Francois Sandre, Head of Asia & JPAC for Sanofi Pasteur outlines the importance of a sustainable global vaccine ecosystem and why a value-based approach, ensuring a steady supply of vaccines, and encouraging innovation are all crucial to meeting the public health goals of the future.
Vaccination is one of the most cost-effective ways of avoiding diseases – it currently prevents two to three million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccination improved
World Health Organization 
The Global Vaccine Action Plan (GVAP), a framework approved by the World Health Assembly in 2012, has a vision to deliver universal access to vaccination to all people regardless of where they are born, who they are, or where they live. Overwhelming evidence shows that vaccination is one of the most successful and cost-effective health interventions.
Vaccines are an integral part of ensuring healthy lives and well-being, with governments and international aid programs the world over making great strides in improving coverage rates. However, more hurdles are rising with the potential to knock us back. With infectious diseases also on the rise, now more than ever it’s essential that we safeguard steady vaccine provision and innovation.
The health of the vaccine ecosystem relies on us asking – and answering – some big questions:
- Can a steady supply of vaccines really be guaranteed, especially during peaks of high demand (e.g. outbreaks)?
- How are the market-shaping interventions focused on vaccine price reductions impacting production?
- What more can be done to encourage future vaccine innovation?
As we look to a new decade, how can we better address these questions with the right degree of ambition?
Rebalancing the vaccines ecosystem
Evaluating outcomes vs costs
While high-income countries fund their own immunization programmes, global health organisations such as GAVI have been developed to support low- and middle-income countries in financing and procuring vaccines. Through its pooled procurement method, GAVI has successfully managed to procure quality vaccines at an affordable price. However, putting an emphasis on vaccine prices has made the vaccines market less viable for producers who are required to overcome high manufacturing costs and for those who invest in vaccine Research & Development (R&D).
Policies that explore a value-based approach, where spending is linked to economic output and societal impact, can help make a clear case for investing in the right pricing for vaccination. Additionally, as the economies of many low- and middle-income countries continue to grow, there is potential for them to fund an increasing proportion of their immunization programmes.
There is also a need to explore new, innovative and sustainable methods of funding, with an emphasis on shared accountability between countries and development partners.
Ensuring steady vaccine supply
The development of vaccines and other immunization innovations are facing increasingly complex manufacturing and regulatory processes, in addition to rising research, development and production costs.
Sustaining supply will require multi-party involvement in order to create an environment that enables suppliers to strengthen their capabilities while meeting the country’s public health needs. Countries need a forum where they can clearly communicate and coordinate expected demand for new vaccines and provide guidance on desired product profiles to allow manufacturers in scaling up their production capacity with adequate supplies to maximize vaccination coverage rate for the countries.
Again, as low- and middle-income countries continue to grow, in turn, they can make a greater contribution to their respective national immunization programs.
The development of new vaccines is a lengthy process often taking more than a decade to develop one vaccine and bringing it to market is estimated to range between USD$500 million and USD$2 billion. Vaccine innovation is necessary to improve existing vaccines and to develop new vaccines to answer unmet needs, or new needs from emerging infectious diseases. R&D-based producers, who produce the vaccines they have researched and developed, re-invest 15 – 20% of their sales in R&D.
A healthy vaccine ecosystem provides the right balance between all the stakeholders from policymakers, donors, countries, R&D- and non R&D-based producers. It is crucial for all actors in the ecosystem to approach vaccine pricing in an objective manner so that vaccine production continues to be viable for various manufacturers that invest in research and development.
A new decade
Immunization partners have a responsibility to maintain dialogue and forge solutions, within and beyond the vaccines ecosystem, that will support shared goals for immunization.
Together, with more and better policies that are supportive of continuous research and development, as well as for manufacturing and supply of high-quality vaccines, we can enhance access to vaccination in the next decade at a much faster pace than the last.
 World Health Organization. Ten threats to global health in 2019. Available at: https://www.who.int/emergencies/ten-threats-to-global-health-in-2019 Last accessed: October 2019
 World Health Organization. Global Vaccine Action Plan 2011-2020. Available at https://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/. Last accessed November 2019.
 Gavi, the Vaccine Alliance. Supply and procurement strategy 2016-2020. Available at https://www.gavi.org/library/gavi-documents/supply-procurement/supply-and-procurement-strategy-2016-20/. Last accessed November 2019
 https://www.ifpma.org/wp-content/uploads/2016/02/IFPMA_Vaccine_Healthier_World_verF.pdf. Accessed on 10 December, 2019
 https://amr-review.org/sites/default/files/Vaccines%20and%20alternatives_v4_LR.pdf. Accessed on 10 December, 2019
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