COVID-19 vaccines are flowing into the private sector. What does this mean for equity?
While the vast majority of Covid-19 purchases have been through the public sector, we have also seen some private sector deals. This appears to be increasing recently, as governments are partnering with private sector health providers to widen the reach of their vaccine rollouts.
Back in 2020, the Russian Direct Investment Fund (RDIF) was selling Sputnik V to private companies and setting up private distributers in countries including Egypt, India, and Mexico. At the time, there was very little private sector involvement with any other vaccine and most developers pledged that they would work only with governments during the pandemic.
We are seeing an uptick of private sector involvement now, often at the invitation of governments, as countries struggle to ensure both supply and distribution. This makes sense particularly in countries where a large proportion of health care is provided in the private sector. Private sector involvement is a wide tent, however, and there are at least three key variables:
- Who purchases the vaccine – private company or government?
- Who pays for the vaccine – purchaser or end user? and
- Who decides the priority groups and schedule for recipients?
The third variable holds the most risk of inequity at the country level.
COVID-19 VACCINES For example, private companies could deliver government-purchased vaccine following the government’s priority schedule. This is a pragmatic move, leveraging all available health care providers and locations and is happening in many countries, both rich and poor, as vaccines are rolled out through local pharmacies and private care providers.
Or private companies could purchase their own vaccine and provide it to end users willing to pay. Where vaccines are sold directly to the public through private sector pharmacy chains or provided by employers, it can reduce the cost burden for governments that have not been able yet to purchase enough vaccine for their population. This may be on balance a positive trend in countries such as India, that have wide income disparity, where a large wealthy population can (and will) pay for a vaccine, ensuring that limited government funds support those in most need.
As in the case of India and Indonesia, private employers could purchase the vaccine and provide it to their employees free of charge. (In Indonesia, these doses must be acquired through the government and also be separate from the doses intended for the public sector campaign.) In the Philippines, more than 30 companies came together to purchase vaccine doses and promised to donate half to the government, while using half to cover their employees.
All of these options can relieve pressure on overburdened public health systems. But if people willing to pay are able to get vaccinated ahead of the priority schedule set by the government, countries risk creating a two-track vaccine rollout. Rich people will be vaccinated before poor people and may have access to different vaccines. It may also drive up prices for vaccines as a commercial product, tempt manufacturers to prioritize higher-paying private sector purchasers, and lead to an increase in fraud and black market activity.
While there is a critical and positive role for the private sector in the equitable distribution of vaccines at the national level in many countries, the key risk is when these companies work outside of the government priority schedule. Vulnerable populations around the world need to receive the vaccine on the same timescale to ensure the best results for everyone; the same is true at the country level. Public health priorities should continue to guide vaccine rollout, regardless of which sector administers the doses.