Letter Urging Gavi, UNICEF to Negotiate Fair Price of Mpox Vaccines
Dr. Sania Nishtar
Chief Executive Officer, Gavi
Gavi Executive Board Members
Catherine Russell
Executive Director, UNICEF
UNICEF Executive Board Members
August 27, 2024
Dear Dr. Nishtar, Ms. Russell, and Members of the Gavi and UNICEF Boards,
We write deeply concerned about the growing mpox crisis and the challenges surrounding vaccine access and pricing. With mpox cases escalating and the outbreak spreading rapidly, the threat to global health security is real and growing. The need for an equitable, transparent, and coordinated response could not be more urgent.
The World Health Organization’s recent announcement that Gavi and UNICEF can begin procuring mpox vaccines before WHO emergency use listing or prequalification is an important and positive step forward. Dr. Nishtar’s recent Lancet commentary, which details Gavi’s role in the mpox emergency—including data generation, dose procurement, and facilitating donations—highlights the importance of this development. Gavi’s readiness to use its newly approved First Response Fund (FRF), which totals $500 million, is commendable. However, we are concerned about how Gavi and UNICEF will manage the procurement process, particularly the transparency of contract negotiations and the price that Gavi will pay for vaccines purchased with public funds.
During the 2022-2023 mpox outbreak, Bavarian Nordic, the manufacturer of the Jynneos (MVA–BN) vaccine, adopted a troubling pricing strategy.[1] Despite requests for transparency and fair terms, Bavarian Nordic maintained a stance that created significant barriers to access. This approach appears to persist.
As Gavi and UNICEF prepare to purchase Bavarian Nordic mpox vaccines, the estimated price of $50-75 per dose [2]remains prohibitively expensive, particularly for low- and middle-income countries (LMICs). With a two-dose regimen required, this high price would mean that Gavi’s $500 million FRF could immunize only about 3.3 million people if fully allocated to vaccine procurement alone, which is far short of the Africa CDC’s estimate of at least 10 million doses (5 million people) needed across the continent. Moreover, the high price may deplete FRF resources designed to last seven years and be available for future emergencies.
The COVID-19 pandemic exposed significant barriers to vaccine access in LMICs, including limited supply, inequitable distribution, a lack of transparency in pricing and procurement, and high price. At the same time, companies such as Moderna, Pfizer, and BioNTech made astronomical profits. This led to devastating disparities in vaccination coverage, causing unnecessary death and suffering and undermining global efforts to control the virus.
The lack of coordination among key stakeholders was also a significant barrier to effective vaccine distribution. As the mpox outbreak continues, avoiding repeating these access failures is crucial. The Africa CDC is taking the lead in coordinating the response to the mpox emergency. Gavi and UNICEF must ensure robust coordination with Africa CDC to ensure that mpox vaccines are procured affordably and distributed equitably and transparently. The lack of clarity around coordination responsibilities poses a serious risk to the success of vaccine distribution efforts.
Public Citizen’s research has identified nine global manufacturers, six of which are based in LMICs, that produce vaccines using similar processes for as little as $4 per dose,[3] compared to the high price of the Jynneos vaccine. This evidence of a significant disparity in pricing raises serious concerns about the prices that Gavi and UNICEF may be negotiating right now. The new WHO Global Strategic Preparedness and Response plan calls for leveraging “market-shaping advantages to secure affordable and equitable access to countermeasures, particularly for low-income countries.”[4] Gavi and UNICEF must use their positions as the largest vaccine purchasers for LMICs to negotiate affordable cost-plus pricing and ensure that public funds are spent responsibly and effectively. To that end, maintaining transparency is also critical. Even if the manufacturer uses tiered pricing, lower pricing may not be sufficient without transparency, which would afford procurers more bargaining power. Greater insight into Bavarian Nordic’s pricing strategy will surely help guarantee that negotiations yield a fair price.
In February, civil society groups called for Gavi and UNICEF to reject secrecy in medical product procurement agreements.[5] We reiterate this call today, urging your organizations to uphold transparency in negotiations and ensure that public funds are used in the best interest of global health. We urge Gavi and UNICEF to take all necessary steps to secure mpox vaccines at an affordable price, avoiding the mistakes made during the COVID-19 pandemic.
Additionally, we think GAVI and UNICEF could also play a role supporting Africa CDC in urging Bavarian Nordic and any other approved mpox vaccine manufacturers to license their vaccine and engage in enabling technology transfer to qualified producers, especially in Africa. Increasing self-sufficiency and lowering prices from multiple lower-cost manufacturers will have impacts for mpox, but also strengthen regional biopharmaceutical and vaccine manufacturing capacity more broadly. Of course, GAVI and UNICEF should simultaneously announce their support for procurement from newly licensed and quality-assured manufacturers.
Looking forward, as Gavi finalizes its 2026-2030 strategic plan and seeks $9 billion in funding, the approach to negotiating with Bavarian Nordic will be a critical indicator of Gavi’s commitment to fairness and responsible resource management. These funds must be used effectively and not allocated to premium-priced vaccines that could limit access. This is a critical moment for Gavi and UNICEF to affirm their commitment to equity and the prudent use of public resources.
We look forward to your leadership in helping secure a just and effective response to the mpox emergency.
Sincerely,
Public Citizen
MSF Access Campaign
Health GAP
NETWORK Lobby for Catholic Social Justice
People’s Medicine Alliance
Partners In Health
[1] The Bavarian Nordic vaccine MVA-BN is marketed under the brand names Jynneos in the United States, Imvanex in the European Union, and Imvamune in Canada.
[2] https://www.who.int/publications/m/item/mpox-global-strategic-preparedness-and-response-plan
[3] https://www.citizen.org/article/ramping-up-mpxv-vaccine-production/
[4] https://www.who.int/publications/m/item/mpox-global-strategic-preparedness-and-response-plan
[5] https://www.citizen.org/article/open-letter-to-medical-procurers-say-no-to-secrecy-in-medical-product-agreements/