Modernizing Vaccine Procurement in Jordan

Although Jordan has one of the region’s most successful national immunization programs, significant gains can be achieved in equitability, affordability, and sustainability through regulatory reform. Moreover, lower annual expenditures can support the sustainability and expansion of the immunization program and adaptability to emerging needs, including public health crises such as COVID-19.

Pharmaceuticals, including vaccines, represent 2.05% of Jordan’s GDP and 23% of total health spending. Negotiation is not permitted under the Government Procurement Bylaw (GPB), which contributes to significant differences between international reference prices and local procurement prices. While pharmaceutical prices are regulated and set through the Jordan Food and Drug Administration (JFDA), vaccines prices are not, which is a burden on public resources. In an informal analysis conducted by the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program in collaboration with the Government Procurement Department (GPD) for a six-vaccine sample available in Jordan, median price difference compared to UNICEF-supplied rates was high.

Further, analysis of national vaccine procurement for 2018, conducted by MTaPS and the GPD, found a lack of competition in the market: 61% of GPD-procured vaccines had one bidder. Offers exceeded the GPD price estimates in 39% of bids, and bids exceeded estimates by an average of 3 Jordanian Dinars per unit for nearly half of all procured vaccines. The findings were consistent with the GPD 2018 annual report.

In 2019, a National Vaccines Procurement Modernization Committee (NVPMC), formed by the Government of Jordan, developed a research-based National Operational Plan with USAID’s support that recommended 17 regulatory actions. Following a slowdown of efforts because of the COVID-19 pandemic, in 2021, MTaPS was tasked with providing support to the NVPMC and advancing five priority actions from the National Operational Plan.

MTaPS’ Support Advances Reform Agenda

Challenged with the complexities of many stakeholders, MTaPS honed a two-pronged strategy to create an enabling environment for reform: inclusive NVPMC meetings and separate one-on-one meetings with stakeholders to obtain feedback and align efforts. Leveraging the Committee’s knowledge and expertise while providing technical and legal backstopping, MTaPS secured collective and unanimous agreement and buy-in for reforms from all Government of Jordan stakeholders, including the JFDA, GPD, Ministry of Health, and Legislation and Opinion Bureau. With robust follow-up and strategic communication, MTaPS ensured that the momentum created was converted to action to accelerate the pace of reform. All recommendations were documented and communicated to appropriate entities, further institutionalizing the Committee’s efforts.

At a National Vaccines Procurement Modernization Committee meeting. Photo credit: USAID MTaPS Jordan

Backed by USAID’s support and a rigorous approach to coordination and communication, MTaPS facilitated implementation of 5 of the 17 NVPMC-identified actions. These regulatory actions—three involving legislative articles and two institutional policies—further institutionalized procurement best practices, facilitated market entry, and increased competition in Jordan’s pharmaceutical landscape.

Regulatory Reforms Implemented

JFDA’s institutional policies

• Fast-tracking vaccine registration by integrating WHO-prequalified vaccines into JFDA’s registration policies and procedures. The JFDA announced updated registration principals in the National Gazette on October 17, 2021.
• Informing the GPD of vaccine reference prices by the JFDA. The JFDA communicated vaccine reference prices to the GPD on November 24, 2021.

Procurement-related legislative articles

• Permitting partial prepayment for vaccine procurement by activating and implementing GPB Article 93. The Ministry of Health sent a letter to the GPD, MOH Procurement and Supply Directorate, and Ministry of Finance on August 30, 2021, to activate prepayment via Article 93 for vaccine procurement.
• Extending the maximum limit of procurement framework agreement with suppliers from two years to five years by amending GPB Article 57. On September 29, 2021, the Legislation and Opinion Bureau confirmed to the MOH the integration of a framework agreement extension into the draft GPB reform sent to the Prime Ministry for approval.
• Permitting negotiations with suppliers under specific, exceptional provisions by adding an article to the GPB or within implementation instructions. A letter sent by the Legislation and Opinion Bureau to the MOH on September 29, 2021, confirmed the addition of a new article, as drafted with MTaPS’ support, into the draft GPB reform submitted to the Prime Ministry for ratification.

The actions permitting partial prepayment and longer agreement duration will incentivize new suppliers and increase international bidding, which will spur competition and lead to better pricing and optimal agreements. Further, access to information on existing suppliers and registered products in the local market and local and international reference prices will strengthen GPD decision making power. Lastly, streamlining and expediting registration requirements will facilitate vaccine market entry without compromising quality.

Next Steps

To continue building on progress to reform Jordan’s vaccine procurement, MTaPS will support the following in FY22:

• Developing guidelines to optimize procurement framework agreements and negotiations
• Facilitating cooperation among key stakeholders
• Advocating for legislative reforms to foster competition and international bidding and support related coordination with the Ministry of Industry and Trade
• Conducting research to determine potential additional resources for vaccine procurement

Conclusion

Through strategic partnership and coordination, MTaPS supported the efforts of USAID and the NVPMC, as well as other national and international entities, to advance reform for Jordan’s vaccine procurement. Implementation of the five policy and legislative reforms will further institutionalize procurement best practices, facilitate market entry, and increase competitiveness, thus securing and strengthening the country’s immunization programs and safeguarding the health of its population.