Vaccine Landscape
Implications for 202X
May 2, 2011
2
Vaccine Landscape (1920 – 1979)
Rabies
Measles
DTP
(1963)
Vaccine Characteristics
(1948)
Rubella
(1969)
Smallpox
OPV
(1903)
Yellow Fever
IPV
(1926)
(1955)
• Relatively low price for most vaccines
(<$1.00/treatment)
• Large multi-dose vial sizes (minimize
cost/dose and immunization logistics
impact)
(1963)
(1948)
BCG
FIRST Vx LICENSURE
(1880s)
Mumps
(1967)
• Typically high wastage (25 – 70%)
MMR
(1971)
1920s
1930s
1940s
1950s
1960s
1970s
1980s
<5% of infants immunized
globally each year
EPI Introduced
(BCG, DTP, Measles, OPV)
(1974)
1990s
2000s
2010s
EPI catalyzed the
strengthening of
country supply
logistics systems
2020s
3
Vaccine Landscape (1980 – 1999)
Rabies
Measles
DTP
(1963)
FIRST Vx LICENSURE
(1880s)
(1948)
Rubella
DTP-HepB+Hib
(1969)
Smallpox
(1903)
Hib
Pentavalent
(1988)
Vaccine
(1998)
OPV
Yellow Fever
(1963)
HepB
(1948)
BCG
IPV
(1926)
1920s
(1981)
(1955)
1930s
1940s
1950s
Mumps
(1967)
MMR
(1971)
1960s
1970s
1980s
1990s
2000s
2010s
2020s
Vaccine Characteristics
• Hib 1st of the higher priced vaccines
(>$3.00/dose)
<5% of infants immunized
globally each year
EPI Introduced
(BCG, DTP, Measles, OPV)
(1974)
• High wastage comes at a higher cost 
trend toward smaller multi-dose vials
• Shift to pentavalent combination vaccine
4
Health Systems Investments (1980-1999)
BMGF
established
Building Blocks of a Highly Functional Health System*
CCL training modules
Medical Products,
Vaccines, and
Technologies
WHO standardized
immunization schedules
Health
Information
System
WHO PQ
established
Equipment
info sheets
VVMs
available
Joint statement
on AD syringes
TechNet
e-Forum
Health
Service Delivery
Leadership and
Governance
WHO GAG
established
EPI
introduced
TechNet
established
PAHO
Revolving Fund
established
Health
Financing
GPV
established
SAGE
established
UNICEF Vaccine
Independence Initiative
established
Health
Workforce
1975
1980
1985
* Everybody’s Business: Strengthening Health System's to Improve Health Outcomes,
WHO’s Framework for Action, 2007
1990
1995
2000
5
Average % Vaccine Coverage Rates in
Low & Lower Middle Income Countries
Investment = Impact (1980 – 2000)
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Year
BCG
Source: WHO Global Atlas
http://apps.who.int/globalatlas/dataQuery/default.asp
DTP3
MCV
Pol3
6
Vaccine Landscape (2000 – 2010)
Rabies
RotaTeq
(2006)
PCV 10
(2009)
RotaRix
DTP-HepB+Hib (2006)
Pentavalent
Vaccine
(1998)
MenA
(2009)
(1880s)
Measles
DTP
(1963)
(1948)
Smallpox
Rubella
(1903)
(1969)
OPV
Yellow Fever
IPV
(1926)
(1955)
HepB
(1981)
Mumps
Cervarix
PCV7 (2007)
(2000)
JE
(2010)
(1967)
MMR
(1971)
1920s
1930s
1940s
1950s
1960s
Cholera
(2009)
Hib
(1988)
(1963)
(1948)
BCG
PCV 13
(2009)
FIRST Vx LICENSURE
Gardasil
(2006)
1970s
1980s
1990s
2000s
2010s
2020s
Vaccine Characteristics
• Multinational suppliers targeting low income markets earlier than in past
• Prices >$3.00 per dose becoming the norm
• Different product profiles for vaccines targeting the same disease
7
Health Systems Investments (2000 – 2010)
BMGF
established
Building Blocks of a Highly Functional Health System*
CCL training modules
Medical Products,
Vaccines, and
Technologies
WHO standardized
immunization schedules
Health
Information
System
WHO PQ
established
Equipment
info sheets
FSP
rollout
TechNet
e-Forum
Health
Financing
Effective Vx
Stores Mgmt
rollout
GAVI
ISS
WHO GAG
established
TechNet
established
EPI
introduced
PAHO
Revolving Fund
established
GPV
established
Effective Vx
Mgmt rollout
cMYP
rollout
VMA
rollout
Health
Service Delivery
Leadership and
Governance
WHO PQS devices
and equip specs
Joint statement
on AD syringes
VVMs
available
CCEM
rollout
Project
Optimize
initiated
GAVI
HSS
VPPAG
established
SAGE
established
UNICEF Vaccine
Independence Initiative
established
UNICEF includes
VVMs in tender &
bundles AD syringe
for each dose
IPAC
established
CCL
Task Force
established
GAVI Alliance
established
Health
Workforce
Global Health
Workforce Alliance
created
1980
1985
1990
* Everybody’s Business: Strengthening Health System's to Improve Health Outcomes,
WHO’s Framework for Action, 2007
1995
2000
2005
2010
8
Investment = Impact (2000-2010)
Average % Vaccine Coverage Rates in Low
& Lower Middle Income Countries
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2000
2001
2002
2003
BCG
2004
DTP3
*2009 and 2010 forecasted data for Pol3 not available
2005
MCV
2006
2007
2008
2009
2010
Pol3
8
9
Vaccine Landscape (2000 – 2019)
Malaria
(~2014-2016)
HPV
(2006)
Measles
(1963)
DTP
(1948)
Smallpox
(1903)
DTP-HepB+Hib
Pentavalent
Vaccine
(1998)
Rubella
(1969)
OPV
(1963)
Yellow Fever
(1948)
BCG
(1926)
IPV
(1955)
1930s
1940s
1950s
HepB
(1981)
Mumps
(1967)
1960s
Rota
(2006)
MenA
(2009)
Hib
(1988)
Pneumo
(2000)
1970s
1920 – 1939:
1940 – 1959:
1960 – 1979:
1980 – 1999:
2000 – 2019:
Cholera
(2009)
Typhoid
Conjugate
(~2013)
Dengue
(~2015-2016)
rBCG
(~2014-2018)
JE
(2010)
MMR
(1971)
1920s
Shigella
(~2011-2015)
Typhoid
PS
(2011)
1980s
1990s
1 vaccine
3 vaccines
4 vaccines
3 vaccines
>13 vaccines
2000s
FIRST Vx LICENSURE
Rabies
(1880s)
Leishmaniasis
(~2016-2018)
ETEC
(~2013-2016)
2010s
2020s
9
10
New Vaccine Characteristics
Characteristic
Change
Implication
Price
Many have higher costs
(> $10/treatment)
Impacts affordability &
vaccination sustainability
Presentation
Many have smaller vial sizes
(1-2 dose vials)
Minimizes vaccine wastage,
increases cold chain needs
& waste disposal costs
Target
Population
Birth Doses, Infants,
Adolescents, & Adults
More vaccines delivered
outside the EPI system
Vaccination
Strategy
Routine + catch-up,
mass campaigns,
school-based routine,
school-based mass campaigns
Significant immunization
logistics implications
Product
Profile
Not all vaccines the same – differ by
dose schedule, serotypes, route of
administration, preservative use
Country preferences become
a greater factor, immunization
logistics need to be managed
More interventions available at the same
time than ever before
Country decision-making in face
of much greater complexity
(which disease, which product,
what timeframe, what trade-offs)
Intervention
Portfolio
11
CURRENT VACCINE LANDSCAPE
BCG
rBCG
YF
Currently
At Scale
Lower
priced IPV
OPV
MCV
Hexavalent
DTwP-HepB-Hib-IPV
Td / TT
DTP-HepB
Hib
Being
Scaled Up
Pneumo
Pneumo
Pneumo
(conjugates)
(common protein)
(Killed whole cell)
Pneumo
Rotavirus
Rotavirus Rotavirus
(116E)
(BRV)
MenA
Cholera
JE
Waiting for
Scale Up
Typhoid
HPV
conjugate
Typhoid
Flu
(Lentigen)
Malaria
(RTS,S)
BCG Boost
Currently
Under
Development
ETEC
Leishmaniasis
Shigella
Hookworm
Dengue
Licensed or WHO PQ’d prior to 2011
2011
2012
2013
2014
2015
11
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025