SUPPORTING THE GLOBAL CHOLERA CONTROL
ROADMAP
Duncan Steele, Tina Lorenson, Megan Carey, Amber Zeddies Enteric and Diarrheal Diseases
Bill & Melinda Gates Foundation GTFCC 6th Annual Meeting
BILL & MELINDA GATES FOUNDATION ORGANIZATIONAL
STRUCTURE
WATER, SANITATION & HYGIENE GENDER EQUALITY FINANCIAL SERVICES FOR THE POOR AGRICULTURAL DEVELOPMENTGLOBAL GROWTH & OPPORTUNITY
GLOBAL
DEVELOPMENT GLOBAL HEALTH
GLOBAL DELIVERY PROGRAM TEAMS
EMERGENCY RESPONSE & MLP
AFRICA & INDIA COUNTRY OFFICES VACCINE DEVELOPMENT OTHER PROGRAM TEAMS ENTERIC & DIARRHEAL DISEASES DISCOVERY, INNOVATION, LSP PROGRAM ADVOCACY & COMMUNICATIONS CHINA COUNTRY OFFICE DEVELOPMENT POLICY & FINANCE STRATEGY, PLANNING & MANAGEMENT POLICY, ADVOCACY & COMMUNICATION
OUR EVALUATED STRATEGIC OPTIONS – LOOKING BACK
Understand epidemiology Develop and optimize tools Optimize market dynamicsEnable and scale delivery of tools • Support of modeling efforts to generate global estimates • Understanding epidemiology in endemic areas. • Successful WHO-PQ
of oral cholera vaccine
• Low-cost Gavi-eligible vaccine • Euvichol-plus FS, Shanchol CTC • Revitalization of the GTFCC Secretariat.
• Advocacy for cholera
control; Stop Cholera.
Assess impact
• 36 million doses of
OCV used since 2013.
• 26 countries requested OCV (11 GTFCC, 15 ICG mechanism). 2013 -20 1 8 Accomp lishm e nts • GTFCC Roadmap released in 2017 outlining use case of vaccine in
OUR EVALUATED STRATEGIC OPTIONS
Understand epidemiology Develop and optimize tools Optimize market dynamicsEnable and scale
delivery of tools Assess impact
Strat eg ic op tion s con sid ere d for 20 19 -20 2 5
Develop new vaccine
Eg. injectable format, improved efficacy, improved duration of protection Improve demand predictability Anticipate country engagement in control programs Increase supply Partner with manufacturers for expansion Identify cholera hotspots geomapping of incidence,
sero-surveys for recent
cholera exposure
Supporting surveillance
Country partnerships for lab diagnostics, rapid diagnostics of outbreaks
Global body to deliver vaccine Continued partnership with the GTFCC Support country implementation programs
Partner with institution for in-country focus
Cholera control in endemic settings surveillance post-introd. follow-up serosurvey, improved diagnostics, measurements on WASH OCV - emergencies vaccine coverage, migration level, decreased cholera incidence, integration with other sectors
Optimize existing vaccine
Eg. out of cold chain,
infant formulation,
decreased COGS
SHIFTS IN CHOLERA
Strategic Options
• Due to the immediate need of OCV requests outstripping
supply and our BMGF competitive advantage, increasing
OCV supply by partnering with manufacturers is our top
priority. 27 39 10 24 38 27 44 62 46 37 27 59 75 93 98 0 20 40 60 80 100 120 2018 2019 2020 2021 2022 Dem a n d ( m illi o n s o f d o se s) Base demand forecast (Gavi) Current range between high and low demand forecast: 60M doses Medium high scenario (Gavi) Medium low scenario (Gavi) Understand epidemiology Develop tools Enable delivery of tools Assess impact Increase supply
Partner with manufacturers for expansion. Optimize market dynamics 5 000 000 10 000 000 15 000 000 20 000 000 25 000 000 30 000 000 35 000 000 2013 2014 2015 2016 2017 2018
Sum of Overall doses requested (from request form)
Sum of Doses approved (from request form)
• Identify cholera hotspots through geomapping incidence and conducting of sero-surveys for recent cholera exposure
• Partner organizations:
• John’s Hopkins University, School of Public Health
• International Centre for Diarrheal Disease Research, Bangladesh • Mass General Hospital, Partners in Health
OCV Data and Demand Forecast Process Map | April 2019 DRAFT
Shipment plans
Gavi’s SDS (20 yrs) & financial forecast (10 yrs)
Gavi operational forecast Demand Model Stage 1 & 2 - First possible campaign date - Demand calculation
Operational Demand Forecast and Supply Allocation
Outstanding questions to be answered immediately:
- Does everyone agree on this overall process and tools? Are these the right tools for your needs? Do you have additional needs?
- Are these the primary use cases for the demand forecast model?
6-month view 3-year view 3-year view
Other key input - Emergency vax
use forecast (external analysis)
- One output with rolling views:
o Monthly view for 6-months
o Annual view for 3 years
Outstanding questions to be answered in the next 6-9 months:
- Which organization should own the demand forecast model? How do you envision all the tools fitting together to provide you information needed?
© 2018 Bill & Melinda Gates Foundation | 7
• Our objective is to optimize existing vaccines, using innovations such as re-formulation of
the current vaccine, single-prefilled compact delivery devices and labeling for controlled temperature chain to enable ease of access to target populations.
• We are engaging to optimize production efficiencies and expand manufacturing capacity given the growing demand for OCV
• We are working with WHO GTFCC to standardize the NCCP process and improve OCV demand
forecasts • Partner organizations: • IVI • Manufacturers • MMGH • Gavi
• We will continue to support the GTFCC Secretariat to lead the global implementation of the #ENDCHOLERA Roadmap and shift from outbreak to preventive use of OCV
• Our focus over the next 3 years is to ensure continued funding for OCV
• including operational expenses through the Gavi replenishment
• We are exploring options with other funding organizations to support country-focused efforts:
• Expand knowledge around burden, interventions and the path to elimination
• Engage with countries to develop, mobilize resources and execute NCCPs
• Demonstrate impact by tracking hotspots post-interventions and over time
• We encourage surveillance and WaSH funders and advocacy organizations to contribute to