Access ahead: Powering the path in Europe’s private vaccine market

Published in

ZS Associates

7 min readApr 1, 2024

By: Jennifer Wong, Samantha Reichard, Emmanuel Lo, and Emmanuel Colliot

Private payer opportunities have often been overlooked or deprioritized in favor of public funding historically. For vaccines included in national immunization schedules, patient access is nearly guaranteed, particularly in Europe. For vaccines without a broad national recommendation in many key European markets, manufacturers must turn to private access and reimbursement channels, with further uptake challenges across distribution and administration. Several trends point to the need for refocusing on the private market:

Privately-funded vaccines cover a broad range of diseases, including some that may not be included on essential lists at the population level or those traditionally considered travel vaccines or vaccines specifically for occupational risks. For instance, reimbursement of vaccines for Hepatitis A and rabies may be limited to a specific geography or population based on the level of risk.
Significant cost pressure has increasingly forced healthcare systems to further restrict what they can fully or even partially reimburse. In 2020, the EU’s average healthcare expenditure amounted to 10.9%¹ and is expected to increase by 0.8% annually².
The number of patients with health insurance via private payers or employer coverage has increased. The market size of health insurance in Europe rose by a compound annual growth rate (CAGR) of ~5.3% between 2017 and 2023³.

Let’s dive further into 1) when and why private market opportunities should be prioritized, 2) which stakeholders in the private market ecosystem manufacturers should engage and 3) key considerations to help navigate this evolving paradigm in Europe.

Decisions influencing the public vs. private access split for vaccines

In key European markets, National Immunization Technical Advisory Groups (NITAGs) have direct influence over vaccine decision-making, prior to Health Technology Assessment (HTA) processes. Conducted by independent agencies, NITAGs evaluate various aspects of vaccines such as epidemiology, immunology, effectiveness, safety, cost-effectiveness and ethics before making recommendations for inclusion in national immunization programs (NIPs)⁴, which are typically publicly-funded.

While positive NITAG recommendations do not always translate to broad public funding, the lack of a recommendation can completely prevent an HTA for a vaccine. For example, in Germany, vaccines not recommended by the Standing Committee on Vaccination (STIKO) are ineligible for the Federal Joint Committee (G-BA) process⁵ (see Figure 1). This prevents the statutory health insurance (SHI) — which covers medications for about 90% of the population — from funding these vaccines. Vaccines without a STIKO recommendation are therefore only accessible via the private market, posing challenges to pharma such as lower demand and higher price sensitivity from consumers. There are also an increasing number of instances where a NITAG recommendation is only for a certain patient population. For instance, STIKO recommended the herpes zoster vaccination only for patients who are either over the age of 60 or over the age of 50 and at an increased risk⁶. Manufacturers must be ready to navigate a combination of public and private funding for one vaccine.

Figure 1: **Vaccine market access pathway in Germany**

Across Europe, private vaccine funding opportunities have grown substantially and will likely continue to grow. Avenues for manufacturers to engage with private market stakeholders and offer dynamic pricing agreements should be further explored.

Leveraging private access channels for vaccines

In recent years, private channels have grown more prevalent and relevant for many vaccines:

Vaccines traditionally associated with travel or leisure are becoming necessary beyond travel outside of Europe, as are those geared toward environmental and exposure-based infections, due to climate change. Mosquito-born viral infections such as dengue and Chikungunya, once mostly associated with travel to more distant locations, are growing more prevalent throughout Europe, as are tick-born diseases such as Lyme.
Transmission via contaminated food or water (e.g., invasive E. coli disease) has also risen as the global population continues to expand.
Vaccines like Shingrix for shingles, targeted toward older adults, may be publicly reimbursed for certain populations, but there is an opportunity to leverage private market funding outside those demographics.

Strategies to navigate this new paradigm

To optimize opportunities for vaccines in the private channel, consider the key stakeholders and their intrinsic motivations and incentives (see Figure 2). While many nuanced differences vary by country, a core set of key players remains common across major European markets. Additionally, employers, private insurers and pharmacists present an increasing opportunity for manufacturers to influence uptake of non-publicly funded vaccines.

Figure 2: **High-level stakeholder map for vaccines in the private market**

Employers: Particularly as a result of the COVID-19 pandemic, employers both large and small increasingly recognize the benefits of vaccines to ultimately reduce absenteeism, productivity loss and healthcare costs. Many companies are implementing more widespread vaccination policies or programs. This may include expanding their employer-sponsored insurance offerings or bringing healthcare providers (HCPs) into the workplace for on-site vaccination drives. In addition, many employers with a younger demographic are pushing to become more competitive in recruitment and retention. Since younger generations are increasingly in tune with health benefits and coverage in an era of accelerating health care costs, vaccines play a critical role in that effort.

Manufacturers must leverage the collective size and influence of employers to increase the opportunity for privately-funded vaccines. They can:

Co-create programs or financial incentives (e.g., discounts, vouchers, or free delivery) for employers who reimburse a vaccine for their employees
Show what employers need to do to set up vaccination programs and clinics at their workplaces or nearby convenient locations
Quantify the benefits for employers (e.g., days of work missed), benchmarks, disease and treatment specific information, incidence data (including results from retrospective cohort study) and data relevant to their industry and demographics
Highlight the difference between travel vaccines that employers might think employees should pay for themselves versus vaccines actually relevant in day-to-day life (e.g., an employee walking through a park or hiking)
Target industries competing for talent (e.g., tech), large employers with inclusive benefits like fertility or gender-affirming care coverage looking to retain talent (if benefits are available publicly) or large employers with at-risk employees (e.g., outdoor workers) to improve uptake
Define and engage with other decision-making influencers with a large share of voice (e.g., benefits consultants, unions, etc.)

Private Insurers: With the value of preventive healthcare becoming more widely recognized, private insurers are expanding vaccination coverage. This not only protects their insured members from preventable diseases but also reduces the burden of treatment costs in the long run. Moreover, insurers can play a pivotal role in raising awareness about the importance of vaccination, thereby driving demand in the private market. However, the extent of coverage and the types of vaccines covered can vary across different insurance plans and markets, necessitating tailored strategies for engagement and advocacy. To better ensure private coverage, manufacturers can:

Demonstrate the clinical and economic benefits of vaccination for members of private insurance plans using data from clinical trials, cost-effectiveness analyses or real-world evidence collection
Co-create portfolio and bundling deals with private insurers to drive volume and address shared priorities
Engage with other stakeholders who may influence private insurer decision making — such as regulators, policymakers, employers, providers or consumers — to promote the value and importance of vaccine coverage as a key component of overall preventative healthcare

Pharmacists: The shifting legal environment in several major European markets increases the need for pharmacists to gain authorization to prescribe and administer vaccines on-site. France⁷, Germany⁸, UK⁹ and some regions of Italy¹⁰ have already implemented this important evolution in care, allowing pharmacists to administer and prescribe some vaccines without a prescription. For example, in France, pharmacists can now prescribe and administer diphtheria, tetanus, poliomyelitis, influenza, COVID-19, measles, mumps, rubella and HPV vaccines¹¹. In Spain, pharmacists are not allowed to administer vaccines but have an important role in patient educational campaigns encouraging vaccination¹². Pharmacist administration can significantly increase the accessibility and convenience of vaccination by eliminating time spent scheduling, awaiting and attending one or several doctor’s office visits, especially if the office does not regularly stock the vaccine and must order it for a subsequent visit.

Manufacturers must seize this early opportunity to increase uptake of privately-accessible vaccines by engaging with pharmacists. To increase the urgency for stocking more non-publicly-funded vaccines, manufacturers can:

Negotiate directly with pharmacist groups (e.g., “centrale d’achat pharmaceutiques” in France) and wholesalers to reach a volume threshold meaningful enough to enable better discounts for pharmacists while limiting the effort of targeting individual pharmacies
Support national measures for pharmacists to become part of the group permitted to prescribe and administer vaccines

Conclusion

The landscape of vaccine access in Europe is evolving, with private market opportunities gaining prominence alongside traditional public funding avenues. Understanding the dynamics of private payer engagement is imperative as vaccines target a broader range of diseases and populations. To optimize access through private channels, stakeholders must engage with key influencers in each market, tailoring strategies to their motivations. By seizing these opportunities and fostering collaboration across the private market ecosystem, manufacturers can increase uptake of non-publicly-funded vaccines, contributing to improved public health outcomes in Europe.

Access ahead: Powering the path in Europe’s private vaccine market

Written by Jennifer Wong