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Supplies and Logistics

Q and A: Information on constrained Yellow Fever vaccine market

 May 2016

Summary:  Yellow fever (YF) is a mosquito-borne disease that is endemic in a band of countries in Central, West and East Africa, as well as in the South and Central Americas region. More information on the disease, the vaccine and recent outbreak information can be found here: http://www.who.int/csr/disease/yellowfev/en/ 

Yellow fever vaccine (YFV) is effective in preventing YF. UNICEF procures YFV for use in routine immunization programmes, preventive campaigns, and in outbreak response. In response to an outbreak in Angola, which has claimed over 200 lives since December 2015, the global YFV emergency stockpile has been depleted.  Cases of returning travellers to other countries, for example, China, DRC, Kenya, Mauritania and Morocco, have heightened concern that the outbreak will spread. International attention is focused on mitigating the YFV shortage, and its potential negative impact.

Further information and guidance can be found in the WHO WER no. 14, 2016.91: http://www.who.int/wer/2016/wer9114.pdf?ua=1

How much YFV does UNICEF procure? 
UNICEF procures about 34 million YFV doses per year. UNICEF has long-term arrangements (LTAs) with four manufacturers to cover vaccine requirements for emergency stockpile, routine programme requirements and preventive campaigns. During 2014, UNICEF made additional awards to two manufacturers, increasing 2014-2017 total awarded supply from ~78 million to 135.5 million doses. However, supply is still insufficient to meet the increased demand. 

Has demand for UNICEF-procured YFV changed in 2016?  
Due to ongoing outbreak of YF and the heightened risk of this outbreak spreading to other countries, 2016 forecasted demand has grown by 27% (percent) compared to the forecast at the beginning of the year.

How will UNICEF prioritize existing supply of YFV?
In light of the above-mentioned, the YF Partnership (WHO/UNICEF/CDC/GAVI) has resolved to prioritise the immediate outbreak response and to replenish the emergency stockpile that would be available if other outbreaks were to occur. At this point in time, timing and quantities allocated to YFV supply to routine immunization programmes will be minimized, at the same time preventing country stock outs and interruption of EPI programmes. Supply to preventive campaigns will be temporally suspended.  Close collaboration and coordination between WHO, UNICEF and countries that depend on UNICEF-procured commodities is essential to minimize uncertainties in planning and disruptions and to national immunization programme delivery.

What steps are taken to avoid disruptions to routine immunization programmes?   
UNICEF’s programme partners, led by the World Health Organization (WHO), have agreed that countries that receive UNICEF-procured YFV will receive enough supply to prevent stock-outs at country level. Countries will receive shipments one month prior to vaccine stocks are depleted. Such shipments will include enough supply to cover two-month use. While deliveries to countries will be more frequent, quantities will be reduced. This will free remaining vaccines supply for replenishing the global emergency stockpile.

Why can’t UNICEF simply buy more YFV? 
UNICEF procures YFV only from suppliers whose vaccines have been prequalified by WHO. Prequalification assures countries and UNICEF that the vaccine meets WHO-prescribed international standards for quality and safety. Currently there are four suppliers of prequalified YFV. When forecasted demand is as high as it is at the moment, UNICEF procures the entire quantity being made available that meets WHO pre-qualification standards.

How long may the current YVF supply restriction last?
It is difficult to predict, and will depend how long the current epidemic will continue. In consultation with manufactures, and barring occurrence of more outbreaks, UNICEF believes that supply will return to normal during 2nd half of 2016.

What is UNICEF and partners doing to overcome the shortage of YFV supply? 
Achieving vaccine security is the goal of UNICEF’s vaccine procurement strategy. A sustainable, uninterrupted supply of affordable YFV of assured quality is dependent on many factors which UNICEF, along with other international health partners and organizations, works hard to influence positively.  UNICEF is working very closely with manufacturers of prequalified vaccine to procure any remaining stocks and to encourage increased production, while WHO, the Bill and Melinda Gates Foundation and PATH are working with the current four manufacturers to facilitate increased production capacity.

What does YFV cost?
UNICEF-procured YFV weighted average price (WAP) per dose has increased by 7% per year on average since 2001, from ~$0.39 to ~$1.04 in 2015. UNICEF anticipates a near-term YFV WAP per dose of ~$1.10.

Who pays for UNICEF-procured vaccine?
Funding for UNICEF-procured YFV comes from different sources, including:
• Gavi the Vaccine Alliance (Gavi) provides funding for Gavi eligible countries, 
• ICG revolving fund,
• the World Health Organization (WHO)’s emergency contingency  funding, and/or
• national budgets of receiving governments.

Where can national health authorities get more information on their current Yellow Fever vaccine orders? 
National health procurement authorities who have ordered Yellow Fever vaccines through UNICEF in 2016 should contact their UNICEF Health or Procurement Services focal point in the relevant Country Office for more specific information on the status of shipments. UNICEF market analyses of supply and demand are available on https://www.unicef.org/supply/index_54214.html and an updated note on YFV will be available early May 2016.



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