

PCV 40 $3.30 (1-dose) / $26.52 (1-dose) / $15.76 4 2 2

TT 60 $0.05 (20-dose) / $0.93 (10-dose) / $0.23 6 4 14

MMR 56 $1.13 (10-dose) / $7.04 (1-dose) / $3.40 5 3 5

HepB (adult) 78 $0.35 (5-dose) / $4.02 (1-dose) / $1.17 5 4 10

Td 75 $0.11 (10-dose) / $4.98 (1-dose) / $1.55 6 4 13

DT 75 $0.10 (10-dose) / $2.11 (10-dose) / $1.06 5 5 11

Rota 57 $2.11 (1-dose) / $13.07 (1-dose) / $5.63 2 2 3

DTP 50 $0.21 (10-dose) / $3.83 (10-dose) / $0.34 2 2 8

Measles 20 $0.28 (10-dose) / $2.79 (10-dose) / $0.28 2 2 5

Influenza (seasonal – adult) 100 $3.25 (1-dose) / $3.40 (1-dose) / $3.29 2 2 11

YF 100 $18.02 (1-dose) / $21.58 (1-dose) / $19.56 1 1 4

Varicella 75 $20.03 (1-dose) / $25.74 (1-dose) / $25.08 2 2 4

HepA (ped) 75 $12.74 (1-dose) / $17.00 (1-dose) / $13.70 2 2 9

MenA,C,Y,W-135 conj 75 $8.11 (10-dose) / $28.00 (1-dose) / $20.36 3 3 4

DTaP-HepB-Hib-IPV 75 $19.95 (1-dose) / $26.85 (1-dose) / $23.88 1 1 2

Rabies 100 $10.51 (1-dose) / $12.00 (1-dose) / $10.56 1 1 7

MR 33 $0.60 (10-dose) / $3.20 (1-dose) / $0.77 2 1 3

HepA (adult) 100 $15.24 (1-dose) / $24.13 (1-dose) / $22.53 4 3 4

DTaP-Hib-IPV 100 $15.00 (1-dose) / $29.58 (1-dose) / $15.01 1 1 3

Typhoid 100 $3.50 (1-dose) / $6.38 (1-dose) / $4.06 2 1 3

EMR

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

Vaccine type Manufacturers reported by EMR countries Additional manufacturers not reported by EMR

BCG AJ Vaccines A/S; GreenSignal Bio Pharma Limited; Institut Pasteur Iran; Institut Pasteur Tunis; InterVax; Japan BCG Laboratory; Serum Institute of India

BB-NCIPD; Biomed Lublin; China CNBG; FAP (Fundação Ataulpho de Paiva); IVAC (Institute of Vaccines and Medical Biologicals); Mikrogen; PT Bio Farma (Persero); Thai Red Cross Society; Torlak Institute of Virology, Vaccines and Sera

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

Birmex; China CNBG; Haffkine Bio

DT Arabio; InterVax; Razi Institute Iran; Sanofi Pasteur; Serum Institute of India

BB-NCIPD; Biological E; China CNBG; Mikrogen; PT Bio Farma (Persero); Torlak Institute of Virology, Vaccines and Sera

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

DTaP-Hib-IPV Sanofi Pasteur Farmeks; GSK

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

DTP-HepB-Hib Arabio; Biological E; Centro de Ingeniería Genética y Biotecnología; Janssen; LG Life Sciences; Panacea Biotec; Serum Institute of India; Shantha Biotechnics Private Limited

Bharat Biotech; GSK; PT Bio Farma (Persero)

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

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

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

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

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

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

Measles PT Bio Farma (Persero); Serum Institute of India Biovac SA; Mikrogen; POLYVAC (Center for Research and Production of Vaccine and Biologicals)

MenA,C,Y,W-135 conj Arabio; GSK; Sanofi Pasteur Pfizer

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

MR Serum Institute of India Beijing Minhai Biotech; China CNBG

PCV GSK; Pfizer None

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

Rotavirus GSK; Merck Vaccines Bharat Biotech

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

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

Typhoid Sanofi Pasteur Bharat Biotech; FSUE Chumakov

Varicella GSK; Merck Vaccines Green Cross Corporation; Sinergium

YF Sanofi Pasteur Bio-Manguinhos; FSUE Chumakov; Institut Pasteur Dakar

EMR

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.