Fact Sheet Expert Opinion First Person Photo Essay


Vaccine shortages

next Stephen Jarrett, Deputy Director, UNICEF Supply Division

Q: Why has vaccine supply become a critical issue for UNICEF?

Jarrett: We are extraordinarily concerned about the future of vaccine supply. UNICEF meets around 40 per cent of the global demand for children’s vaccines. In 2002, UNICEF procured over 2 billion doses of vaccine for nearly 100 developing countries. We have already had several temporary vaccine shortages and it seems to be becoming a global problem.

Q: How has this vaccine shortage occurred?

Jarrett: One of the reasons is that, in the last five to six years, industrialized countries have begun to use different vaccines than those used in most developing countries. Two examples of this are the vaccines for pertussis (whooping cough) and measles. For example, the price for a dose of combined measles, mumps and rubella vaccine (MMR) can be as high as $28 in the United States, while UNICEF buys a single dose of measles vaccine that costs 10 cents. A third vaccine, Bacille Calmette-Guérin (BCG), which is used for childhood tuberculosis, is no longer being utilized by many industrialized countries because of the relatively low prevalence of the disease. 

The vaccines UNICEF supplies to developing countries are very high quality. All come from producers that have been pre-qualified by WHO. One of the reasons that UNICEF was able to buy vaccines at a competitive price before was because the costs for research and production were largely borne by the industrialized countries.  However, this divergence in the market has reduced the manufacturers' incentive to supply the high-volume markets covered by UNICEF. Now, the number of manufacturers has decreased and the prices for our vaccines are rising.

Q: How has this shortage affected UNICEF’s immunization efforts?

Jarrett:  The major wakeup call for us was the polio vaccine. UNICEF, along with many other partners, has been pursuing the goal of eradicating the wild poliovirus by the year 2005. This is a goal that we have been pursuing for several years and is well on its way to being accomplished. In 1999, the decision was made to dramatically increase immunization activities in 20 endemic countries. This meant that the demand for oral polio vaccine (OPV), which is administrated through a dropper, tripled overnight.

We had large contracts for the polio vaccine, but nowhere near the amount required.  For the first time, the availability of vaccines was determining the eradication activities, with National Immunization Days scheduled according to the release of vaccines. All the programme managers around the world now know that they can’t plan an activity until they have a reality check about the supply of the vaccines.

Q: How is UNICEF responding to this shift?

Jarrett:  The emergence of the poorest countries as a distinct vaccine market has demanded a rethinking by UNICEF of its procurement. As the largest buyer for this market, UNICEF in future must take on a far greater burden in ensuring the predictability and reliability of vaccine supply. There are three ways we are addressing this problem. First, we are trying to enter into much more guaranteed procurement with our major suppliers. This way they can plan ahead, assured of actual purchases by UNICEF. Secondly, in order to have firm contracts with manufacturers, we have to have an assurance of funding. In the past, we were unable to guarantee manufacturers that we were going to purchase vaccines because we had no assurances that funding would be available. Lastly, we have to address the issue of better planning on the ground. We are working very closely with the World Health Organization (WHO) to develop the planning and management skills in developing countries so that we can be assured of the best possible vaccine management once the vaccines reach their destinations.

Q: Why is it necessary to provide such long lead times to manufacturers?

Jarrett:  The production process takes one to two years. It is also difficult to know how much the fermentation process will yield  – there may be impurities, and therefore failures, through the fermentation process. Traditionally UNICEF would be buying 20 to 25 per cent of the vaccine offered to us. When several manufacturers either stopped, or drastically reduced the amount of vaccines they were producing, suddenly we were buying up to 90 per cent of the vaccines available.

This meant that the margin between the vaccines available to us and our consumption was very small, which made us vulnerable.  This is why we are trying to enter into much more binding agreements with manufacturers so that they will feel confident that if they produce the vaccines, we will follow up with our promise to purchase them. In a sense we had asked the manufacturers to take 100 per cent of the risk in terms of vaccine supply.  We are now recognizing that, as a principal purchaser, we have to take on some of that risk.

Q: What is required for UNICEF to enter into these agreements?

Jarrett: At this point in time, we believe it would take $50 million to provide security for the vaccines required in multi-year routine immunization services for the countries we cover. This is the price of the vaccines, which is only five to 10 per cent of the cost of immunizing a child. It is not a huge sum of money, but it is a sum that it is important to have assured several years in advance so that manufacturers will actually make the vaccines. That number does not include the intensive campaign to eradicate polio, which is really a separate requirement. Nor does it include the new vaccines that we are introducing through the Global Alliance for Vaccines and Immunization (GAVI) for which there are substantive resources already available. Our main concern is the daily contact of children with health services to get their traditional vaccines without any interruptions.

Q: How is this shift manifested at the country level?

Jarrett:  Firm contracts will also require accurate planning and forecasting of vaccine demand – combined with improved vaccine management – to ensure maximum usage of the vaccines we purchase. We are working with our immunization partners to help countries plan and predict their needs for vaccines and to improve vaccine management in the field. Wastage is a natural phenomenon in vaccines so we have to take this into account when we are buying. For example, if you have 10 doses in one vial of vaccine and you only have five children coming for immunization, you have to open the vial. If you don’t have more kids that day, then you have to waste the vaccine. You can’t wait for 10 kids to come to open it – the key to immunization is that when a child comes for regular check ups at a health centre, they should be immunized. We have to make sure that even if there is only one child, the vial is open and that child is immunized.

Expert Opinion: vaccine production and purchasing