Athens — Médecins Sans Frontières (MSF) has started vaccinating refugee children on the Greek islands of Chios, Samos and Lesvos using a programme set up to allow children in humanitarian emergencies to access the pneumococcal conjugate vaccine (PCV) at an affordable price.

This marks the first time the ‘Humanitarian Mechanism’ is used in a high-income country—the programme offers the vaccine at a special reduced price of about US$9 per child (for the three doses needed for full immunisation) for humanitarian use by civil society organisations and UN agencies. Pneumonia remains the single largest killer of children under five worldwide, and children living in precarious conditions—including those in refugee camps—are at particularly high risk.

Pharmaceutical corporations Pfizer and GSK are currently the only producers of the pneumonia vaccine, which is the most expensive product in today’s standard childhood vaccination package. In the US, which is opposed to negotiating price with pharmaceutical corporations, the list price for the vaccine is up to $540 per child. France, another high-income country, pays $189 for the same vaccine.  Smaller countries with less negotiating power are often stuck in between; for example, Lebanon pays about $243. The price in local pharmacies in Greece is $168 per child.

“The high price of the pneumonia vaccine has blocked children from being protected against this childhood killer, when the disease is easily preventable with a vaccine,” said Dr Apostolos Veizis, Director of Medical Operational Support Athens at MSF in Greece. “It’s a landmark step that we are able to vaccinate refugee children even in a high-income country at this highly reduced price, but we need more vaccines to be included in the ‘Humanitarian Mechanism’ and for governments hosting children in crisis to be able to access these prices, too. All children in the world should be able to get this vaccine at an affordable price.”

Before the programme was set up, the only way to access the special reduced price for the vaccine was through Gavi, the Vaccine Alliance, a donor-funded organisation that helps the poorest countries access newer vaccines. But this left children in many countries—including those in refugee camps across the globe—without access to the vaccine, and organisations like MSF were not able to buy it at this special price to protect children in need.

The ‘Humanitarian Mechanism’ so far has been used by organisations in several low-income countries, with MSF having used it to vaccinate children in Central African Republic, Niger, Nigeria, South Sudan and Syria. However, the mechanism is currently limited to only one vaccine, and needs to be expanded to include other vaccines for use in humanitarian emergencies that are not covered under any other process.

“Children caught in emergencies are among the world’s most vulnerable, yet do not routinely receive protection from life-threatening diseases,” said Suzanne Scheele, Vaccines Policy Advisor at MSF’s Access Campaign. “The ‘Humanitarian Mechanism’ has been helpful in reaching children that were previously left unprotected from preventable, life-threatening pneumonia. We urge pharmaceutical manufacturers to make it easier for governments and treatment providers like MSF to buy vaccines at affordable prices to protect incredibly vulnerable children in urgent need of vaccination now.”

While the ‘Humanitarian Mechanism’ has been useful in protecting children in crisis, countries at all income levels continue to struggle to access the pneumonia vaccine at an affordable price. Approximately one-third of countries globally have not been able to include the pneumonia vaccine in their standard vaccination package due to the exorbitant price charged by Pfizer and GSK.

Jordan, for instance, is grappling with high vaccine prices while faced with a refugee crisis that has made the country host to the world’s second-highest share of refugees relative to its population. While the country has introduced free immunisation for all children regardless of citizenship or migration status, it cannot afford costly vaccines such as this one, leaving all children in the country vulnerable to pneumococcal infection.

“The ‘Humanitarian Mechanism’ is a stopgap solution developed essentially because pneumonia vaccine prices are too high,” said Scheele. “What will make a real difference will be when new manufacturers launch more affordable pneumonia vaccines so that children’s lives aren’t at risk due to corporate greed. We can no longer live in a world where vaccines that can protect children against killer diseases remain a luxury for so many.”

Since 2009, Pfizer and GSK have earned $49.1 billion in sales from the pneumonia vaccine alone ($43.5 billion to Pfizer and $5.6 billion to GSK).