Price transparency is a step towards sustainable access in middle income countries

Cernuschi, Tania; Gilchrist, Shawn; Hajizada, Adnan; Malhame, Melissa; Mariat, Stephanie; Widmyer, Greg

doi:10.1136/bmj.l5375

Cited by 12 publications

(11 citation statements)

References 6 publications

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“…While extensive missing data preclude tests for correlation, these findings suggest that, even for these relatively affluent countries, affordability remains a barrier for HPV, but not measles vaccine; it is notable that the cost of one dose of quadrivalent HPV vaccine to UMICs is estimated at around US$15 compared with US$0.69 for one dose of measles vaccine. 48 …”

Section: Discussionmentioning

confidence: 99%

Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

Spayne

Hesketh

2021

BMJ Open

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BackgroundMortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies.ObjectivesThe aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls.DesignThis study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated.ResultsIncidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs.ConclusionsCountries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.

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Section: Discussionmentioning

confidence: 99%

Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

Spayne

Hesketh

2021

BMJ Open

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“…Some countries have already committed to publicly procuring additional doses for booster vaccinations potentially needed later this year,2930 which may help mitigate price increases. However, companies may still raise prices, as has been seen previously in high income countries during government procurement of influenza vaccines 31. Another possibility is that countries with smaller populations may be able to negotiate lower prices by sourcing from one or two companies rather than relying on multiple manufacturers to provide adequate supply.…”

Section: Achieving Fair Pricingmentioning

confidence: 98%

“…However, companies may still raise prices, as has been seen previously in high income countries during government procurement of influenza vaccines. 31 Another possibility is that countries with smaller populations may be able to negotiate lower prices by sourcing from one or two companies rather than relying on multiple manufacturers to provide adequate supply.…”

Section: Achieving Fair Pricingmentioning

confidence: 99%

Future of covid-19 vaccine pricing: lessons from influenza

Ramachandran

Dhodapkar

Ross

et al. 2021

BMJ

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“…Understanding the market and prices for vaccines provides countries with better leverage in procurement negotiations and can inform policies of international development agencies (Cernuschi et al 2020). In 2014 WHO launched the vaccine product, price, and procurement initiative, referred to as Market Information for to Vaccines (MI4A).…”

Section: Levers To Increase Market Informationmentioning

confidence: 99%

“…This aimed to improve vaccine price transparency and therefore support country immunisation planning and budgeting, price negotiation, and, ultimately, improve access to vaccines. The study by Cernuschi et al (2020) shows the importance of price transparency for fair and lower vaccine prices and understanding market trends on which countries and industries can respond. As the study concludes, there are no obvious signs from the MI4A data that either vaccine availability or prices are negatively affected by greater transparency.…”

Section: Levers To Increase Market Informationmentioning

confidence: 99%

Lessons Learned from Market Shaping Interventions to Stimulate Vaccine Production in LMIC

Quak¹

2021

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This rapid review synthesises the literature from academic, policy, and knowledge institution sources on the lessons learned on how market shaping tools can be used to stimulate vaccine production in low- and middle-income countries (LMICs) with a focus on Africa. The purpose is to learn from these interventions in the context of shaping the vaccine markets in Africa to become less dependent on imports and to stimulate local production of vaccines. The rapid review concludes that it is the combination of market shaping tools (supply and demand sides) with efforts to mobilise resources and a clear industrial policy and strategy with long-term political commitment that is needed to develop fully integrated vaccine facilities in LMICs at the national and regional levels. These facilities or “vaccine manufacturing networks” in LMICs, particularly in Africa, need to sell below their production cost for many years after entering the market. This is because they compete within well-established global vaccine markets to which the low-income countries have access through pooled procurement mechanisms. This means that governments in low-income countries have arguably good access to affordable but imported vaccines while needing heavy investment and subsidies to develop competitive vaccine manufacturers. The literature on market-shaping is mainly conceptual without mentioning much empirical evidence. It has a bias on firms and presumes firm strategies to shape markets for their own benefit. The literature often underestimates the role that governments play in shaping markets. As such, this rapid review relies on other sources to investigate the interventions by governments to shape markets and how donors could support these governments in their efforts.

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Price transparency is a step towards sustainable access in middle income countries

Abstract: Tania Cernuschi and colleagues show how information from the Market Information for Access to Vaccines database is strengthening the ability of middle income countries to negotiate with vaccine producers

Cited by 12 publications

References 6 publications

Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

Future of covid-19 vaccine pricing: lessons from influenza

Lessons Learned from Market Shaping Interventions to Stimulate Vaccine Production in LMIC

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