Pakistan opens private market for Covid-19 vaccines, raising concerns over inequalities

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This is what Covid vaccines are worth for Big Pharma



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Last month, therefore, it became one of the few countries to allow the private sector to import and sell vaccines.

Several centers sold out within days. Others who initially allowed walk-in tours have switched to online registrations after being inundated with people. Many online reservation systems have since been put on hold as clinics slowly work on a backlog of inquiries.

The government has received 2.56 million doses of the vaccine, all from China, according to local reports citing the Ministry of Health. About a million people have been vaccinated with these vaccines since February, mostly in priority groups such as healthcare workers and people over 50 – leaving a huge percentage of the country’s 238 million people on hold, figures show official.

Private vaccines, however, are open to everyone – and many people otherwise ineligible for the government program are now hoping to secure a place in private clinics.

“It’s good that it is available privately, I don’t know when our turn will come from the government,” said Anushka Jatoi, 35, who received the vaccine with her family at a private hospital in Karachi city. , in the south of the country.

But the private sales have also raised concerns about pricing and affordability, and highlighted deep-rooted social inequalities in the country. Most private sales are in large cities, such as Karachi and Islamabad, and remain inaccessible to residents of more rural areas – and the price remains above most of the Pakistani population.

This is what Covid vaccines are worth for Big Pharma

The Sputnik vaccine currently costs 12,000 Pakistani rupees ($ 80) for two doses, according to the Drug Regulatory Authority of Pakistan (DRAP).

That’s four times the international market price, which is less than $ 20 for two doses, according to vaccine developers. And that’s about 30% of a household’s average monthly income, at $ 273.2 (Rs 41,545), according to the most recent data available from Pakistan’s Bureau of Statistics.

The third wave

Pakistan has approved only a handful of vaccines for emergency use, including three Chinese vaccines, Russia’s Sputnik V and the Oxford-AstraZeneca vaccine. So far he has relied heavily on donations from other countries – primarily China, which provided more than one million doses of Sinopharm.

A worker transports a case of the Sputnik V Covid-19 vaccine to Karachi, Pakistan, March 19.A worker transports a case of the Sputnik V Covid-19 vaccine to Karachi, Pakistan, March 19.

Pakistan is on the verge of import three million more doses of the Chinese CanSinoBio vaccine this month. Russia also announced in April that it would soon provide Pakistan with 150,000 doses of the Sputnik vaccine. It is not known whether the Sputnik and CanSinoBio vaccines are donations or purchases.

And Pakistan is still awaiting more than 17 million vaccine doses allocated by COVAX, a global vaccine-sharing initiative with reduced or free doses for low-income countries.

With long delays in the COVAX program and vaccines arriving from Russia and China relatively slowly, the Pakistani government has allowed the private sector to intervene. Businesses and private hospitals must complete an application with the country’s regulator, DRAP, to receive a No Objection Certificate (NOC) – the document that allows them to import and sell vaccines.

There are, however, certain rules, in particular with regard to the prohibition of selling the vaccine on the retail market; private institutes and clinics can only administer the vaccine on their premises and under the supervision of health professionals, according to the DRAP. Private clinics must also have their facilities assessed by the provincial director of general health.

People wait to receive a dose of the Russian Sputnik V vaccine in Karachi, Pakistan on April 5.People wait to receive a dose of the Russian Sputnik V vaccine in Karachi, Pakistan on April 5.

Executives at AGP, the pharmaceutical company that supplies Sputnik’s private injections, have argued Pakistanis are running out of time as the epidemic worsens. By sharing the burden between the state and the private sector, more people can get vaccinated faster and get the economy back on track, they say.

Pakistan has recorded more than 721,000 cases and more than 15,000 related deaths, according to data from Johns Hopkins University, and is currently in the midst of a third wave.

“We were aware that with 113 million (adults) in Pakistan, immunization by the public health care sector will be a huge challenge,” said AGP CEO Nusrat Munshi. “Someone had to rise to the challenge. “

Only a handful of other countries have authorized the marketing of vaccines. India has allowed some private facilities to distribute doses, although prices have been regulated by the government. Colombia decided in early April to allow private imports, but demanded that injections be free for consumers. Indonesia has started a private vaccination program, where companies can purchase government-purchased vaccines for their employees. And Kenya had allowed private sales for a while, but shut them down on April 2 over fears that counterfeit vaccines could enter the private market.

The price war

Pakistan’s decision to allow private sales has sparked a debate over the ethics of marketing vaccines during a pandemic – and a legal battle between the government and AGP over pricing.

Initially, the government allowed an exemption on price caps, which meant that private companies could import and sell vaccines at any price they chose. Critics have argued that this encourages companies to enjoy despair, and could get ahead of the poorest and most vulnerable residents while benefiting the privileged few.

Jatoi acknowledged her privilege, describing the private hospital where she was vaccinated as “like a hotel,” with free snacks and croissants in the waiting room. “We are lucky to be in this position,” she said.

Here's how many vaccines are sold on the illegal market Here's how many vaccines are sold on the illegal market

Transparency International Pakistan, the national arm of the international anti-corruption non-profit organization Transparency International, wrote to Prime Minister Imran Khan last month urging the government to ban imports and private sales. Commercialization of vaccines would essentially allow the rich to cut the line and exacerbate existing inequalities, the letter said.

“Selling this vaccine is just unethical and too bad for the community,” said Dr Tipu Sultan, former head of the Pakistan Medical Association. “Only a few people who have the money are going to buy it. Most of the population cannot afford it. “

Eventually, the government overturned its decision and DRAP announced that it would set a price cap – prompting AGP to sue the government. Since 50,000 doses of Sputnik vaccine had already arrived, the company obtained an interim order allowing it to sell the vaccines at $ 80 for two doses until the final price was decided.

Munshi, the CEO, defended the cost of the vaccine. There are many additional charges included in the process, including the cost of international shipping, government taxes, border crossing fees, warehouse costs, domestic supply chains, and specialized storage to keep the items safe. vaccines at the required temperature minus 18 degrees Celsius, she said.

The company used the pricing formula recommended by DRAP to achieve its “plausible” end price, she added. “At this point, the availability of the vaccine is much more important than the price. “

But critics say even the current $ 80 price tag is too high, out of reach for much of the public.

“It should not exceed 1,000 rupees or 1,200 rupees ($ 6.6 or $ 7.9),” Sultan said. “It is the duty of the state to provide vaccination to every citizen. And if they start selling it, then obviously it will be expensive. “

The waiting game

Everyone in Pakistan is now waiting – for more vaccines to arrive, for them to be registered in private clinics, for the government to make a decision on prices.

But the process of getting a privately sold snapshot comes with many complications, even for those who can afford it.

“I am very frustrated because I have to travel for my job and I cannot get the vaccine,” said Maha Mussadaq, content manager at Foodpanda Thailand, stranded in Islamabad. She has been trying all week to sign up for the vaccine, but was unable to confirm a time slot, she said. She went online to register and was told she would receive a phone call with more details, but was not given any indication as to when that might happen.

“There is no system in place, and there is no definition of a timeline,” she said. All of her travel plans for work depend on her being able to receive the first dose, but with the news of the vaccine being sold, she quickly loses hope that this will happen.

And even those who have had their first pictures are worried. “I’m afraid there’s no guarantee we’ll get the second dose, what if stocks run out?” Jatoi said. “There is a lot of uncertainty. “

Muslim worshipers wash the floor of the Jamia Mosque in Rawalpindi, Pakistan on April 6, ahead of Ramadan.Muslim worshipers wash the floor of the Jamia Mosque in Rawalpindi, Pakistan on April 6, ahead of Ramadan.

Meanwhile, authorities are preparing for the events of Ramadan which will begin on Tuesday. During the Muslim holy month, worshipers usually observe fasts and congregate in mosques for daily prayers. At the end of the holy month, called Eid al-Fitr, friends and families come together to celebrate with holidays, festivities and special prayers.

It’s one of the biggest holidays in Islam – and it poses a Covid-19 risk. Around the same time last year, countries around the world experienced devastating first waves and imposed lockdowns that saw Ramadan events at home and virtual.

But this time around, many of those lockdowns have been lifted. In Pakistan, mosques will be allowed to remain open and organize services, but with rules such as wearing masks, social distancing and disinfection requirements.

The government warned last week that if the outbreak worsens during Ramadan and cases increase, it may review and tighten restrictions again.

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