Friday, March 04, 2011

Pneumoccal vaccine in Africa: one step forward, one step back?

It is pretty well known that many routine medical interventions in the world's more affluent countries make infrequent appearances -- or sometimes none at all -- in the world's poorer ones. The publicly-financed health care systems in some sub-Saharan Africa look to be decades behind the United States, Canada or the United Kingdom when it comes to devices, drugs and procedures. For that reason, initiatives that seek to close the gap are, in principle, to be welcomed. Oftentimes, however, these initiatives are accompanied by moral baggage.

Take for instance the launch of a new pneumoccal vaccine among children in Africa. Considering the number of childhood deaths attributable to pneumonia in this part of the world, the effort has an initial air of nobility. Many lives will be saved, many illnesses avoided. But if one looks more closely, serious ethical problems seem to emerge. There are two multinational pharmaceutical companies involved in the campaign -- GlaxoSmithKline and Pfizer/Wyeth -- who have agreed to sell 30 million doses every year for ten years at $10.30 per child vaccinated. These companies also stand to each gain $225 million in subsidies through their involvement in this scheme. Doctors Without Borders worries that this price for vaccination is very high for many countries, and that the lock on the market exercised by GSK and Pfizer/Wyeth will strongly discourage local companies from developing cheaper generic equivalents. The companies are establishing their brand under favorable circumstances to themselves; after that, all bets are off.

Some people argue that pharmaceutical companies should be given incentives to focus greater attention on developing countries, otherwise they will simply develop whatever is likely to sell to richer consumers elsewhere. But the pneumoccal vaccine example can make you think twice about the wisdom of 'incentivizing'. In the short term, many children will be vaccinated. But in the long term, unless prices are made to go down, children of wealthy elites within developed countries are most likely to benefit. The usual pattern threatens to repeat itself: big business wins, the higher classes win, and the rest struggle on.

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