Authors: Miloud Kaddar, Grace Chee, and Leah Ewald
Last week, the Learning Network for Countries in Transition (LNCT) and the UNICEF Vaccine Procurement Practitioners Network (VPPN) co-hosted its first regional procurement workshop in Tbilisi, Georgia. LNCT members Armenia, Georgia, Moldova and Uzbekistan joined fellow VPPN members North Macedonia and Serbia for three days of focused exchange around vaccine registration and regulatory issues, forecasting and budgeting, procurement options, and conducting performance assessments. It was great to see participants’ energy for tackling vaccine procurement and regulatory challenges and developing action plans to strengthen their procurement and regulatory processes, supported by experts from UNICEF, WHO, and LNCT. We also visited Georgia’s National Center for Disease Control and Public Health, where we viewed Tbilisi’s new vaccine warehouse and Lugar Center, Biosafety Level 3 laboratory.
We are grateful to the country teams for their willingness to share their procurement experiences with frankness and insight. Two key takeaways that came out of the discussions were that:
- Considering global supply constraints and small market sizes in most participant countries, it is advisable to make best use of UNICEF procurement services for EPI vaccines and to look beyond the country’s borders to build strong relationships with the National Immunization Programs and procurement agencies of neighboring or similar countries. Countries may be able to improve their attractiveness to suppliers and negotiation position by pooling their market intelligence, capacity and demand.
- Vaccine procurement involves a wide range of actors and skills and requires strong coordination and alignment between entities in charge of immunization programs, budget and financing, vaccine supply and management, and regulation. All countries agreed that strengthening coordination was critical to ensuring efficient and strategic procurement processes.
Here are just a few things that we learned about what these countries are doing that other LNCT members might like to learn about:
- Armenia issued a governmental decree that allows drugs and vaccines that are registered in International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) countries or have WHO pre-qualification to undergo a simplified procedure to be registered in just 30 days instead of the standard 140.
- Georgia uses data on demographics, coverage, stock, vaccine loss, and warehouse and cold chain capacity from an electronic data management system to support immunization planning and budgeting. The use of this data, along with other factors including the introduction of three new vaccines, contributed to a 500% increase in the EPI budget since 2012. Watch this video to learn more about Georgia’s electronic data management system.
- Moldova separated their procurement agency and national regulatory authority to avoid conflicts of interest that can arise when the same agency that procures vaccines is also in charge of evaluating vaccine quality and performance. Now, the independent national regulatory agency approves specifications proposed by the National Agency of Public Health, while tenders are carried out separately by the Center for Centralized Health Procurement.
- Uzbekistan partnered with UNICEF to conduct a mapping of immunization financing sources and to develop a new multi-year budgeting tool that considers all components of an immunization budget, including the cost of cold chain equipment and maintenance. The Excel-based tool calculates the quantity and cost of vaccines and supplies to be purchased based on adjustable parameters including target population, coverage, vaccine stock, buffer, price, and exchange rates, and is fully compatible with the cMYP.
- North Macedonia increased the efficiency of its procurement process and reduced the frequency of stockouts by switching to multi-year procurement, centralizing procurement for vaccines and other drugs, and introducing an Electronic System for Public Procurement.
- Serbia has worked hard to strengthen its NRA as a vaccine producer to WHO maturity level 3 of a possible 4. Level 3 indicates a stable, well-functioning and integrated system for oversight of medical products. Serbia has also established a separate line item for vaccines and ensures that when the country does not spend the full allocated amount, the savings can be re-invested in the vaccine budget rather than being directed elsewhere.
These small regional workshops are a fantastic opportunity for countries to explore possible solutions to their specific challenges with countries that are operating in similar contexts. We look forward to following up with participants as they implement their procurement action plans and continue to build relationships with each other online. We are also excited to continue building on our new partnership with the VPPN during future sub-regional procurement workshops – please stay tuned for news!