High Mpox Vaccine Price to Pose Key Hurdle in Africa Order Talks

(Bloomberg) -- The price of Bavarian Nordic A/S’s mpox vaccine is set to become a key sticking point in talks to secure millions of shots for Africa, with the Danish company under growing pressure to lower its charge.

As the first batch of more than 200,000 doses arrive in the Democratic Republic of the Congo, talks led by agencies including Unicef are underway to secure more vaccines for crisis-hit African countries. Initial agreements are slated to be finalized by mid-September.

Bavarian Nordic, one of the few companies with an approved mpox vaccine, is set to be a key supplier of as many as 12 million doses that the agencies plan to procure by 2025 to deal with an mpox outbreak declared a global public health emergency.

But with a shot significantly pricier than many other vaccines commonly used for immunization in Africa, costs remain a key barrier to getting more orders in place.

The Africa Centres for Disease Control has pegged the price for Bavarian’s vaccine at $100 per dose, while the World Health Organization quoted it at $141. That’s more than what most countries on the continent can afford — and more than many spend on health per capita — in the face of multiple health challenges, including cholera, measles, malaria and HIV. 

“Pricing is a problem,” said Helen Rees, chair of the WHO’s African advisory group on immunization. The price has put the jab among the treatments where “the cost is going to make things prohibitive,” she added.

A pricing model used by global vaccine alliance Gavi has previously beaten down the cost of shots by securing large volumes, making it viable for manufacturers and helping ensure products get where they need to be. But at this stage, Bavarian’s mpox jab doesn’t fit that structure, she said.

“In this kind of circumstance, you’ve got limited supply and a manufacturing side of things that is expensive – this is not a cheap product to make,” Rees said. “There’s a real cost associated.”

The spread of the new strain of mpox from Congo — where children account for more than 80% of deaths from the disease — has seen the number of cases on the continent increase in nations such as Burundi and Gabon. WHO Director-General Tedros Ghebreyesus has urged countries stockpiling vaccines to donate. 

Compared with other commonly used vaccines in low- and middle-income countries, Bavarian’s shot — sold under the names Jynneos, Imvamune and Imvanex — is considerably more expensive, said Andrew Hill, a senior research fellow at the University of Liverpool, who studies the cost of drugs. “Vaccines against most infectious diseases typically cost $1 to $3 per dose when given as part of mass vaccination programs to millions of people,” he said.

Cost-Prohibitive?

Bavarian Nordic “can’t carry on charging these high prices” in Africa and will have to give large discounts or grant permission to generic companies to mass produce this vaccine at close to cost price, Hill said. “Otherwise, Africa won’t be able to afford to protect their population as the epidemic of the new clade Ib grows,” he said.

Public Citizen, a nonprofit consumer advocacy organization, in a letter to Bavarian last month urged the company to provide “equitable access” to the mpox vaccine, saying it feared that Bavarian with its pricing “may be exploiting the latest global health crisis, putting profits over people.”

With few rivals for its vaccine in Africa, Bavarian is in the driver’s seat in setting the price for its jab. While Emergent BioSolutions Inc. and KM Biologics Co. have developed mpox vaccines, there’s a “very big difference between the three vaccines” that tilt in Bavarian’s favor, said Thomas Bowers, health-care equity analyst at Danske Bank A/S.

Emergent BioSolutions’ ACAM2000, which obtained FDA approval for mpox in late August, isn’t recommended for people with a weak immune system and, therefore, probably won’t be used in Africa, Bowers said. Japan’s LC16 vaccine made by KM Biologics is likely to form part of Africa’s vaccine program, but won’t trigger competition on prices, he said. Meanwhile, Moderna Inc. and BioNTech SE’s mRNA vaccine candidates are still “quite a few years” from the market.

The challenge for Bavarian is to negotiate a price that nations can afford but that remains commercially viable. Chief Executive Officer Paul Chaplin in an interview last month recognized that “pricing no doubt is going be an issue,” saying the company wants to look at it “responsibly” but “find the right balance.”

“At the end of the day, if we financially damage Bavarian Nordic in any way, that doesn’t benefit the world’s society because then there’s no vaccine available for anyone,” Chaplin said. 

Chief Financial Officer Henrik Juuel told the Danish state broadcaster last week that Bavarian, when negotiating the price with Unicef, will take into account which countries will pay. Bavarian also entered agreements during the last mpox outbreak with differentiated prices depending on the country buying them, according to a company spokesperson.

‘Large Discount’

Bowers of Danske Bank expects a price of roughly $100 per dose for organizations in Africa buying the vaccine, saying this is still a “relatively large discount” compared to the private market in the US, where the net price is around $200.

“Even if you can produce the dose for $10 or $20 apiece, that’s only the production itself, but owners have invested billions of kroner into developing the vaccine and preparing it for production, and they have taken a big risk,” Bowers said. “That’s also part of what has been put into the dose price. So it’s natural that you don’t just give it away as a gift.”

Yet $100 is still double the price being paid in some instances by the American government, which Bowers said gets a discount because it’s sponsored the entire development program.

Health organizations in Africa could negotiate a lower price if they make larger orders and commit to a vaccine program of at least four to five years, Bowers said. A long-term commitment would give more security for Bavarian, which pays for the maintenance and upkeep of factories even when they’re not producing any vaccine, he said.

While the jab has passed clinical trials as a two-dose immunization, it’s unclear whether countries in Africa would go for a one-shot approach to halve the cost. According to Bavarian’s CEO, data from a number of studies show that a single dose offers up to 80% efficacy and a significant reduction in hospitalizations.

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--With assistance from Naomi Kresge and Jason Gale.

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