Barely a month after the government confirmed a severe shortage of the BCG vaccine in the country; a UN health agency has now declared an emergency, citing shortage of funds to eradicate the polio virus. Bruce Aylward, a WHO assisting Director–General, announced the emergency at the world health assembly in Geneva.

Polio immunization protects against poliomyelitis, a severe disease that can lead to paralysis and death. Immunization against poliovirus infection is said to be one of the world’s greatest medical achievements. The vaccine contains an inactive (dead) form of the polio virus, called an inactivated polio vaccine, or IPV. Both inactivated poliovirus vaccine (IPV) and live, attenuated oral poliovirus vaccine (OPV) were developed in the 1950s and have been used worldwide. At its peak Polio is estimated to have paralysed or killed 500,000 per annum worldwide, by 2007 this had reduced to 1,652 cases.

Global Polio Eradication Initiative stalled by lack of funds

According to a report on the Daily Nation, June, 4th the Global Polio Eradication Initiative, GPEI, needs $2.2 billion to the end of next year, to continue its work but has a shortfall of $945m. The importance of the initiative is that polio can be eradicated in a society by 100% immunization programs.

Without vaccination, the disease has a habit of seeking out pockets of (un-vaccinated) children, and being highly contagious, spreads rapidly. Since the GPE Initiative began in 1988 it is estimated that 8million people are walking today who otherwise would have been debilitated by the disease. Over 2billion vaccinations has been administered by the program. But without adequate funding this trend is likely to reverse.

The BCG vaccine protects children against tuberculosis and its normally administered within the first two weeks of birth here in Kenya and according to the The Head of Immunisation at the Ministry of Public Health Tatu Kamau, the shortage was global and was a result of production delays. According to the World Health Organisation, BCG vaccine, apart from protecting against the more common lung form of TB also has a documented protective effect against TB derived meningitis and disseminated TB in children, hence news about the shortage send chills across the country.

The problems of supply of both of these critical vaccines have different roots, but have a commonality in so far that they are both susceptible to economic pressures. The WHO have budgets, and have to decide how the money is best allocated. By not extending the extra $945m to GPEI doesn’t mean that the polio vaccines wont be available, it means that the initiatives’ prime objective of eradicating the disease wont be achieved this coming year. Whilst some pundits are saying that GPEI could well achieve the ultimate world health objective, others are saying…well they have already done a fantastic job reducing cases to the odd thousand per annum…but couldn’t we better spend nearly $1billion on something else (like research into a new HIV vaccine…) which will continue to save 10’s or 100’s of thousands of lives in the future?

Vaccine production: a question of saving lives or making money?

The lack of BCG vaccine is also an economics problem but more to do with manufacturing. Despite being a $7billion market, vaccines only account for 1.5% of the pharmaceutical industry’s turnover. It’s the poor cousin of the industry. The vast majority of vaccines are made in Europe (18 manufacturing plants) and the USA (3 manufacturers) but in high value countries the incentives to continue manufacture is low.

Vaccine plants are complex and expensive to build, BCG cultures take nearly a year to develop before production starts for instance, and the value gained from them is depressed by bulk buying from organisations buying for aid assisted countries. Add to this the huge insurance costs now need in the west to cover potential litigation against faulty manufacture and you have an industry sub sector which is not likely to have many newcomers.

So, when a plant in the USA takes its BCG production offline. There is going to be a shortfall somewhere around the world. It has happened many times before. Because of the nature of the product (mostly live vaccines) its not always possible to stock pile against emergencies. Manufacturers have to periodically refurbish their lines, cultures take time to restock, and the risk reward ratio is skewed towards a conservative approach to manufacture.

We’re sure the picture would be different if the value of the vaccines fell in line the norms of the pharmaceutical industry, i.e. go up, but this of course would mean less availability given the worlds’ health aid budget.