Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow

Similar to natural ecosystems, the vaccination ecosystem is an organism-community (international organizations, vaccine manufacturers, donor agencies, foundations, NGOs, etc.) that interacts with one another and with their environment. As a consequence, modifications or variations in one of its components can impact this ecosystem balance. The establishment of the WHO Expanded Program on Immunization and GAVI alliance, together with international aid, and philanthropic donors has led to significant decrease of vaccine access gap between high and low income countries by improving vaccination of the world’s poorest children. However, any such changes to an ecosystem will have both intended but also unintended consequences.

Fondation Mérieux organized a conference entitled: “Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow” from January 19-21, 2015, in Annecy-France (hosted at “Les Pensières” Conference Center). Representatives from international organizations (WHO, GAVI, UNITAID, MSF, etc), as well as industry gathered to take stock of how healthy today’s vaccination ecosystem is and its ability to reliably and sustainably supply high quality vaccines whilst maintaining investment in the innovation that we need for tomorrow. The expert panel and the other attendees reviewed and discussed various issues including:

• Global vaccine coverage, demand and supply,
• Principals and practices of market shaping and its impact on vaccine access,
• Description of healthy and unhealthy market (examples of cases studies of market failure).

To elicit more consideration of the vaccine ecosystem, a breakout session was held in order for participants to discuss in small working groups the following topics:

• What are the drivers and barriers to a sustainable vaccination ecosystem?
• What are the metrics of vaccination ecosystem health?
• What should we add, remove, increase or reduce to keep the vaccination ecosystem healthy?

The panel came to the conclusion that today’s vaccine ecosystem is facing a number of challenges that can weaken it. This includes small and decreasing number of suppliers/manufacturing facilities; regulatory pressures, market uncertainties (cost-effectiveness, price, higher demand and supply), political prioritization (competing priorities or distortion due to crisis, political instability), anti-vaccine movements/complacency, technological and programmatic issues (supply chain, cold chain custody, health care workers education).

The following points have been identified as drivers that could insure the sustainability of vaccine’s ecosystem: 1) guarantying return on investment for donors and governments and global stakeholders; 2) presence of multiple effective suppliers to reduce monopolies and secure supply; 3) financing for research and development (R&D), 4) political prioritization by raising awareness about needs, 5) empowering developing country manufacturers (e.g. technology transfer) and 6) balance of public-private perspectives for global public goods and distinction of the roles of each sector.

Furthermore, to maintain the vaccination ecosystem healthy, other alternatives such as, a prioritized list of pathogens to be targeted for specific markets, a global vaccine development fund, and regulatory reform (for example conditional licensure after phase 2b and with final approval after with rapid real-time review of data) need to be added to the existing system.

On the other hand, the metrics i.e. required for tracking the health of vaccination ecosystem concern mainly the following areas: innovation (R&D activities/accelerators; technology transfer and delivery); confidence (perception/acceptance/refusal); coverage (accurate coverage data, epidemiology of unvaccinated); policy/funding; pricing of vaccines and cost of vaccination.

To summarize, the concept of ecosystem is a useful way of thinking about vaccines. A healthy ecosystem should be able to maintain its organization and function over time in the face of external stress. Supply issue is a central aspect that requires much more work. Healthy markets supply the right quantities of goods/services to the right people at the right price(s). Research and development is also facing challenges. Having a prioritized list of vaccine-preventable diseases that should be targeted and matching it with R&D activities could optimize the latter, especially if a global development fund is in place. Mechanisms such as regulatory reforms and technical innovation to improve access to markets and shorten disruption periods will also contribute to the sustainability of the vaccine ecosystem.