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| Vaccine Debt Trap For Poorer Countries Exposed | ||
| One Click Note: According to this posting on Technet21 English, the Technical Network for Strengthening Immunization Services (supported by the Bill and Melinda Gates Foundation, under the oversight of WHO and UNICEF) there have been a rash of publications in very respected journals like the Lancet and Vaccine that have suggested WHO recommendations are prompted by the need for increasing revenues for vaccine manufacturers rather than public heath imperatives. The article by Joseph L Mathew in Vaccine that shows how irrational the recommendation to use pneumococcal vaccine is (WHO advises Pneumococcal vaccine is to be used in countries where under 5 death is 50/1000 or total under 5 deaths is 50,000. The first stipulation covers countries with a high under 5 mortality but that did not use up enough doses of the vaccine so they came up with the second stipulation to get the more populous countries in the ambit of their advise (like India and China) Strangely the WHO has not responded to the original articles as if hoping the questions will simply go away. Read about these three articles in the Technet blog and access the full text of the paper by Joseph L. Mathew entitled 'Pneumococcal vaccination in developing countries: Where does science end and commerce begin?' , J.L. Mathew / Vaccine 27 (2009) 4247–4251, published on One Click. Tech 21 Pneumococcal vaccine, a debt trap for poor countries? Is treating pneumonia more economical than vaccinating? Dr. Omesh Bharti M.B.B.S.,D.H.M.,M.A.E.(Epidemiology) Directorate of Health Services Himachal Pradesh Dear Friends, Recently there have been a number of articles critical of the recommendations for pneumococcal and the pentavalent vaccines in high impact journals. I understand some of this has spilled over to the lay press and it will be good if we can have clarity on these issues. 1. Relates to the pneumococcal vaccine and the pentavalent vaccine. (Dabade et al., The Lancet, 27 June 2009; 373:2195-6.) The main argument seems to be that the WHO effort of promoting the pneumococcal vaccine in developing countries by entering into Advance Marketing Commitments (AMC) with the manufacturers (to make the vaccine affordable in poor countries) is actually squandering the funds donated by philanthropic governments and individuals for the achievement of the MGD. This is because the vaccine only reduces 3.6 cases of pneumonia per 1000 vaccinated (according to Madhi et al in the Oct 2008 issue of Bull WHO). Vaccinating 1000 children costs $250,000 and treating 4 cases of pneumonia with Septran will cost $1.There are more cost effective interventions that will yield better returns for the use of $250,000 of MGD funds. We are aware that GAVI purchases vaccines for $7/dose or $21 per child. At these costs the price of avoiding 4 cases of pneumonia is $21,000. Even this appears very steep. On the face of it, this argument seems difficult to refute. Surely I am missing something here. Does anyone in this discussion group know how to counter this argument? 2. Also this Lancet article quotes a GAVI evaluation that shows that prices of the pentavalent vaccine went up after GAVI funding. (Kamara L, et al Strategies for financial sustainability of immunization programs: a review of the strategies from 50 national immunization program financial sustainability plans. Vaccine 2008;26:6717-26) Projections of the UNICEF show that even into 2010 the prices may come down from $3.40 by about 10c only. See EPI in development: BCG, HepB, Hib and DTP-containing vaccines. The argument here is that GAVI funding used to induce governments to introduce the vaccine is something of a debt trap. 3.This also relates to pneumococcal vaccine: [Mathew JL, Pneumococcal vaccination in developing countries: Where does science end and commerce begin? Vaccine 27 (2009) 4247-4251]. It discusses the WHO recommendation on the pneumococcal vaccine and what WHO considers 'evidence of the disease burden' enough to merit vaccination. This is what the WHO recommendation states: "WHO considers that it should be a priority to include this vaccine in national immunization programmes, particularly in countries where mortality among children aged <5 years is >50/1000 live births or where >50,000 children die annually." (No authors cited. Pneumococcal conjugate vaccine for childhood immunization -- WHO position paper. Wkly Epidemiol Rec 2007; 82:pp. 93-104.) The author points out that the first criteria of under-five-mortality >50/1000 live births was met by 32 countries but the total population to be vaccinated was 18 million. By including the criteria dependent on population size of 'where >50,000 children die annually' only 7 additional countries were added, but it added 161 million to the numbers eligible for vaccination (in populous countries of India, China and Brazil). The WHO recommendations seem dictated by needs of increasing demand for vaccines and profits for manufacturers rather than the needs of public health. There must be a strong reason why WHO made use of the second criteria, and that is not related to trying to increase the demand for vaccines but it is not clear. Discussion on this site will help clarify matters. I will be thankful if I get more clarity on this issue. Thanks and regards, Dr. Omesh Bharti M.B.B.S.,D.H.M.,M.A.E.(Epidemiology) Directorate of Health Services Himachal Pradesh +91-9418120302 bhartiomesh@yahoo.com; bhartiomesh@gmail.com  Review J.L. Mathew / Vaccine 27 (2009) 4247–4251 Pneumococcal vaccination in developing countries: Where does science end and commerce begin? Joseph L. Mathew* Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India ABSTRACT Recently Pneumococcal vaccines have generated considerable interest in developing countries as an intervention for protecting children from pneumonia and thereby reducing childhood mortality. Manyconvincing scientific arguments have been put forward, although they are often based either on extension of information from developed countries, or estimation plus extrapolation of limited local data. In addition, there is also significant commercial pressure to prescribe/recommend Pneumococcal vaccine(s). Against such a background, it is important for developing countries to critically appraise the issues involved in order to make a rational choice. This brief paper explores these issues, showing that the current Pneumococcal vaccines have limited effectiveness in developing countries and the hype surrounding them is more commercial than scientific. 1. Introduction Recently, much has been written and said about the need to include the Pneumococcal conjugate vaccine in the national immunization schedule of developing countries. A lot of scientific data has been quoted and an even larger commercial thrust is evident. This article attempts to explore the facts pertaining to Pneumococcal vaccination with particular reference to the scientific and commercial issues behind it-hence the title. India accounts for 120 out of 478 million (>25%) under-five children (the largest number in any single country) and is seriously considering the inclusion of Pneumococcal vaccine in the childhood immunization programme. Hence the developments in India are particularly highlighted here. However the issues are relevant and applicable to all developing countries in general...... Pneumococcal vaccination in developing countries: Where does science end and commerce begin? J.L. Mathew / Vaccine 27 (2009) 4247–4251 Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India ************* Related Links: * Incidence of pneumonia is not reduced by pneumococcal conjugate vaccine Sona Chowdhary & Jacob Puliyel, Publication: Bulletin of the World Health Organization - Article DOI: 10.2471/BLT.08.054692 ************* |
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