Pakistan's private vaccine sales highlight the rich-poor divide

Access to the coronavirus vaccine has thrown a stark light on global inequality. The United States and other rich countries have bought up most of the world’s vaccine supplies to protect their own people, leaving millions of doses stockpiled and in some places unused.

Less developed countries scramble over what’s left.

To speed up vaccinations, some countries have allowed doses to be sold privately. But those campaigns have been troubled by supply issues and by complaints that they simply reflect the global disparities.

“The Pakistani example is a microcosm of what has gone wrong with the global response — where wealth alone has primarily shaped who gets access,” Zain Rizvi, an expert on medicine access at Public Citizen, a Washington, D.C., advocacy group, said in an email.

“Ending the pandemic will require the global community to do much more than just that.”

India sells vaccines to private hospitals, though they are scrambling to find supplies now that the pandemic there is so serious. Kenya authorized private sales, then blocked them over fears that counterfeit vaccines would be sold. In the United States, some well-connected companies, like Bloomberg, have secured doses for employees.

Indonesia on Tuesday allowed companies to purchase vaccines from the government to inoculate employees and family members free of charge. The only vaccine approved for that program so far is one made by Sinopharm.

Pakistan says the private program could make more free shots available to low-income people. By purchasing doses of the Russian-made Sputnik 5 vaccine, the country’s wealthy wouldn’t need to get the free doses, which are made by Sinopharm of China. Some people would prefer to get inoculated at a private hospital because they are widely believed to be comparatively better organized and more efficient than overwhelmed government facilities.

Pakistan’s need is growing. The country of nearly 220 million people is reporting more than 2,500 new infections a day, but its low rate of testing suggests many more cases remain undetected. The government has toughened restrictions and limited public gatherings.

But the government’s vaccination campaign has been slow. It has started giving doses to people over 40 this month. Younger people may need to wait several months.

Tight global supplies are to blame, said Chaudhry Fawad Hussain, Pakistan’s information minister. In addition to the Sputnik and Sinopharm vaccines, Pakistan earlier this month received 1.3 million doses of the AstraZeneca vaccine from Covax, the international body that promotes vaccinations, and is due to get 3.5 million doses of the Sinovac vaccine from China by the end of May.

Private sales set off a fiery debate in a country where the economy has stalled from the pandemic and from long-standing issues like a lack of foreign investment and heavy government debt. Critics say the decision will deepen the divisions within the country, where a large section of the society lives under the poverty line.

“The government did not think about the suffering of the poor while allowing the importers to sell the vaccine,” said Dr. Mirza Ali Azhar, a leader of the Pakistan Medical Association, the nationwide medical professional body. “Such discriminatory policies will increase the sense of deprivation among the poor young people, especially those with weak immune systems.”

Chaudhry, the information minister, played down the pricing issue, saying that private vaccines could not cater to the public need anyway.

The initiative has run into another problem: Hospitals can’t find vaccines to buy. Demand has been strong. The government sets a ceiling on prices but has been locked in a dispute with private importers over how much that should be.

In April, in the city of Karachi, long lines formed when two private hospitals began selling the Sputnik V vaccine to walk-ins. Private hospitals in Islamabad, the capital, and Lahore faced a similar rush of people and ran short within days. Hospitals in the major cities have now stopped taking walk-ins, and online registration has also been put on hold.

Sputnik V isn’t the only vaccine that the government allows to be sold privately. A one-dose shot made by CanSino Biologics of China is priced at around $28. Demand has been weaker because of greater public confidence in the Russian vaccine. Still, supplies sold out quickly after the CanSino doses went on sale last month. The government has said another 13.2 million doses will arrive in June.

AGP Limited, a private pharmaceutical company that has imported 50,000 doses of Sputnik, is urging patience.

“Sputnik V received an overwhelming response in Pakistan with thousands of people being vaccinated in just a few days and an even higher number of registrations confirmed in hospitals across Pakistan,” said Umair Mukhtar, a senior official of AGP Limited. He said the company has placed large orders for more.

The government price dispute could delay further expansion. The drug regulatory authority wants Sputnik V to be sold at a lower price. AGP won an interim court order on April 1 to sell the vaccine until a final price is fixed.

For those who can afford the doses, frustration is growing. Junaid Jahangir, an Islamabad-based lawyer, said several of his friends got private inoculations. He registered with a private lab for Sputnik V but got a text message later saying that the vaccination drive was on hold.

“I am being denied a fair chance to fight this virus if I end up getting infected,” Jahangir said. “The demand is there, and I don’t see what could possibly be the reason behind the inefficiency in supply.”

Some of the people who paid for private doses justified their decision by citing media reports that some well-connected people were jumping the line to get free, public doses.

In May, at least 18 low-level health care workers were suspended by authorities in Lahore for vaccinating people out of turn after taking bribes.

Iffat Omar, an actor and talk show host, apologized publicly in April for jumping ahead of the line to get the vaccine. “I am sorry,” she said on Twitter. “I am ashamed. I apologise from the bottom of my heart. I will repent.”

Fiza Batool Gilani, an entrepreneur and the daughter of Yusuf Raza Gilani, a former prime minister, said she knows of several young people who jumped the queue and got the free government vaccine in recent weeks.

“I was myself offered out of turn, free vaccine, but I declined as I wanted to avail the private vaccine,” said Gilani. Wealthy people should pay for their doses, she said, adding that her family would pay for CanSino shots for its household staff.

Many people, like Tehmina Sadaf, don’t have that option.

Sadaf, 35, lives along with her husband and a 7-year old son in a working-class neighborhood on the outskirts of Islamabad. Her husband is a cleric at a mosque. She gives Quran lessons to young children. She said the pandemic had negatively impacted the family’s income of around $128 per month. “After paying the house rent and electricity bill, we are not left with much,” she said.

She had her doubts about the public vaccine, “but the price of the private vaccine is very high,” she said. “It should have been lower so that poor people like us can also afford it.”