Pakistan opens up private market for Covid-19 vaccines, raising concerns about inequality

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So last month it became one of the few countries that allowed the private sector to import and sell vaccines.

Several centers sold out in a few days. Others who initially allowed access switched to online registrations after being flooded by people. Many online booking systems have been discontinued since then, as clinics operate slowly through a series of requests.

People receive the Sinopharm Covid-19 vaccine at a vaccination center in Lahore, Pakistan, on April 1.
The government has received 2.56 million doses of vaccines, all from China, according to local reports citing the health ministry. About million people have been vaccinated with these shots since February, especially in priority groups such as health workers and those over the age of 50 – leaving a huge percentage of the country’s 238 million inhabitants waiting, according to official figures.

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

“It is good that it is available privately, I have no idea when it will be our turn through the government,” said 35-year-old Anushka Jatoi, who received the vaccine with her family at a private hospital in the southern city of Karachi. .

But private sales have also raised concerns about price and affordability and highlighted the country’s deep-rooted social inequalities. Most private sales are in big cities, such as Karachi and Islamabad, and remain inaccessible to residents in more rural areas – and the price remains beyond the majority of Pakistan’s population.

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

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

The third wave

Pakistan has approved only a handful of emergency vaccines, including three Chinese vaccines, Russia’s Sputnik V and the Oxford-AstraZeneca vaccine. So far he has done it relied largely on donations from other countries – mainly China, which supplied more than a million doses of Sinopharm.
A worker is carrying a box of Sputnik V Covid-19 vaccine to Karachi, Pakistan, on March 19.
Pakistan is established at is importing another three million doses of CanSinoBio vaccine from China this month. Russia also announced in April that it would soon supply Pakistan with 150,000 doses of Sputnik vaccine. It is unclear whether Sputnik and CanSinoBio vaccines are donations or purchases.
Pakistan is still waiting for more than 17 million doses of vaccines allocated by COVAX, a global initiative to share low-dose or free vaccines for lower-income countries.

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

However, there are some rules, including a ban on the sale of the vaccine on the retail market; private institutes and clinics can administer the vaccine only at their premises and under the supervision of medical staff, according to DRAP. Private clinics must also be evaluated by the provincial director of general health.
People are waiting to receive a dose of Russian Sputnik V vaccine in Karachi, Pakistan, on April 5.

The leaders of AGP, the pharmaceutical company that provides private shots from Sputnik, claimed that Pakistanis were exhausted as the outbreak worsened. By sharing the burden between the state and the private sector, more people can be inoculated faster and get the economy back on track, they say.

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

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

Only a handful of other countries have allowed vaccines to be marketed. India has allowed private facilities to distribute doses, although prices have been regulated by the government. Colombia decided in early April to allow private imports, but mandated that the photos be free for consumers. Indonesia has launched a private vaccination program, where companies can buy state-procured vaccines for their employees. And Kenya has allowed private sales for a while, but closed it on April 2, citing 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 vaccine trading during a pandemic – and a legal battle between the government and the AGP over pricing.

Initially, the government allowed a price cap exemption, which means that private companies can import and sell vaccines for any price they want. Critics have argued that this has encouraged companies to take advantage of despairand could eliminate the poorest and most vulnerable residents, while benefiting a few privileged people.

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

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

“The sale of this vaccine is simply unethical and bad for the community,” said Dr. Tipu Sultan, former head of the Pakistan Medical Association. “Only a few people who have money will buy this. Most of the population can’t afford it.”

Eventually, the government overturned its decision, and DRAP announced that it would set a price limit – prompting the AGP to take the government to court. Since 50,000 doses of Sputnik vaccine have already arrived, the company has been granted a provisional order allowing it to sell the vaccines for $ 80 for two doses until the final price is set.

Munshi, CEO, defended the cost of the vaccine. There are many additional fees included in the process, including the cost of international transportation, government fees, border compensation fees, warehousing costs, national supply chains and specialty warehousing to keep vaccines at the required minus of 18 degrees Celsius, she said.

The company used the price formula recommended by DRAP to arrive at their final, “plausible” price, she added. At this point, the availability of the vaccine is much more important than the price.

But critics say that even the current price of $ 80 is too high, unable to reach a large part of the public.

“This 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 ensure the vaccination of every citizen. And if they start selling it, then it will obviously be expensive.”

The waiting game

Everyone in Pakistan is waiting now – for more vaccines to come, to register at private clinics, for the government to make a decision on pricing.

But the process of getting a photo sold privately has many complications, even for those who can afford it.

“I am very frustrated because I have to travel for work and I am not able to get my vaccine,” said Maha Mussadaq, a content leader at Foodpanda Thailand, who was stranded in Islamabad. She tried all week to sign up for the vaccine, but failed to confirm a time frame, she said. He went online to register and was told he would receive a phone with more details, but was not given any clue as to when he might come.

“There is no system in place and there is no definition of chronology,” she said. All of his travel plans for work depend on the possibility of receiving the first dose, but with the news of the vaccine being sold, he quickly loses hope that this will happen.

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

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

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

It is one of the biggest holidays of Islam – and presents a Covid-19 risk. During this period, last year, countries around the world faced devastating waves and imposed blockages that saw Ramadan events at home and virtual.

But this time, many of these blockages have been lifted. In Pakistan, mosques will be allowed to remain open and provide services, albeit with rules such as wearing a mask, social distance and disinfection requirements.

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

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