The Inconvenient Truth About Pneumonia Vaccines

How Two Companies Have Duped the World and Why We Must Fight Back

Ananth Ganesan, Regional Advocacy Officer, MSF Access Campaign

If an extraterrestrial from outer space were to visit earth, hearing this statistic — wouldn’t they expect that the disease makes it to the news every week?

Almost a million young lives are taken every year by a single disease — pneumonia. This equates to a quarter of all deaths among children under 5. If an extraterrestrial from outer space were to visit earth, hearing this statistic — wouldn’t they expect that the disease makes it to the news every week? Wouldn’t they think governments, corporations, the media et al. are doing everything they can to prevent the disease from taking more lives? The reality is that, those of us from this planet aren’t surprised at all by the inadequate efforts from the ecosystem. The justification is that these institutions have competing priorities, and global health and pneumonia have been allotted a specific amount of their time and money. But are limited resources really the barrier to defeating pneumonia?

Although effective vaccines and medicines to prevent and treat pneumococcal-derived pneumonia have existed for more than a decade now, they still haven’t reached parts of the world. There’s a simple explanation to why millions of children in 50 different countries remain unvaccinated for pneumonia — because their governments cannot afford to pay the high prices charged by pharmaceutical companies.

But the narrative here can be framed in two different ways: 1) some countries are unable to pay the market price for pneumonia vaccines and hence children die — this is the argument from limited resources, or 2) patent protections and market monopolies have kept pneumonia vaccine prices artificially high, so countries can’t afford them and hence children die — this is the argument from a failed system. One of these two narratives is simply wrong. Although international vaccine organizations backed by wealthy countries have poured billions of dollars into band-aiding this broken system, pneumonia vaccines continue to be out of reach for many developing countries.

Having dealt with global health organizations for some years now, I can say with some confidence that their decisions aren’t exclusively evidence-based nor do they always treat the disease over the symptom. In case of pneumonia vaccines, organizations such as Gavi, the Vaccine Alliance, often choose to band-aid or by-pass the real issue that limits access and kills children — the artificially high market prices. Gavi has committed to pay $4 billion for pneumonia vaccines by the end of 2021 and has already paid almost $1.2 billion in additional subsidies to two giant pharma companies that have maintained a vice-like grip over the pneumonia vaccine market — Pfizer and GSK.

An MSF doctor vaccinates a refugee child against pneumonia in the island of Samos, Greece (March 2019)

I’ve struggled to understand why Gavi consistently chooses to ignore the gaping hole in what it calls its ‘market shaping’ strategy. While its efforts in aggregating demand from buyers can be effective in treating the symptoms of market failure, they do almost nothing to resolve the root cause i.e. the artificially high vaccine prices driven by corporate greed. I don’t for a moment doubt Gavi’s intentions — their work has helped vaccinate millions of children in low-income countries and they should be proud of it. However, when it comes to resolving systematic issues in the vaccines market, Gavi has failed time and time again.

It’s high time for Gavi to face the inconvenient truth — when it phases out funding for countries it supports, they will still have to deal with the high prices charged by big pharma. Sure, Gavi will have momentarily left these countries in a better position than they were before, but would they have really addressed the root cause for under-vaccination? Pneumonia vaccines have consistently been the most expensive vaccine in Gavi’s portfolio over the last 10 years, taking up 40% of the organization’s multi-billion-dollar budget. It’s astonishing that Gavi is supposed to be paying prices much lower than the market average and yet it almost bankrupts them. I can see why Gavi might not hold all the cards at the negotiating table with Pfizer and GSK — especially with it being a seller’s market, but more can be done to change that dynamic. When countries lose Gavi funding, they will themselves be at the same negotiating tables with these companies, and with lesser bargaining power than Gavi. To empower these countries in the future, and to treat the disease instead of the symptom, Gavi must look for answers outside its existing thought bubble of temporary market fixes.

Ananth has been working on access to affordable pneumonia vaccines with MSF’s Access Campaign, based in Manila, Philippines. Previously he worked for the Clinton Health Access Initiative.

I am by no means an expert on pneumonia vaccines — but it doesn’t take an expert to see why a company that has earnt $45 billion from pneumonia vaccine sales doesn’t really need a subsidy to sell at lower prices. While developing countries do desperately need the pneumonia vaccine at subsidized prices, the answer isn’t to simply transfer billions of dollars in taxpayer money to existing monopolistic companies.

Let’s try to not get trapped in the loop of raising billions of dollars in public money to pay high prices and subsidies to these companies, and when the money runs out — well, raise some more again.

This feeds into the one-dimensional narrative of limited resources — that we could save more lives from pneumonia if governments and international agencies simply had more public money to pay these companies. This narrative also makes the rest of the world that wants to support the cause feel powerless — as though they could help only by contributing in cash. Lawyers, activists, regulatory agencies, media and the public have as much of a part to play in expanding pneumonia vaccination as do governments and UN organizations. If Gavi and the rest of the world were serious about ending pneumonia, they must work toward putting an end to the root cause — the consistently high prices of vaccines fuelled by a corrupt monopoly and a broken patent system. Now is a good time for us to join forces to untie the noose Pfizer and GSK have around their customers, and help open up the market to new competitors to bring prices down.

Correction: An earlier version of this article stated that Gavi paid $4 billion in sales over the past 10 years to Pfizer and GSK. The article has been updated to reflect that Gavi has committed to pay $4 billion for PCV vaccines by the end of 2021. https://www.gavi.org/support/nvs/pneumococcal/

MSF Access Campaign

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This blog is a space for ideas, opinions, and debates about access to medicines. For the official MSF Access Campaign website please visit msfaccess.org.

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