How vaccine companies take steps to make vaccines affordable
and available

Pricing & Registration

GSK leads, followed by Merck & Co., Inc. and Sanofi with equal total scores. GSK’s pricing strategy for vaccines is the most sensitive to each country’s ability to pay, relative to peers’ strategies. GSK and Merck & Co., Inc. lead in transparency, publishing their complete pricing strategies and reporting that they do not prohibit governments from publishing manufacturer prices. Sanofi is the leader in registration, filing to register most of its relevant vaccines in 30-50% of both low-income countries and lower middle-income countries in scope.


Vaccines for routine immunisation are generally purchased by governments or through pooled-procurement systems aiming to lower prices. There are three main organisations involved in these systems: the United Nations International Children’s Emergency Fund (UNICEF), the Pan American Health Organization (PAHO) Revolving Fund, and Gavi, the Vaccine Alliance. The vaccine market is consolidated, with four companies accounting for the majority of vaccine revenues (GSK, Merck & Co., Inc., Pfizer and Sanofi). There is also a growing number of vaccine manufacturers based in emerging markets which focus on manufacturing traditional, lower-priced vaccines.

What the Index measures

The Access to Vaccines Index evaluates data from six companies in relation to vaccine pricing and registration: GSK, Johnson & Johnson, Merck & Co., Inc., Pfizer, Sanofi and Serum Institute of India.

The Index examines the following areas:

  1. Vaccine pricing decisions: whether and how companies consider affordability in pricing strategies for public sectors in low- and middle-income countries.
  2. Price trends: how prices of key new vaccines for Gavi-eligible countries have changed over time.
  3. Transparency in pricing: whether companies are transparent around the factors they consider in their pricing strategies and whether they support vaccine price transparency.
  4. Availability: how widely companies file to register vaccines in low- and middle-income countries.


The six companies evaluated each consider multiple factors when setting vaccine prices, the combination of which is unique to each company and dependent on their portfolio. Across all companies, the most frequently considered factor is whether a country is eligible for Gavi support. This is followed by GNI per capita, which is considered by four companies for at least some low- and middle-income countries. Some companies publish their complete pricing strategies online for all vaccines, yet in general, the transparency of pricing strategies varies. Most companies state that they do not include clauses in government contracts that prevent manufacturer prices being published. Vaccines are not being filed for registration widely: for the 91 vaccines that qualify for analysis, the registration process has begun in less than a quarter of low- and middle-income countries within the scope of the Index.

When pricing vaccines, companies need to address affordability systematically – especially for countries that receive no support from Gavi and do not participate in pooled procurement via PAHO or UNICEF. Companies can form and share clear pricing strategies for all low- and middle-income countries. Companies should also enable global information sharing about vaccine prices to promote a more competitive supply environment, facilitate negotiations and help ensure that prices are fair. There is also a gap regarding vaccine registration: companies need to file to register vaccines more broadly in low- and middle-income countries according to public health need. In turn, governments and procurers must invest sufficiently in national regulatory systems and immunisation programmes.