1 / 35

The Intersection of Economics and Access: Sustainability Issues

The Intersection of Economics and Access: Sustainability Issues. Andrew Farlow University of Oxford Oxford Conference on Innovation and Technological Transfer for Global Health 9 th -13 th September 2007. Overview of Session. Sustainable infrastructure and human resources

dhartfield
Download Presentation

The Intersection of Economics and Access: Sustainability Issues

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Intersection of Economics and Access:Sustainability Issues Andrew FarlowUniversity of Oxford Oxford Conference on Innovation and Technological Transfer for Global Health9th-13th September 2007

  2. Overview of Session • Sustainable infrastructure and human resources • Sustainability of vaccine programs • Sustainability of global health funding • Power from the bottom to drive sustainability?

  3. HIV/AIDS Reverses Life Expectancy Source: United Nations Population Division, World Population Prospects (2004 Revision)

  4. Projections of Future Burden due to HIV/AIDS

  5. Capital Flight at its Peak… Now the problem is human brain drain and depletion of human resources… With severe consequences…

  6. Infrastructure: Health WorkersDistribution of health workers by level of health expenditure and burden of disease Source: WHO World Health Report (2006)

  7. Infrastructure: Health WorkersCountries with a critical shortage of health service providers (doctors, nurses and midwives) Source: WHO World Health Report (2006)

  8. Infrastructure: Consequences for Maternal Mortality Source: WHO “The World Health Report 2005 – make every mother and child count” (2005) http://www.who.int/whr/2005/chap1-en.pdf

  9. Maternal Mortality per 100 000 Live Births in 2000 Source: WHO “The World Health Report 2005 – make every mother and child count” (2005) http://www.who.int/whr/2005/chap1-en.pdf

  10. Sustainable Vaccine Programs?Countries with DTP3 Coverage < 50% 1990 DTP3 coverage < 50% (19 countries) 2000 DTP3 coverage < 50% (20 countries) 2004 DTP3 coverage < 50% (10 countries) Source: WHO/UNICEF estimates, 2005 192 WHO Member States. Data as of September 2005

  11. Hib Vaccine and Hib3 Coverage 1997: 26 countries introduced Hib vaccine introduced but no coverage data reported (26 countries) Hib vaccine not introduced (166 countries) 2004: 92 countries introduced in infant immunization schedule Hib3 > 80% (78 countries or 41%) Hib3 < 80% (12 countries or 6% ) Hib vaccine introduced in part of the country (2 countries or 1% ) Hib vaccine not introduced (100 countries or 52% ) Source: WHO/UNICEF estimates, 2005192 WHO Member States. Data as of September 2005

  12. $35.0 HepB DTP+HepB+Hib DTP+HepB (mono) $30.0 $25.0 $20.0 Non-Vaccine Costs $15.0 New/Underused Vaccines (HepB; Hib; YF) $10.0 Traditional Vaccines (BCG; DTP; Measles; Polio) $5.0 $- Mali Haiti Kenya Ghana Zambia Burundi Uganda Gambia Vietnam Rwanda Tanzania Lao PDR Tajikistan Kyrgyzstan Cambodia Uzbekistan Côte d'Ivoire Madagascar Mozambique Burkina Faso Cost / Fully Immunized Child Avg. Resource Requirements per DTP3 Targeted Child (Total Period)

  13. Estimated DeathsSaved by Vaccination

  14. EPI Coverage, Select Countries

  15. 27 Million Children Still Not Vaccinated (DTP3 2003a)

  16. Sustainability:Global Fund Requirements to 2010 for TB, Malaria, HIV/AIDS Source: The Global Fund “Partners in Impact Progress Report” (2007) http://www.theglobalfund.org/en/files/about/replenishment/oslo/Progress%20Report.pdf

  17. Vaccine Funding 2005-15 18.0 New Vaccines Existing Vaccines Billions required to achieve targeted €vaccine programs over 10 yr. period. 8.5 3.4 2.7 1.4 0.9 UK Germany Poland Mexico Thailand GAVI A prospective analysis in UK, Germany, Poland, Mexico, Thailand - Smart Pharma Consulting

  18. Financial Sustainability • GAVI: “Although self-sufficiency is the ultimate goal, in the nearer term, sustainable financing is the ability of a country to mobilize and efficiently use domestic and supplementary external resources on a reliable basis to achieve target levels of immunization performance.”

  19. Phasing in… • 5 year Vaccine Fund commitment extended over 8 year phase • Countries will be notified of 5 year Vaccine Fund commitment Investments in Immunization program

  20. Meeting the Resource Gap Immunization Program Financing

  21. Future Resource Requirements, Financing & Gaps $250 $200 Gap $150 Other Bilaterals Multilaterals GAVI Government $100 $50 $- Pre-VF Year VF Year 2004 2005 2006 2007 2008

  22. Financial Sustainability ‘Innovative’ Financing Mechanisms • Global Alliance for Vaccines & Immunization • The Vaccine Fund • Advanced Development & Introduction Plans • International Finance Facility for Immunization • Other Funding Mechanisms • PAHO Revolving Fund • Vaccine Independence Initiative • ARIVAS (Appui au Renforcement de l’independence Vaccinal en Afrique Sub-Saharien ) • ‘Advance Market Commitments’/prize funds GAVI, IFFIm, and prize funds $5bn-$10bn 2006-2010

  23. 1. What is the IFFIm? • An IFF for immunization (IFFIm) has been proposed as a pilot for the IFF mechanism in general • IFF a large-scale US$50-75 billion per year mechanism to double global aid and help meet the MDGs • On September 9th 2006 the IFFIm was launched in London with the five donors - UK, France, Italy, Spain, and Sweden: now Norway and Brazil have announced contribution as well; South Africa is considering a contribution • Estimated disbursable of $3.2 billion before 2015 • Ongoing effort to secure resources from additional donors to reach $4 (now $6) billion resource goal • First bond issuance took place late 2006

  24. $700 Over 2005-15, 5.3 million under 5 deaths and an additional 5 million adult deaths could be prevented $600 New and under-used vaccines: $1.9 b $500 Systems support for new vaccine introduction: $290m US$ (millions) $400 Mortality reduction campaigns: $515m $300 $200 Funds for services strengthening: $1.1b $100 Polio stockpile: $175m 2010 2015 2005 2006 2007 2008 2009 2011 2012 2013 2014 International Finance Facility for Immunization • IFFIm will raise additional funds for GAVI programs • Pilot of the UK-sponsored International Finance Facility to frontload immunization financing over 10 years • $4 billion borrowed from the capital markets in the form of bonds

  25. The IFF: Donor Pledges Disbursements (to programs) Pledges from Donors Spare cash – “cushion”

  26. Implications of the IFFIm • Influencing the market • Long-term predictable commitments allow longer-term planning for supply strategy • Increased industry capacity and lower vaccine prices • Better planning and sustainability for countries • Commitments can be made to countries over longer-term allowing for better integration within national planning cycles and longer lead time to plan for country financing and eventual sustainability

  27. Implications of the IFFIm • Additional financing & donors • Countries not previously contributing to GAVI attracted • Accelerating coverage of immunization with traditional and new and under-used vaccines • But: • Transaction costs have proved much higher than expected (not per se negative, but must be factored in) • It has to be repaid, and will phase out at a later date • How will funding be sustained if still needed?

  28. Price declines over time Marginal cost Prizes: Previous Vaccine Prices Price pays for R&D Quantity(& time)

  29. sponsorsguarantee to top upprice developing countriesbuy at lowprice sponsors top upthe price for a maximum numberof treatments Prize: Two Stage Pricing Guaranteedfirst stage price Price In return, firms obliged to sell at lowerlong run price $(x)bntotalmarket Marginal cost Quantity(& time)

  30. Some Issues Though • No Simple one-off vaccine solution, • Can’t have a quantity guarantee • Must allow less exhaustive technical standards • Firms must face demand risk? • How to set right? • How to make credible and avoid time inconsistency • Still need to keep pressure on affordability • If a package of measures, how to use a ‘prize’ for one of them? • What about all those ‘on-the-ground’ infrastructure failures? • How to fit in with the typical ‘philosophy’ of PDPs?

  31. Pneumococcal Vaccine Pipeline:Recent Developments Pre-clinical stage Clinical trial Phase I Clinical trial Phase II Clinical trial Phase III Launched Development Stage Multi-national 13-valent 9-valent Prevnar (7-valent) ~20 vaccines in research/ Pre-clinical stage (includes conjugate & protein-based vaccines) Steptorix1 10-valent Expected launch 2008 11-valent 7-valent Emerging suppliers >5 mulit-valent conjugate vaccine projects Discontinued 1Completed first Phase III trial; results announced in Jun05 Source: BCG Global Supply Strategy 2005 PneumoADIP team analysis

  32. Projected Impact from Accelerated Pneumococcal Vaccination 3.9 million child deaths prevented by 2025 5.4 million by 2030

  33. Strategic Demand Financing Requirements US$ millions

  34. However… • According to key sponsor files, most resources are gone by 2015 • Leaving 98% of total burden out to 2030 • Follow on vaccines • Capacity risks • Cost of goods • Packaging issues in first round countries • Costs of sustaining first round countries

  35. THANK YOUComments and feedbackalways welcome:andrew.farlow@sbs.ox.ac.uk

More Related