With the release of a second tranche of information showing how South Africa was bullied into paying outrageously high prices for its Covid-19 vaccines, the Health Justice Initiative (HJI) has expressed concern about the NHI scheme, which will also involve mass state-private negotiations for medicines and vaccines.
On Tuesday, the HJI released more details of the previously secret Covid jab deals, showing that although the government had resisted several of the terms demanded by Pfizer, it was ultimately forced to pay a premium and carry the risk of any delays or harm caused by the shots.
The health advocacy group said the findings are particularly worrying, given that the NHI Act includes measures to establish a government-controlled fund to buy services and commodities provided by the scheme.
The newest information about the vaccine deals from the Health Department – provided to the HJI following a High Court ruling in 2023 – shows how SA was strong-armed by Moderna and Pfizer in negotiations that heavily favoured the multinational corporations over public interest.
In August 2023, the Health Department provided the HJI with documents covering its contracts with Pfizer, Johnson & Johnson (J&J) and the Serum Institute of India (SII), and the international vaccine-sharing mechanism Covax, which the HJI previously said showed the companies had held SA to ransom.
The department provided a second set of records to the HJI in September and November 2023, which the HJI said on Tuesday revealed further evidence of the extent to which SA was bullied into contracts with unfavourable terms.
This time its analysis, conducted with the assistance of US-based Public Citizen, highlighted negotiations with Pfizer and Moderna, the two companies that led the way in developing mRNA vaccines.
“These companies’ attempts to extract excessively high prices are now documented for the whole world to see,” said HJI founder Fatima Hassan.
“We hope this disclosure will have a bearing on last-ditch efforts in Geneva to negotiate a fair, equitable and transparent pandemic accord. The absurd power CEOs have in pandemics has to be addressed with urgency.”
Negotiators from the WHO’s member states are still in talks about a pandemic treaty they hope will be adopted at the World Health Assembly later this month.
SA never entered into a final agreement with Moderna which, according to the HJI, sought a price as high as $42 per dose, a 15-year ban on the disclosure of confidential information, and a prohibition on using any of the confidential information that was disclosed in any future challenge to Moderna’s patents.
The records of the negotiations with Pfizer, which agreed to provide SA with at least 30m doses at $10 each – a 32.5% premium on the price it charged the EU – show officials tried to include contract provisions that would mitigate Pfizer’s control and enable a degree of transparency with Parliament and the Auditor-General, in line with domestic legislation.
Officials sought to insert terms that would hold Pfizer accountable for late or incomplete deliveries, narrow its indemnification requirements, and allow SA to sell or donate excess doses to other countries.
SA entered into its vaccine negotiations at a time of global scarcity, when governments with domestic manufacturing capacity prioritised their own citizens, leaving African nations that relied entirely on imports struggling to find supplies.
Both Western governments and India initially restricted exports.
SA was forced to pay a premium on the prices charged in many other jurisdictions, including the first batch of vaccines it procured: it agreed to pay the SII $5.35 for a dose of AstraZeneca’s shot, more than 2.5 times the price the EU paid AstraZeneca directly.
NHI fears
University of KwaZulu-Natal senior lecturer in pharmacology Andy Gray said it was not clear how medicines and other health technologies would be priced under NHI. “Simply stating that the fund will ‘set’ prices obscures the legal challenges to that process,” he said.
While the NHI fund had the potential to bring more pressure to bear on prices than the state tender system, it could not rely on a limited bidding process with one winner per item tendered, he said.
“It needs to maintain competition in the longer term, by moving from a procurement to a reimbursement model, with a maximum reimbursement price per pharmacological category.”
See more from MedicalBrief archives:
Crisp agrees SA ‘screwed over vaccines’
NHI inadequate for medicines provision, warns lobby group
Pharmacists concerned over 'limited dialogue' on NHI Bill
SA ‘bullied, held to ransom’ and paid double for Covid vaccines