According to the World Health Organization (WHO), pneumonia accounts for 15% of all deaths of children under the age of 5, killing an estimated 922,000 children in 2015. That’s approximately one child dying of pneumonia every 35 seconds.
While pneumonia is preventable with timely treatment, 75% of children around the world remain unprotected against it. There are significant issues with administration and supply chain management – especially maintaining a consistent and safe temperature range from lab to limb – but the cost of the medicine itself is a significant access barrier as well.
Even at the lowest, most accessible prices, it costs 68 times more today to fully immunize a child in developing countries than it did in 2001. The high price of the pneumonia vaccine alone makes up nearly 50% of that increase. The lowest global price for the vaccine is $10 per child – this includes all three doses and is only available to the poorest countries through Gavi, an international organization bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children in the world’s poorest countries. A producer in India is working on creating a pneumonia vaccine for $6 per child, which will assist in driving down costs from competitors, but it’s not set to be released until 2019. Between now and then, as many as 4 million more children could die because of this lack of access to the vaccine.
At the World Health Assembly in May 2015, 193 governments met in Geneva where they unanimously passed a landmark resolution demanding more affordable vaccines and increased transparency around vaccine prices. 50 counties specifically called out the increased financial burden of new vaccines, like the pneumonia vaccine, indicating that they were unable to introduce it because they didn’t have the funding or they wouldn’t be able to sustain its usage in their routine immunization programs.
Gavi is a significant voice in the global conversation about vaccine affordability. Part of their work as an organization includes: defining the lowest available price for the vaccines it purchases; identifying the countries that merit the lowest price; and defining the budgetary responsibility of Gavi-graduated countries.
The current threshold for Gavi support is $1,580 GNI per capita, which means 54 countries will be eligible for vaccine support from Gavi in 2016. For those who don’t qualify because they’ve graduated from Gavi would only need to allocate 0.6% of their heath budgets to support the full cost of the vaccines (this figure is based on a financial analysis model commissioned by Gavi).
This measurement has been used as justification for the ‘affordability’ of financially supported immunization programs. However, there are many outside factors that make this analysis problematic in real-life applications.
- The model includes external resources, such as grants from the Global Fund and the World Bank. These funds often fluctuate according to global economic conditions and priorities.
- The model uses a static estimate for the number of vaccines introduced. Each additional vaccine will increase the eventual cost of full immunization for Gavi-graduated countries. The estimate that vaccines will cost 0.6% of health budgets is unlikely to hold for countries introducing more new vaccines.
- Gavi-graduating countries do not have secure access to all Gavi negotiated prices. The prices are time-limited and company-specific, with procurement caveats that may be challenging to implement.
- Vaccine investment at country level has increased more slowly than was assumed in original financial analyses.
There are so many barriers to successfully implementing global vaccination programs: medication costs, cold supply chain management, dosing schedules, efficacy of oral vaccines and administration routes, just to name a few. There are solutions to make these vaccines more accessible to children and eradicate these life-threatening, preventable diseases once and for all. Childhood death by pneumonia can become a thing of the past; a “remember when” story shared by public health advocates and players with a shake of the head. All that is necessary at this point is decisive action and accountability across all touch points.