Supply of vaccines world-wide has changed significantly over the past several years. As an example, several countries formerly relying on centralized procurement through UNICEF and WHO are now responsible for purchasing their own vaccines. Additionally, donor agencies previously using the WHO/UNICEF system are increasingly working with commercial agents to purchase vaccines. These changes, which imply a commitment by countries to support their own immunization programmes, are reassuring. However, the jump from dependence on the WHO/UNICEF system to independence is not easy and many countries have benefited from WHO’s expertise and experience.
To offer the best possible guidance to countries seeking vaccine independence through procurement, WHO has been working in a number of areas. In collaboration with UNICEF, the first move has been to offer a management system called the Vaccine Independence Initiative. Using this system, countries can pay for their own vaccines but continue to use all or part of the UNICEF procurement system.
WHO has also been working with public interest agencies such as PATH, BASICS/USAID and the World Bank to produce a vaccine procurement manual (1). The manual provides a detailed guide and reference and covers all aspects of vaccine procurement. A vaccine procurement training manual to support the training of countries new to vaccine purchase is also nearing finalization. WHO believes that procurement of vaccines differs from that of other commodities and successful procurement of vaccines is highly specialized (2). It cannot be carried out without extensive knowledge of the specific attributes of biological substances. Generally, vaccine procurement is understood to cover those vaccines bought for public health use, the largest of which is the national infant immunization programme. The procurement system should determine what is needed, sources, what prices should be paid, who will pay and how will they pay, and include issues of timeliness and delivery. Overall, sources must be pre-qualified to ensure compliance with specific standards of quality and reliability. In addition, mechanisms for lot release and for monitoring the impact of products should be in place and documented. Generally, these quality issues are handled by the national regulatory authority (NRA) working in concert with the procurement unit, which in turn will collaborate with the authorities of the national immunization programme - the vaccine consumers - to ensure that the products will meet public health requirements.
Several types of vaccine procurement systems exist:
• national systems, which serve only one country;
• small group procurement systems, which may serve up to ten countries; and
• agency procurement systems such as that administered by UNICEF.
The possible advantages and disadvantages of each system must be analysed with respect to the following considerations:
• Forecasting demand
• Supplier qualification and selection
• Receipt and release of products (quality aspects)
• Dispute resolution/surveillance for safety and efficacy.
Characteristics of procurement systems
Three types of procurement systems thus exist according to the features listed above: single country, small group, and agency. Generally, single country procurement proves to be most flexible. However, this system may suffer as a result of the comparatively small volumes of vaccines being procured and the concomitant dependence on a single supplier, with a possible lack of expertise in handling some of the technical aspects of vaccine procurement. Large international agency procurement allows the country to take advantage of an operational system which handles all the details of procurement: from supplier selection to tender preparation to price negotiation to dispute resolution. However, countries participating in such a system may have less choice in their vaccine sources and timing of shipments. Group procurement may solve some of these problems, although it could impose others. The following specific example of group procurement by the Gulf Cooperation Council is described below.