Still the Foundation has the flexibility and ability to be creative and welcomes innovative proposals.

D. Rodriguez added that the PAHO Revolving Fund is now focusing on vaccine affordability rather than on security, and thus agreements are on an annual or biannual basis, rather than long-term multiyear agreements like UNICEF. The large majority of member LY2157299 supplier States in the Americas use their own funds to acquire vaccines, and pool procurement is based on solidarity with small countries that would not have access to good deals if out of the pool. M. Malhame added that GAVI engages with manufacturers and donors through an open dialogue on potential demand, including the industry in the discussions of forecast and roadmaps for vaccine introduction. Limited vaccine supply is often a challenge, meant D. Rodrigues,

such as presently Yellow Fever (YF) vaccine supply shortage. Despite four YF manufacturers the demand is Sirolimus not met, due to cumbersome technology and the lack of incentives to larger volumes’ supply, despite some signal of expanded campaigns to come. Another challenge is an imbalance created by increased Pentavalent demand in some countries that could result in shortage of DTP for other countries. A concern to manufacturers of developing countries is the increasing requirements for registration in individual countries, delaying access, even when vaccines have gone through prequalification, while the tools and instruments exist to expedite registration. P. Duclos presented WHO’s Strategic Advisory Group of Experts (SAGE) on immunization, which issues global policy recommendations

and strategies to supporting regional/national challenges. SAGE recommendations have an impact on countries’ vaccination policies, global partnerships, regulatory processes, vaccine demand and vaccine supply by industry. The technical advisory committees and working groups provide evidence to inform the global policy recommendations and strategies of SAGE that can be adapted and implemented, within the local epidemiological and and socio-economic context, at regional and national levels. SAGE working groups, composed by SAGE members and additional independent experts, are established to review evidence and address specific issues in great depth and prepare for fruitful discussions at plenary SAGE meetings. Issues taken into consideration by SAGE include disease epidemiology, vaccine characteristics, clinical and immunization features and economic considerations. Additionally, health system opportunities and other existing interventions and control strategies, social impact, legal and ethical issues are also considered.