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The Children’s Vaccine Initiative: Continuing Activities: A Summary of Two Workshops Held September 12–13 and October 25–26, 1994 Pan American Health Organization has operated a similar revolving fund in Latin America for the last 2 decades. Recently, UNICEF changed its policies for donating vaccine. Now, rather than giving vaccine to any nation that requests it, UNICEF targets donations to the poorest countries. A workshop participant from the public health sector predicted that this reconstituted UNICEF customer list will force many more countries to begin buying vaccine. This increased demand, in turn, may provide an incentive for U.S. manufacturers to enter the developing-world vaccine market. RESHAPING THE EPI Despite evidence of stable prices for the current group of EPI vaccines, there are problems with the UNICEF purchasing system. One important limitation has been the difficulty of correctly forecasting the yearly demand for vaccine. The resulting fluctuations in demand have had a negative impact on suppliers. As a partial fix, UNICEF is encouraging recipient nations to provide more timely and accurate estimates of vaccine need. To provide greater stability for manufacturers, the agency is considering lengthening the period of its tender agreements from the current 2 years to 5 years. UNICEF may also divide the vaccine it buys into two parts—a “baseload” amount of essentially guaranteed purchases and the remainder, which would vary in quantity month by month and would be purchased at a slight premium. Both moves are intended to assist industry efforts to plan and manage their vaccine production capacity and facilitate inventory control. A key problem facing the EPI, and by extension the CVI, is how to incorporate newer, more costly vaccines into the immunization programs of developing countries. For new vaccines already marketed in the industrialized world that could become part of the EPI armamentarium, UNICEF is evaluating two alternative supply arrangements: (1) sole-source agreements, or multiyear commitments to purchase a new vaccine from a single supplier; and (2) a variation on this approach in which UNICEF would donate vaccine only to selected countries, freeing the sole supplier to sell directly to other more prosperous developing nations. Sole-source contracting does have risks, noted one former member of the vaccine industry. The most significant is the danger of vaccine shortages should the supplier have production problems or for other reasons fail to meet its obligations. UNICEF is aware of this potential pitfall but believes such arrangements may be the only way the agency can gain access to proprietary products at an affordable price. Hepatitis B vaccine will be the first to be purchased using one of these new supply strategies. For products still in development—new vaccines and vaccine combinations that form the core of the CVI vision—UNICEF is considering partnerships with
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