Barring oral polio vaccine, the cost of other routine vaccines that added up to a little over a quarter of the annual routine immunization budget has increased to account for more than 50% of the entire budget, shows the response to an RTI application filed with the Vaccine Procurement Cell in the health ministry by Dr K V Babu, central council member of the Indian Medical Association.
In 2006-07, over 90% of the DPT (diphtheria, pertussis, tetanus) vaccine doses and over 80% of the tetanus toxoid vaccine used for UIP were supplied by the Pasteur Institute of India (PII) in Coonoor and the Central Research Institute (CRI) in Kasauli. In 2012-13, the two institutes together barely produced 36% of the DPT vaccines used and 23% of the TT vaccine used for the UIP.
The price of DPT vaccine has more than doubled between 2006-07 and 2012, going up from Rs 12 to Rs 28 per vial of ten doses. Similarly, the price of TT vaccine has gone up from Rs 6 to Rs 15.
The BCG Vaccine Laboratory in Guindy, Chennai was the sole supplier of BCG vaccine for the UIP. The government is now entirely dependent on the private sector as no other government institute produces BCG vaccine. The two other manufacturers of BCG vaccine, Serum Institute of India (SII) in Pune and Green Signal Bio-Pharma Ltd in Chennia, are private companies. Since 2008, the price of BCG has gone up from Rs 13 to Rs 30 per vial of ten doses.
Interestingly, the least increase in cost has been in the case of measles, where prices have risen by less than 25% despite the demand for doses in 2012-13 being five times what it was in 2006-07. Perhaps it is no coincidence that the measles vaccine was the one that already had a private monopoly even in 2006-07.
The three government institutes, which produced the bulk of the vaccines required for the basic immunisation programme against six diseases, were shut down in 2008 reportedly for not being compliant with good manufacturing practices (GMP) by then health minister Anbumani Ramadoss. This move was sharply criticised by the parliamentary standing committee on health and family welfare which observed that it was the government's responsibility to invest in its own institutes to ensure they were GMP complaint instead of using that as an excuse to shut them down leaving the UIP at the mercy of the private sector.
Though all three institutes were reopened in February 2010, so far, the BCG Vaccine Laboratory has not produced a single dose of vaccine for the immunisation programme and PII Coonoor and CRI Kasauli have been producing a fraction of what they used to supply earlier.
The two other vaccines in the basic UIP are OPV and measles vaccine. For the measles vaccine, the RTI reply of the vaccine procurement unit of the ministry lists only one supplier, the Serum Institute of India in Pune, though the Central Bureau of Health Intelligence (CBHI) lists Indian Immunological Ltd and Human Biologicals Institute, two government units, as suppliers too. However, they do not seem to produce any significant amount. A measles vaccine dose currently costs the government over Rs 10.
In the case of OPV vaccine, the biggest suppliers seem to be two private companies Panacea Biotech Ltd and Bharat Biotech International Ltd in Hyderabad, which seem to meet the bulk of the demand. Though BIBCOl Bulandshahr, a government institute, and Haffkine Biopharmaceutical Ltd in Mumbai, a public sector unit (PSU), are listed as producers of OPV, their contribution seems negligible, going by the data of the CBHI.
The government units which made an insignificant contribution to the UIP were not chosen for being closed down. It is the units which contributed to a large share of the immunisation programme's demand that were shut down, resulting in the entire market for the vaccines produced by these units being turned over to the private companies.
