Costs in Focus: A Pharmacoeconomic Comparison of Vaccine Prices for Immunization

Introduction

Approximately 86% of children globally were immunized with essential vaccines in 2018, safeguarding them against prevalent public health ailments like polio, diphtheria, tetanus, pertussis, and measles.¹ Immunization presently averts around 2 to 3 million fatalities annually on a global scale. Despite the substantial impact of COVID-19 on the public health system, immunization rates have nearly returned to pre-COVID levels.¹ The number of children who did not receive any vaccines, referred to as zero-dose children, decreased from 18.1 million in 2021 to 14.3 million in 2022.² This brings the number close to the levels observed before the pandemic in 2019, which stood at 12.9 million.² However, challenges persist, as indicated by the fact that the proportion of children receiving the first dose of the measles vaccine only increased from 81% in 2021 to 83% in 2022, still below the 2019 level of 86%.^2,3 Despite considerable progress, over 1.5 million individuals worldwide succumb to vaccine-preventable diseases annually.³

In India, the Expanded Programme on Immunization was established in 1978 and subsequently renamed the Universal Immunization Programme (UIP) in 1985 to broaden its reach beyond metropolitan regions.⁴ The Universal Immunization Program is a flagship and one of the major public health project of the government, with an annual focus on more than 26.7 million newborns and 29 million pregnant women.⁵ Mission Indradhanush was a project initiated in December 2014 with the aim of attaining more than 90% immunization coverage rate for children In India.⁶

Even though government initiatives provide free vaccines, the private sector remains a crucial access point for a significant portion of the population, particularly in urban areas, for both routine immunization programs (UIP) and newer vaccines. It was noted that out of the total immunizations, public sector immunization for Bacillus Calmette-Guérin (BCG) accounted for 19.23%, HiB pentavalent for 11.09%, hepatitis B for 5.75%, oral poliovirus vaccine for 5.48%, Diphtheria-Pertussis-Tetanus (DPT) for 2.66%, and measles for 2.17%.⁷ Additionally, newer vaccines such as hepatitis A (4.2%), rotavirus (3.4%), typhoid (3.3%), and pneumococcal conjugate vaccine (2.5%) are also administered significantly through the private sector.⁷

Ensuring access to vaccines is of utmost importance for maintaining public health, particularly in countries such as India where the rates of death among children under the age of five are a serious issue. Although the government offers free vaccines through the public sector, the situation changes in the private sector, where vaccines, especially newer ones, are provided with payment.⁸

With this rationale, this study was conducted to compare the costs of different vaccine brands available in India. By evaluating the financial implications of various vaccine options, this research serves as a roadmap for policymakers, healthcare providers, and stakeholders to make informed decisions regarding vaccine procurement, resource allocation, and public health strategies.

Materials and methods

Results

A total of 21 vaccines available for immunization in India were analyzed. This including Oral Polio Vaccine (OPV), Hepatitis B vaccine, Pentavalent vaccine (a combination vaccine protecting against Diphtheria, Pertussis, Tetanus, Haemophilus Influenzae type B, and Hepatitis B), Diphtheria, Pertussis, and Tetanus vaccine (DPT), Haemophilus Influenzae type B vaccine (Hib), Pneumococcal vaccine, Rotavirus vaccine, Inactivated Poliovirus Vaccine (IPV), Influenza vaccine, Typhoid conjugate vaccine, Hepatitis A vaccine, Varicella (chickenpox) vaccine, Tetanus and diphtheria toxoids (Td), Meningococcal vaccine, Rabies vaccine, Yellow fever vaccine, Bacillus Calmette–Guérin vaccine (BCG), Measles-Rubella vaccine (MR), Japanese Encephalitis vaccine (JE), and Cholera vaccine ( Table 1). Among these, five vaccines—Yellow fever, BCG, MR, JE, and Cholera—had a single brand manufacturer, and thus, only their costs were reported ( Table 2). The individual costs of the costliest and the cheapest brands are given in Tables 1 & 2.

The cost of the vaccines varied significantly, ranging from Rs 21 to Rs 5440 across all categories. Notably, the highest cost variation was observed between the most expensive and the least expensive brands of the Diphtheria, Pertussis, and Tetanus (DPT) vaccine, Hepatitis B vaccine, Haemophilus influenzae type b (Hib) vaccine, Influenza vaccine, and Tetanus and diphtheria toxoids (Td) vaccine. Conversely, the Inactivated Poliovirus Vaccine (IPV), Meningococcal vaccine, and Rabies vaccine demonstrated the least cost variation among various brands ( Table 2). The details of cost variations of all the vaccines are given in Table 2.

Discussion

This probably is a first-of-its-kind study wherein the costs of various vaccines available in India for immunization were analysed. The findings of this study highlight the various intricacies of costs of vaccines and the factors towards the same thereby helping us understand its implications on immunization strategies. The study revealed the range and variation of vaccine prices across different brand and formulations available in India underscoring the importance of understanding, evaluating and addressing the cost dynamics of vaccination.

Major cost variations were noted in the Diphtheria, Pertussis, and Tetanus (DPT) vaccine, Hepatitis B vaccine, Haemophilus influenzae type b (Hib) vaccine, Influenza vaccine, and Tetanus and diphtheria toxoids (Td) vaccine. The observed results of cost variation of vaccine can be attributed to a plethora of factors, each contributing to the pricing dynamics. It can be primarily attributed to the multiple number of manufacturers and companies producing these vaccines, leading to competitive pricing strategies in these segments. High competition often results in a broader range of prices as companies strive to capture market share through varying pricing models. Conversely, vaccines like Yellow fever, BCG, Measles-Rubella (MR), Japanese Encephalitis (JE), and Cholera had only one brand manufacturer, resulting in uniform pricing due to the absence of competitive forces. Also, some of the vaccines that were are newly launched in India had a higher price as only one manufacturer or company was producing it.

The main components that decide the cost of vaccines include the raw materials used, their availability and procurement, the transport, the manufacturing process and the quality control of the entire process.¹³ For instance, complex vaccines that require advanced technology and stringent quality assurance, such as the Pentavalent and Pneumococcal vaccines, tend to be more expensive.¹³ Differences in the cost of production and manufacturing technology and the scale of operations can lead to significant price discrepancies among brands. Vaccines with substantial differences in cost, such as the Hepatitis B vaccine, reflect varying levels of investment in research and development. Brands that invest heavily in R&D to improve efficacy, reduce side effects, or extend the shelf life of their vaccines may pass these costs on to consumers.^13,14 Additionally, newer vaccines or those that have undergone recent enhancements tend to be more expensive due to the recovery of R&D expenses.

The supply chain logistics, including storage, transportation, and distribution channels, can also influence vaccine costs.¹⁵ Vaccines requiring cold chain logistics may have higher distribution costs, contributing to the overall price variation.¹⁶ Using of existing resources and creating an efficient supply chain management can significantly reduce costs, which can be passed on to lower the price of the vaccines.^16,17 Economic conditions and government policies play a crucial role in vaccine pricing. Subsidies, import duties, and taxation policies can affect the final cost of vaccines. Additionally, fluctuations in currency exchange rates can impact the cost of imported vaccines, contributing to price variations.

The perceived value of a brand and its market positioning can influence pricing strategies. Established brands with a reputation for high quality and reliability may command higher prices compared to lesser-known brands.¹⁷ Consumer trust and brand loyalty often allow premium pricing, which is evident in the significant cost disparities observed. The minimal cost variations observed in the Meningococcal, Rabies, and IPV vaccines suggest a more stable market with less aggressive pricing competition. These vaccines might be produced by a few manufacturers with similar production costs and market strategies, leading to relatively consistent pricing across brands.

The observed differences in vaccine pricing across brands and formulations highlight the multifaceted nature of vaccine procurement and distribution in India. This variability poses challenges for policymakers, healthcare providers, and individuals alike, as it necessitates careful consideration of cost-effectiveness and affordability in vaccine selection and distribution strategies. Moreover, these findings emphasize the importance of addressing disparities in vaccine pricing to ensure equitable access to immunization services. Access to affordable vaccines is essential for reaching vulnerable populations, including those in underserved communities and rural areas. Failure to address these disparities may perpetuate healthcare inequities, resulting in uneven vaccine coverage and leaving certain segments of the population at higher risk of vaccine-preventable diseases.

The importance of considering costs within the realm of vaccination extends beyond mere financial implications, encompassing multifaceted social, economic, and accessibility considerations. Socially, the equitable distribution of vaccines hinges on their affordability, ensuring that no segment of the population is excluded from protection against preventable diseases due to financial constraints.^18,19 Economically, vaccines represent a judicious investment in public health, with the potential to avert significant healthcare expenditures associated with treating vaccine-preventable illnesses. Moreover, accessible pricing facilitates broader vaccine uptake, bolstering community immunity and reducing the overall disease burden.²⁰ Socially, the affordability of vaccines plays a crucial role in ensuring equitable access to preventive healthcare.²¹ In many societies, particularly in low- and middle-income countries, socioeconomic disparities can significantly impact individuals’ ability to afford vaccines.²² Without adequate financial resources, marginalized communities may face barriers to accessing essential immunization services, leading to disparities in vaccine coverage and ultimately widening health inequalities. Therefore, considering the social dimension of vaccine costs is essential in addressing these disparities and promoting health equity.

Accessibility refers to the ease with which individuals can obtain vaccines when needed. Cost is a key determinant of vaccine accessibility, as high prices can act as a barrier, particularly for vulnerable populations. In regions with limited healthcare infrastructure or remote communities, accessing vaccines may already be challenging due to logistical constraints. When vaccines are unaffordable, accessibility becomes further compromised, exacerbating disparities in healthcare access.

Conclusion

In conclusion, the significant cost variations among different brands of vaccines in India highlight the complex interplay of market competition, production costs, R&D investments, regulatory requirements, supply chain logistics, economic factors, and brand perception. Understanding these factors can help policymakers and healthcare providers make informed decisions to ensure the availability and affordability of vaccines.

Consent

Not applicable. No human participants, patient records, or identifiable personal data were used in this study.

Ethics statement

This study is a pharmaco-economic analysis conducted entirely using publicly available secondary data and published sources. No human participants, patient records, or identifiable personal information were involved. As such, institutional ethics committee approval and informed consent were not required.