Polio vaccination at the UN-House Protection of Civilians (PoC) 3 site in Juba, South Sudan. Credit: JC McIlwaine/UN Photo

This week is World Immunization Week, created to drive awareness for one of the globe’s most critical issues threatening the lives of infants today: access to vaccines. The World Health Organization (WHO) estimates that nearly 20 million babies worldwide are still missing out on basic vaccines. And almost one third of deaths of children under 5 years — nearly 2 million children — could be prevented through vaccination.

Although governments hold primary responsibility to ensure that their population receives essential health services such as immunization, for that to be possible, vaccines must be effective and affordable. And that obligation falls on the manufacturers — who hold research and development (R&D) expertise, set pricing levels of vaccines and manage vaccine supply chains.

UNICEF support the vaccination activities in Tergol town in coordination with UNHCR, the government Administration for Refugee and Returnee Affairs (ARRA) and the Gambella region Health Bureau. Credit: UNICEF Ethiopia 

Which is why the Access to Vaccines Index launched last month is so important. It is the first ever report of its kind that transparently measures the efforts of pharmaceutical companies and whether they are playing an effective role in reaching children in low- and middle-income countries with vaccines. Thus, playing a useful nudge to drive companies to do more to ensure no child is left behind.

The vaccines index does not rank companies in an order of performance as their product portfolios are so diverse, that giving each an overall ranking would be misleading. So instead, the Index evaluates how well major vaccine companies are doing in improving access to vaccines across three key areas: research, pricing and supply.

How did they do?

GlaxoSmithKline (GSK) performs the best across all three evaluation areas, with Sanofi also performing well across the board. For R&D specifically, our partners Johnson & Johnson scored closely behind GSK — J&J have been taking an increasing focus in vaccines and invested the most globally of any company evaluated into research and development of new vaccines in 2014-15.

Yet, Pfizer, who Global Citizens successfully put the pressure on to reduce the price of their pneumonia vaccine for children in humanitarian crises last year, “falls short in multiple areas compared to peers” according to the report. Their move to make pneumonia vaccine more affordable could save thousands of lives, and is very much a step in the right direction. The Index identifies several opportunities for Pfizer, and all companies evaluated, to do more to truly serve those most in need.

Read more: Pfizer Drops the Price of its Vaccine after 430,000 People Ask them To

The company enjoys one of the largest vaccine revenues. However when it comes to pricing, it supports the use of price confidentiality provisions, stating that they mitigate a major risk for manufacturers and governments. This lead to a below average transparency score. Plus, the company performs “below average in R&D, with a relatively small pipeline”, and is “lagging in several aspects of manufacturing and supply”. Namely, they do not commit to communicating their plans externally when they are reducing or stopping supply of vaccines.

All companies appear to be taking action to balance global supply and demand, which is vital in order to mitigate against the devastating impact of vaccine shortages, that arise when demand outstrips supply — in the event of an outbreak, for example. The four companies taking comparatively strong action on this area are GSK, Johnson & Johnson, Merck & Co., Inc. and Sanofi.

A health worker vaccinates a child at the Merb Mieti Health Center in Enderta Woreda (district) in Tigray Region. Credit:Balasundaram/UNICEF Ethiopia

The global vaccine market is considerable. And it’s growing: between 2000 and 2014, it expanded from $6 billion to $33 billion. Governments are spending more on vaccines, and that includes poorer countries. Many lower-income countries procure vaccines with financial support from Gavi, the Vaccine Alliance and through organizations such as UNICEF — who doubled their vaccine spend between 2010 and 2014, to $1.5 billion.  

However, while many lives have been saved by the growing number of vaccinations being dispensed, they are still out of reach for a number of countries, including because companies are setting the prices of vaccines prohibitively high.

This is an issue that affects middle-income countries not supported by the Gavi, the Vaccine Alliance (who by necessity focus on the poorest countries), which means children are dying simply because they are born into a country unable to afford the current rates.

Hamda Yusuf, 36 gets her 7 months old daughter Raqi Hassa vaccinated against Polio. Credit: Meklit Marsha/UNCIEF Ethiopia

The index does not find clear evidence that companies systematically consider countries’ ability to pay. And decisively concludes that they must do in future, especially for countries that receive no support from Gavi or are not part of pooled procurement programs.

In 2015, 25 countries reported a net decrease in coverage since 2010. In these countries that are being left behind, children — particularly from poor households, in marginalized communities and affected by conflict and emergencies — continue to be overlooked and are not being immunized. And WHO estimates that 1.5 million lives could be saved every year, just by improved vaccination coverage.

The Access to Vaccines Index is therefore a much needed agitator to urge improved practice across the pharmaceutical industry, and bring us closer to a day when no child is needlessly lost to a preventable disease.