UNICEF Update

IPC Meeting

Geneva, 8-9 December 2016

UNICEF expenditure by major material groups, 2015 & % of procurement done in collaboration with UN agency or development partner

$3.428 billion of supplies and services

Vaccines

$1.725 billion Pharmaceuticals

$151.4 million

Nutrition

$150.6 million

Medical supplies

$110.4 million

International freight

$104.3 million

Water & sanitation

$96.4 million

Bed nets & insect.

$58.7 million

Construction

$ 102.3 million

Education

$66.1 million Cold chain

$75.6 million

100%

95%

100%

100%

100%

30%

100%

~30%

30%

100%

> 85% of UNICEF procurement is in collaboration with other UN agencies ($2.9b) > 90% with UN agencies and other development partners ($3.1b)

Gavi, BMGF, WHO, PAHO MSF, CDC

Gavi, BMGF, WHO, PAHO

WHO, UNFPA, UNDP, GF UNITAID, CHAI, MSF, CDC

WHO, WFP,, MSF, CIFF

WHO, UNFPA, UNDP, GF UNITAID

WHO, Oxfam, SAVE, UNHCR

WHO, UNFPA, UNDP, GF UNITAID, CHAI, MSF

SAVE, WB

SAVE, WB

UNDP, UNHCR, UNOPS, WHO

Funding channel for UNICEF procurement

• Procurement on behalf of partners (i.e. PS funded) has grown in absolute and relative terms

• Þ Underscores the evolution of economic development, of donor (supply) financing policies:

― Countries in transition

― Trend towards commodity co-financing

48%

63%

65%

52%

37%

35%

0

500

1000

1500

2000

2500

3000

2005 2010 2015

US$

Mil

lio

ns

Procurement Services Programme3

ARVs and Antimalarials: Destination and Funding mechanism

a) Majority supplied to Sub-Saharan Africa b) Largest funding mechanism is PS

72%

11%

6%

4%

4% 3% 0%

Destination per region of the cumulative orders by value ( 2006-2016)

ESARO

WCARO

EAPRO

TACRO

CEE/CIS REGION

MENA

ROSA

0% 20% 40% 60% 80% 100%

Antimalarials

Antiretrovirals

2006-2016 Order value by funding Mechanism %

PROG PS

Medicines – key updates

• New updated PEP kit is now available from UNICEF WH – Substitution of Zidovudine 100mg caps, Lamivudine 150mg tabs and

3TC150mg+AZT300mg tabs with 3TC300mg+TDF300mg ; ATV/r 300mg+100mg ; 3TC30mg+AZT60mg disp; LPV/r 200+50mg heat/st tabs and LPV/r 100+25mg heat/st tabs

• Sourcing constraints : – Global shortage of quality assured SP

– Single sourcing for SMC products and Artesunate injection

– No quality assured rectal Artesunate

– Ripple effects of NOCs in 2016 affecting the supply base for a number of products.

• UNICEF SD Focus on “Periphery Kit” and “Community Kit”, followed by “Central Reference Kit” and “Hardware kit”

• A modular approach by allowing storage on a module basis and not full kit base

New Cholera Kit – UNICEF Supply Approach

UNICEF Health Emergency Preparedness Initiative (HEPI)

7

© U

NIC

EF/N

YHQ

2011

-009

8/N

OO

RAN

I

“Strengthening the organization’s capacity for responding to health emergencies

systematically”

• Inter-divisional, cross-sectoral UNICEF effort • Key Activities at Supply:

1. HEPI Emergency Supply Lists: • Modelling practical readiness in order to ensure effective

emergency preparedness deliveries

2. HEPI R&D: • Driving development of Zika IVD and Zika Vaccine in partnership

with WHO, PAHO and other partners. • Exploring the R&D pipeline for health technologies that

prevent, diagnose and treat diseases that are a public health threat under the guidance of WHO’s R&D blueprint.

Health Emergencies Preparations Initiative (HEPI)- UNICEF disease

prioritisation

HEPI Emergency Supply Lists

Experience & expertise: collaboration with US CDC in development of preparedness packages for priority pandemic diseases to ensure UNICEF is ready to respond.

Disease-specific preparation:

preparedness packages include disease-specific

emergency supply lists to support rapid

response.

© U

NIC

EF

/PF

PG

20

15

-22

53

/Lyn

ch

Need/Challenge, ZIKV Diagnosis: • >95% of ZIKV diagnosis are clinical. • Lead-time for lab diagnosis is 4-8 weeks, if lab is available.

Target: • Product(s) available for procurement that meets joint WHO-UNICEF-

PAHO TPP: • Point of Care & molecular • Viral load & antibody & antigen • Prefer differential diagnosis (ZIKV, DENV, CHIKV), but minimum is

ZIKV.

Need/Challenge, ZIKV Vaccine: • Vector control measures largely ineffective. • Epidemic modelled to continue to be reoccurring.

Targets: • Joint TPP with WHO

• 2 vaccine candidates to mitigate greatest risk:

• child bearing age females (9-45);

• then, to control outbreak as part of HEPI programme.

Mechanism for access to vaccine for use in Humanitarian Crisis - Background

SAGE

- Oct 2015 “more guidance needed” …. “necessary to assess how activities

can be carried out” …” stresses necessity to address access issues and call for more collaboration between WHO, Gavi, UNICEF, MSF, …. facilitate prompt provision of vaccines to the most vulnerable populations. ”

- April 2016, …. “continuous efforts in strengthening vaccination in humanitarian crises including further updating of field vaccination guides.”

During World Immunization Week 2016, partners such as UNICEF profiled the vaccination needs of conflict-affected children, noting that almost two-thirds of all unvaccinated children live in conflict affected countries

Mechanism for access to vaccine for use in Humanitarian Crisis – Supply related Goal and Objectives

Goal To make progress towards reducing vaccine-preventable deaths in emergencies through scaled up vaccination services for crisis-affected populations and address the challenges to access affordable prices and availability in these situations.

Objectives • Define the demand through collective quantitative data on the

historical trend and determine a crude projection of vaccines for emergencies and humanitarian crisis (through CSOs and UNICEF)

• Access to affordable/low price for vaccine used in Humanitarian response

• Establishment of streamlined procurement process, and supply chain allowing timely response to emergencies

Mechanism for access to vaccine for use in Humanitarian Crisis - Mapping of the context and methodology

• UNICEF disseminated a survey tool to immunization partners for data collection. The survey captured both quantitative and qualitative information to identify demand trend as well as challenges faced by different stakeholders.

• Responses were cross-referenced with reports of humanitarian emergencies issued by UNOCHA

Key considerations: Vaccines that already had mechanisms for global access for outbreaks were excluded

(OPV, Measles containing and outbreak response vaccines such as YF, OCV, and Meningococcal A, C, W)

Syria was analyzed separately in the historical demand

Demand projection remains a challenge

Mechanism for access to vaccine for use in Humanitarian Crisis – Historical demand trend by antigen (Excluding response to Syria)

• 1.4 Million doses delivered in 4 years with a peak in 2015

• PCV and Penta vaccines are the key drivers of the large volumes

• This also excluded antigens that are readily accessible e.g. MR,MMR,OPV

187,924

92,450

2,148

104,988

10,109

45,926 376,688

138,400

1500

8,871

13,381

236,523

160,000

41,162.0

34560

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2013 2014 2015 2016

Trend of demand for Humanitarian Emergencies, 2013-2016

DTP, Hib

IPV

Penta

Hexavalent (Penta+IPV)

PCV

Yellow fever

Cholera

Mechanism for access to vaccine for use in Humanitarian Crisis – Historical demand trend by antigen (Including Syria)

• The escalation of the Syria crisis situation is a reflection of the large demand for routine immunization programs that skews the 2016 data

10,109 45,926

376,688 138,400

1500

8,871 13,381

236,523

6,086,800

632,162

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

2013 2014 2015 2016

Trend of demand for Humanitarian Emergencies, 2013-2016 (including Syria)

DTP, Hib

IPV

Penta

Hexavalent (Penta+IPV)

PCV

Yellow fever

Cholera

Mechanism for access to vaccine for use in Humanitarian Crisis – Vaccine registration requirements

• 13 out of 25 countries that have been receiving the highest number of vaccines for humanitarian emergencies, require registration.

• Waiver for emergency could be explored, though more information and clarity needed on the process in emergency response

• UNICEF will work with WHO, countries and suppliers to reduce bottlenecks in regulatory issues

Afghanistan Central African Rep.

Chad DR Congo

Haiti Lebanon

Liberia Fiji

Rwanda Somalia

South Sudan Yemen

Accepts WHO PQ, 12

Collaborative procedure, 4

Full national licensure, 9

0 2 4 6 8 10 12 14

Accepts WHO PQ

Requires Registration

Accepts WHO PQ Requires Registration

Accepts WHO PQ 12

Collaborative procedure 4

Full national licensure 9

Ethiopia

Greece Iraq

Jordan Kenya

Pakistan Tanzania

Turkey Syria

Mali Myanmar

Sudan Uganda

DTwP-Hib-HepB -

Pentavalent

BCG

MMR (LZ)

  JE

DT/DPT/HepB

TT/Td

PCV

Special offers made by GSK and

Pfizer for access to affordable

prices for Humanitarian Response.

Contractual arrangements are

being put in place for streamlined

access to vaccines.

Rota

HPV

Hep E Has not been procured through

UNICEF in the past

OPV/mOPV Managed through the GPEI

IPV Managed through the GPEI

Measles/MR Managed in collaboration with MRI

Yellow Fever &

Meningitis

Managed through the ICG for

response to outbreak

Oral Cholera Vaccine

Managed through the ICG for

outbreak response; through the

GTFCC for preventive campaign

Emergency/outbreak response

vaccine (contractual

agreements for emergency

response and/or stockpile)

Vaccines currently under

UNICEF Long Term

Agreements

Same or similar price level to Gavi

supported countries been accessed

Vaccines with no

arrangements for non-Gavi

markets

Mechanism for access to vaccine for use in Humanitarian Crisis – Vaccines used in Humanitarian Response

72

Hours

96

Hours

72

Hours

72

Hours

I C G

GPEI

Current context -

Existing mechanisms for Emergency and Outbreak response Mechanism for access to vaccine for use in Humanitarian Crisis – Existing mechanisms for Emergency and Outbreak response

Mechanism for access to vaccine for use in Humanitarian Crisis - Next steps: Supply arrangement

• UNICEF to issue an Expression of Interest to invite industry’s engagement on vaccines with no supply arrangement for supply of antigens that are not readily accessible (currently on LTA) or that are not accessible under current supply arrangements

• UNICEF to issue RFP based on the outcome of the EoI to establish supply arrangements for those vaccines in Humanitarian context and establish:

– Time bound for non-routine vaccines (Hep-E)

– Target bound for other vaccines

Supply Chain Strengthening:

A renewed focus on linking supply chain

improvements to Health System Strengthening (HSS)

Guided by the Convention on the Rights of the Child (CRC) & the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and in l ine with the Sustainable Development Goals (SDGs) and Every Woman, Every Child (EWEC)

A world where no child dies from a preventable cause, and all children reach their full potential in health and well -being

UNICEF Health Strategy for 2016–2030 V

isio

n

M&

E A

ctio

ns

Go

als

Ap

pro

ach

es

Pro

gram

me

ar

eas

• Build capacity of management and health providers

• Support programmes, including service provision, in particular at community level and in emergencies

• Strengthen supply chain systems

Strengthen service

delivery

• Support evidence-based policymaking and financing

• Promote scale-up of effective interventions/ innovations

• Share knowledge & promote south-south exchange

Influence

government policies

Advocate for every

child’s right to health

• Engage for social and behaviour change

• Generate demand • Strengthen accountability

Empower

communities

End preventable

maternal, newborn & child deaths

Promote the health and

development of all children

Address inequities in health outcomes

Promote integrated, multi-sectoral policies and programs

Strengthen health systems, including emergency preparedness and resilience

Measurement, learning and accountability

• Support data capture, evidence generation, and use

• Engage with partners • Expand available resources

Proposed actions and program areas represent global "menu" to be tailored to country context by country offices

Maternal, newborn, and child health (focus on equitable access to quality primary health

care)

Older child and adolescent health (focus on public policies and

supportive environments)

Ach

ieve r

esu

lts t

hro

ug

h p

art

ners

hip

Supply Chain Strengthening Initiatives

• HR Country Support Package for SC Managers • SC System Design Workshops, Guidance, Partnerships • Comprehensive Improvement Planning (CIP) Guidance • New GAVI iSC Strategy Website on Technet (HR, System Design, Cold

Chain, Data for Management and CIP) • Process Guide and SC Toolkit for Strengthening Public Health SCs • SC Health Checks • National Logistics Working Groups/SC Committees • Effective Vaccine Management Assessments

• Publishing case studies on SC capacity development • Publishing case studies on SC System Design • Developing Evidence Brief on System Design Process • HR Landscape Analysis

• HR capacity development plans supported including in Ethiopia, Kenya, South Sudan, Malawi, Uganda, Lesotho, Zambia

• System Design efforts supported in Mozambique, Nigeria, Liberia, Pakistan • SC Improvement Planning supported in Timor Leste, Pakistan and Mozambique • National SC Strategies supported including in Zambia, Nigeria, Uganda and

Ethiopia • Nutrition SC Assessments supported including in Afghanistan, Malawi, Burundi,

Mozambique, Kenya, Niger, Chad and Cameroon

Supply Financing Solutions

• Pre-financing work continues to grow, with pre-financing of both vaccines and medicines/ other commodities for both delayed government budgets and delayed grants / loans.

• UNICEF held a conference in Nairobi which was attended by 9 governments from both MoH and MoF, and focused on improving countries’ access to private sector financing.

• UNICEF is working on moving forward the operationalization of a working capital finance facility for suppliers who are based in countries where we have programmes.

Share knowledge, experiences, innovative solutions and best practices.

• Immunization SC Forum

15 countries : 31 May – 3 June

• Nutrition SC Practitioners Forum 9 countries : 21 – 23 June

• CMS CEO Consultation

6 countries : 24 June

• Vaccine Procurement Practitioners Exchange Forum

9 countries : 4-6 October 2016

Convening countries for horizontal learning