Vaccine procurement in Spain
In the neighboring country, the procurement system is not centralized, with vaccines being purchased autonomously by each province. Unlike Portugal, price remains the determining factor in the choice of suppliers, a factor that was not considered beneficial by the participants of table 2 in the debate in moderation by Boi Ruiz, director of the Chair of Sanitary Management and Health Policies at the International University from Catalonia, and participation by Esther Redondo, section head of the Madrid International Health Center, Imaculada Cuesta, secretary of the Spanish Association of Nursing and Vaccines, Pilar Arrazola, head of preventive medicine at the 12 de Octubre University Hospital, and Agustin Rivero, former general director of Cartera Basic Services of the National Health and Pharmacy System.
Immaculada Cuesta recalled that "the public purchase of vaccines is made for the citizen, and that quality should be privileged first and only then the price". And Esther Redondo stressed that the economic criterion is the preponderant in 70% of the awards against 30% of technical criteria when it should be the other way around. The lack of cohesion in the public purchasing system was another factor highlighted, with regions using the price criterion and others using lists with 22 criteria. The way to achieve uniformity of these criteria was discussed by the panel that concluded that the multiple criteria system should be applied to the selection of suppliers, however, there is a discrepancy regarding the definition of those criteria that would have to be established ad hoc, although with common parameters between autonomous communities.
The influence of the “price” factor
The Portuguese Pedro Pitta Barros proposed a reflection on the best way to ensure competition in public tenders without affecting the final price of vaccines. Also participating through a conference call, the researcher from the Nova School of Business and Economics presented on the table 3 of the Conference the conclusions of his study “Self-destructive contests based only on price: evidence from the Portuguese vaccine market”, a research done with based on data analysis from several Portuguese tenders.
Ensuring national supply is the main concern of all countries in an international context in which demand is systematically higher than supply, said economist Jorge Mestre, from Carlos III University, in the introduction. In this context, the study by Pita Barros concludes that competition in the context of tenders should be stimulated, since the price tends to decrease when it is higher and to increase when there is a single supplier. But the establishment of very low base prices was considered negative, since it could lead to the absence of suppliers in the following years, with a consequent price increase, which occurred in Portugal in 2017, revealed Pita Barros.
In the debate, the difficulty of implementing a centralized purchasing system in Spain was mentioned, with Pitta Barros suggesting the exploration of systems for dividing by lots in Spain, as well as carrying out equivalent studies for the Spanish market.
Spain: main obstacles
The lack of timely economic planning, the difficulty in executing contracts in the event of unforeseen events and the lack of communication between the different players in public procurement were the main obstacles pointed to greater efficiency in the system in Spain. José Maria de Higuera, coordinator of the public procurement strategy for innovation at the Andalusian Health Service, suggested the possibility of including the preliminary consultation with suppliers in the purchase procedure itself, so as not to delay the procedures. And Rosa Sancho, from the Public Health sub-direction of Guipúzcoa, pointed out the limits of the current public procurement law that does not meet the specificities of health. In the conclusions of table 4, moderated by Esmeralda Martos, responsible for the Legal department of Tesera de Hospitalidad, there was a consensus regarding the disconnect between planning and completing the purchase of vaccines, leaving the idea of the professionalization of managers in the area of health as a possibility to improve the sustainability of the vaccine system.
Dematerialization: the success of Portugal
At the end of the debate, Andreia Túlia, Director of Health Purchasing in Portugal, gave a presentation on the multiawards system, or multi-award, emphasizing the dematerialization of 95% of the procedural circuit as the parameters of operational efficiency of the Portuguese system. Communication via the digital platform facilitates communication between the various agents, ensuring equity, transparency, sustainability and savings, he said, adding that the current framework agreement currently includes six suppliers for 25 vaccines and that the supply is usually divided into two lots at most .
“Right now, our digital platform is being matured to version 2.0. We want to make it a kind of Amazon for public procurement, ”he said.
The scarcity of the market and the legislative constraints were the main challenges pointed out to the current Portuguese system, being overcome with the use of some creativity in procedural design, logistics and planning, in order to guarantee the timely acquisition in short periods. The importance of constant monitoring of processes, especially in the case of seasonal influenza, was highlighted, as well as the need to carry out comparative studies between several years, in order to evaluate and optimize processes.
In conclusion, the Director of Purchasing for Health in Portugal stated: “Until 2018, we had a single supplier model that brought us many concerns, especially related to the risk of running out of vaccines, but the possibility of operating by multi-award and making several contracts throughout the year brought us additional guarantees and it has been a success ”.