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The new Access to Vaccines Index: how do pharmaceutical companies measure up?

A health clinic that Save the Children supports in Afar, Ethiopia (photo: Zacharias Abubeker/Save the Children)

The first-ever Access to Vaccines Index was launched today by the Access to Medicine Foundation. This is an exciting to new tool – the first of its kind to transparently measure the efforts of pharmaceutical companies and how well they’re doing in bringing vaccines within the reach of every last child.

Vaccination saves lives and is one of the most successful and cost-effective health interventions. Progress in the coverage of immunisation services has been impressive, with 86% of children globally receiving basic vaccinations. However, our recent report Further, Faster, Fairer: Reaching every last child with immunisation, shows that 19.4 million children under 1 year old – that’s 1 child in 7 – are still excluded from this critical health intervention. Lack of affordable vaccines is one of the obstacles undermining progress.

Save the Children welcomes the Index as a new catalyst to help stimulate action from companies to do more to improve vaccine access for low- and middle-income countries.

Where do companies stand?

The new Index analyses how well 8 of the largest vaccine companies are doing in improving access. It explores their policies and practices across three critical vaccine access issues: R&D, vaccine pricing, and manufacturing and supply.

While cross-company comparisons are difficult due to diverse business models, scope and approaches to access, the Index scored GSK’s performance highest overall, with Sanofi also highlighted as doing well across the board. When it comes to pricing, for example, the Index found GSK’s pricing strategy to be the most sensitive to countries’ ability to pay, while GSK and Merck & Co., Inc. are frontrunners in transparency for publishing their pricing policies. We congratulate these companies on the progress they are making in these areas.

However, like the Access to Medicines Index, this new Index does not benchmark companies against a target. Rather they are scored relative to others in the industry. So a good score means good compared with others; it doesn’t necessarily mean companies are doing enough to improve access. The Index shows that vaccine companies can and must do more. For example, they must do more in considering countries’ ability to pay when setting vaccine prices. This is particularly salient for middle-income countries and countries transitioning from Gavi support (and hence moving away from access to Gavi prices).

Prohibitive vaccine prices: a key access issue

Prohibitive vaccine prices should not be a barrier to reaching every last child with immunisation – but unfortunately in many countries they are. While the increasing number of vaccines in immunisation schedules means that children are protected from more diseases, it also means that the full vaccine package is more expensive. The bulk of recent additional costs come from the newer pneumococcal and rotavirus vaccines, which help protect children from two of the leading causes of child deaths – diarrhoea and pneumonia. Meanwhile, manufacturers make huge profits from these vaccines – eg, Pfizer’s pneumococcal vaccine (Prevnar) generated revenues of $6.25 billion in 2015 alone, while GSK revenues for its pneumococcal vaccine (Synflorix) were £381 million the same year.

Due to limited competition – which otherwise might to help drive down prices for these two vaccines – prices remain high. So while many lives have been saved by these new vaccines, they may be out of reach for many countries, and hence many children. Although the pneumococcal vaccine has been made more affordable for CSOs working in humanitarian situations, manufacturers must improve affordability for countries so that immunisation gains can be expanded and sustained. Prices and price-setting must also be transparent so that countries can negotiate on a fair playing field – as agreed by 193 countries at the World Health Assembly in 2015 (resolution 68.6).

Driving lasting change for every last child

While governments have primary responsibility for ensuring that immunisation and other essential health services reach every last child, to do so, vaccines and the equipment needed to administer them must be affordable and appropriate. As the Index points out, the global vaccine market is immense and it is growing – it reached US$33 billion in 2014. Manufacturers hold R&D expertise, set vaccine prices, and manage vaccine supply planning and production. They therefore play a central role in helping to improve access and have a clear responsibility to act.

Save the Children continues to call on industry to make vaccines affordable for governments. And through our five-year partnership with GSK, we have been making the case about their pricing policy directly to the company.

We therefore welcome the Access to Vaccines Index as a catalyst to stimulate change, increase accountability and drive improved practice across pharmaceutical companies. We urge the sector to play its part to improve affordability and access of vaccines, and help the world move towards universal immunisation coverage.

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