The intensified search for an effective and safe vaccine against Covid-19 has renewed the urgency to ensure that poor countries have access to all essential vaccines affordably and at the right time.
Since the WHO introduced expanded programmes on immunisation in the 1970s, global efforts have focused on increasing the benefits of vaccines across all countries and population groups. Today, vaccines are considered one of the most cost-effective means of promoting the health, well-being and survival of children. Overall, few medical interventions have been as successful in improving public health.
Millions of children’s lives have been saved from vaccine-preventable diseases such as measles, diphtheria, polio, influenza, hepatitis, meningitis, mumps, whooping cough, rubella, tetanus, TB and yellow fever. Yet more than 22 million babies born every year go unvaccinated, leaving them at risk of lifelong scars and disabilities or death.
In Africa, Nigeria ranks second in the unenviable top 10 countries with the most unvaccinated children. Others are Ethiopia, DR Congo, South Africa and Uganda. The 10 collectively account for more than 70 percent of the world’s tally.
The low immunisation coverage rates are often the result of many issues, including weak health systems and inadequate cold storage and transport systems to rapidly deliver vaccines to remote areas that often lack electricity and refrigeration facilities.
The unprecedented increase in the prices of vaccines over the past 20 years — from single digits to sometimes triple — is another big worry.
Almost all of the world’s essential vaccines are researched, developed, patented and sold by a multibillion-dollar pharmaceutical industry operating from rich countries. The industry and its investors argue that they have to recoup research and development costs to continue to innovate.
Rich countries, the major purchasers of pharmaceuticals, often negotiate favourable prices with manufacturers or impose price controls for vaccines for their populations. But poorer countries, who bear a disproportionate burden of vulnerable populations desperately in need of the vaccines, pay the full price. For them, the industry will offer fixed lower prices for vaccines only when they see a market with sufficient size and income to cover costs.
Affordability concerns have troubled the global development community, which advocates universal access to essential vaccines. Essential medicines and vaccines are public goods for the benefit of all, a critical component of the right to health. Vaccine prices must, therefore, be fair, equitable and affordable, especially for poor populations and the health system that serves them. To effect this equity principle, GAVI, the global vaccine alliance, was set up in 2000 to accelerate equitable uptake and coverage of vaccines, especially in poor countries and for underserved populations. Its business model is to aggregate demand from eligible countries and then mobilise sufficient funds for the large-scale demand.
This has created an incentive for the industry to set up tiered pricing, with low-income countries being charged less than higher-income countries for the same product. Some 58 countries, 38 of them in Africa, now pay a fraction of a vaccine’s market price in industrialised countries.
However, only countries with Gross National Income per capita of $1,580 (Sh158,000) are eligible for the subsidies. Kenya, for example, contributes just Sh21 ($0.21) to the full cost of the PCV vaccine, which has reduced hospital admissions due to pneumonia by over a quarter since 2011. But by 2022, it will enter an ‘accelerated transition’ phase that will see the GAVI subsidy reduce rapidly until 2027. It will pay the full Gavi-negotiated price of Sh305 ($3.05) per dose.
With an annual allocation of Sh700 million, there are real concerns how Kenya will fund the immunisation budget when the total cost of vaccines shoots to Sh5 billion by 2026. This predicament that Kenya and other African countries with severe immunisation woes face is now more urgent, given the Covid-19 deaths.
Governments and international partners must unite around a global guarantee that, when a safe and effective vaccine is developed, it is produced rapidly at scale and made available to all affordably. Governments and pharmaceutical companies should also pool intellectual property to allow widespread, low-cost manufacturing of vaccines.
Monopolies, crude competition and short-sighted nationalism should not stand in the way of affordable vaccines.
Ms Nininahazwe is the African Union and East Africa director for ONE Campaign; [email protected]