Price, quality, a healthy market and ensuring injection safety for children have driven a decade of market shaping efforts around auto-disable (AD) syringes. These efforts culminated in 2009 with a more healthy supplier base and prices falling below five cents per unit for the first time.
In 1999, with the goal of preventing the transfer of blood-borne diseases such as HIV/ AIDS and hepatitis B and C, the World Health Organization (WHO), UNICEF and the United Nations Population Fund (UNFPA) developed a policy on injection safety. The policy was designed to sensitise the market to a shift toward safer injection devices with the goal of phasing out the use of non-AD syringes and syringe sterilisation by 2003. At the time, there was almost a monopoly situation in the AD syringe market, with prices several times higher than regular disposable syringes.
Simultaneously, greater awareness around the need for injection safety led to increasing demand for the devices, supported by Global Alliance for Vaccines and Immunization (GAVI) who became a funding vehicle for governments to buy AD syringes. The need for a healthy market was paramount - to ensure a sustainable supply over the long term which could meet the increasing global demand and drive prices down. UNICEF communicated its goal to achieve a more balanced market to several stakeholders, encouraging current smaller suppliers to increase their production capacity to obtain economy of scale, while at the same time not guaranteeing that UNICEF would buy their products. In 2005, a recognised industry standard for AD syringes was introduced.
In the 2005, 2007 and 2009 tender processes UNICEF signalled to industry its preference for devices with early activation (disabling mechanism activated before full dose is administered). This preference was considered part of the evaluation of the 2009 tender. The tender outcome resulted in the price dipping below five cents per syringe.
From a healthy market perspective the tender resulted in one new supplier entering the market and three new products added. It means more children can be safely vaccinated than before due to the price reduction, and from a sustainability perspective, three of the long term arrangement products are smaller therefore reducing waste.