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Mainstream, VOL LVIII No 21, New Delhi, May 9, 2020

Important Role of Public Sector in Vaccine Production in Developing Countries

Saturday 9 May 2020, by Bharat Dogra

Vaccines have been widely recognized as an important part of health programs of various countries. Now vaccine development and production has in fact become the most discussed aspect in the times of COVID-19 when there is a worldwide rush foe developing and then manufacturing vaccine for COVID 19. However in the prevailing situation of domination of international vaccine scene by networks of multinational companies, private billionaires with strong interests disguised as philanthropists and organizations supposed to protect health but controlled by donors driven by narrow interests, where is the guarantee that the interests of people of developing countries will be protected?

By now it is well-recognized that government authorities who come under the influence of imperialism and big business do not hesitate to kill their own invaluable institutions. Several public sector institutions and organisations of great value have been destroyed in this way, with the willing participation of international organisations which too are sadly, frequently under the sway of multinational companies and developed countries. This crime becomes all the more unpardonable when it takes place in the area of health, threatening the life of many people particularly children.

The health sector of developing countries like India functions in a situation of severe fund constraints. Even if the demands for significantly increasing the health budget are met, so immense is the task of providing satisfactory health care to all that we need maximum efforts to keep costs (particularly costs of medicines and equipment) low. The tendency of most drug companies to keep medicine prices high and fleece even poor countries is well-known. Therefore self-reliance in the production of low-cost medicines and vaccines is extremely important for these countries. What is more, some critical areas and certain levels of production of medicines have to be retained in the public sector, so that the country is capable of meeting critical and emergency needs as well as retain the ability to keep the costs of essential medicines within reasonable limits.

However what we have seen in recent times is the decline and decay of public sector units producing medicines while the private sector’s ability to charge high prices which have no relation to costs has been increasing. This did not happen suddenly and did not happen on its own - deliberate efforts were made by vested interests with the collusion of important people within the government to achieve this result.

It is in this framework that the decision of the government to cancel the licences of three vaccine-manufacturing public enterprises in 2008 must be seen. The three institutions affected by this decision at that time were - The over-100-year-old Central Research Institute (CRI), Kasauli; the 100-year-old Pasteur Institute of India (PII), Coonoor; and the 60-year-old BCG Vaccine Laboratory (BCGVL) in Chennai.

The All-India Drug Action Network (AIDAN), a national network of organisations that have been working on pharmaceutical policy issues, issued the following statement at that time and this is still useful to understand the forces at work, "While there should be no compromise on the quality of medicines and vaccines produced, the cancellation of the licenses for the three vaccine-manufacturing public enterprises under the Ministry of Health and Family Welfare smacks of arbitrariness, and a planned attempt to kill these institutions and clear the way for private companies to operate in a segment which serves a critical national need - the production of vaccines for the large Expanded Program of Immunization. Recent newspaper reports of alleged nexus between the Ministry of Health and Family Welfare and a private vaccine manufacturing company in blatant disregard of the public responsibilities of their role, use of coercion to effect closure of vaccine production units with a proven record of safety and quality, and the comments in the preliminary audit report of the Comptroller & Auditor General (CAG) point to an unprecedented disregard for public good."

Responding to the government claim that these enterprises were ordered to suspend production for non-compliance with ’good manufacturing practice’ (GMP), this statement by AIDAN asked, "Since the public enterprises were under the Ministry of Health and Family Welfare, and had been requesting for assistance to upgrade their facilities since the past many years , what did the Minister of Health and Family Welfare do over the past 4 years to ensure their compliance with newer norms?

Further this important statement by AIDAN said, "The entire sequence of events over the past few years, with allegations of purchase of raw material for measles vaccines at inflated cost from private companies, providing them raw material from these 3 units at either free or at ridiculously low prices, and further agreeing to give 70 per cent of the profit from vaccine manufacturing to the private company needs an enquiry at the highest level.

"The harm to public health in India due to this malafide closure of public sector units is already being seen. many states are now facing dangerous shortages of vaccines like DPT and Tetanus toxoid, which were only to be expected. Shall the Minister assume the responsibility if any child dies of tetanus or diptheria? The All India Drug Action Network (AIDAN) calls on the Government to stop playing games with the health and lives of innocent children and with the pharmaceutical security of the nation, in its attempts to pave the way for private enterprise."

Although later some efforts were made under strong public pressure to repair some of the damage caused by this step, it is still important to learn from this experience as even temporary closure of some important institutions can do a lot of damage to national efforts for self-reliance in this important field.

If we look at the past experience of how public health enterprises are destroyed to benefit big business, then generally the following pattern can be seen :

1. Suddenly develop new criteria and norms which will be difficult for public sector enterprises to satisfy under existing conditions. Rope in international ’experts’ and institutions to push for these norms.

2. Use government’s powers to deny funds and facilities which would enable public enterprises to meet these norms.

3. Then use this as an excuse to take action against public health enterprises, all the time hiding behind so-called public health and quality concerns.

This was precisely the pattern behind the closure of the vaccines manufacturing facilities of these three units. Otherwise how can we explain the curious phenomenon of the government taking action against its own units while denying them funds and facilities to improve?

Learning from these experiences and recognizing the fast increasing importance of the vaccines sector strong steps should be taken immediately to strengthen the production of vaccines in the public sector in India to meet the real needs of the country at reasonable cost ( as opposed to inflated and distorted supplies imposed by foreign or multinational suppliers at high cost). Other developing countries should also take this path. Cooperation among various developing countries in this sector should be promoted widely and strongly.

The writer is a freelance journalist who has been involved with several social movements.

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