The cost of lifesaving vaccines is nearly 70 times what it was in 2001, an international medical agency says. The astronomical rise has been particularly hard on the world’s poorest countries, and groups trying to help them.
Six million lives in the world’s poorest countries could be saved if global leaders respond to a call for funding on Tuesday.
Gavi, The Vaccine Alliance, is asking for US$7.5 billion (Dh27.5bn) to cover 300 million vaccines for children from next year to 2020.
The Reach Every Child event in Berlin is being hosted by German chancellor Angela Merkel.
Poorer countries, which benefit from Gavi assistance, receive vaccines through a system that effectively tests their gross national income. As they become more prosperous, the amount they pay increases until eventually all support ends – leaving them to pay the market price.
It is what happens then that concerns Medecins Sans Frontieres (MSF – also known as Doctors Without Borders), which last week claimed the cost of a full vaccine package today is nearly 70 times more expensive than the 2001 price. It accused some pharmaceutical companies of seeking “blockbuster revenues” as prices have skyrocketed.
Naming and shaming pharmaceutical companies Pfizer and GlaxoSmithKline, the group urged them to cut the pneumococcal vaccine prices to $5 in poorer countries. Pneumococcal disease kills about one million children a year with MSF claiming it costs some countries $10 per child for the vaccine.
Several vaccines have been added to the World Health Organisation immunisation schedule in the past 14 years, and the number has risen from six to 12.
According to MSF, it cost a minimum of 67 cents to administer the full package in 2001, but $32.09 last year.
“While the number of diseases against which a child is immunised has doubled between 2001 and 2014, the cost of the vaccine package to fully immunise a child has disproportionately multiplied 68-fold,” the organisation said.
It noted that while global immunisation coverage had reached 84 per cent in 2013, it had completely stagnated in some areas.
Two years ago, MSF was administering more than 6.7 million doses of vaccines but the group says rising costs and a lack of vaccine products for low-resource settings is making its job increasingly challenging.
Prices of vaccines, it says, are affected by several factors: “A few multinational companies dominate the market; lack of competition; various procurement strategies and purchasing conditions; and the business practices of the pharmaceutical industry.”
One of the main topics in its report, The Right Shot: Bringing Down Barriers to Affordable and Adapted Vaccines, is Gavi.
The Geneva-based organisation brings together the public and private sector “with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries”.
Working with pharmaceutical companies, governments and NGOs, Gavi aims to reduce the prices of vaccines for certain countries. Its vaccines include measles, meningitis A, pneumococcal, yellow fever, rotavirus and human papillomavirus.
While its funding model has made an impact, MSF warned that some countries slipped through the net because they did not meet the financial criteria.
“Many children living in middle-income countries are not benefiting from new, lifesaving vaccines as a result of irrational and unaffordable pricing policies; some countries even have lower immunisation coverage rates than Gavi-eligible countries.”
Dr Seth Berkley, Gavi chief executive, visited GCC countries last month to discuss funding with the countries’ leaders.
Speaking in Abu Dhabi, he explained how Gavi determined its eligible countries. Any nation with a gross national income per capita equal to or less than $1,570 could qualify.
“We don’t tell countries what to do, countries make their own choice. But if they’d like to, they can apply for a vaccine,” he said. “We help them with the scale-up of the vaccine and the roll-out of the vaccine. The other part of this is the countries themselves also have to pay. This is about sharing the burden. If you’re very, very poor you just pay a small amount.
“As the countries get wealthier they pay more and more until eventually they cross a threshold, which is $1,570 right now, and they graduate from Gavi.”
Currently, there are 53 eligible countries with 20 more having already graduated. Support is phased out over a five-year period.
Eligible countries in this region include Yemen and Afghanistan. Gavi also works in India, Pakistan and Bangladesh.
Although Syria is beginning to see the remergence of diseases such as polio and scabies, and with many children not vaccinated, the country is not currently eligible for Gavi assistance.
“We’re not in Syria even though there’s a huge need there” said Dr Berkley. “The reason is we have this economic cut-off. If you’re below US$1,570, you’re eligible. If you’re above it, you’re not. Syria started off as a wealthy nation. It may some day, unfortunately, get to that point, but right now it’s not eligible.
“Conflict is clearly related to performance economies et cetera, but that’s not why we’re so heavily in this region. It has to do with the belt across North Africa that is resource-lacking and very poor.”
What happens when countries cease to receive Gavi support is a major concern for MSF, which estimates that over the next five years more than a quarter of eligible countries will graduate.
“Even if countries can maintain their procurement at the lowest price, the end of Gavi subsidies will drastically increase their immunisation budgets,” the organisation warned.
Honduras, for example, is currently graduating, MSF said, and will stop receiving support next year. It will lose the $5 million annual support and have to find the money elsewhere. This figure represents a 38 per cent increase in the government’s spending on immunisations.
Despite its concerns about graduating countries, MSF acknowledged that Gavi had played a key role in reducing vaccine prices for eligible countries.
Dr Berkley, however, said this was not necessarily the case.
“If you’re a poor country and wanted to buy these vaccines, it would cost you six, eight, 10 per cent of your health expenditure, which I think would be a good buy as someone who cares about vaccines.
“But you can understand that a country, which has many health needs, by the time they cross the graduation threshold, on average, they would need to spend 0.6 per cent of their health expenditure on those vaccines. That becomes a number that we believe is affordable for any country.”
On Tuesday Gavi will host the conference for the $7.5bn in investments it seeks to cover for its work from next year through 2020.
The vaccine prices for Gavi is significantly lower than those on the open market.
“We purchase vaccines for 60 per cent of the world’s population so as a result we are able to work with companies to scale-up the production lines, the amount of vaccines that are made, as well as bringing new companies into the game,” Dr Berkley said.
“This is important because if you start out with one or two companies that are making the vaccine in small quantities, the cost is very high. As you scale that up the cost per dose goes down so we have been able to have 90-95 per cent reduction in costs of vaccines, but also because we’ve created a stable market for developing countries where there wasn’t one, new manufacturers are coming in from the developing world.”
MSF urged Gavi to do more to stimulate competition and broaden the vaccine base, and encourage better adaptations of vaccines to avoid issues over factors such as refrigeration that make vaccine delivery difficult. It also said a lack of investment in adapting vaccine products to better suit resource-limited places was another obstacle to mass vaccination.
GSK and Pfizer were named by MSF as overcharging for the pneumococcal vaccine, which, it says, would account for more than a third of Gavi’s requested $7.5 billion.
“It’s time for GSK and Pfizer to do their part to make vaccines more affordable for countries in the long term, because the discounts the companies are offering today are just not good enough,” said Rohit Malpani, policy and analysis director for MSF’s Access Campaign.
GSK responded to the criticism arguing that many of its vaccines were “advanced and complex and require significant upfront capital investment to make and supply”.
It said it had recently committed to a five-year price freeze for countries graduating from Gavi.
munderwood@thenational.ae
