Hefty margins on every shot

NEW DELHI: Hefty margins being offered by companies for doctors or hospitals on the price of vaccines have raised a question that whether the decision to give a particular vaccine is based on its scientific rationale or on the generous margins.Many paediatricians say they are forced to administer expensive combination vaccines, especially those with inactivated polio vaccine (IPV), as standalone IPV is no longer available in the open market. While this might be true in the case of combinations with IPV, there are several other combination vaccines where cheaper standalone alternatives are available and yet many doctors choose the expensive combinations instead.One often used justification is that parents want to minimise needle jabs for the baby and hence prefer combination vaccines despite the much higher price. Whether or not this is true, doctors or hospitals are being offered hefty discounts on every dose of vaccine. The margins are particularly high for vaccines not recommended by the government as part of the national immunization programme.“The MRP of DPT is about Rs 15.50 and the cost to doctors is Rs 12.50. The MRP of DaPT is Rs 699 and the cost to doctors is Rs 595. So doctors prefer to administer the DaPT vaccine,” said Dr Yash Paul, consultant paediatrician from Jaipur. This is despite the Indian Academy of Paediatrics (IAP) recommending DPT, which contains whole cell pertussis vaccine, and not DaPT, which contains acellular pertussis vaccine. “We recommend the whole cell vaccine as it has longer lasting immunity and better efficacy and the WHO also recommends this,” said Dr S Balasubramanian, convenor of IAP’s Advisory Committeee on Vaccines and Immunisation Practices (ACVIP). The national immunization programme also uses the whole cell vaccine.The much more expensive acellular version used in most combination vaccines manufactured by multinationals like Sanofi and GSK is promoted as a painless vaccine. “Whether acellular or whole cell, one cannot avoid the needle prick; nothing painless about that. But with whole cell vaccine, the baby gets fever and hence is more irritable,” explained a paediatrician.“There is no rationale behind the high prices being charged for combination vaccines. Complexity of manufacturing processes cannot justify a jump of over Rs 1,000 or more in some cases,” said Dr Arun Gupta, senior paediatrician and president of the Delhi Medical Council. For instance, the MRP of the DPT vaccine against diphtheria, tetanus and pertussis is Rs 13.50 and that for DT (containing vaccine for diphtheria and tetanus) is Rs 17.50, but GSK’s Boostrix, a combination sold as a booster shot for adults for the same diseases, but containing the acellular pertussis vaccine, is sold for Rs 1,098.Other than the vaccines recommended by the government, private practitioners offer a whole host of other vaccines on which they get hefty margins which vaccine manufacturers dismiss as standard marketing practices.Dr Vipin Vashishtha, former convenor of IAP’s immunization committee, argued that there is a strong case for regulation of vaccine prices in the open market even though vaccines in the national immunisation programme are provided free of cost in government facilities. “According to recent national survey data, for immunisation, the private sector caters to 7.2% of the total population with 16.7% in urban areas. This is a significant chunk and in some states like Kerala, the numbers are even higher,” explained Dr Vashishtha. He added that there should be a crackdown on the huge margins offered to doctors and a cap on profit margins of vaccine companies through price control.