A decade of global product innovation and market influencing has made the whole cell Pertussis pentavalent vaccine more available.

Both low- and middle-income countries now have better access to a vaccine that protects children under 5 against diphtheria, tetanus and with pertussis (DTP), hepatitis B (HepB) and Haemophilus influenzae type b (Hib) at an affordable price.

When the pentavalent vaccine became available in 2001, most countries were already immunizing their children against DTP. Pentavalent’s ‘five-in-one’ combination made it possible for governments to safeguard DTP coverage while introducing newer vaccines against HepB and Hib – a major cause of childhood pneumonia and meningitis. Increasing the number of doses per vial from one to 10 reduced the vaccine’s price per dose as well as the capacity required for the cold chain storage and transportation.

Between 2001 and 2006, only one supplier had a pentavalent vaccine qualified by the World Health Organization (WHO) which met the international standards for quality and safety. Availability to UNICEF was limited and averaged approximately 16 million doses per year. A second vaccine manufacturer with WHO pre-qualification joined the market in 2006 and, by 2010, there were five suppliers. Today there are seven manufacturers with WHO-prequalified pentavalent products. From 2007 onwards, demand and supply increased and reached 177.3 million doses in 2013 for Gavi, the Vaccine Alliance eligible countries and middle-income countries.

A stark reminder of the market’s vulnerability occurred in 2010–2012, when concerns about quality compelled WHO to withdraw pre-qualification status from two manufacturers and others had interruptions in supply. This resulted in a temporary setback of vaccine availability. However, over this period, competition offered by newly pre-qualified suppliers from India helped in sustaining reduced pricing.

UNICEF’s special contracting terms, efforts by Gavi, the Vaccine Alliance Partners and countries’ preference for 10-dose presentations, also helped to continue driving down prices. Increased transparency on vaccine pricing – published by UNICEF and available in the public domain – provides reference points that can be used by self-procuring middle-income countries negotiating with suppliers.

Between 2007 and 2014, the weighted average price per dose for Gavi-supported countries dropped by 46 per cent from $3.60 to a projected $1.94. The trend towards further reductions is expected to continue. For self-funding middle-income countries that procure through UNICEF, the weighted average price has reached an all-time low of $1.98 per dose in 2014.

In 2013, the global pentavalent supply was sufficient for all countries supplied by UNICEF. The trend in decreasing prices should give confidence to the first 16 countries that will graduate from the Gavi support and take over funding of this vaccine beginning in 2016.

The pricing and market stability have positively impacted both low- and middle-income countries and are life-saving wins for all children, especially the most vulnerable.