Are companies bribing doctors to push vaccine combos?

A vaccine against five diseases costs Rs 2,800. Add one for a sixth disease, Hepatitis B, to this combination and the price jumps to Rs 3,900 though the Hepatitis B vaccine by itself is just Rs 60.

Another vaccine against five diseases including Hepatitis B costs Rs 382, but the addition of a polio vaccine pushes the price up to Rs 2,392 though the standalone injectable polio vaccine (IPV) costs just about Rs 400 in the open market. Paediatricians question these huge price increases with the addition of just one more vaccine.

Vaccine companies’ spokespersons say it is because adding a component makes the manufacturing process more complex. What makes this a real problem is that the standalone IPV is not available any more, forcing paediatricians to buy the combination vaccine.

Earlier, two brands of standalone IPV were available in India, Erapol from Biological Evans and Imovax from Sanofi, for Rs 400. Sanofi told TOI IPV was not available in the open market because of a global shortage. Sanofi supplies the standalone IPV to the immunisation programme at Rs 172.

A dose of Easy Five vaccine from Panacea Biotec, against diphtheria, pertussis, tetanus, pneumonia and hepatitis, costs Rs 382 in the open market as it’s under price control. However, Easy Six, which includes all vaccines in Easy Five plus IPV, costs parents Rs 2,392, Rs 1,610 more than when the two are given separately.

While companies claim the extra cost is due to the complexity of manufacturing combination vaccines, whether it is Pentaxim or Hexaxim, the maximum retail price leaves a margin of Rs 600-750 for paediatricians/hospitals giving them an incentive to choose these combo vaccines.

Even in the case of Easy Six, cheapest vaccine against six diseases at Rs 2,392, over Rs 475 goes as incentive to doctors orhospitals. Most firms dismiss this as a practice of “fixed margins” on MRP prevalent across pharma and vaccine industries or as “business terms” offered to customers.

But of course, it’s the person who decides which product to choose – the doctor or hospital -- who gets to pocket the incentive, while the baby’s parents pay the MRP.