{"id":46534,"date":"2020-01-29T12:34:09","date_gmt":"2020-01-29T11:34:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46534"},"modified":"2020-02-04T11:25:42","modified_gmt":"2020-02-04T10:25:42","slug":"new-shot-protecting-children-pneumonia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/29\/new-shot-protecting-children-pneumonia\/","title":{"rendered":"A new shot at protecting children from pneumonia: will leaders accelerate access for the millions of children left behind?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-46536\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/01\/kate_elder_2020-scaled.jpg\" alt=\"\" width=\"215\" height=\"162\" \/><span style=\"font-weight: 400\">Every 39 seconds, a <\/span><a href=\"https:\/\/data.unicef.org\/topic\/child-health\/pneumonia\/\"><span style=\"font-weight: 400\">child dies from pneumonia<\/span><\/a><span style=\"font-weight: 400\">\u2014the leading infectious killer of children under the age of 5 worldwide, which claims more than 800 000 young lives each year. This week the <\/span><a href=\"https:\/\/stoppneumonia.org\/latest\/global-forum\/\"><span style=\"font-weight: 400\">first ever global conference on childhood pneumonia<\/span><\/a><span style=\"font-weight: 400\"> is taking place in Barcelona, aimed at mobilising countries and leading stakeholders to protect all of our children from this preventable disease. Leaders in global vaccination\u2014Gavi, the Vaccine Alliance, World Health Organization (WHO), UNICEF, Bill &amp; Melinda Gates Foundation\u2014have a critical opportunity to set a course of action that could save many more children\u2019s lives. But this opportunity could easily slip away if commitments aren\u2019t made to do more with the money and resources at hand.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Children can be protected against pneumonia using the pneumococcal conjugate vaccine (PCV). However, <\/span><a href=\"https:\/\/www.jhsph.edu\/ivac\/wp-content\/uploads\/2019\/11\/VIEW-hub_Report_Sep2019.pdf\"><span style=\"font-weight: 400\">about 55 million children worldwide<\/span><\/a><span style=\"font-weight: 400\"> live in places where PCV is not available in their country\u2019s national immunisation schedule, largely because of its high price.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Two PCVs\u2014Pfizer\u2019s Prevnar13 and GSK\u2019s Synflorix\u2014have long held a duopoly on public and private markets, with MSF\u2019s Access Campaign calculating that the companies have generated about <\/span><a href=\"https:\/\/msfaccess.org\/us262-million-subsidy-should-not-go-pharma-giants-pfizer-and-gsk-pneumococcal-vaccine\"><span style=\"font-weight: 400\">US$50 billion<\/span><\/a><span style=\"font-weight: 400\"> in sales since 2009 based on their revenue reports. The lowest global price for these PCV products is offered to Gavi at <a href=\"https:\/\/www.unicef.org\/supply\/files\/2019_04_12_PCV_Price_web_update.pdf\">US$8.70 per child<\/a>, but is restricted to the immunisation programmes of the poorest countries. Thanks to Gavi\u2019s support, these countries have paradoxically been able to introduce PCV earlier than the majority of \u201cmiddle income\u201d countries, where the cost of this lifesaving vaccine ranges widely from around US$49 to <a href=\"https:\/\/moph.gov.lb\/en\/Pages\/3\/3101\/drugs-public-price-list-#\/en\/view\/24642\/drugs-public-price-list-2019\">US$245 per child<\/a>. MSF\u2019s analysis of <\/span><a href=\"https:\/\/www.jhsph.edu\/ivac\/resources\/view-hub-reports\/\"><span style=\"font-weight: 400\">global vaccine data<\/span><\/a><span style=\"font-weight: 400\"> has determined that in 2018, 90% of Gavi financed countries had introduced PCV compared with only 52% of middle income countries (which receive no Gavi funding).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The need for middle income countries to finance and negotiate PCV prices themselves has had a chilling effect on the vaccine\u2019s availability, leaving millions of at-risk children unprotected in their critical first years of life. The task of negotiating prices is made even more difficult since <\/span><a href=\"https:\/\/health-e.org.za\/2019\/04\/10\/msf-secret-medicine-prices-cost-lives\/\"><span style=\"font-weight: 400\">pricing information<\/span><\/a><span style=\"font-weight: 400\"> is often confidential and national health ministries are kept in the dark on what other countries are paying for PCV.<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, a <\/span><a href=\"https:\/\/www.path.org\/media-center\/new-pneumococcal-vaccine-serum-institute-india-achieves-who-prequalification\/\"><span style=\"font-weight: 400\">third, much more affordable PCV<\/span><\/a><span style=\"font-weight: 400\"> called Pneumosil has now hit the market and is poised to introduce competition. Last month, WHO <\/span><a href=\"https:\/\/www.who.int\/medicines\/regulation\/prequalification\/prequal-vaccines\/about\/en\/\"><span style=\"font-weight: 400\">quality assured<\/span><\/a><span style=\"font-weight: 400\"> this vaccine, which is manufactured by one of India\u2019s largest vaccine manufacturers and suppliers, the Serum Institute of India. This is the first PCV produced by a manufacturer based in a developing country.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Serum Institute has stated that they plan to sell the vaccine at <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(19)31084-0\/fulltext\"><span style=\"font-weight: 400\">about US$6 per child to Gavi and to the poorest countries, and at US$11 or less to middle income countries<\/span><\/a><span style=\"font-weight: 400\">. This pricing is about 30% lower than Pfizer\u2019s and GSK\u2019s lowest price to Gavi. For non-Gavi middle income countries, the new PCV would be 5-25-fold cheaper than PCV from Pfizer and GSK. If taken up by national immunisation programmes, this could boost access to PCV for millions more children.<\/span><\/p>\n<p><span style=\"font-weight: 400\">To do so will require the health ministries of middle income countries, along with Gavi, WHO, UNICEF, and the Gates Foundation, to step up and help overcome the regulatory, logistical, and political barriers to introducing a new PCV\u2014especially in places where it has yet to be introduced because of its high price. Now that a more affordable vaccine is finally available, these stakeholders must play their crucial parts to ensure that every country can start protecting all its children against pneumonia.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Roughly one third of the countries that have received funding from Gavi are now in the process of transitioning off of Gavi financial and technical assistance. As they lose eligibility for Gavi grants and are increasingly expected to become financially self-sufficient, ready or not, their vaccine bills will rapidly multiply. This raises major concerns about the future financial sustainability of procuring vaccines that were introduced into national immunisation programmes through Gavi support.<\/span><\/p>\n<p><span style=\"font-weight: 400\">At this week\u2019s global conference on childhood pneumonia, all the major stakeholders and concerned countries will be gathered to \u201cagree practical pathways that governments and their partners can take\u201d and \u201cdeliver concrete measures with the potential to save hundreds of thousands of children\u2019s lives.\u201d Such paths and measures must prioritise prevention of pneumonia through vaccination, and how to reach the remaining 40% or more of the world\u2019s children without access to PCV today. They should also consider affordable access to future PCVs currently in the development pipeline.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As Gavi turns 20 this year, and revs up for a new round of replenishment funding in June, what better way to celebrate their birthday than to support broader access to a much more affordable new lifesaving vaccine, which can help ensure that many more children can celebrate their next birthday, too?<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Kate Elder<\/strong> is the senior vaccines policy adviser for the MSF Access Campaign.<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare the following interests: None.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Every 39 seconds, a child dies from pneumonia\u2014the leading infectious killer of children under the age of 5 worldwide, which claims more than 800 000 young lives each year. This [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/29\/new-shot-protecting-children-pneumonia\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":46539,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263,750],"tags":[],"class_list":["post-46534","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health","category-msf"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>A new shot at protecting children from pneumonia: will leaders accelerate access for the millions of children left behind? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/29\/new-shot-protecting-children-pneumonia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A new shot at protecting children from pneumonia: will leaders accelerate access for the millions of children left behind? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Every 39 seconds, a child dies from pneumonia\u2014the leading infectious killer of children under the age of 5 worldwide, which claims more than 800 000 young lives each year. 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