Malhame Melissa, Baker Edward, Gandhi Gian, Jones Andrew, Kalpaxis Philipp, Iqbal Robyn, Momeni Yalda, Nguyen Aurelia
Gavi, The Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, Grand-Saconnex 1218, Switzerland.
UNICEF Supply Division, Oceanvej 10-12, Copenhagen 2150, Denmark.
Vaccine X. 2019 Jul 18;2:100033. doi: 10.1016/j.jvacx.2019.100033. eCollection 2019 Aug 9.
Market shaping for health products used in lower-income countries strives to benefit public health. As a funder of vaccines, Gavi, The Vaccine Alliance (Gavi) has goals for its market shaping efforts, achieved through a strategy developed and implemented by the Gavi Secretariat, UNICEF, the World Health Organization (WHO) and the Bill & Melinda Gates Foundation (BMGF). A case-study of Gavi's fifteen-year engagement with a vaccine against diphtheria, tetanus, pertussis, hepatitis B and type b (pentavalent) provides evidence of the benefits and potential risks of trying to influence markets. During 2001-18, Gavi disbursed US$3.5 billion to support use of 50 million pentavalent doses annually before 2005, increasing to ∼300 million doses annually by 2016. During this time, eight manufacturers invested in vaccine development and manufacturing and the first two manufacturers have subsequently ceased production. Following its strategy, Gavi implemented coordinated market interventions including technical assistance to manufacturers, improving market information transparency, risk-sharing agreements and innovative procurement aiming to stimulate and capitalize on a competitive market. In 2018 supply allows ∼80 million children per year to be immunised, a sixteen-fold increase from 2005, with vaccine-related costs per child for donors and countries of one-quarter the 2005 level. Lessons learned include the importance of frameworks and strategies; the need to adjust interventions with changing conditions; the important role of manufacturers; and the potentially powerful effects of interconnected markets. This case study is limited by its focus on a single health product in a specific market, however the lessons can inform other market shaping efforts when taken in context. While countries and children have improved vaccine access, risks of financial sustainability and continued manufacturer investment in Gavi vaccine markets are being monitored. Gavi should continue implementing a market shaping strategy, adjust with market conditions and expect and measure unintended consequences.
为低收入国家使用的卫生产品塑造市场，旨在促进公共卫生。作为疫苗资助方，全球疫苗免疫联盟（Gavi）对其市场塑造工作有目标规划，这些目标通过Gavi秘书处、联合国儿童基金会、世界卫生组织（WHO）以及比尔及梅琳达·盖茨基金会（BMGF）共同制定和实施的战略来实现。一项关于Gavi在15年里推广白喉、破伤风、百日咳、乙型肝炎和b型流感嗜血杆菌联合疫苗（五价疫苗）的案例研究，为试图影响市场的益处和潜在风险提供了证据。在2001年至2018年期间，Gavi拨款35亿美元，以支持在2005年之前每年使用5000万剂五价疫苗，到2016年这一数字增至约3亿剂。在此期间，八家制造商投资于疫苗研发和生产，前两家制造商随后停止了生产。按照其战略，Gavi实施了协调一致的市场干预措施，包括向制造商提供技术援助、提高市场信息透明度、风险分担协议以及旨在刺激和利用竞争性市场的创新采购。2018年的供应使每年约8000万儿童能够接种疫苗，比2005年增长了16倍，捐赠方和各国为每个儿童承担的疫苗相关成本仅为2005年水平的四分之一。吸取的经验教训包括框架和战略的重要性；根据不断变化的情况调整干预措施的必要性；制造商的重要作用；以及相互关联市场的潜在强大影响。本案例研究的局限性在于其聚焦于特定市场中的单一卫生产品，不过，结合具体情况来看，这些经验教训可为其他市场塑造工作提供参考。虽然各国和儿童获得疫苗的机会有所改善，但仍在监测Gavi疫苗市场的财务可持续性风险以及制造商持续投资的情况。Gavi应继续实施市场塑造战略，根据市场情况进行调整，并预期和衡量意外后果。
