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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (3): 437-445. doi: 10.19723/j.issn.1671-167X.2026.03.001

• 论著 •    下一篇

全球疫苗集中采购的价格效应

黄玉鑫1, 于潇依1, 许铭1,2,*()   

  1. 1. 北京大学公共卫生学院全球卫生学系, 北京 100191
    2. 北京大学全球健康发展研究院, 北京 100871
  • 收稿日期:2026-02-26 出版日期:2026-06-18 发布日期:2026-04-07
  • 通讯作者: 许铭

Price effects of global vaccine pooled procurement

Yuxin HUANG1, Xiaoyi YU1, Ming XU1,2,*()   

  1. 1. Department of Global Health, Peking University School of Public Health, Beijing 100191, China
    2. Institute for Global Health and Development, Peking University, Beijing 100871, China
  • Received:2026-02-26 Online:2026-06-18 Published:2026-04-07
  • Contact: Ming XU

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摘要：

目的: 评估以联合国儿童基金会(United Nations Children's Fund, UNICEF)和泛美卫生组织(Pan American Health Organization, PAHO)为代表的国际集中采购机制对疫苗价格的影响。方法: 基于2013—2024年188个国家的14 497条疫苗采购交易记录，采用高维固定效应模型与事件研究法识别价格效应及动态趋势，并进行多维异质性分析。结果: (1) 基准模型表明，相比单一国家的自主采购，通过UNICEF进行集中采购的疫苗价格平均显著降低27.6%(β=-0.323, P < 0.01)；PAHO机制同样显示出约30.9%的初步降价潜力(β=-0.370, P=0.052)。(2)事件研究法严格验证了平行趋势假设(事前系数联合显著性检验F=0.27, P=0.845)，动态追踪显示，在由自主采购转换为集中采购的当年，即可实现约30.0%的价格降幅(β=-0.356, P < 0.01)，且该降价效应在后续年份中保持持续稳定。(3)异质性检验揭示，集中采购具有显著的“扶弱”效应，即小规模买家获得的降价幅度(38.5%, β=-0.487, P < 0.01)显著高于大规模买家(22.5%, β=-0.255, P < 0.01)；非全球疫苗免疫联盟(Global Alliance for Vaccines and Immunization，GAVI)援助国家的边际降价系数(β=-0.418, P < 0.01)远大于GAVI受援国(β=-0.118, P < 0.05)；高收入国家组的降幅最大(β=-0.475, P < 0.01)。(4)供给侧调节效应分析表明，UNICEF的集体议价能力具备跨市场结构的鲁棒性(robustness)，未因市场集中度的上升而发生统计学意义上的显著衰减(交互项β=0.095, P>0.10)。结论: 制度化集中采购能够显著降低疫苗价格；对处于免疫规划融资转型期及面临高自主采购基准价的国家，加入高效的国际集中采购平台是替代外部资金援助、维持疫苗长期可负担性的重要制度安排。

关键词: 疫苗, 集中采购, 成本及成本分析, 全球健康, 市场结构

Abstract:

Objective: To evaluate the impact of international pooled procurement mechanisms, which are primarily represented by the United Nations Children ' s Fund (UNICEF) and the Pan American Health Organization (PAHO), on the procurement prices of vaccines. Methods: Based on 14 497 vaccine procurement transaction records collected from 188 different countries spanning the period from 2013 to 2024, this research employed a high-dimensional fixed effects model along with an event study metho-dology to accurately identify the price effects and dynamic temporal trends, while simultaneously conducting a multidimensional heterogeneity analysis. Results: (1) The baseline model demonstrated that, when compared to the independent self-procurement conducted by individual nations, utilizing pooled procurement through the UNICEF significantly reduced the average vaccine prices by 27.6% (β=-0.323, P < 0.01). The PAHO mechanism similarly exhibited an initial price reduction potential of approximately 30.9% (β=-0.370, P=0.052). (2) The event study method strictly validated the parallel trend assumption (joint significance test of pre-treatment coefficients: F=0.27, P=0.845). Dynamic tracking revealed that a price reduction of approximately 30.0% (β=-0.356, P < 0.01) was achieved exactly in the year of transitioning from self-procurement to pooled procurement, and this reduction effect remained persistently stable in subsequent years. (3) Heterogeneity tests revealed a significant "pro-poor" effect of pooled procurement: the price reduction margin obtained by small-scale buyers (38.5%, β=-0.487, P < 0.01) was significantly higher than that of large-scale buyers (22.5%, β=-0.255, P < 0.01). The marginal price reduction coefficient for non-Global Alliance for Vaccines and Immunization (GAVI) eligible countries (β=-0.418, P < 0.01) was substantially larger than that for GAVI eligible countries (β=-0.118, P < 0.05). The high-income country group experienced the most substantial price drop (β=-0.475, P < 0.01). (4) The supply-side moderating effect analysis indicated that UNICEF' s collective bargaining power maintained robustness across diverse market structures, showing no statistically significant attenuation despite increases in market concentration (interaction term β=0.095, P>0.10). Conclusion: Institutionalized pooled procurement mechanisms are capable of significantly reducing vaccine prices. For those countries that are currently in the immunization financing transition period, as well as those facing high self-procurement benchmark prices, participating in an efficient international pooled procurement platform serves as a critical institutional arrangement to replace external financial aid and to effectively maintain the long-term affordability of vaccines.

Key words: Vaccines, Pooled procurement, Costs and cost analysis, Global health, Market structure

中图分类号: 

  • R186

表1

交易数量(观察)的描述性统计"

Vaccine Other Other pool-procurement PAHO Self-procurement UNICEF Total
BCG 18 3 176 385 683 1 265
Combination vaccines 147 45 1 084 2 386 2 427 6 089
HPV 21 5 136 258 221 641
Hepatitis B 37 12 313 713 451 1 526
Hib 15 3 38 192 10 258
Measles 2 0 0 74 253 329
Pneumococcal conjugate 36 4 124 415 596 1 175
Polio 29 15 387 464 1 542 2 437
Rotavirus 20 15 102 189 438 764
Rubella 1 0 0 12 0 13
Total 326 102 2 360 5 088 6 621 14 497

表2

关键变量汇总统计"

Items Observations Mean SD Minimum Maximum
Price per dose (USD) 14 497 7.72 16.83 0.03 240.30
Transaction volume (doses) 14 497 1 578 766.53 8 827 643.06 1.00 5.56×108
HHI (market concentration) 14 497 0.00 0.27 -0.45 0.55
Procurement: self-procurement (dummy) 14 497 0.35 0.48 0.00 1.00
Procurement: UNICEF (dummy) 14 497 0.46 0.50 0.00 1.00
Procurement: PAHO (dummy) 14 497 0.16 0.37 0.00 1.00
Procurement: other pool-procurement (dummy) 14 497 0.03 0.17 0.00 1.00
WHO PQ certified (yes=1) 14 497 0.73 0.44 0.00 1.00
GAVI eligible country (yes=1) 14 497 0.37 0.48 0.00 1.00
Income: high (dummy) 14 497 0.26 0.44 0.00 1.00
Income: upper-middle (dummy) 14 497 0.29 0.45 0.00 1.00
Income: lower-middle (dummy) 14 497 0.29 0.46 0.00 1.00
Income: low (dummy) 14 497 0.15 0.36 0.00 1.00

表3

采购机制和疫苗价格的基准回归结果"

Items Model 1 ln(price) Model 2 ln(price) Model 3 ln(price) Model 4 ln(price) Model 5 ln(price)
UNICEF SD, mean (SE) -0.478 (0.082)*** -0.487 (0.082)*** -0.323 (0.074)*** -0.285 (0.077)*** -0.265 (0.075)***
PAHO, mean (SE) -0.528 (0.167)*** -0.557 (0.168)*** -0.370 (0.189)* -0.341 (0.231) -0.280 (0.236)
Other pool-procurement, mean (SE) -0.027 (0.136) -0.042 (0.127) 0.207 (0.136) 0.486 (0.133)*** 0.542 (0.136)***
Other, mean (SE) 0.168 (0.083)** 0.137 (0.084) 0.109 (0.086) 0.005 (0.112) 0.026 (0.108)
ln(volume), mean (SE) -0.061 (0.008)*** -0.027 (0.007)*** -0.021 (0.007)*** -0.018 (0.007)**
WHO PQ certified, mean (SE) -0.024 (0.057) -0.025 (0.056) -0.065 (0.028)** -0.037 (0.026) -0.048 (0.045)
Country FE Yes Yes Absorbed Absorbed Absorbed
Product FE Yes Yes Absorbed Absorbed Absorbed
Year FE Yes Yes Yes Absorbed Absorbed
Country-product FE No No Yes Yes Yes
Product-year FE No No No Yes Yes
Country-year FE No No No Yes Yes
Manufacturer FE No No No No Yes
Observations 14 269 14 269 13 081 12 675 12 439
R-squared 0.929 0.930 0.969 0.982 0.982

图1

处理组事件的时间分布"

图2

联合采购的动态价格效应"

表4

买方异质性分析"

Items Baseline Buyer size GAVI eligibility Income group
Small buyer Large buyer GAVI Non-GAVI LIC LMIC UMIC HIC
Other, mean (SE) 0.109 (0.086) 0.040 (0.063) 0.116 (0.125) 0.060 (0.099) 0.124 (0.098) -0.528 (0.300)* 0.025 (0.107) 0.335 (0.221) 0.063 (0.055)
Other pool-procurement, mean (SE) 0.207 (0.136) 0.343 (0.182)* 0.304 (0.222) 0.453 (0.187)** 0.201 (0.139) 0.252 (0.176) 0.203 (0.136)
PAHO, mean (SE) -0.370 (0.189)* -0.379 (0.276) -0.340 (0.190)* -0.134 (0.061)** -0.616 (0.351)* -0.268 (0.292) -0.256 (0.118)** -0.185 (0.220) -1.222 (0.267)***
UNICEF SD, mean (SE) -0.323 (0.074)*** -0.487 (0.130)*** -0.255 (0.072)*** -0.118 (0.048)** -0.418 (0.093)*** -0.311 (0.289) -0.288 (0.108)*** -0.386 (0.086)*** -0.475 (0.073)***
ln(volume), mean (SE) -0.027 (0.007)*** -0.052 (0.014)*** -0.010 (0.009) -0.002 (0.005) -0.038 (0.011)*** 0.002 (0.007) -0.017 (0.008)** -0.040 (0.016)** -0.036 (0.017)**
n 13 081 5 681 6 959 4 987 8 033 1 963 3 847 3 565 3 336

表5

卖方异质性分析"

Baseline HHI interaction PQ interaction
UNICEF SD, mean (SE) -0.323 (0.074)*** -0.317 (0.073)*** -0.381 (0.104)***
PAHO, mean (SE) -0.370 (0.189)* -0.357 (0.189)* -0.376 (0.179)**
Other pool-procurement, mean (SE) 0.207 (0.136) 0.202 (0.138) 0.459 (0.200)**
Other, mean (SE) 0.109 (0.086) 0.124 (0.092) 0.067 (0.076)
ln(volume), mean (SE) -0.027 (0.007)*** -0.027 (0.007)*** -0.027 (0.007)***
WHO PQ certified, mean (SE) -0.065 (0.028)** -0.064 (0.028)** -0.098 (0.045)**
HHI (centered), mean (SE) -0.038 (0.074)
UNICEF×HHI, mean (SE) 0.095 (0.140)
UNICEF×PQ certified, mean (SE) 0.069 (0.074)
Country-product FE Yes Yes Yes
Year FE Yes Yes Yes
Observations 13 081 13 081 13 081
R-squared 0.969 0.969 0.969
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ISSN 1671-167X
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