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Immunization

Vaccine purchasing

next Stephen Jarrett, Deputy Director, UNICEF Supply Division

Q: What is UNICEF’s role in purchasing vaccines?

Jarrett: UNICEF has been buying vaccines since the 1950s. We started with Bacille Calmette-Guérin (BCG), an anti-tuberculosis vaccine. Today, we act as a bulk purchaser for about 70 low-income countries, delivering 40 per cent of the demand for global vaccines in the poorest countries.

The growth over the last few years has been just phenomenal. In 1980 we spent only about $5 million on vaccines. In 2002 we spent $220 million (40 per cent of our supply budget of $620 million) on vaccines. So they are by far our most important commodities.

Q: How are vaccines produced and regulated?

Jarrett: Vaccines are extraordinarily complex products, traditionally produced through fermentation processes. Today vaccines are being produced increasingly through new technologies that don’t require fermentation. However, the bottom line is that most vaccines require one or two years to produce.

The vaccines are produced in bulk, usually about 3 million doses, and the batches are then tested. They are then filled and labelled in vials, which are also tested. We have very thorough regulation of vaccines. The World Health Organization (WHO) has a clear mandate in terms of the quality control of both vaccines and manufacturers. We only buy vaccines from WHO pre-qualified manufacturers.

Q: How does UNICEF determine the availability and need for vaccines each year?

Jarrett: Because of the long production process, we are actually working with the manufacturers to track their batches of vaccines and predicting when they are coming online. Thus, when countries ask for vaccines, we know of the availability and we know if we can match the request. 

Furthermore, every three years we put together a three-year forecast for vaccines and we spend time with the manufacturers alerting them to these forecasts. Then for the current year, these forecasts are revised on a monthly basis and communicated to the manufacturers. The forecasts of individual countries are only between 30 and 60 per cent accurate, whereas our overall forecast is 80 per cent accurate. This allows us to be a pretty sound buyer of vaccines for developing countries. We are also available to help about 25 middle-income countries that are having trouble arranging their own supply.

Q: How does a vaccine get from the manufacturer to a child?

Jarrett: We do not stock vaccines. All of our vaccines are produced in highly-sophisticated facilities around the world and then air-shipped directly by manufacturers. All vaccines need to be kept under temperature control in dry iceboxes. By the time they leave a factory anywhere in the world, they have to be back in a cold store in a country within 72 hours.

Those cold stores are normally at the airport or in the capital city.  Many of the countries we ship to do not have direct flights from the manufacturers, so we have many shipments moving from one plane to another. It demands a very precise operation from a logistics point of view. After 72 hours or so, once that dry ice starts to wear off, we run the risk of vaccines failing.

Q: What are the challenges UNICEF faces as a major vaccine supplier?

Jarrett: In addition to guaranteeing supply and maintaining the cold chain, one of the main challenges is to get manufacturers to sell vaccines at favourable prices. The cost of delivering a full course of vaccines to a single child is $5, of which $4.50 goes to wages, refrigerators, cold chain maintenance and transport. The cost of the vaccine is a mere 50 cents. UNICEF has traditionally paid low prices for vaccines because other buyers, mainly industrialized countries, have covered production costs, including the recovery of costs related to research, development and start-up capacities.

However, these low prices can exist only in the presence of differential pricing in which other buyers, mainly industrialized countries, pay significantly higher prices for the same vaccines. The problem is that, over the last five to six years, industrialized countries have begun to use different vaccines than those used in developing countries. We have already had several temporary vaccine shortages and it seems to be becoming a global problem.

Expert Opinion: Vaccine shortages