Investment Case for Rotavirus Vaccines

1
Investment Case for Rotavirus Vaccines

• Dr. John Wecker
• Director
• Rotavirus Vaccine Program

PATH Rotavirus Vaccine Program, a partnership
between PATH, US CDC and the WHO, and supported
by the GAVI Alliance.
2
The Investment Objective

• Accelerate the introduction and maturation of the
  market for rotavirus vaccines
• GAVIs investment in rotavirus vaccines can by
  2025
• Prevent the deaths of more than 2.4 million
  children
• Prevent nearly 100 million hospitalizations and
  clinic visits
• Save US500 million in direct medical costs

3
Inequitable Distribution of Rotavirus Mortality
Estimated Annual Global Distribution of
Rotavirus-related Deaths (from Parashar, 2006)
4
Approved Rotavirus VaccinesMultinational
Manufacturers
Results of the large safety and efficacy trials
for GSK and Merck vaccines published
Both vaccines shown to be safe and efficacious in
the populations where they were evaluated
Graphics courtesy of Duncan Steele, WHO
5
Will Rotavirus Vaccines Work Throughout the
Developing World?

• WHO SAGE Recommendations (November 2005)
• Use of rotavirus vaccines is appropriate in
  regions where tested
• Lessons of vaccine introduction and
  post-marketing surveillance will be important
• Efficacy data in Africa and Asia should be
  collected
• Partnership established with GSK and Merck,
  respectively, to conduct clinical trials in
  Africa and Asia

6
When Will We Know Whether Rotavirus Vaccines
Protect Children in Africa and Asia?
Merck Bovine reassortment, multivalent
GSK Human, monovalent
Africa
2Q2009
4Q2008
Asia
2Q2009
1Q2007 (Phase II)
7
Rotavirus Vaccines are Cost-Effective

• Criteria for evaluating cost-effectiveness
• Cost-effective if the cost/DALY1 averted is less
  than GDP2 per capita
• Cost-effective if the cost per DALY averted is
  less than US175 (World Bank)

• Rotavirus vaccines are cost-effective across a
  range of vaccine prices
• Rotavirus vaccines are cost-effective over time

1Disability-adjusted life year 2Gross Domestic
Product
8
Vaccine Supply
Rotarix GSK
RotaTeq Merck

• Multinational vaccine manufacturers
• GSK and Merck have committed to tiered pricing
  for GAVI
• Sufficient supply available to meet projected
  demand through at least 2011
• Several developing country manufacturers have
  rotavirus vaccines in development

9
Two Investment Decisions
Investment One (2007)
Investment Two (2010)
10
Impact of Investments 2007 - 2015

• Investment 1
• Prevent the cumulative deaths of more than 30,000
  children
• Prevent more than 2 million hospitalizations and
  clinic visits
• Save more than 11 million in direct medical
  costs
• Catalytic and informative experience
• Investment 2
• Prevent the cumulative deaths of 340,000 children
• Prevent more than 12 million hospitalizations and
  clinic visits
• Save more than 60 million in direct medical costs

11
How Many Lives Can Be Saved Over the Next 20
Years?
Total Infants Vaccinated 716 million Lives
Saved1 2.4 million Hospital and Outpatient
Visits Avoided2 93M
1 Adapted from Rheingans et al. 2005
(unpublished) 3.4 lives saved per 1000 infants
vaccinated (range 2.5 to 5 lives saved per 1000
1.8 to 3.6 million lives saved) 2Adapted from
Rheingans et al. 2005 (unpublished) and Parashar
2003 100 hospitalizations avoided per 1000
infants vaccinated
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Challenges Ahead

• Epidemiological and vaccine performance
• Technical
• Institutional
• Social and cultural
• Vaccine supply security and price evolution

13
Strategic and Technical Activities Necessary

• Financing Support
• Policy Development

• Demand/Supply Monitoring
• Project Management

• Enhanced Active Disease Surveillance
• Post-marketing Surveillance
• Demonstration Projects

• Enhanced Active Disease Surveillance
• Vaccine Effectiveness Study

14
Estimated Costs (2007 2015)
Costs to GAVI
Costs to Countries
15
Accelerated Introduction of Rotavirus Vaccines is
Achievable
Incremental Lives Saved 1.4 Million
16
Rotavirus Vaccine Program

• CDC
• Dr. Marc-Alain Widdowson
• Dr. Joe Bresee
• Dr. Jon Gentch
• Dr. Roger Glass
• Dr. Umesh Parashar
• Dr. Reina Turcios

• PATH
• Dr. Debbie Atherly
• Dr. Robin Biellik
• Ms. Kelli Brooke
• Ms. Joyce Erickson
• Ms. Kristen Lewis
• Dr. Kathy Neuzil
• Mr. Dave Oxley
• Ms. Deborah Phillips
• Mr. Evan Simpson
• Dr. Chris Victor
• Dr. John Wecker

• WHO
• Dr. Duncan Steele