Anuradha Gupta, a Haryana cadre IAS officer, was appointed as the deputy chief executive officer of Geneva-based Global Alliance for Vaccines and Immunisation (Gavi) in April 2014. She spoke to Chief of Bureau, Hitender Rao on Gavi’s role in driving down vaccine prices and why India needs to bring more vaccines under its Universal Immunisation Programme (UIP).
How has Global Alliance for Vaccines and Immunisation (Gavi) brought down the cost of vaccines?
Gavi has registered success in terms of shaping the vaccine market. It has driven down prices and encouraged vaccine manufacturing in developing nations. The prices in the open market are incredible. Gavi has actively contributed in expanding the numbers of vaccine manufacturers thus opening up the competition and thereby contributing to reduce vaccines prices. Secondly, Gavi very smartly aggregates demand. Because we work with 73 countries it gives us the advantage of pooling demand and leveraging volumes.
But why there is a huge price disparity in the vaccine market in India?
Very few people understand that vaccine gets licenced in private markets and therefore are recommended by the Indian Academy of Paediatrics (IAP). Then they are widely prescribed by private doctors. But they are exorbitantly priced. It can be gauged from the fact that the price charged by private doctors for one dose of Pentavalent vaccine can range from Rs 1,200-2,000 per dose. This means that for a full course of three doses it can cost Rs 5,000 to 6,000. In comparison, the lowest price negotiated by Gavi globally is $1.19 per dose (Rs 60-70). The Gavi price for a full course of nine doses of three key life saving vaccines — Rota, Pneumococcal and Pentavalent vaccines is $21 (about Rs 1,200). However, in private market in India the cost of vaccinating one child with the full course of these vaccines can be as high as Rs 25,000. Similarly, Hepatitis-B vaccine used to cost Rs 1,500 for a full course of three doses some years ago. After it was introduced in the UIP, its prices fell to less than Rs 3 per dose (Rs 15 for three doses).
Is there a way to bring down the prices of the vaccines in the open market?
India has the world’s largest birth cohort with nearly 2.7 crore births every year. Even if 30% of the children access vaccines in the private market it translates into huge numbers. The fact that introduction of a vaccine in UIP brings down the vaccine prices substantially is a pointer to the fact that in the absence of its availability in UIP, there is a likelihood of artificial jacking of prices. It is important that all those vaccines, which are available in the private market must be introduced soon in the government’s UIP, which provides free of cost vaccination.
You often speak about the “virtuous cycle” in context of vaccine administration. What is it?
There is empirical evidence to show that high child mortality rates are co-related with high fertility rates. When children are vaccinated, their survival improves. Mothers become more confident of the survival of their kids resulting in declining fertility rates. They know that they do not need to produce more children as their kids will survive. Once the fertility rate starts to drop, the maternal health starts to improve and mothers are able to raise their kids better. Empirical evidence shows a strong connection between vaccinated kids and their performance at school. They grow up as more productive individuals with potential for higher earnings.
What has been you experience about Haryana, a state where you have worked as a bureaucrat?
We are all aware that Haryana has progressed economically and yet has lagged behind on human development. A particular challenge is deep inequities within the state. The state needs to map its weak spots and prioritise them for resources and results.
What is Gavi
Founded in 2000, the Global Alliance for Vaccines and Immunisation (Gavi) is an international organisation bringing together public and private sectors with an aim to create equal access to new and underused vaccines for children living in the world’s poorest countries. Gavi’s endeavour is to close the gap in access to life saving vaccines and contribute to millennium development goal (MDG) 4 by reducing child mortality caused by vaccine preventable deaths. WHO, UNICEF and World Bank are Gavi’s key implementing partners.