The PDP is updated to include activities of each functional area to launch and implement vaccination programmes.

The implementation of the business plan is closely monitored with input from Market, Access and Implementation. Launch in early adopter countries is closely followed up from a business perspective.

Demand (from ‘Market, Access and Implementation’) and supply (from ‘Production Process’) are validated, considering the sequence of launch in the early adopter countries, where recommendation and funding may be granted.

Opportunities to expand the business is constantly considered, in particular with partners involved in manufacturing and distribution.

For the routine production of vaccine product for the market, a production plant has to be available. For attenuated live strains of Mtb or BCG it is likely to be a dedicated production facility. For a subunit vaccine product, campaign-wise production after change-over in a multi-purpose facility could be considered, also linked to the required volumes.

All the resources required for sustainable delivery of a sufficient amount of product need to be secured at the correct quality level. This includes trained personnel, approved documentation, released seed stocks, raw materials and disposables, and validated production equipment. In addition, a system to effectively deal with deviations has to be in place (Corrective actions/Preventive actions for all types of failures, CAPA).

To support routine manufacturing the resources for long term QC activities need to be secured, at the required quality level (raw materials/ reagents, trained personnel, equipment, reference standards).

When Marketing Authorisation has been obtained from a stringent Regulatory Authority (or scientific opinion from Article 58 procedure with EMA), the WHO prequalification dossier is completed and submitted. WHO prequalification allows supply of the vaccine to the health agencies of GAVI eligible low-income countries, non-GAVI eligible middle-income countries or PAHO countries.

The WHO prequalification process includes a review of production and quality control, testing of consistency lots and audit of the manufacturing facilities. WHO  ensures that vaccine efficacy data and studies are relevant to the target population, that vaccines used in immunisation programmes are safe and effective and meet the specific needs of the programme (programmatic aspects),which are: WHO recommendations and UN tender specifications are met, stability meets the needs of immunisation programmes, the immunisation schedules are compatible with those existing in national immunisation programmes, data on no interference with co-administered vaccines are available, and finally samples, labels, inserts and packaging will suit the UN tender requirements.

A model Package Leaflet for BCG vaccines  has been prepared by WHO to provide guidance to manufacturers on format and content for preparation of Package Leaflet for their vaccine. It is not intended to provide information specific to any particular vaccine brand. Vaccine manufacturers using this model to prepare their own Package Leaflet, should ensure that the information on their vaccine Package Leaflet is specific to their vaccine. Specific information should be consistent with (does not contradict) the model but can be more comprehensive and detailed.

WHO has published guidelines on international packaging and shipping of vaccines (WHO/IVB/05.23).

The vaccine can then be launched in the countries. Launch involves a number of regulatory activities that depend on countries regulations. For example, after release of commercial batch by the manufacturer, application for official batch release by the Official Medicines Control Laboratory of the country of manufacture should be sought. Another example is the application for export licence. Another is to create, as per national/regional requirements, packaging elements with prescribing information derived from the authorized Summary of Product Characteristics (Package Leaflet, legible, clear and easy to use, labelling, primary and secondary packages). These may require approval by regulatory authorities before launch. Finally, to notify regulatory authorities of initial placing on the market of the product as per national/regional requirements.

Phase 4 studies are initiated and carried out

The community engagement activities will continue at this stage of the development for more information on community engagement refer to guidance under Stage C.

Phase 4 safety studies are initiated and performed as planned.

Phase 4 studies to determine vaccine effectiveness are initiated and carried out as planned.

This stage covers, based on regulatory approval, and WHO pre-qualification, obtention of SAGE recommendations, funding commitments through GAVI and/or national mechanisms (recommendations and/or procurement). This requires a general update and regional/national adaptations of the value dossier (including data from Phase 4 clinical studies) and integration of additional requirements from authorities, policy makers and payers.

Pricing negotiations and agreements are finalised.

Commercial launch is achieved in the early adopters’ countries starting potentially with private market with dedicated marketing activities.