Vaccines are important preventive medicines for primary health care, and a critical component in a nation’s health security. Although international agencies such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) promote global immunization drives and policies, the success of an immunization program in any country depends more upon local realities and national policies.
The market for vaccines in India shows immense potential. The country has not only been self-sufficient in meeting its domestic requirements but has also emerged as a leading global exporter of vaccines across the world. The Indian vaccine industry began as a network of state owned manufacturers supplying basic childhood vaccines to the national immunization program. India’s vaccine production sector is likely to expand dramatically to an estimated size of $871 million by this year which was estimated to be $350 million in 2011, says a report by GBI research.
India articulated its first official policy for childhood vaccination, a policy that was in alignment with the WHO’s policy of “Health for All by 2000” (famously announced in 1978 at Alma Atta, Kazakhstan) and introduced six childhood vaccines (Bacillus Calmette-Guerin, TT, DPT, DT, polio, and typhoid) in its immunization program. Measles vaccine was added much later, in 1985, when the Indian government launched the Universal Immunization Program (UIP) and a mission to achieve immunization coverage of all children and pregnant women by the 1990s. The last few years have brought many achievements for the Indian vaccine industry. A new bivalent oral cholera vaccine, meningitis-A vaccine, and an indigenous Japanese encephalitis (JE) vaccine were developed by Indian manufacturers in collaboration with international partners and are now licensed in India. In March 2014, India received its polio-free certification from WHO, in line with the disease being eradicated from the country. Recently, Bharat Biotech, an Indian vaccines manufacturer, has announced a breakthrough in developing the world’s first Zika vaccine. The company is now looking to seek regulatory approvals to expedite further clearances.
Vaccine pricing strategies usually consist of a set of process that include but not limited to- carrying out the target population analysis; constructing a vaccine target product profile (TPP) and comparing it to projected or actual TPPs of competing vaccines; determining vaccine positioning in the marketplace; estimating the vaccine price-demand curve; calculating actually vaccine costs (manufacturing, distribution, and research and development); accounting for various legal, regulatory, third party and competitor factors; overall product portfolio; pricing objectives; and pricing structure. The routinely administered vaccines in India which are usually administered by infants and children (BCG, Hep-B, Measles, chicken pox, Rota virus, pneumonia vaccines, etc) are priced between Rs 150 to 4,000. However, prices may vary due to change in brands and/or different vaccine administration charge and consulting fees of the doctor.
In recent decades, however, a number of privately owned firms have emerged, which have completely transformed the industry landscape. Their biggest success factor is similar to the approach that has been followed by Indian generic pharmaceutical manufacturers. This model involves concerted efforts to develop vaccines for not only tropical neglected diseases, but also cheaper alternatives of vaccines that are already available in the West. Despite its recent growth, however, the Indian vaccine industry still has a number of challenges to address. Even though the market is growing continuously, India is lagging behind its global peers in terms of vaccine coverage with a significant number of lives lost due to vaccine preventable deaths.
According to UNICEF, vaccination coverage varies considerably from state to state, with the lowest rates in India’s large central states. Differences in uptake are geographical, regional, rural-urban, poor-rich and gender-related. On average, girls receive fewer immunizations than boys and higher birth order infants have lower vaccination coverage. UNICEF works closely with the Indian government on its Universal Immunization Programme (UIP). Introduced in 1985, the UIP has made great progress in expanding Routine Immunization (RI) coverage across the country, and today, it is one of the largest programmes of its kind in the world. The UIP supports national and state governments to boost routine immunization (RI) and supplementary immunization, including for polio, measles, and Japanese encephalitis. It also supports the introduction of new vaccines such as Pentavalent, Hepatitis B and rubella.
Despite such a bright picture, vaccinations for babies are proving to be excellent money-spinners for doctors, especially the newer ones that have not been recommended by the government and are not even a part of the National Immunization Programme. The profit margins are much higher for the non-mandatory vaccines and doctors are made to prescribe those in order to position these unnecessary products. Costs of vaccines and vaccination coverage have been big issues in India in recent years, as the country’s healthcare system has expanded and demand for treatments increased, with very little vaccination coverage. Despite price caps and some discounting on the part of big pharma, some therapies remain too expensive for Indian patients to afford. If irrational vaccines with high costs enter the market without being a part of the national immunization programs; the patients are likely to face the challenges of spending huge amount of money.