As an integral player in the global pharmaceutical market, India has long been dubbed the ‘pharmacy of the world’. Recent news that a pneumococcal vaccine (PCV) – to protect against childhood pneumonia – developed by the Serum Institute of India (SII) has received marketing authorization by regulatory authorities is much welcomed. India has provided a lifeline to combat the world’s biggest infectious killer of children.
What does this mean for Indian children?
Every four minutes an Indian child dies from pneumonia. This translates to more than 127,000 children dying every year due to pneumonia – the second highest toll in the world.
One of the primary causes of deadly childhood pneumonia is the Streptococcus pneumonia bacteria which has more than 90 varieties (serotypes) that vary by region. Prevention is the best strategy to fight this disease. And vaccines are the most affordable route – PCV can reduce overall childhood pneumonia mortality by 30%. These vaccines are among the most complicated and expensive to be manufactured. SII’s PCV protects against the most likely bacterial strains to cause pneumonia in the world’s highest-burden regions – Africa and Asia.
The cost of PCV had previously been prohibitive for widespread use in public health programming in low- and middle-income countries. Through the public health system, PCV is available in only a few states in India and is still not part of the Universal Immunization Program across the country. Many children do not receive the vaccine and remain susceptible to pneumonia. In the private sector, this has meant the use of imported and very expensive vaccines.
SII’s PCV, which is produced locally, will help break the barriers of accessibility and affordability for both public- and private-sector providers. This will enable childhood pneumonia vaccination programmes to provide substantial protection across the whole population. By tackling childhood pneumonia with adequate vaccination coverage, this will have positive effects on the protection of the whole community, including vulnerable older populations.
Bringing PCV to the world – an arduous journey
Being the most expensive vaccine in the portfolio of GAVI, the Vaccine Alliance, PCV remains inaccessible to countries without GAVI support. 54 counries are yet to introduce PCV because the vaccine is too expensive. Improved PCV access would be a strong indicator of the effort being made to reduce inequality in health services in low- and middle-income countries.
In June 2020, SII became the first Developing Country Vaccine Manufacturer (DCVM) in Gavi’s Advance Market Commitment (AMC) mechanism. The vaccine is now available at a cost of US$2.00 per dose, compared with earlier rate of $3.50 per dose from the earlier GAVI price (43% reduction) – making it more accessible and affordable not only for children in India but in several low- and middle-income countries. Under the agreement SII will provide 10 million PCV doses to GAVI-supported countries every year for the next ten years.
According to Every Breath Counts:
The introduction of a new vaccine into Gavi’s portfolio as well as its availability at a more affordable price to non Gavi-eligible governments widens the chance that children in these countries will be able to receive the appropriate protection.
What are the next steps?
In 2017, India introduced the PCV in a phased manner in its Universal Immunization Program. This vaccine is available for free in only six states (Himachal Pradesh, Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan and Haryana) made possible by Gavi’s support. However, India is scheduled to graduate from Gavi support at the end of this year. Therefore, it is all the more important to use a lower priced substitute for continuing PCV in the national schedule and for extending it country-wide.
SII’s PCV has already been approved by the government of India and has also received the World Health Organziation’s seal of approval. This lower cost vaccine can now be rolled out more widely in India and also address supply needs in other low- and middle-income countries.
Our call
Today, World Pneumonia Day 2020, Save the Children urges India’s Ministry of Health and Family Welfare to hasten the introduction of PCV in the Universal Immunization Programme.
This will ensure that all children – including those from poor and marginalised sections of our country – have the best fighting chance to beat the biggest threat to their young lives.
