The LNCT Network Coordination team recently sat down with Miloud Kaddar, Senior Health Economist, Independent Consultant and LNCT Technical Facilitator, for an interview regarding his work on the recent UNICEF report, ‘Immunization Financing in MENA Middle-Income Countries’.
Miloud, who does the UNICEF Regional Office in MENA serve and why did they contract you and Helen to carry out this report on immunization financing?
Miloud Kaddar: UNICEF’s regional office, headquartered in Amman, Jordan, works with 20 countries. This includes six high-income countries and 14 middle income countries, including three Gavi countries (Djibouti, Sudan, and Yemen). I think the UNICEF Regional Office is concerned with helping countries work towards equitable and sustainable immunization financing and wanted a “landscape” of the situation and recommendations for how it might best support countries.
We’d like to focus on the middle-income countries in the region, since they might have the most lessons for LNCT countries. What are some of the key challenges facing the middle-income countries in MENA?
MK: Economic growth has been very uneven over the past few years and health budgets have been squeezed. Many of the middle-income countries that are not eligible for Gavi-support have been unable to secure the budgets to introduce new vaccines such as rotavirus and PCV. Conflict has affected the region greatly, with some countries in-conflict and others affected by large numbers of refugees. Coverage has fallen in some countries, such as Iraq, Syria, and Yemen.
How are countries approaching vaccine procurement?
MK: The Gavi-eligible countries are all using UNICEF Supply Division to procure vaccines and the non Gavi-eligible, countries such as Algeria, Egypt, Jordan, Morocco, and Tunisia, tend to use a mix of UNICEF Supply Division for some vaccines and direct procurement for others. Non-Gavi middle income countries in MENA are facing many challenges for example the global vaccine market has limited competition for some vaccines, manufacturers are not always interested in countries with small population, there is also a high level of information asymmetry, and market is quite segmented. At the country level, there may be challenges with public procurement rules, human capacity and practices. As a group, countries are very concerned with getting good quality vaccines at affordable prices and are looking for ways to improve efficiency in vaccine procurement. Reforms and changes are under discussion.
We understand that the region attempted to develop a regional pooled procurement system some time ago. What happened?
MK: Since many of the countries represent fairly small markets, there was a lot of interest in pooling efforts to procure vaccine. Several years back, a lot of effort went into developing a regional pooled procurement system. This initiative did not materialize because it was difficult to agree on a common set of vaccines and presentations across countries. There were also important differences between countries in their regulatory and financial arrangements. In the end, conflict and lack of political support in some countries made this option impossible. However, there are important lessons to be heeded from this experience and the extraordinary efforts of partners and member states.