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world pneumonia day

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"Abdullah is lucky, but a child’s health shouldn’t come down to chance"

Mary.jpg

Mary Gallagher is based in Jordan and works on MSF’s A Fair Shot campaign, pushing to reduce the price of the pneumonia vaccine in developing countries. 

 

“You are going to love this room,” announced Dr Anas. He was taking me on a tour of MSF’s mother and child hospital in Irbid, a town in northern Jordan, close to the border with Syria. And he was right, I was happy to find myself walking into a room of babies sleeping peacefully. Most of them had been very unwell, but they didn’t look it; they were already well on the way to recovery.

 

Except for Abdullah. Abdullah looked really sick. He was lying in an incubator and struggling to breathe. When he gasped through the oxygen tube, his chest looked like it was collapsing under his ribcage and falling into his spine.

 

I’ve worked on MSF’s A Fair Shot campaign for over a year, campaigning to lower the price of the pneumonia vaccine (PCV), but this was the first time I’d seen a baby sick with the disease. And it was difficult to watch. It was harder still when I realised that the young woman walking towards Abdullah’s incubator was the same woman I’d seen crying and looking exhausted in the corridor earlier that morning.

 

Anyone would be distraught in this young mother’s situation. Abdullah was four days old, underweight and clearly in pain. His mother asked Dr Anas what he thought of Abdullah’s condition – something she did whenever he passed. She had already asked him three times that morning. Dr Anas smiled as he answered, “You can see as well as I can that he is looking better all the time”. If this was better, I can’t imagine what Abdullah had looked like the day before.

 

Abdullah’s mother is a 17-year-old Syrian refugee. When I asked if she knew other children who had got sick with pneumonia, she said that she’d never heard the name of the disease, but that it was normal for children to get very ill with chest infections like this. She said that her older child, who is two, had also been very unwell but, like Abdullah, he had been given antibiotics and was okay now.

 

A vaccine would not have helped Abdullah directly; at just a few days old, he is too young to receive it. But the fact that suffering like this is so common, so unremarkable, is something that has to change. Children like Abdullah are so vulnerable because many governments around the world cannot afford to buy the vaccine that could protect them.

 

It is an under-reported fact that pneumococcal disease kills more children under five than any other disease. Nearly one million children die from it each year.[1] Many of those children die in so-called middle income countries – countries not quite poor enough to qualify for assistance and discounts from organisations like Gavi, the Vaccine Alliance, but not wealthy enough to pay sky-high prices.

 

Jordan falls into this category, and the government has been outspoken on the need for fairer vaccine pricing and a more transparent market. With an average vaccination coverage rate of 99 percent,[2] it is a country that is good at vaccinating its children. It does so regardless of the child’s status – refusing to differentiate between Jordanian children and the growing number of refugees that the country hosts (currently there are 656,170 officially registered refugees from Syria alone, and more when including non-registered refugees). But the pneumonia vaccine – known as the pneumococcal conjugate vaccine (PCV) – has thus far proved to be prohibitively expensive. The only two companies that make it, Pfizer and GlaxoSmithKline (GSK), have refused to offer the country a fair price.

 

The most recent prices offered to Jordan were 43.05 JOD (US$60.90) per child for the vaccine made by Pfizer and 36.54 JOD (US$51.51) per child for the vaccine made by GSK (this is the cost of all three doses required to fully protect a child). These numbers add up; according to the Jordanian Ministry of Health, the total cost of purchasing the vaccine is estimated to be between 12.2 million and 14.4 million JOD. This is a staggering amount of money when you consider that, if introduced, the cost of the pneumonia vaccine alone would represent between 57 and 67 percent of the country’s entire current immunisation budget (and approximately 3 percent of the total health budget).

 

The result of these high prices is that, when children get sick with pneumonia in countries like Jordan, they will continue to rely on antibiotics to get better (if indeed they have access to treatment). This is a solution that comes once a child is already very sick, and so it is unnecessarily cruel. It is also unsustainable: globally we are facing the threat of antibiotic resistance, and so the use of antibiotics in situations like this – where a protective tool already exists, but is unaffordable – is irresponsible. 

 

The good news in this story is that, just ten days after I first met him, Abdullah has completely recovered from pneumonia. Dr Anas tells me that the baby is back to a healthy weight, has been feeding well and has already been discharged from hospital.

 

Abdullah was lucky. But there is no reason to leave the health of young children to chance. We must demand that Pfizer and GSK make their vaccine affordable for countries like Jordan.


MSF’s hospital for mothers and children in Irbid

 

In November 2013, Médecins Sans Frontières (MSF) opened a mother and child hospital in the northern Jordanian governorate of Irbid. The hospital provides services for Syrian refugees and vulnerable Jordanians residing in the local community, which have become even more important due to increased pressure on Jordan’s health system.

 

In the hospital’s maternity unit, skilled staff are on hand to manage complicated deliveries and carry out caesarean sections. The hospital also has a neonatal unit for premature babies. With Syrian refugees in Jordan facing increasing economic and social difficulties, a mental health support programme was opened in 2014 for  Syrian children, which now includes outreach activities to reach out to Syrian refugee communities in the north of Jordan and surrounding governorates.

 

[1] www.who.int/mediacentre/factsheets/fs331/en 

[2] DTP3 coverage in 2015 (latest year for which data is available). Source: www.who.int/immunization/monitoring_surveillance/data/jor.pdf

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“What haunts me is knowing how different it can be for each child, depending on where he or she lives”

Interview with MSF doctor Alan Gonzalez

Dr. Alan Gonzalez is from Mexico and joined MSF in 2009. He’s completed 17 MSF field assignments since then, including in Cameroon, Central African Republic, Democratic Republic of Congo, Haiti, Iraq, Ivory Coast, Kenya, Libya, Syria and Tanzania. Here he describes his experiences providing care to children suffering from pneumonia.

Doctors seem to have a difficult time recalling specific patients with pneumonia. Can you tell me why that is?


Right. For me, it took a long time to recall a particular story as well. That’s because most of the children we see in MSF clinics have pneumonia, malaria, or malnutrition. Many times, they are affected by two or three of these diseases at the same time. I try to remember all the patients I’ve encountered, but it’s very difficult when so many of them have similar symptoms.

Many kids who don’t get medical care die from pneumonia — almost one million kids a year, in fact. The kids you are able to treat, do they recover?


They can get better under our care, but the question still lingers… why does pneumonia affect so many children? It’s especially infuriating since we have the means to prevent kids from getting sick with pneumonia. The vaccine for pneumonia exists.


It’s especially infuriating since we have the means to prevent kids from getting sick with pneumonia. The vaccine for pneumonia exists.


I know, but not all kids have access to the vaccine…


I imagine that’s a reason why I see many incidences of pneumonia at our MSF projects.


Tell me about one of your experiences.


While I was on assignment with MSF in Abidjan, Ivory Coast, I remember treating a boy with an extreme condition. I didn’t meet him when he had pneumonia. I met him when he had developed a pneumothorax — a condition where air leaks into your chest cavity and causes your lung to collapse. While it’s rare for people who have pneumonia to develop pneumothorax, pneumonia can be one of several causes. Since the child was only one and a half years old, and based on his medical history, we concluded that his condition was caused by a severe case of pneumonia.

That sounds really painful.


Well it is incredibly difficult to breathe, and you can see how much he was struggling for air. First, we treated his pneumonia by giving him some antibiotics and oxygen. His infection cleared up quickly, but he still could not breathe well because of the collapsed lung. We needed to place a catheter to relieve the air from the chest cavity.


What does that do?


Once the air is out, then the lung can expand normally and breathing is regular again. It’s a fairly simple procedure for physicians to perform (I’ve done it several times on adults and young adults), but since he was a child, it’s a lot more complicated. We asked around to see if any of the local hospitals could treat him, and no one wanted to do it. Finally, after searching for a couple of days, we found a hospital that was willing to try. They had a physician there with a lot of experience doing this procedure.


We sent him to the nearby hospital where they placed the catheter to let all the excess air out. He had to stay there for a few days, and we felt like we left him in good hands.

Did he recover?


Yes! He came to visit us after he left the hospital, and we were relieved to see how well he was doing.


But you see, we were really lucky. Since we were located in Abidjan, the biggest city in the Ivory Coast, we were lucky to have had a nearby facility that we could send him to and connect him with the treatment he needed.


And you don’t always have that extra option, depending on where you’re located?


No. I’ve worked in many settings, both with MSF and with other organisations, where that’s not the case. Before joining MSF, I spent a few years working in the south of Mexico with indigenous populations. We traveled very long distances to reach remote locations, and worked with communities that only saw a doctor twice a year. Basically, that meant the two times we came to set up clinics, since there weren’t regular health facilities around.


How did that affect the health of these communities?


Well, in a way, the children I met in the south of Mexico came into our clinic with very similar symptoms as the children I met while working in the Ivory Coast — with severe presentations of pneumonia. What haunts me now, is knowing how different the outcomes can be for each child, depending on where he or she lives.


I can imagine. In countries like the U.S., kids these days generally don’t get sick with pneumonia because they have been vaccinated. But pneumonia remains the number one killer of children around the world. It’s so drastically different.


That’s why regular vaccination programs and vaccination campaigns are so important. But countries have to be able to afford the vaccine, and the pneumonia vaccine is one of the most expensive vaccines ever.


But countries have to be able to afford the vaccine, and the pneumonia vaccine is one of the most expensive vaccines ever.


Right, up until recently, even MSF had to pay absurdly high prices for the vaccine. Towards the end of last year, Pfizer and GSK announced that they would sell the vaccine to humanitarian organisations for use in emergencies at around $9/child (a significant reduction from what we’ve had to pay previously).


It’s good news. This way, we can protect more kids caught in conflicts, places where MSF works.


Do you think Pfizer and GSK should lower the price of the pneumonia vaccine for all developing countries too?


Of course! Mexico has gotten a lot better through the years, but we are still not a rich country. Luckily, we have been able to introduce the pneumonia vaccine into our regular immunisation schedule for children, but there are other low- and middle-income countries who haven’t been able to do the same because the price of the vaccine is too high.

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Pfizer drops the price for humanitarian organizations

MSF welcomes Pfizer’s pneumonia vaccine price reduction for children in humanitarian emergencies 

Pfizer and GlaxoSmithKline (GSK) should extend their price reduction to all developing countries.

NEW YORK, 14 November 2016 – The international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders/ (MSF) welcomes Pfizer’s decision to lower the price of its pneumococcal conjugate vaccine (PCV) for children caught in humanitarian emergencies. For seven years, MSF urged Pfizer and GSK – the only two manufacturers producing the pneumonia vaccine – to offer the lowest global price to humanitarian organizations, but they refused until September, when GSK announced that it was finally reducing the price of its pneumonia vaccine for humanitarian situations. Now with its announcement on Friday, Pfizer is following GSK’s footsteps. 

 

“It’s good to see that Pfizer is now finally reducing the price of its life-saving vaccine for children in emergencies,” says Dr Joanne Liu, MSF’s international president. “With Pfizer and GSK’s price reductions, humanitarian organizations will be better able to protect children against this deadly disease.” 

 

Pneumonia is the leading cause of child mortality worldwide, killing nearly one million children every year. Crisis-affected children, such as those caught up in conflict or in humanitarian emergencies, are particularly susceptible to pneumonia. MSF medical teams often see the deadly effects of pneumonia – a vaccine-preventable disease – in the vulnerable children treated in our health facilities.

 

The price reductions are a significant step forward in protecting vulnerable children who are reached by humanitarian organizations like MSF.  From 2009 to 2014, MSF conducted negotiations with Pfizer and GSK to access a fair and sustainable price for the pneumonia vaccine, before making a notable exception to our policy governing donations from pharmaceutical companies. In agreeing to the limited-term donations, both Pfizer and GSK assured MSF that they would work on a longer-term solution to improve affordability. Since then, in absence of such a solution, MSF and other humanitarian organizations struggled to purchase pneumonia vaccines at an affordable price; earlier this year, MSF paid 60 Euros (US$68.10) for one dose of the Pfizer product to vaccinate refugee children in Greece – 20 times more than the lowest price offered by GSK and Pfizer. 

 

One third of the world’s countries have not been able to introduce PCV because of its high price. Millions of children living in countries such as Jordan, Thailand, and the Philippines are left out. In 2015, all 193 countries at the World Health Assembly passed a landmark resolution demanding more affordable vaccines and increased transparency of vaccine prices.  “Both Pfizer and GSK should now redouble efforts to reduce the price of the vaccine for the many developing countries that still can’t afford to protect their children against pneumonia,” said Dr. Liu.

Pfizer’s announcement on Friday indicated that the price reduction was a new and specific pricing tier for civil society organizations (CSOs) including MSF. We now hope that Pfizer will extend its price reduction efforts to all developing countries and accelerate the registration process to rapidly increase access to the pneumonia vaccine for all who need it. 

 


Background

It is now 68 times more expensive to vaccinate a child than in 2001, according to a 2015 MSF report, The Right Shot: Bringing down Barriers to Affordable and Adapted Vaccines. The pneumonia vaccine accounts for almost half the price of the entire vaccination package for a child in the poorest countries. After years of unfruitful negotiations, in 2015, MSF launched A Fair Shot, a public campaign asking Pfizer and GSK – the only two manufacturers of the pneumonia vaccine - to reduce the price of the vaccine. Earlier this year, on April 27th, MSF delivered the names of more than 416,000 people from 170 countries who signed a petition asking Pfizer and GSK to reduce the price of the pneumonia vaccine to US$5 per child (for all three doses) for crisis-affected populations and for all developing countries. . In September, GSK announced that it was finally reducing the price of its pneumonia vaccine for humanitarian situations. Now with its announcement on Friday, Pfizer is following GSK’s footsteps. 
 

 

 

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Open letter to Pfizer employees: We need allies

Dear Pfizer employees,

Almost a year ago to the day, we were outside your office in New York City piling fake cash in front of your doorstep. Six months ago, we returned to lay 2,500 flowers into a crib — all this to illustrate that the life-saving pneumonia vaccine Pfizer makes isn’t reaching children in need.

I know we may not have started off on the right foot, so let me introduce myself: I’m Mary Jo, and I’ve worked as a nurse with Doctors Without Borders for 17 years.

By now you may have heard what our campaign, A Fair Shot, is asking of you: pneumonia vaccine for $5/child for all developing countries and humanitarian organizations. I need this possibility to become a reality, because the reality we live in now — where nearly a million kids die every year from this preventable disease — is heartbreaking.

Let me tell you about Mohamed, a six-year-old boy I met on my most recent mission to Nigeria. He was sitting on the floor with his younger brother when I arrived at the clinic. They both looked very thin and had terrible, painful-looking ulcers on their lips. Mohamed was pretty much non-responsive. At the same time, though, he was huffing and trying desperately to breathe. He had a respiratory rate of 60, about three times higher than what it should be for a kid his age — meaning his lungs were working extra hard to get the amount of oxygen he needed.

I picked him up immediately. His breathing rate was a clear sign of pneumonia. Later we confirmed that Mohamed had malaria, measles, pneumonia — the trifecta of childhood killers — and malnutrition, too. We found an isolation bed for him and placed an IV in to administer the fluids and medicine he needed.

What struck me most about Mohamed was his seriousness. Even though I could tell he was in a lot of pain, and he didn’t have an appetite to eat or drink water, he was committed to his own autonomy. He wanted to hold the cup in his own hands, because it’s not normal to need someone else to have to feed you when you’re six years old. He was so weak, but he was committed to holding on.

Mohamed went home with his mom and brother that night. The next day, I went to another MSF clinic, closer to his home, and looked for him. When I walked into the pediatrics ward, I saw him just as when I met him the day before, sitting on the floor with his brother. But this time, he was lively. He was smiling. The turnaround was incredible. Mohamed was lucky he came into our clinic when he did, and we were lucky the antibiotics worked against his pneumonia. This isn’t always the case.

I think about what kids like Mohamed experience. Many of the kids we meet go through so much in life at such a young age — war, conflict, the constant running, and horrible poverty. We can’t prevent these things from happening. But the diseases? Those we can prevent. If we can at least protect kids with vaccination, then they have a fighting chance of surviving the rest of this stuff.

Mohamed’s pneumonia could’ve been prevented if your vaccine was available. Even when countries, like Nigeria, have introduced the pneumonia vaccine into the regular immunization schedules, sometimes conflict or natural disasters will disrupt routine health programs. That’s when humanitarian organizations can help provide some relief until situations stabilize.

Mothers line up with their kids to get the measles vaccinations at an MSF clinic in Nigeria. © Sylvain Cherkaoui/COSMOS   
Mothers line up with their kids to get the measles vaccinations at an MSF clinic in Nigeria. © Sylvain Cherkaoui/COSMOS
 

That’s why it’s important to lower the price of the pneumonia vaccine for countries who don’t receive donor-funded vaccines and humanitarian organizations.

We know that in order for this to become a reality, the desire for change has to come from within Pfizer, too. Will you stand in solidarity with kids like Mohamed?

It may not be easy, but if this resonates with you, please help spread the word by sharing this with a co-worker.

Thank you.

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What's it like to have pneumonia?

The reality of pneumonia can be a very scary and dangerous. Each year, it takes the lives of nearly one million kids. There’s a vaccine to prevent it, but it’s too expensive for many countries to afford. That’s why we need #Pfizer and #GSK to drop the price to $5/child for all developing countries and humanitarian organizations. #AskPharma

Andrew and Andrew, from New York City

"He's just recovering from pneumonia. Still has two days' worth of medications to take. He's a lot better now, and has a little bit of a dry cough, but the first few days were really scary. It started out like a cold, and we thought maybe it would go away soon. I remember saying to my wife, 'Let's take him to the doctors just in case.' Luckily we did, because the doctors confirmed it was pneumonia. I'm so glad he's ok."

We met Andrew and his son (also named Andrew) on the streets of New York today. We gave him a more cuddly-version of pneumonia he can hold on to while he fights pneumonia in real life. We'll be cheering for your swift recovery, Andrew!

Huy, 28 years-old from the US

College is supposed to be stressful, especially when you are pre-med student, I thought. So when I developed a cough and extreme fatigue while studying for my exams, I waved it off as a normal occurrence. However, the symptoms worsened and over the next few days I found it increasingly difficult to get out of bed, eat, or sleep. Forget studying, I couldn’t read anything for more than a few minutes before getting a headache. The cough persisted but it was only when I coughed up a spot of blood that I decided to seek help. I went to the University health physician who listened to my lungs, took a chest X-ray, and told me I had community-acquired pneumonia and put me on a course of oral antibiotics. My symptoms slowly resolved over the next few days and I was able to focus on my studies again. 

Even though my symptoms were mild and luckily did not last too long, it was distressing to experience and completely sapped my mental and physical strength. Years later, I am now a physician and have treated many patients with pneumonia. I've seen presentations ranging the entire gamut from mild to deadly. We are fortunate to live in a world now where there is a vaccine that can prevent many of these cases. I believe vaccines should be given to all those who need them. 

JonJon, 33 years old from the US

I will never forget the MONTH I had pneumonia. It started on a cold Tuesday night in early December 2010. At the time I thought I was coming down with a cold, and by Thursday I was fully convinced I caught a bad flu. Little did I know by that Saturday morning I would be admitted into my local hospital’s ER and diagnosed with streptococcus pneumonia.

 

I had a high fever, my vision was blurred, and time seemed to slow down with every breath I took as I struggled to fill my lungs with air. I literally felt like I was drowning, and I felt helpless. As the doctor put me under to calm me down, I remember still gasping for air to let my mom that I loved her and my family. I truly believed I was going to die.

 

I woke up days later from a medically induced coma, intubated to a machine that was breathing for me. I found out that my lungs had filled up so much with infection that only 1/3 of my right lung was capable in taking oxygen. For the next two weeks it was a battle between pneumonia and me.

 

I was taken off the machine and released home just before New Year’s Eve. Since I was bedridden, and deprived of solid food and water for a few weeks, I was left frail, and I could barely walk or stand on my own. My lung capacity was next to none and after I spoke a sentence I was out of breath as though I had been jogging for miles. Slowly but surely I made a full recovery.

I was thankful and blessed I made it through that experience, and I always say I would never wish pneumonia on anyone.

Dr. Ilaria Moneta, Italian pediatrician currently on a MSF mission in the Central African Republic

One of the patients who touched me the most is an 18 months old boy who was suffering from pneumonia and severe malnutrition.  He was very weak when he was admitted, but improved significantly during his 10 days stay with us. You know, it’s not good for small children to stay that long in a hospital. But this little boy recovered remarkably, and towards the end of his stay he was so much better, always giving me a big smile when I would come, grabbing my hand, wanting to engage. But yesterday he came back for his follow up appointment, and he worried me. He lost a lot of weight in a week – that’s not good for a such a young child. I could see right away that he was not well: he didn’t recognize me anymore, he was sad, he was like another person. I wanted to hospitalize him again to keep an eye on him, but we couldn’t. They live in town, so at least they don’t have to travel far to come to us. They didn’t come back today, so he must be doing OK. I hope so.

Photo © Sandra Smiley/MSF

Photo © Sandra Smiley/MSF

Garry, 35 years old from the UK

On those two night flights home - Bangladesh to Turkey, and onwards to London - something wasn’t quite right.  

 

Turning the key into my door later that day, I realized why. I moaned to my wife about how offices in warm countries always choose the parched iciness of full-blast air-conditioning: I always catch a cold there, and today I’d brought one home. It’s a special, nasty kind of cold too. It never starts with a gentle runny nose, but with a presence somewhere deep inside your chest.

 

I did what I usually do. I ignored it. This one felt like a slow-burner, though. For want of a better description, my lungs felt itchy, as if the virus wasn’t sure it wanted to grow and come out. I wasn’t coughing, though. I was barely sick. Some six days later, I sat down at my desk to write an email.

 

I’ll never forget the next second, because there was no other feeling like it.

It was like getting smacked in the temple with an ice pack, the ice then seeping into my skin and coursing through my blood. I shivered uncontrollably. I could barely steady myself up the stairs. “I’ll work in bed,” I thought, but could barely focus my eyes on the screen. So I closed them, and an hour of delirium ensued: something to do with Bangladesh, mixed with the thriller series I’d watched the night before. When I came to, my body craved ice water. The thought of going back down the stairs; moving my trash can so I could get to my freezer; opening the freezer; then the drawer; then cracking open the ice tray; was almost unbearable. After several minutes, including a break halfway down the stairs, I got there.

 

Two days later, I messaged a doctor friend to say: ‘Three days with fever, no need to see my doctor yet right?’, and he said, ‘Nope. Wait a bit longer.’

 

The next day was similar - until the excruciating, sharp stabbing sensation in my right side. Every cough turned into a gasp of pain. I called an Uber, cancelled everything else, and made my way to the hospital. The driver dropped me off and wished me a nice day. 

 

The next bit unfolded like a dream. I was given some drips. The wheelchair man pushed me along to the X-ray department. “You have pneumonia, a nasty one,” a doctor said. A few hours and four infusions later, I was given a box of antibiotics and sent on my way. The choreography was truly impressive. I’m glad I was taking the drugs before the next episode: when I started coughing blood. At least I was taking something, and over a few days felt much better.

 

I joked with my doctor friend, the one I messaged, that he’d been careless telling me not to see my doctor. His reaction was along the lines of, ‘Well you’re still alive, aren’t you?’ But, as an afterthought, he asked to look at my x-ray himself, in case he could recommend a follow-up check. A few days later with no news, I gave him a call.

 

“Did you get hold of the X-ray?” I asked.

 

 “Oh, yeah,” he said. “You’re fine. You have very sexy lungs.”

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Jab, Jab: MSF Vaccination Campaign in CAR

Bangassou area – Mbombou province – Central African Republic

Bangassou area – Mbombou province – Central African Republic

Crowds draw into the local schools and churches of little villages, nestled against lush forests. Mothers wait with their children, lined up on wooden benches. Everyone is quiet – surprisingly enough for a long line of people made up mostly of the under-6 years-old crowd. But the closer the children get to the nurses, the more their curiosity morphs into terror. 


Open the mouth for the oral polio vaccine. 
Prepare one leg for the pentavalent. 
The other one for the pneumonia vaccine.
Jab, jab. 


Then they’re done, and the children are left open-eyed, cheeks wet from tears. 
Amongst the screams, some mothers laugh. It’s hard to see your kids cry, but they know it’s better to struggle with a healthy child trying to escape the needle, than to have to carry a limp, feverish child for a few hours walk to the nearest affordable clinic instead. 


“If my children get sick, I don’t know what to do apart from giving them paracetamol”, says Carole Mbamanza. “Here in my village’s health center, we have to pay US$4 to $6 for a consultation and I can’t afford it. So instead, I have to go to (MSF-supported) Yongofongo health center where it is free. But it’s not easy to walk 10 kilometers, about 2 hours, carrying a sick child!” 


This is a reality that many parents deal with in Central African Republic (CAR). Health centers are few and far between, poorly stocked and staffed, and their limited services are unaffordable for most. In CAR even more than in the rest of the world, one had better not fall sick. Even before the latest crisis, vaccination coverage was already very low at barely an estimated 40%, which meant high childhood mortality due to easily preventable diseases. The 2013-2014 conflict that killed thousands and forced up to a quarter of the entire population to flee their homes further disrupted an already barely functioning health system. All state functions ground to a halt, including routine vaccination programs, making an already bad situation even more dire. 


In Bangassou, the main city of Mbomou province, respiratory infections are the third cause of mortality among children, after malaria and neonatal deaths. But during the upcoming dry season when malaria cases wane, respiratory illnesses jump to the top as the deadliest disease for the youngest. To boost children’s protection, MSF organized catch-up vaccination campaigns in most of its 17 projects across the country for the under-six-year olds who, for the most part, did not get any routine shots. 20,000 children in Bangassou, and over 100,000 across the country received vaccination against nine potentially deadly diseases2, including pneumonia.

 

Photos © Sandra Smiley/MSF

Around the world, pneumonia is the number one killer of children under age five. It can be a parent’s worst nightmare, which Blanche Foutcho, a mother from CAR, knows all too well. “My 9-month old son, Jésuré, was sick two months ago. He started breathing strangely, very quickly. We were very worried, and we walked 2 hours to reach Yongofongo where it’s free. From there, we were transferred to Bangassou, and Jésuré was hospitalized for a week. Now he’s doing better, but he still gasps for air when he cries,” she says.


When a country's health facilities collapse due to conflict, humanitarian organizations can provide some relief by responding to healthcare needs. We can help parents, like Blanche, avoid this nightmare by providing access to the pneumonia vaccine. But vaccinating kids living in crisis-affected countries can be challenging when the price of the pneumonia vaccine is too high for governments and humanitarian organizations to afford. 


So who will help to protect the millions of kids caught in conflict?


Let's not let our children go unprotected. We need to give all kids A Fair Shot. We need Pfizer & GSK to lower the price of the pneumonia vaccine to $5/child for all developing countries and all humanitarian organizations. 

 

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There is no such thing as “free” vaccines: Why we rejected Pfizer’s donation offer of pneumonia vaccines.

By Jason Cone, Executive Director of Doctors Without Borders in the United States

 

I recently had the difficult task of telling Ian Read, Pfizer’s CEO, that Doctors Without Borders/ Médecins Sans Frontières (MSF) is rejecting the company’s offer to donate a significant number of pneumonia vaccine (PCV) doses for the children we serve. This is not a decision that we took lightly, since our medical teams working in the field witness the impact of pneumonia every day. 

 

Pneumonia claims the lives of nearly one million kids each year, making it the world's deadliest disease among children. Although there's a vaccine to prevent this disease, it's too expensive for many developing countries and humanitarian organizations, such as ours, to afford. As the only producers of the pneumonia vaccine, Pfizer and GlaxoSmithKline (GSK) are able to keep the price of the vaccine artificially high; since 2009, the two companies have earned $36 billion on this vaccine alone. For years, we have been trying to negotiate with the companies to lower the price of the vaccine, but they offered us donations instead. 

 

You might be wondering, then, why we'd rather pay for the vaccine than get it for free. Isn't free better?

 

No. Free is not always better. Donations often involve numerous conditions and strings attached, including restrictions on which patient populations and what geographic areas are allowed to receive the benefits. This process can delay starting vaccination campaigns, which would be an untenable situation in emergency settings, or grossly limit who you’re able to reach with the vaccine.

 

Donations can also undermine long-term efforts to increase access to affordable vaccines and medicines. They remove incentives for new manufacturers to enter a market when it’s absorbed through a donation arrangement. We need competition from new companies to bring down prices overall – something we don’t have currently for the pneumonia vaccine. 

 

Donations are often used as a way to make others ‘pay up.’ By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine. Countries, which continue to voice their frustration at being unable to afford new and costly vaccines such as PCV, need lower prices as well to protect children’s health.

 

Critically, donation offers can disappear as quickly as they come. The donor has ultimate control over when and how they choose to give their products away, risking interruption of programs should the company decide it’s no longer to their advantage. For example, Uganda is now facing a nationwide shortage of Diflucan, an essential crytpococcal meningitis drug, in spite of Pfizer’s commitment to donate the drugs to the government. There are other similar examples of companies’ donation programs leaving governments and health organizations in a lurch without the medical tools they need to treat patients. 

 

To avoid these risks and to limit the use of in-kind medical products donations, the World Health Organization (WHO), and other leading global health organizations such as UNICEF and Gavi, the Vaccine Alliance, have clear recommendations against donation offers from pharmaceutical corporations. 

 

Donations of medical products, such as vaccines and drugs, may appear to be good ‘quick fixes,’ but they are not the answer to increasingly high vaccine prices charged by pharmaceutical giants like Pfizer and GSK. 

 

There are times, however, when overwhelming pragmatic needs demand a short-term solution. Such was the case in 2014, when, after five years of unsuccessful price negotiations, MSF agreed to accept a one-time donation from Pfizer and GSK of their pneumonia vaccines. This was a notable exception to our prohibition on in-kind corporate donation policy that was made with great consideration, so that children would not go unvaccinated while issues of affordability and sustainability were under discussion. But in agreeing to the donation, both Pfizer and GSK assured us that they would work on a longer-term solution for children caught in crisis and developing countries. 

 

Finally, just last month, in a significant shift - and after years of negotiations and months of public campaigning - GSK announced that it would offer its pneumonia vaccine to humanitarian organizations at the lowest global price (currently $3.05 per dose or $9.15 per child for all three doses needed for full vaccination). This is an important step towards a sustainable solution for humanitarian organizations that wish to extend the benefits of pneumonia vaccination to children caught in crisis. In contrast, Pfizer has not made any pricing concessions, and has yet to announce any meaningful solutions. They continue to offer donations that give Pfizer a tax break rather than offer a sustainable solution by lowering the price of the vaccine overall. Accepting Pfizer’s donation today would not do anything for the millions of children living in countries like Iraq, Jordan, Philippines, Romania, and Thailand, among many others, where neither their parents nor their governments can afford the expensive vaccine. 

 

We can no longer live in a world where a vaccine that protects children against pneumonia is a luxury; too many young lives are at stake. Doctors Without Borders does not believe that our medical work, nor the work of other humanitarian organizations or governments trying to serve their people, should be at mercy of the voluntary ‘goodwill’ of pharmaceutical corporations. 

 

Pfizer should lower the price of its lifesaving pneumonia vaccine for humanitarian organizations and all developing countries to $5 per child. Only then, will we have a meaningful step towards saving children’s lives both today and in the future. 

 

To Mr. Read, I hope to hear soon from you that Pfizer is reducing the price of the vaccine for the millions of children who still need it. 

 

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GSK lowers the price of the pneumonia vaccine for some of the world's most vulnerable children

MSF calls on Pfizer to match GSK’s move and offer the humanitarian community access to the lowest price available globally

 

NEW YORK/ LONDON, 20 September 2016 – The international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders/ (MSF) welcomes the decision by GlaxoSmithKline (GSK) to lower the price of its pneumococcal conjugate vaccine (PCV) for humanitarian organisations that serve refugee and crisis-affected children. For seven years, MSF has been in discussions with GSK and Pfizer – the only two manufacturers producing the pneumonia vaccine – for access to a more affordable price. GSK’s price reduction is a significant step forward in protecting vulnerable children who are reached by humanitarian organisations like MSF. MSF now hopes that Pfizer will match GSK’s offer, and that both companies will additionally reduce the price of the vaccine for governments of developing countries which still can’t afford to add the PCV vaccine to their standard childhood immunisation package.

 

“GSK has taken a critical step forward for children in emergencies,” says Dr Joanne Liu, MSF’s international president. “With this price reduction, our teams will finally be able to expand their efforts to protect children against this deadly disease. GSK should now redouble efforts to reduce the price of the vaccine for the many developing countries that still can’t afford to protect their children against pneumonia.”

 

Pneumonia is the leading cause of child mortality worldwide, killing almost one million children every year. Crisis-affected children, such as those caught up in conflict or in humanitarian emergencies, are particularly susceptible to pneumonia. MSF medical teams often see the deadly effects of pneumonia – a vaccine-preventable disease – in the vulnerable children we serve.

 

Until now, neither MSF nor other humanitarian organisations have been able to purchase pneumonia vaccines at an affordable price; earlier this year, MSF paid 60 Euros (US$68.10) for one dose of the Pfizer product to vaccinate refugee children in Greece – 20 times more than the lowest price that GSK and Pfizer offer. 

 

In May, MSF delivered the names of more than 416,000 people from 170 countries who signed a petition asking Pfizer and GSK to reduce the price of the pneumonia vaccine to US$5 per child (for all three doses) for crisis-affected populations and for all developing countries. 

 

With its 19 September announcement, GSK has now pledged to offer humanitarian organisations a price of about US$9 per child (US$3.05 per dose). While GSK’s announcement removes one significant barrier to humanitarian access to the pneumonia vaccine, Pfizer’s pneumonia vaccine (PCV13) is still an indispensable tool in many countries where MSF and other organisations provide assistance, yet Pfizer continues to refuse to offer an affordable price for its pneumonia vaccine to humanitarian organisations.

 

“Pfizer should now match GSK’s move and help build a broader solution for the humanitarian community by also offering the lowest global price,” says Liu. Instead of lowering the price for the humanitarian community, Pfizer has offered only a donation programme. MSF prefers to have access to affordable and sustainably-priced vaccines so that the health of vulnerable children does not rely on the voluntary goodwill of companies.

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