Vaccine prices are 20 times higher in refugee camps, aid group charges

A young girl in Elliniko refugee camp in Athens receives vaccinations to protect against measles, tetanus, pertussis, influenza, polio, hepatitis B and certain forms of pneumonia. (Credit: Pierre-Yves Bernard/MSF)

ATHENS — Doctors Without Borders (MSF) has decried the high cost humanitarian organizations pay for vaccines – up to 20 times the normal prices – for vulnerable children in refugee settings. MSF and Save the Children are calling on drug companies to lower vaccine prices.

Humanitarian organizations have targeted pneumonia, along with polio, diphtheria and tetanus, in their efforts to vaccinate young children in Greek refugee camps. Pneumonia, according to an MSF news release, is the “single largest killer of children under five worldwide,” adding that it is a disease that “is particularly acute in humanitarian crises.”

Despite this, organizations have been paying $68 to vaccinate just a single child against the disease. The global price, in comparison, is roughly around $3 a dose. Further, the pneumococcal conjugate vaccine (PCV) has to be taken in three doses to ensure full efficacy. In the past month alone, Doctors without Borders has vaccinated 5,000 children across Greece.

Medical organizations also aim to provide the hexavalent vaccination, which protects against six diseases, including diphtheria, polio, tetanus and polio – diseases common in camps. This vaccine, also provided by GlaxoSmithKline, costs $70 per child. This is “a very high cost for humanitarian organizations,” said Apostolos Veizis, director of a medical operational support unit in Athens.

There are a few reasons for such extortionate prices, from intellectual property patents, lack of competition in the market, as well as the lack of coordinated efforts, both from the public and private sector, to come up with a funding structure that works.

The fight against neglected tropical diseases is often a fight where the best tools are often available to organizations working in development contexts, but not humanitarian. Vaccine alliances, such as Gavi and the Global Fund, ensure that children can be vaccinated both at scale and at more economically viable costs. As of November 2015, 58 countries were eligible to access the PCV vaccine through the Gavi system.

But similar structures do not exist in refugee contexts, Veizis said, and that is what humanitarian organizations are hoping to change. Medical NGOs, governments and companies that work with the Gavi vaccine alliance, for example, are able “to have more leverage to negotiate with pharmaceutical companies, and therefore they keep a low price.”

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Adding to the problem is that refugees have been settling in Greece, a country crippled by an economic crisis and austerity measures, which have slashed the country’s health budget by 40 percent. It does not fall under Gavi criteria for funding support, where “the structure is limited to low-income countries,” said Mihir Mankad, Save the Children health policy adviser. “Prices for vaccines are rather high” as result.

Aliénor Devalière, EU policy and advocacy adviser for Doctors Without Borders’ Access Campaign said that “the classification on what determines whether a country is a low-, middle- or high-income country has to make more sense. These classifications don’t exist anymore,” especially in Greece, given the current economic climate.

Outside the Gavi agreement, “there’s no agreement to purchase vaccines at lower price ranges,” Mankad said, adding that this means Pfizer and GlaxoSmithKline are “more capable of dictating how much the vaccine will cost.”

Save the Children has had a corporate partnership with GlaxoSmithKline since 2013, which has led to the vaccination of 23,500 children. It is a union that has, however, been criticized in the past.

Control of intellectual property for the PCV vaccine by Pfizer and GlaxoSmithKline has created a duopoly that has driven up the cost of vaccines. In recent months, Doctors Without Borders has filed a “patent opposition” in India against Pfizer to prevent it from obtaining a patent on the PCV vaccine.

“Most of our medicines come from India” Veizis said, arguing that more must be done to bring alternative market players online. India, for example is the center of a booming pharma industry and could provide such competition.

However, control of patents often means control of the vaccine market, which is limiting other pharmaceuticals from entering this vaccine market. The way around this, for Veizis, is by “increasing competition between companies, both big pharmaceuticals and smaller companies” in order to drive down costs.

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But Mankad said that patents are just one piece of a bigger issue. He said that additional associated costs – including research and development, and manufacturing and regulatory costs – make it difficult for rivals to enter the vaccine market.

Agreements such as the Doha Declaration in 2001 also allow member states to overrule patents if they are in breach of public health concerns.

“Countries have the authority, if they seek to use it, to limit the impact of intellectual property” on vaccinations as well as medicines, Mankad said. “There shouldn’t be intellectual property barriers that interfere with public health.”

Often, however, as with the case of Pfizer’s attempts to control patents for the PCV vaccine, big pharmaceuticals overpower states. Veizis said that “unfortunately medicines today are often treated as health products and not as an important vaccine. …Vaccinations and access to treatment is the role of public health; it is not a luxury.”

Mankad said that Save the Children has been in discussions with GlaxoSmithKline recently “about how it might be possible to reduce prices of vaccines and medicines in general to ensure that there’s maximal access in the areas in which we work.”

Though humanitarian organizations have been lobbying for Pfizer and GlaxoSmithKline to lower their prices, “so far, both pharmaceutical corporations have refused to reduce the price, and there remains no solution in sight for populations living in crisis,” according to an MSF news release.

Veizis and Mankad said they are confident in the ability of private and public actors to collaborate to bring down the cost, if such structures can be created in humanitarian situations in the ways they are currently available in development contexts.

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Charlie Ensor

Charlie Ensor is a Nairobi-based freelance journalist, focusing on refugee rights, development and humanitarian crises in East Africa. His work has also featured on the Guardian and WhyDev; he also writes his own blog on development and aid issues. Charlie tweets @charlieensor, and you can contact him at charlieensor1990@googlemail.com