Curbing Vaccine Costs Key To Extending Global Immunisation ReachPublished on 22 April 2013 @ 5:12 pm
By Rachel Marusak Hermann for Intellectual Property Watch
As the World Health Organization kicks off a week devoted to the promotion of vaccines, newly published research has identified challenges, such as weak supply systems and information gaps, that need to be addressed to scale-up global vaccine coverage. But some observers say that more attention should be paid to the soaring costs of vaccines, starting with a mechanism to track prices.
Coinciding with WHOâ€™s â€œWorld Immunization Week,â€ which began 20 April, the journal Vaccine published a Decade of Vaccines supplement that includes contributions from a wide range of stakeholders from government, industry, global agencies, and civil society on topics related to the Global Vaccine Action Plan (GVAP). Endorsed by the World Health Assembly in May 2012, the GVAP establishes a framework for achieving the â€œDecade of Vaccinesâ€ (DoV) goal of 90 percent global vaccine coverage by 2020.
Launched in 2010, the DoV initiative received widespread support by the public health community including the Bill & Melinda Gates Foundation, WHO, UNICEF, and the GAVI Alliance. In order to reach the 22 million children who are not being vaccinated today, the DoV partners are focussed on health and delivery systems – not intellectual property rights – to improve access to high-quality vaccines.
The DoV supplement underlines this focus, highlighting the importance of improving supply and logistics systems to scale-up global vaccine coverage, according to a WHO press release. Logistical challenges include weak supply chain systems that make it difficult to store and transport vaccines at required temperatures and poor vaccination recordkeeping. But some members of civil society are calling on global health leaders to increase their focus on other key challenges, especially the increasing cost of vaccines.
Monitoring Vaccine Prices
While the MÃ©decins Sans FrontiÃ¨res (MSF, Doctors Without Borders) Access Campaign supports the DoV, the organisation said that it â€œlacked ambition when it comes to bringing vaccine prices down,â€ in a recent press release. MSF pointed to the increasing cost of vaccines as a major hurdle in scaling-up and maintaining global immunisation coverage, noting that the WHO-recommended package of vaccines to fully immunise a child has increased from USD$ 1.38 to USD$ 38.80.
â€œThe USD$ 57 billion Global Vaccine Action Plan does not contain any mechanism to track vaccine prices, despite the alarming fact that the cost to fully vaccinate a child has skyrocketed by 2,700 percent over the last decade,â€ said Kate Elder, vaccine policy advisor for the MSF Access Campaign.
The market cost of vaccines is important for the sustainability of access as donor support to pay for vaccines fluctuates over time and as developing countries lose eligibility for preferential prices through the GAVI Alliance. According to the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation), 17 countries are in the process of graduating in the coming years (IPW, Public Health, 28 February 2013).
Although WHO does not currently track vaccine prices, member states will have the opportunity to consider the development of such a mechanism at the upcoming World Health Assembly (WHA) from 20-28 May.
Member states are called on to note a GVAP report (A66/19) [pdf], which includes a proposed framework for monitoring, evaluation and accountability, and a revised list of indicators. Additionally, â€œa report on trends in vaccine prices, classified according to the procurement mechanisms used, will be presented for review by the Strategic Advisory Group of Experts. The Advisory Group will also be requested to advise on an appropriate indicator for monitoring such price trends.â€
New GAVI Partnership Cuts Vaccine Costs
Meanwhile, the GAVI Alliance is actively working to reduce vaccine prices and shape the vaccine market through public and private partnerships. Timed with the start of the â€œWorld Immunization Week,â€ the GAVI Alliance announced a major price reduction in pentavalent, a key combination vaccine, through a deal with Biological E, an Indian vaccine manufacturer.
According to the announcement, the cost of the vaccine, which provides immunisation to five infectious diseases – diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B (Hib) – will be available to GAVI for USD$ 1.19 per dose, rather than what it costs on average, USD$ 2.17.
â€œThis is great news for children in the worldâ€™s poorest countries and it shows that our innovative public-private partnership model is working well,â€ said Seth Berkley, CEO of the GAVI Alliance. â€œA decade ago we had just one European supplier and a price of US$ 3.56. Today we have five suppliers, including two in India, and a price that is down to its lowest level yet. This marks the realisation of a vision that GAVI started a decade ago to create a healthy, competitive and sustainable global market for pentavalent vaccine. â€
Beyond challenges associated with vaccine prices, UNICEF, the worldâ€™s largest provider of vaccines in developing countries, raised concern about the â€œstagnationâ€ of political will needed to boost global immunisations, pointing to a decline in the number of vaccinations being delivered.
According to UNICEF, the number of children who were not immunised in 2011 – about 22 million – had increased by over one million from the year before. Only 152 out of 193 WHO member states had dedicated budgets for immunisation that year. UNICEF called for increased political support to succeed in providing vaccines to children living in the poorest communities.
The DoV partners – UNICEF, WHO, the GAVI Alliance, and the Gates Foundation – will be at the Vaccine Summit in Abu Dhabi from 24-25 April.
Pharma Calls for Strong IP to Protect Biotechs
In terms of the industryâ€™s perspective, a paper supported by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), â€œDelivering the promise of the Decade of Vaccines: opportunities and challenges in the development of high quality new vaccines,â€ was also published in the Vaccine DoV supplement. It provided the IFPMA and the Biotechnology Industry (BIO) perspective on the GVAPâ€™s strategic objectives and a number of policy recommendations including increased vaccine awareness, predictable demand, and sustainable financing.
The paper also called for vaccine policies that â€œsupport intellectual property and competitive markets,â€ noting that small biotechs are increasingly partnering with manufacturers in developing countries, such as India, in the development of new vaccines.
“These partnerships often include transfers of technologyâ€¦. In all cases, these technology transfers will be successful only where they meet the mutual needs of the partners, and where the necessary enabling conditions are in placeâ€¦. Of utmost importance, host governments must respect internationally recognized principles of intellectual property protection, and ensure that the proprietary information of the originator company is preserved,â€ according to the IFPMA paper.
Meanwhile, according to a report, while speaking at the Shoolini University of Biotechnology and Management Sciences on 18 April, former president of India A P J Kalam said the country must emerge a global leader in the production of inexpensive vaccines for HIV, cancer, and malaria.
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Rachel Marusak Hermann may be reached at email@example.com.
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