After years of refusing vaccine handouts from big pharmaceutical companies, international medical humanitarian group Médecins Sans Frontières is bending its policy to accept donations of the pneumococcal conjugate vaccine.
The announcement came at the same time the medical group launched a report that aimed to give a picture of the difficulties countries face in securing vaccines recommended by World Health Organization for routine immunizations without support from Gavi, the Vaccine Alliance. The public-private partnership is able to secure lower than market prices for 10 vaccines in the list, but this is only made available to Gavi-supported countries, as per agreement with pharma companies.
Countries that have reached or are approaching a per capita gross national income of $1,570 will have to pay the full cost of each vaccine, and many of them are expecting to see a large increase in funding needed to finance their immunization campaigns as Gavi starts to phase out support. Indonesia, for instance, which is now being touted an emerging donor, would need to spend an estimated $32.31 million by 2018 to continue full immunization coverage, a 1,547 percent increase from the $2 million it spent in vaccine co-financing in 2012.
MSF, which also does routine immunization campaigns in its emergency work, has been negotiating with big pharma companies for years to expand access to these lower-cost vaccines to all countries as well as relief organizations like them, which are also subject to vaccine market rates, under its Access Campaign. But after years of failed negotiations, the organization has decided to accept donations for a “limited supply” of PCV, the vaccine to fight pneumonia.
MSF argues “the serious delays in providing lifesaving vaccines for children living in crisis have forced MSF to make this pragmatic, though unsustainable, decision.”
François Servranckx, the group’s communications lead for Access Campaign, said the agreement is limited to only three years, and that despite the decision, they will continue to argue their cause to pharmaceutical companies and donor countries supporting Gavi.
“We are not asking for charity from big pharmaceutical companies, but for fair prices enabling every country in the world to buy vaccines for its own population,” he told Devex.
He also doesn’t think this would dilute the organization’s advocacy, “in the sense that we have already said that a donation is not a solution.”
MSF is one of the few organizations with strict policies on donations. It does not accept bilateral donor funding in conflict situations, and also does not accept donations from companies benefiting from the production or sale of tobacco, alcohol, arms and pharmaceuticals, and from extractive industries like minerals, oil and gas.
In 2013, MSF turned down donations of PCV for its emergency immunization work in the Yida refugee camp in South Sudan and instead bought vaccines from GlaxoSmithKline PLC at $7 per dose; MSF claims that was double the price offered to Gavi. The decision led MSF to limit its immunization coverage to children up to 23 months old.
Servranckx also called on donors, many of which are expected to be on the pledging table next week for the Gavi replenishment conference in Berlin, Germany, to “better negotiate with pharma companies and better use taxpayer money.”
In a response, GSK argued that around 80 percent of all its vaccines, including PCV, are provided to developing countries “at a substantial discount.” These prices are offered to both Gavi and UNICEF, but to discount it further “would threaten our ability to supply it to these countries in the long term.”
Nevertheless, the pharmaceutical giant said it is looking at other ways to support vaccination in developing countries. One notable example is its commitment to a five-year price freeze for countries that graduate from Gavi support. Twenty of the 73 Gavi-supported countries are expected to “graduate” in the next few years.
Pfizer, for its part, said it had committed to a reduced price for Prevenar 13, another pneumonia vaccine, to countries no longer receiving Gavi support until 2025.
In a rebuttal, MSF challenged both companies to prove their claims for not being able to reduce their vaccine prices by submitting to an independent audit of production costs. Rohit Malpani, the campaign’s director of policy and analysis, argued: “Right now the cost of manufacturing — like the prices paid and the actual cost of research and development — is guarded like a state secret” — an issue also tackled in the report.
He also said GSK’s five-year pricing freeze “is not enough.” The Serum Institute of India for instance has committed to sell its pneumococcal vaccine for $2 a dose when it becomes available in 2016. A deeply discounted price in developing countries, meanwhile, only reflects the unaffordability of vaccine prices in developed countries.
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