[Ip-health] PAHO Revolving Fund for Vaccines & GAVI

[judit.rius@keionline.org]

Find below a Financial Times article published this week on the PAHO
Revolving Fund for Vaccines that is getting it wrong. The issue is going
to be discussed tomorrow Thursday at the PAHO Executive Committee.

Instead of criticizing the PAHO Revolving Fund for Vaccines, the article
should have recognized its more than 30 years of success in strengthening
Latin American and Caribbean capacity to extent immunization and
recommended other regions of the world to explore similar mechanisms to
collectively negotiate better prices for vaccines.

The article is trying to create a confrontation between the African and
the Latin American and Caribbean countries by defending the GAVI/GATES
tier-pricing and donation model that would apply to only 6 Latin American
countries, it does not take in consideration income inequalities within
countries, and has important problems of sustainability.

Yesterday during a side event about the revolving fund, the PAHO Director
General Dr. Mirta Roses, made a powerful intervention emphasizing the
importance of national ownership and the competitive supply of vaccines.
And defined the PAHO approach as one of public health where everyone
should be able to receive vaccination.

During the side event on the PAHO revolving fund, the World Bank presented
on the AMC pilot for pneumo vaccine and explained that the current pilot
is not an incentive mechanisms for new vaccines but a subsidy to vaccine
manufacturers to scale-up production.

An excellent evaluation of the AMC pilot was made by MSF a few days ago
here:
http://www.msfaccess.org/media-room/press-releases/press-release-detail/?tx=
_ttnews[tt_news]=3D1550&cHash=3D98b6e0c55d

The PAHO Director General made again a very substantive intervention about
AMCs and asked for a study to assess the impact of AMC in countries that
do not meet GAVI eligibility criteria.  PAHO DG made reference to an
intervention by the Ambassador of Bolivia in Geneva where important
questions about the GAVI model were raised.

The GAVI representative said that the AMC model is not in competition with
innovative incentive mechanisms that promote competitive supply like
innovation inducement prizes. Hopefully this will be the beginning of a
long needed discussion on innovative financing and incentive mechanisms
for the Latin America and Caribbean countries at the PAHO region in the
regional implementation of the WHO Global Strategy and Plan of Action on
Public Health, Innovation and Intellectual Property.

FINANCIAL TIMES ARTICLE

Vaccine system hampers African efforts
By Andrew Jack in London
Published: June 22 2009 16:46
Source:
http://www.ft.com/cms/s/0/1fef88b8-5f48-11de-93d1-00144feabdc0.html?nclick_=
check=3D1

Efforts to make newer and more costly vaccines widely available to the
poorest in Africa are being hampered by a long-standing system that makes
vaccines affordable to middle-income Latin American countries.

The board of the Pan American Health Organisation will this week discuss
its =93revolving fund=94 for vaccine purchases as concerns mount that it
deters manufacturers from offering deeper discounts on such products to
the world=92s least developed countries.

Disagreement between the organisation and the Geneva-based Global Alliance
on Vaccines and Immunisations (Gavi), established by government donors to
accelerate use among the poorest, has already delayed wider use of certain
vaccines.

The revolving fund, which began in 1979, negotiates substantial discounts
with manufacturers on prices in richer countries, offering in exchange
significant volumes, predictable demand and funding.

However, it includes a clause demanding that the vaccines are made
available at the =93lowest possible price=94 charged anywhere in the world,
making it impossible for producers to propose still lower prices to poorer
countries.

The principle has come into increasing conflict with efforts by
manufacturers of recently launched vaccines to meet international demands
for access to the poor through =93tiered=94 pricing tied to local incomes.

Like the makers of anti-retroviral therapies for HIV, companies have been
increasingly willing to offer discounts on western prices to poorer
countries.

But they want richer countries to pay more in line with income levels to
help support access to the poorest as well as research for future
products.

Tension emerged last year over Wyeth=92s vaccine against pneumonia and
meningitis, which was offered to the revolving fund at $26 a dose, less
than a third of its price in richer countries.

However, the fund=92s demand for the lowest possible price clashes with
negotiations at $7 a dose for countries served by Gavi =96 with gross
national income less than $1,000 a head.

GlaxoSmithKline, which has developed a rival vaccine, has yet to commit to
a Gavi deal because it also wants to charge more in Latin America.

Tensions will increase as talks advance on other high-priced new vaccines.