The Pneumococcal Vaccine Investment Case

1
The Pneumococcal Vaccine Investment Case

• Dr. Orin Levine, Executive Director
• GAVIs PneumoADIP at
• Johns Hopkins Bloomberg School of Public Health

2
Overview

• Investment objective
• Pneumococcal disease
• Pneumococcal vaccines
• The challenges
• The proposed project and its costs
• The expected return on investment

3
Investment objective

• Accelerate pneumococcal vaccine use by 15 years
  over historical precedents
• Prevent 3.9 million child deaths by 2025
• GAVIs financing will
• Motivate industry to dedicate capacity
• Support country demand
• Contribute to sustainable, affordable pricing

4
Relevance to GAVI principles

• Principle 1. Contributes to MDG 4
• Principle 2. Promotes equity between rich and
  poor children and countries
• Principle 5. Focuses on new vaccine introduction.
• Principle 7. Coherent with partner mandates,
  especially WHO/UNICEF GIVS

5
Pneumonia Leading child killer

• Pneumonia
• Mortality 25 of the 10M child deaths / yr
• Morbidity 151 million cases each year
• 13-20 million are severe enough to require
  hospitalization
• Pneumococcal disease
• Pneumococcus is the leading cause of child
  pneumonia deaths (40)
• About 1 in 10 child deaths due to pneumococcal
  disease

• CONCLUSIONS
• Reaching MDG 4 for child survival requires
  pneumonia prevention.
• Pneumococcal disease especially important target.

6
Nearly 70 of 2 million child pneumonia deaths
occur in Africa So. Asia
Projections based on Williams BG et al Lancet
2002 Each dot representing 5000 deaths
7
Prevention of pneumococcal disease is important

• HIV increases risk 20-40 times
• Antibiotic resistance complicates treatment
• Pneumococcal pneumonia follows pandemic influenza
• Additional 4.5M pneumococcal pneumonia cases and
  450,000 deaths in children in GAVI countries

8
Established efficacy in developing countries

• WHO SAGE expressed confidence in the available
  evidence of the safety efficacy of pneumococcal
  vaccines, in numerous settings, ranging from
  industrialized to developing settings, and
  including infants with HIV infection. (WER,
  2006, 811-12)

9
Pneumococcal vaccines are highly cost-effective

• Key findings from cost-effectiveness analysis
• 22 per DALY saved
• 691 per death averted
• Cost-effectiveness greatest in countries with
  highest child mortality rates
• Results are robust over a range of pricing and
  vaccine efficacy assumptions
• Meets WHO criteria for very cost-effective

Weighted global average
10
Pneumococcal vaccine supply

• Multinationals
• Wyeth 7-valent Prevnar/Prevenar licensed in 70
  countries.
• Wyeth 13-valent expected licensure in late
  2009/early 2010
• GSK 10-valent expected licensure in Q4 2008
• Supply adequate to meet GAVI demand through 2011
• Emerging market suppliers
• Several companies with active programs
• Entry expected between 2015 and 2020
• Will be stimulated by GAVI / donor commitments to
  finance

11
Expected impact of the investment
12
Accelerating the Introduction of Pneumococcal
Vaccines - 2015

• IMPACT BY 2015
• Prevent 446,000 cumulative child deaths by 2015
• Prevent 117,000 child deaths in the year 2015
• Reduce child mortality in children aged 3 to 59
  months by 9 in the countries where it is used

13
Projected mortality impact from accelerated
pneumococcal vaccination
3.9 million child deaths prevented
14
Challenges ahead

• Assuring vaccine supply pricing
• Measuring vaccine impact
• Integrating with health systems
• Sustaining and expanding political will

15
Strategic Technical Support
16
Estimated costs (2007-15)
Costs to GAVI
Country co-payments
17
Why 7-valent? Why now?

• Pneumococcal disease is No. 1 vaccine preventable
  cause of child deaths
• Safe, effective vaccine available
• Significant health impact expected
• Use now builds base for wider use of extended
  protection vaccines later

18
Impact of accelerating pneumococcal vaccine
introduction
19
The Investment Case Team

• GAVIs PneumoADIP at Johns Hopkins
• Angeline Nanni
• Maria Knoll
• Hans Kvist
• Kate OBrien
• Earl Wall
• Farzana Muhib
• Rabia Akram
• Benedicta Kim
• Michelle Moncrief-Foreman
• Rebekah Heinzen
• Elaine Baruwa
• Jennifer Moïsi
• Chizoba Wonodi
• Ellen Lee
• Julie Buss
• Heather Parsons
• Tracy Montgomery
• Avanti Johnson

• WHO
• Thomas Cherian
• Souleymane Kone
• Harvard University
• Anushua Sinha
• Tracy Lieu
• RuderFinn
• Selina Haylock
• John Preston
• Emma Keeling
• David Campbell-Morrison
• Applied Strategies
• Sandra Wrobel
• Carol Marzetta
• Mercer Management
• Andrew Pasternak
• Adam Sabow
• ADIP Management Committee members
• many others in technical institutions, industry,
  and countries who contributed