Higher price of MPOX vaccine poses major hurdle in negotiations over African order

The Africa Centres for Disease Control has set the price for Bavaria’s vaccine at $100 per dose, while the World Health Organization has put it at $141. That’s more than most countries on the continent can afford — and more than many spend per capita on health — amid multiple health challenges including cholera, measles, malaria and HIV.

“Prices are an issue,” said Helen Rees, chair of the WHO’s African advisory group on immunization. The price has put the jab among treatments where “cost is going to make things unaffordable,” she added.

A pricing model used by the global vaccine alliance Gavi has previously driven down the cost of jabs by securing large volumes, making them viable for manufacturers and helping ensure products got to the right places. But Bavarian’s mpox jab doesn’t fit into that structure at the moment, she said.

“In these kinds of circumstances you have limited inventory and a manufacturing side that is expensive — this is not a cheap product to make,” Rees said. “There are real costs to it.”

The spread of the new variant of mpox from Congo — where children account for more than 80 percent of deaths from the disease — has sent cases on the continent soaring in countries including Burundi and Gabon. WHO Director-General Tedros Ghebreyesus has called on countries stockpiling vaccines to donate.

Compared with other widely used vaccines in low- and middle-income countries, Bavaria’s shot — sold under the names Jynneos, Imvamune and Imvanex — is significantly more expensive, said Andrew Hill, a senior research fellow at the University of Liverpool who studies drug costs. “Vaccines against most infectious diseases typically cost $1 to $3 per dose when administered as part of mass vaccination programs to millions of people,” Hill said.

Too expensive?

Bavarian Nordic “cannot continue to charge these high prices” in Africa and will have to offer deep discounts or give permission to generic companies to mass-produce this vaccine at a price close to cost, Hill said. “Otherwise Africa will not be able to afford to protect their population as the epidemic of the new clade Ib grows,” he said.

Public Citizen, a nonprofit consumer advocacy group, urged Bavarian in a letter last month to provide “fair access” to the mpox vaccine. The company feared that Bavarian’s pricing “may be exploiting the latest global health crisis and putting profits over people.”

With few rivals to its vaccine in Africa, Bavarian holds the reins in pricing its jab. While Emergent BioSolutions Inc. and KM Biologics Co. have developed mpox vaccines, there is a “very big difference between the three vaccines” that works in Bavarian’s favor, said Thomas Bowers, a health-care equities analyst at Danske Bank A/S.

Emergent BioSolutions’ ACAM2000, which received FDA approval for mpox in late August, is not recommended for people with weak immune systems and therefore unlikely to be used in Africa, Bowers said. Japan’s KM Biologics’ LC16 vaccine will likely be part of Africa’s vaccination program, but will not create price competition, he said. Meanwhile, mRNA vaccine candidates from Moderna Inc. and BioNTech SE are still “quite a few years” away from the market.

The challenge for Bavarian is to negotiate a price that countries can afford but that remains commercially viable. Chief Executive Officer Paul Chaplin acknowledged in an interview last month that “pricing is undoubtedly going to be an issue,” and said the company wants to look at it “responsibly” but “get the balance right.”

“Ultimately, if we financially harm Bavarian Nordic in any way, then global society will not benefit from that, because then there will no longer be a vaccine available to anyone,” Chaplin said.

Chief Financial Officer Henrik Juuel told the Danish state broadcaster last week that Bavarian will take into account which countries will pay when negotiating the price with Unicef. Bavarian also struck deals during the last mpox outbreak with tiered prices depending on which country buys them, a company spokesman said.

‘Big discount’

Danske Bank’s Bowers expects a price of around $100 per dose for organisations in Africa that buy the vaccine. He says this is still a “relatively large discount” compared to the private market in the US, where the net price is around $200.

“Even if you can produce the doses for $10 or $20 each, that’s just the production itself, but owners have invested billions of crowns in developing the vaccine and preparing it for production, and they’ve taken a big risk,” Bowers said. “That’s also part of what went into the price of the doses. So it makes sense that you don’t just give it away as a gift.”

Still, $100 is double the price paid by the U.S. government in some cases. According to Bowers, the government gets a discount because it sponsors the entire development program.

Health organizations in Africa could negotiate a lower price if they place larger orders and commit to a vaccination program of at least four to five years, Bowers said. A long-term commitment would provide more certainty for Bavarian, which pays for the maintenance and upkeep of factories even when they are not producing vaccine, he said.

While the jab has passed clinical trials as a two-shot immunization, it’s unclear whether countries in Africa would opt for a one-shot approach to halve the cost. According to Bavarian’s CEO, data from a number of studies show a single dose offers up to 80 percent efficacy and a significant reduction in hospitalizations.

First publication: 09 Sep 2024 | 07:34 am IST