Pakistan is opening a private market for Covid-19 vaccines, raising concerns about inequality

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

Several centers were sold out within days. Others who initially allowed walk-ins switched to online submissions after being inundated with people. Many online booking systems have since been on hold as clinics are slowly processing a backlog of inquiries.

People will receive the Sinopharm Covid-19 vaccine at a vaccination center in Lahore, Pakistan on April 1.
According to local reports, the government has received 2.56 million doses of vaccines, all from China, according to local reports quoting the Ministry of Health. About a million Since February, people have been vaccinated with those shots, mostly in priority groups like health workers and those over 50, leaving a huge percentage of the country’s 238 million residents waiting, according to official figures.

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

“It’s good that it’s available privately, I have no idea when our turn will come 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 country’s deep-seated social inequality. Most private sales take place in major cities, such as Karachi and Islamabad, and remain inaccessible to residents of more rural areas – and the price remains higher than most of the Pakistani population.

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

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

The third wave

Pakistan has only approved a handful of vaccines for emergency use, including three Chinese vaccines, the Russian Sputnik V and the Oxford AstraZeneca vaccine. Until now it has largely dependent on donations from other countries – mainly China, which has provided more than a million doses of Sinopharm.
An employee transports a crate of Sputnik V Covid-19 vaccine in Karachi, Pakistan on March 19.
Pakistan is set to import three million additional doses of the Chinese CanSinoBio vaccine this month. Russia also announced in April that it will soon supply Pakistan with 150,000 doses of the Sputnik vaccine. It is not clear whether the vaccines against Sputnik and CanSinoBio are donations or purchases.
And Pakistan is still waiting for more than 17 million doses of vaccines to be allocated by COVAX, a global initiative to share reduced- or free-dose 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. Businesses and private hospitals must apply to the country’s regulator, DRAP, to receive a ‘No objection’. Certificate (NOC) – the document that allows them to import and sell vaccines.

However, there are some rules, including a ban on retail sales of the vaccine; According to DRAP, private institutions and clinics are only allowed to administer the vaccine on their premises and under the supervision of healthcare professionals. Private clinics must also have their facilities assessed by the provincial director of general health.
People are waiting to receive a dose of the Russian Sputnik V vaccine in Karachi, Pakistan on April 5.

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

Pakistan has recorded more than 721,000 cases and more than 15,000 related 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 system will be a huge challenge,” said AGP CEO Nusrat Munshi. “Someone had to rise to 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 have been regulated by the government. Colombia decided in early April to allow private imports, but required the shots to be free for consumers. Indonesia has launched a private vaccination program where companies can purchase state-obtained vaccines for their employees. And Kenya had allowed private sales for a while, but closed it on April 2, fearing counterfeit vaccines would hit the private market.

The price war

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

Initially, the government had allowed an exemption from price caps, which meant that private companies could import and sell vaccines for any price they wanted. Critics argued that this encouraged companies to take advantage of despair, and could outstrip the poorest and most vulnerable while benefiting the privileged few.

Recognizing her privilege, Jatoi described 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 arm of the international anti-corruption non-profit organization Transparency International, wrote to Prime Minister Imran Khan last month urging the government to ban private imports and sales. The commercialization of vaccines would essentially allow the wealthy to break the line and exacerbate existing inequality, the letter said.

“The sale of this vaccine is just unethical and too bad for the community,” says Dr. Tipu Sultan, former head of the Pakistan Medical Association. “Few people with money will buy it. Most of the population cannot afford it.”

In the end, the government reversed its decision and announced DRAP that it would set a price cap, prompting AGP to take the government to court. With 50,000 doses of Sputnik vaccine already coming in, the company was given an interim order that allowed it to sell the vaccines for $ 80 for two doses until the final price is set.

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

The company had used the DRAP-recommended pricing formula to achieve their final, “plausible” price, she added. “At the moment, the availability of the vaccine is much more important than the price.”

But critics say even the current $ 80 price is too high, out of reach for much 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 provide vaccination for every citizen. And if they are going to sell it, it will obviously be expensive.”

The waiting game

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

But the process of getting a privately sold shot has its fair share of complications, even for those who can afford it.

“I am extremely frustrated because I have to travel for work and I cannot get my vaccine,” said Maha Mussadaq, a content leader at Foodpanda Thailand who is stranded in Islamabad. She’s been trying to sign up for the vaccine all week, but hasn’t been able to confirm a timeslot, she said. She went online to register and was told she would receive a call with more details, but was given no indication of when it might come.

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

And even those who took their first photos are concerned. “I’m afraid there is no guarantee we will get the second dose, what if the supply runs out?” Jatoi said. “There is a lot of uncertainty.”

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

Meanwhile, authorities are bracing for the Ramadan events starting on Tuesday. During the Islamic holy month, devotees typically 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 feasts, festivities and special prayers.

It’s one of the biggest holidays in Islam – and it poses a Covid-19 risk. This time last year, countries around the world experienced devastating first waves and imposed lockdowns that saw home and virtual Ramadan events.

But this time, many of those lockdowns have been lifted. In Pakistan, mosques are allowed to remain open and hold services, albeit with rules such as wearing masks, social distance and disinfection requirements.

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

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