So last month, it became one of the few countries to allow the private sector to import and sell vaccines.
Several centers sold out in days. Others that had initially allowed walk-ins switched to online sign-ups after being inundated with people. Many online booking systems have since been paused, as clinics slowly work through a backlog of inquiries.
The private vaccines, however, are open to everyone — and many people, otherwise ineligible for the government’s program, are now hoping to secure a slot in private clinics.
“It’s good that it’s available privately, I have no idea when our turn will come through the government,” said Anushka Jatoi, 35, who got the vaccine with her family at a private hospital in the southern city of Karachi.
But the private sales have also raised concerns about pricing and accessibility, and highlighted the country’s deep-rooted social inequality. Most private sales are in large cities, such as Karachi and Islamabad, and remain inaccessible to residents in more rural areas — and the price remains beyond most of Pakistan’s population.
The Sputnik vaccine currently costs 12,000 Pakistani rupees ($80) for two doses, according to the Drug Regulatory Authority of Pakistan (DRAP).
The third wave
With long delays in the COVAX program, and vaccines arriving from Russia and China relatively slowly, Pakistan’s government has allowed the private sector to step in. Companies and private hospitals must fill out an application to the country’s regulator, DRAP, to receive a No Objection Certificate (NOC) — the document which allows them to import and sell vaccines.
Leaders at AGP, the pharmaceutical company supplying the private Sputnik shots, have argued that Pakistanis are running out of time as the outbreak worsens. By sharing the burden between the state and the private sector, more people can get inoculated faster and get the economy back on track, they say.
Pakistan has recorded more than 721,000 cases and more than 15,000 related deaths, according to data from Johns Hopkins University, and is currently in the middle of a third wave.
“We were cognizant of the fact that with 113 million (adults) in Pakistan, vaccination by the public health care sector will be a huge challenge,” said AGP CEO Nusrat Munshi. “Someone had to rise to the challenge.”
The pricing war
Pakistan’s decision to allow private sales has ignited a debate around the ethics of commercializing vaccines during a pandemic — and a legal battle between the government and AGP over pricing.
Jatoi acknowledged her privilege, describing the private hospital where she got vaccinated as being “like a hotel,” with complimentary snacks and croissants in the waiting area. “We’re lucky to be be in this position,” she said.
Transparency International Pakistan, the national branch of the international anti-corruption non-profit organization Transparency International, wrote to Prime Minister Imran Khan last month, urging the government to ban private imports and sales. The commercialization of vaccines would essentially allow the wealthy to cut the line and exacerbate existing inequality, said the letter.
“The selling of this vaccine is just unethical, and too bad for the community,” said Dr. Tipu Sultan, former head of the Pakistan Medical Association. “Only few people who are moneyed are going to buy it. The bulk of the population cannot afford it.”
Eventually, the government reversed its decision and DRAP announced it would set a price cap — prompting AGP to take the government to court. Since 50,000 doses of Sputnik vaccine had already arrived, the company was granted an interim order allowing it to sell the vaccines at $80 for two doses until the final pricing is decided.
Munshi, the CEO, defended the cost of the vaccine. There are many additional fees included in the process, including the cost of international shipping, government taxes, border clearing charges, warehouse costs, national supply chains, and specialized storage to keep the vaccines at the required minus 18 degrees Celsius, she said.
The company had used DRAP’s recommended pricing formula to reach their final, “plausible” price, she added. “At this point in time the availability of the vaccine is far more important than the price.”
But critics say even the current price of $80 is too much, out of reach for much of the public.
“This should not be more than 1,000 rupees or 1,200 rupees ($6.6 or $7.9),” said Sultan. “It is the duty of the state to provide vaccination for every citizen. And if they start selling it, then obviously it will be costly.”
The waiting game
Everyone in Pakistan is now waiting — for more vaccines to arrive, for registration at private clinics, for the government to reach a decision on pricing.
But the process of getting a privately sold shot has numerous complications, even for those who can afford it.
“I’m super frustrated because I have to travel for work, and I’m unable to get my vaccine,” said Maha Mussadaq, a content lead at Foodpanda Thailand, who has been stranded in Islamabad. She tried all week to sign up for the vaccine, but has not been able to confirm a time slot, she said. She went online to register, and was told she would receive a phone call with more details, but was given no indication of when it might come.
“There’s no system in place, and there’s no definition of a timeline,” she said. All of her travel plans for work are dependent on whether she can get the first dose, but with news of the vaccine selling out, she is quickly losing hope of that happening.
And even those who got their first shots are worried. “I’m afraid there’s no guarantee that we’ll get the second dose, what if supplies run out?” said Jatoi. “There’s a lot of uncertainty.”
Meanwhile, authorities are bracing for the Ramadan events that will start on Tuesday. During the Muslim holy month, devotees typically observe fasts and gather in mosques for daily prayers. At the end of the holy month, called Eid al-Fitr, friends and families gather to celebrate with feasts, festivities, and special prayers.
It’s one of Islam’s biggest holidays — and it poses a Covid-19 risk. Around this time last year, countries around the world were experiencing devastating first waves, and imposed lockdowns that saw at-home and virtual Ramadan events.
The government warned last week that if the outbreak worsens during Ramadan and cases surge, it could revise and tighten restrictions again.