It also considered the capital investment NVP-BGJ398 required to establish a manufacturing facility, the time needed for product approval, and the relative cost of vaccine produced by each method. The review concluded that the egg-based inactivated influenza vaccine (IIV) production process was potentially the easiest to establish as it is used to produce more than 90% of vaccines available on the market and presents few unknowns in the path to regulatory approval. In contrast, tissue-culture based production of

IIV requires much greater financial investment and, at the time of the review, faced numerous regulatory questions. For pandemic surge capacity, egg-based LAIV requires smaller capital investment than IIV and offers significantly higher yield, faster quality control and release and, importantly, needle-free administration. This made LAIV an attractive option, particularly for developing countries with very large populations and limited numbers of health-care workers able to administer injectable IIV in a short period of time. However, while the LAIV manufacturing process is simple and potentially easier to transfer to developing countries than IIV, the production and distribution of LAIV requires a licence agreement with one of the two technology

owners (see Section 3.3 below). The review did not evaluate in detail upstream vaccine technologies such as recombinant antigens, viral vector- Capmatinib cost or DNA-based vaccines. Although promising, none of these technologies were

licensed at that time, and it was therefore premature for WHO to recommend them to developing countries. The review did, however, point out that the addition of adjuvants, particularly oil-in-water emulsions, to IIV permitted significant dose reduction and could therefore be very useful for surge production in the event of a pandemic. Following a first public call for proposals via the WHO web site in 2007, six developing country vaccine manufacturers were awarded grants (out of nine who applied) to establish or expand influenza vaccine manufacturing capacity, and a further five were selected either subsequent to a second call in 2009. The 11 vaccine manufacturers (Table 1) have received grants of between US$ 0.5−4.27 million. All proposals were evaluated against mandatory criteria, technical merit, public health value and potential domestic and regional impact by an independent external Technical Advisory Group. In addition, each manufacturer was required to demonstrate government support for its proposal − a critical element to ensuring that manufacturing plans are in line with immunization plans. One mandatory criterion was that a manufacturer was producing at least one human vaccine approved by the national regulatory agency.