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

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

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Last month, therefore, it became one of the few countries that allowed the private sector to import and sell vaccines.

Several centers were sold out within days. Others who initially had access switched to online logins after being flooded by people. Many online booking systems have since been disrupted as clinics slowly work through a backlog of queries.

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

However, the private vaccines are open to everyone – and many people, who otherwise would not be eligible for the government’s program, are now hoping to get a place in private clinics.

“It is good that it is available privately. I do not know when we will get through the government,” said Anushka Jatoi, 35, 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 pricing and accessibility, highlighting the deep-rooted social inequality in the country. Most private sales are in major cities, such as Karachi and Islamabad, and remain inaccessible to residents in more rural areas – and the price remains above most of Pakistan’s population.

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

According to the vaccine developers, this is four times the international market price, which for two doses is less than $ 20. And that is about 30% of the monthly income of an average household, at $ 273.2 (41,545 rupees), according to the most recent available data by the Pakistan Bureau of Statistics.

The third wave

Pakistan has approved only a handful of vaccines for emergency use, including three Chinese vaccines, the Russian Sputnik V, and the Oxford-AstraZeneca vaccine. So far it has relied mainly on donations from other countries – mainly China, which provided more than a million doses of Sinopharm.
A worker transported a crate of the Sputnik V Covid-19 vaccine in Karachi, Pakistan on March 19.
Pakistan is set to imports another three million doses of CanSinoBio vaccine this month. Russia also announced in April that it would soon supply 150,000 doses of Sputnik vaccine to Pakistan. It is not clear whether the Sputnik and CanSinoBio vaccines are donations or purchases.
And Pakistan is still waiting for more than 17 million doses of vaccines granted by COVAX, a global initiative division with discounts or free doses for lower-income countries.

With long delays in the COVAX program and vaccines coming relatively slowly from Russia and China, the Government of Pakistan has allowed the private sector to intervene. Companies and private hospitals must complete an application with the country’s regulator, DRAP, to receive no objection. Certificate (NOC) – the document with which they can import and sell vaccines.

However, there are some rules, including the ban on the sale of the vaccine in the retail market; According to DRAP, private institutions and clinics can only administer the vaccine on their premises and under the supervision of health professionals. The provincial director of general health should also have their private clinics evaluated.
People are waiting to receive a dose of Russian Sputnik V vaccine in Karachi, Pakistan, on April 5.

Leaders at AGP, the pharmaceutical company that supplies the private Sputnik shots, argued that Pakistani time is running out as the outbreak worsens. By sharing the burden between the state and the private sector, more people can be vaccinated faster and get the economy back on track.

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

“We were aware that vaccination by the public health sector with 113 million (adults) in Pakistan would be a major challenge,” said Nusrat Munshi, chief executive. “Someone had to take on the challenge.”

Only a handful of other countries have allowed the commercialization of vaccines. India has allowed some private facilities to distribute doses, although prices are regulated by the government. Colombia decided in early April to allow private imports, but ordered the shots to be free for consumers. Indonesia has launched a private vaccination program, where businesses can buy government purchases for their employees. And Kenya has allowed private sales for some time, but closed them on April 2, citing fears that counterfeit vaccines could enter the private market.

The price war

Pakistan’s decision to allow private sales sparked a debate over the ethics of commercializing vaccines during a pandemic – and a legal battle between the government and the AGP over pricing.

Initially, the government allowed exemption from price restrictions, which meant that private companies could import and sell vaccines for whatever price they wanted. Critics have argued that it has encouraged businesses to profit from desperation, and can eliminate the poorest and most vulnerable inhabitants, while the privileged are little benefited.

Jatoi acknowledges her privilege and describes the private hospital where she was vaccinated as a hotel, with complimentary snacks and croissants in the waiting area. “We are happy to be in this position,” she said.

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Transparency International Pakistan, the national branch of the international non-profit organization against corruption, Transparency International, wrote to Prime Minister Imran Khan last month urging the government to ban private imports and sales. The commercialization of vaccines will in fact allow the rich to cut the streak and exacerbate existing inequality, the letter reads.

“The sale of this vaccine is just unethical and too bad for the community,” said Dr. Tipu Sultan, former head of the Pakistan Medical Association, said. “Only a few people who make money are going to buy it. The majority of the population cannot afford it.”

Eventually the government reversed its decision and DRAP announced that it would impose a price restriction, which would lead AGP to take the government to court. As 50,000 doses of Sputnik vaccine have already arrived, the company has been granted an interim order to sell the vaccines at $ 80 for two doses until the final price is determined.

Munshi, the CEO, defended the cost of the vaccine. There are many additional fees included in the process, including the cost of international shipping, government tax, border clearance costs, warehouse costs, national supply chains and specialized storage to keep the vaccines at the required minus 18 degrees Celsius.

The company used DRAP’s recommended pricing formula to reach their final, “acceptable” price, she added. “At this stage, the availability of the vaccine is much more important than the price.”

But according to critics, even the current price of $ 80 is too much, out of reach of many of the public.

“It may not be more than 1,000 rupees or 1,200 rupees ($ 6.6 or $ 7.9),” Sultan said. “It is the duty of the state to give vaccination to every citizen. And if they start selling it, it will obviously be expensive.”

The waiting game

Everyone in Pakistan is now waiting – for more vaccines, for registration at private clinics, for the government to take a pricing.

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

“I am very frustrated because I have to travel for work, and I cannot get my vaccine,” said Maha Mussadaq, a leader of Foodpanda Thailand, who was stranded in Islamabad. She has been trying to sign up for the vaccine all week, but has not yet been able to confirm a timing. She went online to register and said she would receive a phone call with more details but no indication of when it would arrive.

“There is no system in place, and there is no definition of a timeline,” she said. All her travel plans for work depend on whether she can get the first dose, but with the news that the vaccine has sold out, she quickly loses hope that it will happen.

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

Muslim devotees were on 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, worshipers usually fast 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 feasts and special prayers.

It’s one of Islam’s biggest holidays – and it’s a Covid-19 risk. Around this time last year, countries around the world experienced devastating first waves, concluding that home and virtual Ramadan events were taking place.

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

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

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