Vaccines are one of the most powerful and cost effective health interventions available. Yet WHO states that an estimated 19.4 million infants worldwide are still missing out on basic vaccines. Preventable diseases still cost millions of lives each year.

Vaccine companies are a key link in the chain to each successful vaccination. The Access to Vaccines Index is the first benchmark of how these companies are bringing vaccines within the reach of more children. As a tool for change, it can stimulate and guide vaccine companies to improve their practices; it can help uncover where more action is needed and what prevents vaccine companies from stepping in.

The Access to Vaccines Index is funded by the Dutch Postcode Lottery (Nationale Postcode Loterij), which was launched in 1989 to raise money for charity organisations that work to create a fairer, greener world.

The Access to Vaccines Index is the first publically available tool that maps how vaccine companies are responding to global calls to increase access to vaccines. The Index assesses the largest global players in the vaccine market and companies with significant potential for improving access to vaccines. It looks at their efforts to develop, manufacture and supply preventive vaccines for 69 high-priority diseases across 107 high-need countries.

At its core is a set of 13 metrics for assessing companies’ policies and practices in three areas: 1) Research & Development, 2) Pricing & Registration, and 3) Manufacturing & Supply. These metrics reflect stakeholders’ views on how vaccine companies can contribute to global immunisation targets.

Vaccines are one of the most powerful and cost effective health interventions available. Since their discovery, millions of children have been immunised against deadly diseases. However, less than five per cent of all children worldwide receive the full package of vaccines recommended by the WHO – which includes vaccines against measles, mumps, diphtheria, cervical cancer, respiratory diseases, hepatitis and other big killers. Most children without access to this basic package live in low- and middle-income countries.

Successful immunisation programmes depend on a network of organisations and on many different elements. For example: the vaccines must be safe, effective, good-quality and suitable for use by the communities that need them; those communities must be willing for their children to be vaccinated; and children need to be able to complete the vaccination schedules – which in poorer countries often involves long and costly journeys to the nearest clinic. The immunisation programmes themselves depend on strong planning and processes, having sufficient financing, effective procurement systems, robust supply chains and accurate demand forecasting.

Vaccine companies are a key link in the vaccine value chain – they develop, produce and supply the vaccines needed by every child. They also have extensive technical expertise and production capacities. This makes them a significant partner in solving the access-to-vaccines equation. Their role rests primarily in the areas of Research & Development, Pricing & Registration, and Manufacturing & Supply:

1. In Research & Development, companies are expected to address high-priority gaps for new and improved vaccines and delivery technologies.

For certain diseases, such as HIV/AIDS, the first vaccines are yet to reach the market. For others, existing vaccines need to be improved or adapted, for example, to target specific strains of the disease, or to make the vaccine easier to administer. R&D into vaccines is complex, costly and lengthy, and the challenges vary widely depending on the disease in question. Vaccine candidates have to go through increasingly rigorous and complex clinical trials. Vaccine companies are among the only organisations with the expertise required to carry out these activities.

2. In Pricing & Registration, companies are expected to address the affordability of their vaccines for governments with limited resources.

When a new vaccine reaches the market, its affordability comes under close scrutiny. For many governments, financing for vaccine procurement remains a challenge, whether or not vaccines are purchased directly from suppliers or through pooled procurement agencies. New vaccines are generally more expensive than traditional vaccines, putting additional pressure on healthcare budgets. Vaccine manufacturers have a responsibility to work with other stakeholders to ensure all vaccines are affordable for low- and middle-income countries, where the need for better access to vaccines is greatest.

3. In Manufacturing & Supply, companies are expected to have strong policies and processes in place to ensure sufficient high-quality vaccines are available.

Effective immunisation programmes depend on a reliable supply of suitable high-quality vaccines. Yet vaccine shortages occur regularly, caused by sudden disease outbreaks, production interruptions, insufficient stockpiling or a lack of adequate financing, for example. Positioned at the start of vaccine supply chains, vaccine companies clearly have a key role to play in overcoming such hurdles.

The urgent need to increase access to vaccines is being directly tackled at the global level. In the Sustainable Development Goals and the WHO’s Global Vaccine Action Plan, clear targets have been set for driving up immunisation rates. Progress is already being made, but there is more to be done. Success depends on concrete action from many different stakeholders – not least governments, vaccine companies and multi-lateral agencies. Success also depends on publicly tracking progress toward specific goals. The Access to Vaccines Index is the first tool for transparently measuring the efforts of vaccine developers and manufacturers.

The Access to Vaccines Index is an initiative of the Access to Medicine Foundation. It is funded by the Dutch National Postcode Lottery.

The Access to Medicine Foundation is a non-profit organisation based in the Netherlands. It aims to advance access to medicine in low- and middle-income countries by stimulating and guiding the pharmaceutical industry to play a greater role in improving access to medicine. The Foundation is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs and the UK government.

For ten years, the Foundation has been building consensus on the role for the pharmaceutical industry in improving access to medicine and vaccines. It published its first benchmark of industry activity in this area in 2008, in the first Access to Medicine Index. The fifth Access to Medicine Index was published in November 2016.

How the Access to Vaccines Index drives change

The Access to Medicine Foundation has been enabling change in the pharmaceutical industry for more than ten years. It uses a three-part model based on consensus-building, on stimulating competition and on sharing best practices. For the Access to Vaccines Index, this model has been adapted for the vaccines sector. For example, the Access to Vaccines Index is also designed to shed light on the factors that help or hinder companies to expand access to vaccines.

For the Access to Vaccines Index, the Foundation has adapted its three-part model to the vaccine sector. The model has been developed over the ten years that the Foundation has been spurring private sector engagement in access-to-medicine issues.

1 Build stakeholder consensus

We build consensus on where vaccine companies can and should be taking action to address access to vaccines. This stakeholder consensus has been translated into the first set of metrics for measuring how companies are bringing immunisation to more children  in low- and middle-income countries.

2 Stimulate vaccine companies to compete on priority health topics

Our research identifies the best performers on access to vaccines: for example, when it comes to vaccines R&D, or the steps they take to improve affordability, manufacturing and supply. By publicly recognising companies’ positive actions, we trigger other companies to join a “race to do well” on priority targets.

3 Share best practices, remove barriers

Our research identifies best practices within the industry, where more action is needed, and where external mechanisms for engaging the industry in vaccines access are working. We facilitate the wider application of best practices and the development of new approaches to long-standing barriers to access.

At the core of the Index is the first set of metrics for mapping how vaccine developers and manufacturers are working to improve access to vaccines. These are designed to reveal: what companies can and are doing to improve access to vaccines; to bring best practices to wider attention; and to highlight where individual or collaborative engagement can occur.

While developing the methodology, the Index team gathered insights from vaccine experts working in governments, industry, NGOs, procurers, philanthropic organisations and research organisations. Essential strategic insight was provided by a group of Expert Advisors: from the Clinton Health Access Initiative (CHAI) , Gavi the Vaccine Alliance, UNICEF and the International Federation of Pharmaceutical Manufacturers and Associations. These discussions crystallised stakeholder expectations of vaccine developers and manufacturers regarding access to vaccines.

The Access to Vaccines Index will reveal an initial baseline of industry activity regarding access to vaccines, while identifying new opportunities for stakeholders and companies to break down access barriers.

The Index and its methodology can be used to hold companies to account while tracking their progress against globally agreed immunisation targets. It can act as a review mechanism for international immunisation agendas and priorities, including those set out in the WHO’s Global Vaccines Action Plan and the Sustainable Development Goals. Companies and other stakeholders in the vaccine ecosystem can use the Index to inform priority- and strategy-setting, and to clarify where new incentives would spur greater positive change.

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