6_Dr Pillay_Experience from South Africa

PRESENTATION TO THE MSF VACCINE MEETING YOGAN PILLAY, DEPARTMENT OF HEALTH, SOUTH AFRICA OSLO 15 OCTOBER 2013

EPI Schedule

HPV in 2014

2

RSA EPI Vaccine Annual Requirement Annual requirements in doses 3 514 800 2 240 400 4 000 000 2 000 000

Value contribution to EPI budget 1% 1% 34% 10%

Pneumo

3 000 000

36%

Hep B OPV Measles BCG HPV (in 2014)

3 924 520 4 580 500 5 449 000 6 389 000 1 000 000

1% 3% 4% 1% 10%

Doses per annum

36 235 061

Vaccine TT Td DTaP-Hib-IPV Rotavirus

3

Annual spend on vaccines • • • • • •

Total: R1.7b EPI: R1.4b Non EPI: R80m Private sector: R250m Total annual public sector exp: R100b Total annual private sector exp: R100b

4

Supply issues Vaccine

Supply Issues

No of registered products in SA

Source

TT

Generally ok

Sanofi ( France)

1 (Biovac filing for registration in 2014)

Td

Generally ok

Sanofi ( France)

1

DTaP-Hib-IPV

Had issues in 2012 but 2013 smooth

Sanofi (France)

1

Rotavirus

Had issues in 2011 but 2012+2013 ok

GSK ( Belgium)

2

Pneumo

No issues

Pfizer ( USA & Ireland))

2

Heber ( Cuba)

3

Sanofi (France)

1

Sanofi( France)

1 (Biovac hoping to have a registered one in 2014)

Hep B OPV Measles

Quality issues in 2013 Will hopefully be resolved by end 2013 Worlwide demand and campaigns has affected supply to SA in 2013 Worlwide demand and campaigns has affected supply to SA

BCG

Slight supply issues in early 2013, not major.

SSI ( Denmark)

1

HPV

N/A

GSK

2 5

Differences between comparison of PAHO + UNICEF vs SA SA

PAHO + UNICEF

Decision making

Independent, DoH+ NAGI

General.

Supranational organisations: WHO ,SAGE,GAVI ,BMGF play a huge role

volumes

lower

Much larger

Presentation of product

SA specific packs

International pack

Payment

Biovac collects 60days after delivery

Upfront payment before deliveries are made

Price

Public sector prices (Biovac to DoH) c are all inclusive of deliveries to the customer and included in the prices that are in the ‘public’ domain

Prices typically reflect ex-manufacturers prices. Not included in the prices that are in the public domain are extra charges , see below: UNICEF: procurement services handling fee of 4.5%, requirement for a 10% buffer until the transaction has been completed, and freight and insurance costs PAHO: 3.5% of the net cost of the goods (excluding freight and insurance). The 3% goes to the common capital fund to be used by PAHO as working capital to provide a line of credit to participating Member States, and a 0.5% contributes towards the administrative and purchasing activity costs.

Products

• SA uses acellular pertussis penta • IPV already introduced through the pentavalent • Pneumo= SA uses a 2+1 schedule • HPV= unique 2 dose schedule will be implemented

• Mainly whole cell pertussis penta being used • IPV is only being introduced through the polio eradication plan from 2016 • The traditional 3+o schedule is used • HPV= 3 dose schedules to be adopted 6

African Human Vaccine Manufacturers

Egypt Senegal

South Africa)

Source: World vaccines, 2007

7

Developing Regions birth cohort and the proportion of vaccine manufacturers

Region

Birth cohort

No of Vaccine manufacturers

Africa

47m

3

Asia

61m

>20

Latin America

10,7m

7

8

Thank you for your attention!

9