TT Procured by UNICEF 2001 - 08

1. TT

2. TT Procured by UNICEF 2001 - 08

3. Upcoming Tender Period TT historical demand and forecast overview

4. Trends in TT vaccine offered to UNICEF • Good supplier base but still high dependency on one source • One new supplier obtained WHO prequalification in end 2007, enhancing supply availability and vaccine security

5. Summary • Elimination by 2012 • MNT Investment Case (2007-2009) has given campaigns and routine program a boost. • Funds through IFFIM IC for vaccines are fully utilized • Active fund raising for SIAs beyond 2009 • Routine demand for most part is funded through country financial resources

6. Upcoming Tender Period TT Tender quantities 2010-12

7. MEASLES

8. Measles procured by UNICEF 2001-2008

9. Measles – Procurement Overview & Future demand Upcoming Tender Period • Historically demand has been mainly driven by campaigns • Large catch up campaigns in 2006-07 and some in 2008 • 2009-2010 Quantities do not include potential demand for India SIA

10. Trends in Measles vaccines offered to UNICEF- availability • Drastic reduction in the number of suppliers offering WHO pre-qualified vaccine to UNICEF over the past 10 years • High dependency on one manufacturer • Measles containing vaccines are classified as high priority for WHO PQ

11. Mixed results in terms of affordability Weighted Average Prices for Vaccines BCG –stable demand, 4 suppliers,stable pricing DTP, declining demand, 2 suppliers per presentation, increasing prices TT – growing demand, 4 suppliers, adjusted prices, now stable Measles – growing demand, 3 suppliers, increasing prices

12. Summary… • Global Measles mortality reduction by 74% need to Sustain achievement • Expect stabilized demand with; • Increased routine, including 2 dose as per SAGE recommendation, will add to routine demand. • Sustained follow-up campaigns, intervals based on 1st dose coverage, but average every 3 years * Both posing future funding challenges for countries • Measles campaign is often use as the main vehicle for integrated campaigns • Continued monovalent measles vaccine supply needed in the future

13. Upcoming Tender Period Measles Tender quantities 2010-12

14. MMR

15. Upcoming Tender Period MMR Historical demand and forecast overview • The main increase in 2009-12 demand is for 1 one country, introducing MMR in their routine program as of 2009, therefore demand picture can change substantially • Increased quantity only partially due to MR campaigns in 2007

16. Summary • Very limited availability / long lead-time for unplanned demand • Countries are strain aware / sensitive • There is strong strain preference from countries • At times the preference been influenced / diverted based on price and availability • Large price differences between different products • Limited sustainable external funding available – countries need to include in their own budget • The projection / scenario for MR will not impact the MMR demand

17. Upcoming Tender Period MMR Tender quantities 2010-12

18. MR

19. MR – Procurement Overview - Future Upcoming Tender Period • Currently 2 WHO pre-qualified suppliers, high dependency on one • Substantial portion of the demand in 2009 is for one country campaign

20. Upcoming Tender Period MR Tender quantities 2010-12

21. Future of MR vaccine? • June, 2008: Rubella as part of GAVI investment strategy introduced to GAVI the Board (for endorsement, not financial decision) • Rubella: cause of congenital rubella syndrome (CRS) when infected in early pregnancy • It is estimated that there are 110,000 cases of CRS each year and poses high disease burden on poorest countries

22. Future of MR vaccine? • October, 2008: Rubella part of the portfolio for GAVI to consider for future investments (HPV, JE, Rubella, Typhoid) at the October 08 Board • Mindful of the current financial environment, the Board deferred any financial commitment related to the vaccine investment strategy for further review

23. MR VACCINE DEMAND GIVEN INTEGRATED ADOPTION FORECAST Rapid Impact * Source: Applied Strategy – Oct 27, 2008 http://www.gavialliance.org/vision/strategy/vaccine_investment/index.php

24. MR INTEGRATED ADOPTION FORECAST Vaccine Need: 72 VISP Scope: 46* Bangladesh Bhutan Cambodia Haiti India Mongolia Nepal Solomon Is Tajikistan Viet Nam Lesotho Mali Mozambique PNG Tanzania Timor-Leste Zimbabwe Eritrea Ghana Pakistan Rwanda São Tomé and Principe Uganda Benin Burkina Faso Kenya Niger Senegal Togo Indonesia Korea, DPR Myanmar Yemen Cameroon Congo, DR Côte d'Ivoire Gambia Congo, Rep. Guinea Sierra Leone Afghanistan Comoros Malawi Zambia Burundi Djibouti * 14 GAVI countries have already adopted rubella; 12 are not expected to be eligible based on projected MCV coverage rates < 80% through 2020 * Source: Applied Strategy – Oct 27, 2008

25. A Possiblescenario for MR introduction through catch up campaigns…: 2013 - 18 • Assumptions: • Delay the introduction by 3 years compared to rapid impact plan • Total 300 mil ds for 2013 - 2018 • Distribute quantities throughout 5-6 years

26. Total tender quantities of Measles containing vaccines 2010 – 12

27. UNICEF VACCINES • Thank You