COMMENT: Covid-19 vaccines: public health, private interests

Published March 30, 2021
An elderly resident sits in a waiting area after having her first dose of the coronavirus vaccine at a vaccination center in Karachi on March 10. — Reuters/File
An elderly resident sits in a waiting area after having her first dose of the coronavirus vaccine at a vaccination center in Karachi on March 10. — Reuters/File

IMMUNISATION against Covid-19 is a public good. The World Health Organisation “recognises the role of extensive immunisation against Covid-19 as a global public good for health in preventing, containing and stopping transmission in order to bring the pandemic to an end…”. Nobody is safe until everybody is safe, which necessitates that the immunisation of the most vulnerable among us be prioritised.

Notwithstanding the above, the current scramble for vaccines in the world reflects the underlying inequities in healthcare between countries and within countries. The North-South divide in the world is as much a geographical term as it is a euphemism for the haves and have-nots in low and middle-income countries.

The UK has immunised more than 55 per cent of its adult population with a first dose against Covid-19, whereas in more than 30 poor countries no one including frontline health workers and senior citizens is immunised. The low-risk young adults are being vaccinated in high-income countries while high-risk health professionals and elderly people are left behind in poor countries. So much for global solidarity in global health!

Pakistan has the fifth largest population in the world and the second largest Muslim population. In terms of vulnerability to Covid-19, speaking in round figures, we have around all-inclusive two million health and allied professionals and 15 million senior citizens in the country. This comes out at 17 million (or one crore and seventy lacs). The government has rightly identified the following as high-risk groups — frontline health workers: those directly responsible for managing Covid-19 patients; other health professionals who are more exposed to Sars-CoV-2 than the general population because of their presence in health care facilities and their interaction with the affected; and an elderly population, aged 60 years and above, due to their weak immunity, body reserves and high comorbidities.

The priority assigned to these high-risk groups is a good government policy, in line with the WHO recommended policy on prioritised vaccine allocation. The government must also be applauded for putting together an IT platform for registering and assigning centres for vaccination. This system is working fairly well. All in all, it is a good system but clearer communication to the public would be helpful. After all, this is the first time Pakistan is organising a vaccination campaign for the adult population on a national scale.

As this piece is being written, according to information available till March 26, 2021, only 1.16m people of the 17m high-risk population have been registered for vaccination in Pakistan and only 0.561m people vaccinated. This indicates only 6.8pc people of the high-risk population registered and 3.3pc of the high-risk population vaccinated, while merely 0.25pc of the total 220m population have been vaccinated till date.

Pakistan is also facing issues accessing vaccines. Unlike India, we have not paid attention to local vaccine production. Consequently, we are recipient of all kinds of vaccines.

There are four possible sources of Covid-19 vaccines for Pakistan. Firstly, donations from friendly countries such as China that has donated over one million doses of SinoPharm.

Secondly, there are donations from Covax, an international platform established in Geneva to procure and supply vaccines globally. Covax is a critical initiative in global health for fair and equitable access to Covid vaccines in all countries, regardless of the ability of the countries to pay. It aims to get free vaccines to 20pc of the global population. It is co-led by the Coalition for Epidemic Preparedness Innovations, Gavi, and the WHO, alongside key delivery partner Unicef. Pakistan was one of the first countries to officially register our interest in receiving vaccines under this arrangement back in June 2020, and has been actively following it at all levels. More than 17 million doses of vaccines have been approved for Pakistan under this arrangement. While the first tranche was supposed to reach Pakistan in the first week of March, due to repeated delays, it is not yet clear when we will receive these vaccines. Once received, these vaccines will hardly help Pakistan vaccinate all people of the high-risk groups.

The third source is buying vaccines directly from manufacturers. In this connection, reportedly, 60,000 doses of Convidecia are expected to reach Pakistan from CanSino, China. Pakistan was one of the trial sites for this vaccine but did not insist for a right to access these vaccines once they were produced and approved. This was the first such trial in Pakistan. This anomaly should not be repeated with future trials. Our population should not act as guinea pigs, but instead receive a guaranteed fair share from the manufacturers once the trial is complete.

All the above sources of vaccines are for the government. However, there is a fourth source whereby the private sector in Pakistan is allowed to import vaccines and make it available to the people. Allowing the private sector actors to import vaccines and sell it during a health emergency is fraught with problems.

Read: Allowing private imports of Covid vaccines is a 'deliberate policy tool', says govt

Notwithstanding the ongoing vaccine price controversy, there are more fundamental issues involved, both technical and ethical. In a context where over 17m high-risk people are to be vaccinated, making Covid vaccines commercially available changes the whole paradigm from public-health-need to ability-to-pay. If the price issue is resolved and the vaccine becomes available in the market, we may soon have a situation whereby an old person with multiple comorbidities is not yet vaccinated but young children of rich families have received the jabs. On the one hand, it will not be an optimal use of available vaccines in the country and on the other hand it poses an ethical issue and a moral dilemma. This will further aggravate an acute sense of inequality in our society. Once again people will learn that the rich and powerful can get away with everything, be it unpaid hefty loans or access to life-saving vaccines.

Three suggestions can be made in a situation where there is a dearth of vaccines to help avoid the problems mentioned. Firstly, if some private companies have imported vaccines, then instead of allowing them to make these vaccines available in the private sector where they will be sold on a first-come-first-serve basis, regardless of risk consideration, the government should buy this vaccine from importers and supply it free to people according to its own policy of allocation according to risk determination. The federal cabinet had approved US$150 million for buying vaccines in early December 2020. This will create a win-win solution and the act of goodwill on the part of the government will be a bonus.

Secondly, the government should develop a policy for the corporate sector to buy vaccines from importers and provide these to their employees free in accordance with the risk criteria laid down by the government. This will provide protection to workers, securing the continuity of businesses, again a win-win solution. Details of this policy can be developed by the National Command and Operation Centre with inputs from the relevant ministries.

Thirdly, the government may impose its national prioritisation policy of vaccination on private sales as well. This is possible if private selling is also monitored through a government-managed IT platform. This approach can also aid in reaching the targets set by the government for the high-risk population. This will also allow the monitoring of any side effects that may appear and remain unreported otherwise in private sales. Additionally, this will enable the government to monitor and evaluate the cold chain for the privately supplied vaccines, which is critical to ensure the efficacy.

Last but not the least, the government needs to redouble its effort to raise public awareness about the vaccines and registration mechanism in order to increase vaccination rate. Citizens have questions and misconceptions regarding the vaccines. It is imperative that these concerns are proactively addressed and not permitted to spread unabated.

The writer is a former special assistant to the prime minister for health

Published in Dawn, March 30th, 2021

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