Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 384

support for funding. Less than 4 weeks later, the NITAG reversed its recommen-
dation from negative to positive, and Gardasil obtained government funding
(Roughead et al. 2008 ).
Affordability of a vaccine is another important factor in public vaccine purchas-
ing. Budget limitations were the most common reason for lack of implementation of
NITAG recommendations reported in a study of 15 NITAGs (Gessner et al. 2010 ).
The decision by a public purchaser to purchase a new vaccine essentially implies a
commitment to endless funding, since (save for smallpox) infectious diseases are
never fully eradicated. To free up budgetary resources and create “fi scal space” for
new vaccines, public purchasers put pressure on the prices of older vaccines. Thanks
to their greater budgetary resources, high-income countries have historically
adopted new vaccines rapidly, whereas in low-income countries vaccine uptake was
delayed by 15-20 years despite their higher burden of disease (Levine et al. 2011 ).
A recent 147-country multivariate analysis of the time to adoption of the Hib
vaccine showed that, compared to high-income OECD countries, time to adoption
was longer for other countries. Other variables associated with a longer time to
adoption were a higher vaccine price and higher GAVI cofi nancing uncertainty.
Variables associated with a shorter time to adoption were eligibility for GAVI fi nancial
support, having neighbor countries who already have adopted the vaccine, and a
higher degree of democracy (Shearer et al. 2010 ).
Vaccine Procurement by Public Purchasers
Authorities may procure a vaccine directly from the manufacturer, through a public
procurement agency which pools purchases to obtain more favorable conditions, or
they may let health care professionals manage procurement. Public procurement
agents may operate at the national level, pooling purchases from subnational author-
ities, or at a supranational level, pooling purchases from several countries.
In the United States, most vaccines for public immunization programs are pro-
cured by the CDC on behalf of subnational jurisdictions. The original “winner take
all” contracts were later replaced by multiple-supplier contracts that guaranteed the
largest market share to the lowest bidder, followed by the current approach, under
which CDC negotiates each year federal contract prices for all public immunization
programs receiving CDC funds. 20 The contract prices, published together with the
manufacturers' list prices on the CDC website, range from 4 to 67 % below list prices
(Centers of Disease Control and Prevention 2011 ). States and other jurisdictions pur-
chase vaccines through the CDC at the federal contract price. Individual US states also
purchase vaccines directly in some circumstances. 21 When the CDC has contracted
20 CDC provides funds to states and other jurisdictions under the VFC program, which fi nances all
ACIP-recommended childhood vaccines, and Section 317 funds, a program for which there are no
eligibility requirements. The 317 funds must be appropriated each year by Congress.
21 States purchase directly from a manufacturer when there is no federal contract for a specifi c vaccine,
and when they are not allowed to rely on the federal contract for a vaccine, because they are using