Pneumonia vaccine roll-out in Kenya

The Global Alliance for Vaccines and Immunization is distributing free pneumonia vaccines to 19 different countries this year. The vaccine was recently distributed throughout Kenya where 30,000 children die for pneumonia each year.

From the IPS, writer Miriam Gathigah visited a clinic that was a part of the launch.

The Kenyatta International Conference Centre resembled one big nursery with parents and their crying babies. Hundreds of parents with their infants thronged the Centre where they received their first shot against pneumonia, and not even their tears as the shot broke through their skin could dampen the smiling faces of their mothers.

The mothers waited patiently for their infants’ turn to be vaccinated as the painful shot represents a chance to survive a disease that many children have not been lucky to withstand.
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The vaccine, already available in various private hospitals, has remained out of reach for many children. A full dose costs about 188 dollars, which for the many Kenyans living on less than a dollar a day is too expensive.

Government figures reveal that an estimated 30,000 children die annually from pneumonia.

"We are delighted that our children will be vaccinated for free. I am happy with what the government has done today by helping us keep our children healthy. I cannot afford to pay for it seeing that on a good day I only earn three dollars washing clothes in people’s homes," explained an elated Belinda Otieno, a mother of two sets of twins below the age of six.

Despite the fact that new vaccine trials were carried out at the Kenya Medical Research Institute (KEMRI) for over a decade, the drug has remained inaccessible to thousands of children.

This has seen health experts continue to cry foul over what they saw as Kenyan children being used as guinea pigs for a crucial life-saving drug off-limits to them until now.

"We will provide this life-saving vaccine free of charge to every child less than one year old in public health facilities," said President Mwai Kibaki during the launch.

This pledge is literally a breath of life for many children, particularly among the poor, who constitute a significant percentage of the populace.

GAVI says it needs 4 billion dollars by 2015

The Global Alliance of Vaccines and Immunization is warning against cutting money for giving vaccines to the under-developed world. GAVI says that it needs 4 billion dollars through 2015 to continue it's work of providing low coast vaccines.

From the BBC, we read more about the statement from GAVI.

Many developing countries now have, with foreign assistance, built up the infrastructure so that routine immunisations can now be offered to up to 80% of the world's poorest children.

Gavi, a public-private partnership which draws together organisations including the World Health Organization and the Bill and Melinda Gates Foundation, as well as the vaccine industry, is now trying to secure funding for 15 countries to add further vaccines to those existing programmes.

These include immunisations against pneumococcal disease - the most common form of bacterial pneumonia - and rotavirus - the most common cause of diarrhoea.

"Children have a right to health and we have it in our power to set them on a path to healthy and productive lives. There comes a time to stop talking and start doing. I sincerely hope that we will see donors put their money on the table," said the chair of the Gavi board, Mary Robinson.

"Without this funding for immunisation, the world will not reach Millennium Goal 4 to reduce under-five mortality by two-thirds by 2015," she said.

Delay in the pneumonia vaccine deal

Earlier this year, Glaxo Smith Kline and the Global Alliance for Vaccines and Immunizations announced an agreement to bring pneumonia vaccine to the underdeveloped world. The GAVI was to buy the pneumonia vaccine from Glaxo at a reduced cost. The vaccine is easily available in the developed world, but is next to impossible to obtain elsewhere.

What was not announced however, was a year long delay in getting the vaccine to the children. The World Health Organization has not given it's blessing to the project. The WHO has asked for a trial run of the vaccinations to take place in Kenya, before going to the rest of the world.

From the Guardian's Global Health blog, Sarah Boseley explains why the WHO wants the delay.

You might have thought the life-saving vaccine would even now be on its way to most of Africa. Not so. There is a hitch. GSK is not selling the one-dose vaccine it markets in Europe to the developing world, but a two-dose version. The World Health Organisation, which has to approve the vaccine through what is called "pre-qualification", told GSK that it could not give the green light immediately because two-dose vaccines usually require preservatives, and this one does not have them. WHO approved it, but only for Kenya, where GSK must collect two six-months sets of data to prove there is no problem in its correct use by health workers.

While a GSK spokesman told me they supported the idea of a trial to ensure the vaccine was properly used in an African setting, this surely means no African child outside Kenya will be protected by the GSK vaccine before 2012 (the Pfizer vaccine has not yet gone through the pre-qualification process).

It matters not just because GSK won a lot of headlines without mentioning the delay, but because there are those who think there are ways of getting these desperately-needed, life-saving vaccines to small children faster. Medecins sans Frontieres and Oxfam have today produced a report, called Giving Developing Countries the Best Shot, which suggests that the reliance of donors on the giant multinational pharma companies may be misplaced. Their products cost too much and it takes too long to get them to those who need them.

The pneumococcal vaccine will cost $21 a child, say the two organisations, which they describe as "an unacceptably high price for donors and developing countries to bear." Yet we are talking about a vaccine that has been used for a number of years in wealthy countries, which has generated billions of dollars for the pharmaceutical companies.

Low cost pneumonia vaccine deal officially announced

The GAVI Alliance officially announced the deal that will bring thousands of pneumonia vaccines to the under-developed world. The GAVI Alliance negotiated a deal with drug makers Pfizer and GlaxoSmithKline to provide the vaccines at a reduced cost. The drug companies are guarantied a small profit even with the lower price and a new market.

This deal has already been mentioned in the press but the formal announcement was made today.

From the New York Times, writer Andrew Pollack gives more details on the deal.

Under the agreement, Pfizer and GlaxoSmithKline will provide up to 300 million doses each of their vaccines over a 10-year period. The price for the first 20 percent of the supply will be $7 a dose. Then the price will drop to $3.50 a dose for the remainder. The vaccines would be paid for by donations raised by GAVI and by the governments of the countries that ordered the vaccines.

In Western markets, the pneumococcal vaccines sell for $54 to $108 a dose.

“For the price of a Starbucks latte, developing countries are going to be able to buy a dose of a life-saving vaccine,” said Orin Levine, director of the international vaccine access center at the Johns Hopkins Bloomberg School of Public Health, who has worked with GAVI.

But Tido von Schoen-Angerer, who directs the essential medicines program at the international group Doctors Without Borders, said that even with the discounts, “it’s still quite an expensive vaccine in a developing country context.” With at least three doses required, the price would initially be $21 per patient.

The agreement is the first example of GAVI’s program called advance market commitments, in which donor money is used to essentially guarantee a market for vaccine companies if they undertake development of vaccines for poor countries, or if the companies agree to build extra capacity to supply those markets with an existing vaccine.

Such a strategy, if it works, might be particularly useful in spurring companies to develop vaccines for diseases like malaria, for which virtually the entire market would be in developing countries.

Vaccines for the poor deal announced

GlaxoSmithKline and Pfizer have agreed to provide pneumococcal vaccines to the under-developed world at a discounted rate. The agreement was brokered by the Global Alliance on Vaccines and Immunization. The deal will set a maximum price that the drug makers will receive, in exchange for a guaranteed market for the vaccinations. The GAVI Alliance hopes to strike more deals like this in the future to provide drugs for other diseases to the under-developed world.

From Reuters, we find more details about the agreement.

Under the terms of the AMC (Advance Market Commitment) tender, drugmakers were required to make a 10-year commitment to supply a share of the total forecast demand of 200 million doses a year.

Evans said each manufacturer would have a minimum volume order guaranteed in return for a price of $7 per dose for the first 20 percent supplied, dropping to $3.50 dollars for the remaining 80 percent.

The higher price is only paid for the first tranche of doses so as to ensure the drug firm's research and development costs are covered. Beyond that, $3.50 is the maximum price GAVI and countries will pay for the vaccine.

By comparison, Glaxo charges around 40 euros ($54) per shot for Synflorix in Europe.

The AMC scheme was devised to try to encourage drug companies to make and supply medicines and vaccines to boost health in poorer countries, which are generally unable to afford the high prices paid in Western markets. GAVI and its partners say they plan to introduce pneumococcal vaccines in 42 developing countries by 2015.

Selling Bonds to provide vaccines

Investors in the UK can buy bonds that will help provide vaccines to the developing world. International Finance Facility for Immunization raises cash to give free vaccines to over 72 countries. The money raised goes to the Global Alliance for Vaccines and Immunization.

IRIN gives us more details about the bond, and explores the new concerns that socially conscious investing has in this global recession. For more on the bonds, you can click to the GAVI website.

“Normally, when people see a brochure with a poverty-stricken baby on the front, they are being asked for charitable contributions,” said Alan Gillespie, IFFim’s chair, “But with these bonds, we are saying ‘Here are the needs, we are asking you to make an investment.’ Your capital will be paid back with interest from rich donor countries.”

Similar to bonds that governments issue to cover debt, the vaccine bonds raise cash to buy and distribute vaccines by promising a return on investment, said George Richardson, the head of capital markets at the World Bank, which manages the bonds. “We are not asking for handouts. These are investments that support a good cause and have fixed market returns,” he said.

But a good cause is not enough to convince UK secondary school teacher Rosanna Magdalen to make the minimum investment of US$1400, even when she is told that amount can immunise 130 children against five life-threatening diseases, or that her earnings will not be taxed.

“Great idea, the principle is fantastic. I would do it if I had the extra money, but I think anyone would be loath to take any risk in the current financial climate," said Magdalen. "I think HSBC [bank] will be hard pressed to find anyone who would invest. Banks are no longer seen as infallible.”

Risky unregulated lending has been blamed for the global recession, which has forced governments in the US and Europe to pledge some two trillion dollars to rescue their economies.

The World Bank’s Richardson said while he cannot change consumer distrust of banks, vaccine bonds give people a socially-responsible way to save. “Even in a recession, there are people who will diligently put away money,” said Richardson.
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On 2 March HSBC started offering the IFFim vaccine bonds as a five-year tax-free savings account with a 16-percent return. The governments of the UK, France, Italy, Spain, Sweden, Norway and South Africa have collectively pledged US$5.3 billion over the next 20 years to repay investors.