Islamabad: Pakistan may face a serious shortage of seasonal influenza vaccines in the coming flu season as two multinational companies have sought a review of prices, saying that imports at existing rates may not be commercially viable.
The risk of a flu vaccine shortage comes amid a wider crisis in the availability of essential medicines, with price-adjustment cases of 105 hardship-category drugs remaining pending before the federal government since February 2024, despite recommendations by DRAP’s Drug Pricing Committee.
Officials in the federal health ministry and DRAP said Sanofi Aventis and Abbott, whose influenza vaccines are registered in Pakistan, had asked authorities to revise their prices.
They said the companies had informed the government that prices of comparable influenza vaccines in India, Bangladesh and other regional markets were significantly higher than those allowed in Pakistan. If a decision was not taken before import and procurement plans were finalised, Pakistan could receive reduced supplies or no allocation for the coming season, they added.
Federal Health Minister Syed Mustafa Kamal said the health ministry’s recommendations, combined with those of the finance ministry, had been sent to the federal cabinet for a decision on the pending medicine-pricing matters.
Ayesha Tammy Haq, a representative of the Pharma Bureau, which represents multinational pharmaceutical companies in Pakistan, said influenza vaccines were manufactured in limited quantities to meet projected demand and companies had been seeking a decision on their prices for months.
She said the Drug Pricing Committee had fixed a price for the vaccine, but it had yet to be approved by the federal cabinet and notified by DRAP.
“Unless the price is approved by the federal cabinet and notified, there is no official price. If there is no price, we cannot get the vaccine,” she said.
Haq said the industry had approached DRAP, the health ministry, the special committee on medicine pricing chaired by the finance minister, and the prime minister’s office, seeking a timely approval so that companies could place orders.
“As of today, there is no notification of the price, so the vaccine cannot be imported,” she added, saying that the vaccines multinational companies planned to import were prequalified by the World Health Organisation.
An official of one of the multinational companies, requesting anonymity, confirmed that its parent company could be unwilling to provide enough vaccine doses for Pakistan at the prevailing price.
“The parent company has to decide allocations for different markets well before the flu season. At the existing price, it is difficult to justify importing and distributing the vaccine in Pakistan,” the official said.
He maintained that the company was not seeking an extraordinary increase but a reasonable price adjustment to cover import, cold-chain, distribution and other costs, enabling it to make the vaccine available for elderly people and other high-risk patients.
Influenza vaccination is particularly important for people at a higher risk of severe disease and complications, including older adults, pregnant women, children under five, people with heart, lung, kidney, liver and metabolic diseases, and immunocompromised patients, including those receiving chemotherapy, living with HIV or taking long-term steroids.
Seasonal influenza can lead to pneumonia, worsen existing chronic illnesses and cause hospitalisation or death in vulnerable patients. Health workers are also among groups for whom annual flu vaccination is recommended because of their exposure to patients and the risk of transmitting infection.
Influenza vaccines are reformulated periodically because the viruses that cause seasonal flu change over time. The World Health Organisation’s global influenza surveillance system reviews circulating strains and issues recommendations twice yearly for the northern and southern hemisphere formulations.
The potential flu vaccine shortage has brought a new dimension to Pakistan’s prolonged medicines-pricing crisis. Several essential medicines are already unavailable or in critically short supply because manufacturers say their production or import has become financially unviable at existing prices.
The 105 hardship-category cases include oral morphine capsules for severe cancer pain, streptokinase injections used in heart attacks, chemotherapy medicines such as cisplatin, carboplatin and doxorubicin, paediatric digoxin liquid, pilocarpine eye drops for glaucoma, yellow fever vaccine, folinic acid used after chemotherapy, and several immunoglobulin products.
The proposed cabinet decision is also expected to cover price fixation for 52 newly registered life-saving medicines, which cannot be supplied in the market until their maximum retail prices are approved and notified.
Industry officials said a timely decision on influenza vaccine prices was especially urgent, as once manufacturers divert seasonal supplies to other markets, Pakistan may find it difficult to obtain doses during the peak flu period.
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