All 3 vaccines are comparable

THE World Health Organization (WHO), in a recent study, declared that a third pneumococcal vaccine is at parity with the incumbent vaccines being offered to address child pneumonia, the number one killer disease among children. A UNICEF report states that one child dies every 39 seconds because of pneumonia.

Global attention on COVID-19 has somehow taken away attention from pneumonia and other top diseases that could have otherwise been prevented by vaccination. In the Philippines, the Pediatric Infectious Disease Society of the Philippines (PIDSP) in its December 2021 journal cited pneumonia as the third leading cause of death among children 5 years old and below, accounting for 14% in child mortality.

Currently, two PCVs both coming from global vaccine manufacturers are being offered to address child pneumonia — Pfizer’s Prevnar or PCV 13 and GlaxoSmithKline (GSK’s) PCV 10, Synflorix.

There is, however, a third PCV, Serum Institute of India’s Pneumosil, which the WHO study declared as non-inferior to both Prevnar and Synflorix.

Recent WHO and DOH studies on other PCV serotypes

A 2021 WHO study shows that, on pre qualifying PCVs for childhood immunization programs, 10-valent (PCV10) has the “same substantial impact against pneumonia, vaccine-type (VT), invasive pneumococcal disease (IPD), and nasopharyngeal (NP) carriage in a variety of settings,” when compared to the earlier prequalified 13-valent (PCV13) vaccines.

To supplement country choices for such vaccines for childhood immunization programs, the WHO recommended that the “choice of product to be used should be based on programmatic characteristics, vaccine supply, vaccine price, the local and regional prevalence of vaccine serotypes, and antimicrobial resistance patterns.”

These 2021 findings are confirmed in an earlier 2020 study conducted by the Health Technology Assessment (HTA) Council of the Department of Health (DOH), where they reassessed both PCV10 and PCV13 in light of the need to expand the National Immunization Program (NIP) to a more universal vaccine coverage for the country.

In their HTA Unit report ” Reassessment of 10- versus 13-valent Pneumococcal Conjugate Vaccines (PCV) in the Philippines”, the DOH found that multi-dose vial (MDV) PCV13 is at least PHP 5 billion more expensive than single-dose vial (SDV) PCV10. The study concluded that in terms of overall program cost, “PCV10 is deemed more affordable than PCV13.”

Also of note is the earlier 2017 study, wherein the WHO stated that when using PCV10 or PCV13 to directly address empyema or pneumonia, there is “no systemic evidence that one product is better than the other.” The same can also be said for indirectly addressing pneumonia, where the WHO said that ” Overall, there is no clear evidence suggesting a differential effect by PCV product on the incidence of pneumonia in older children and adults.”

Opening opportunities for more vaccine access

Another complicating factor is the fact that targeting different causes of pneumonia and other fatal diseases like meningitis and sepsis, such as Streptococcus pneumoniae bacterium—which is the leading cause of pneumonia and kills more children each year than any other disease—can be addressed by providing various PCV serotypes for treatments.

In light of the WHO and HTAC studies, the country will benefit from a cost-effective vaccine solution, including the PCV10. In the case of the WHO vaccine parity study, it was shown that while PCV10 is as effective as PCV13 serotypes, the former is more affordable and thus will help in saving more lives, especially in economy of scale terms.

Specifically for the Philippines, the DOH can help level the playing field if it adds PCV10 vaccines to the national formulary. Especially in this time of COVID-19, the government can reallocate resources that were saved from a more affordable pneumonia vaccine, to other urgent and fatal diseases.