As the new crown vaccine gets closer, who's going to pay for 1.4 billion people?

The pace of the new crown vaccine is getting closer, with 10 vaccines entering Phase III clinical trials worldwide as of October, according to the WHO.
the world is waiting for a vaccine at a time when the number of new confirmed cases is about to exceed 40 million and more than 1 million deaths.
the threat of this global epidemic is so great that companies have to go through a normal two- to three-year cycle of vaccine development.
optimistic estimate that more than one vaccine will be licensed this year.
But the question is, with 7 billion people worldwide and 1.4 billion people across China barely resistant to the new virus, who will pay for the production, transportation and vaccination of the vaccine? Why can't Medicare pay for the new crown vaccine? At a time when the concept of universal health care is deeply rooted in people's minds, the first thing that comes to mind is health care.
October 9, the National Health Insurance Administration's official website "proposal proposal" column hung more than 800 words of reply, caused the whole network hot discussion.
the origin of a representative of the National People's Congress at the third session of the 13th National People's Congress proposed that vaccination against neo-crown pneumonia be included in the full reimbursement of health insurance.
as a related party, the attitude of the National Health Insurance Administration is obvious, at this stage can not be included in the scope of medical insurance reimbursement.
not only the NPC representative, but also a number of voices have made similar proposals.
why has the National Health Insurance Administration spent so many years trying so hard to include high-priced innovative drugs and anti-cancer drugs in health insurance while refusing to pay for the new coronary pneumonia vaccine? One of the most fundamental reasons that is often overlooked because of the surge in public opinion is the legal obstacle.
a person close to the NHS said, "The trouble with this is that there are legal issues between public health and basic health insurance."
As early as 10 years ago, on October 28, 2010, the Social Insurance Law of the People's Republic of China, promulgated by the Standing Committee of the National People's Congress, listed four cases in which insurance was not paid, one of which was "should be borne by public health".
article 30 clearly stipulates that medical expenses that should be borne by public health shall not be covered by the basic medical insurance fund.
is public health? At present, China does not have a mother law in the field of public health, although the word "public health" appears many times in the central document, but its connotation is not clear.
Over the years, however, the term "public health" has been clear in terms of classification in the field of medicine: medical measures for communities or societies are different from 10 per capita medical measures carried out in hospitals.
such as vaccination, health education, health supervision, disease prevention and disease control, various epidemiological means and so on.
the simplest way to tell what public health and basic health insurance should be, the former focuses on prevention and the latter on treatment.
This can also explain why, at the most critical time of the outbreak, the local health insurance departments temporarily decided to the new nucleic acid testing of new crown pneumonia this new means and items into the Medicare Category B reimbursement, because this has become the current patient hospital treatment must check the item, just like a lot of surgery must do blood routine examination, it is part of the treatment.
, vaccination is a public health issue and almost a consensus.
public health is mainly provided by the government, that is, disease prevention and control programs such as vaccines and vaccination costs should be addressed through funding channels for public health services.
years, China's basic health insurance has never set a precedent for including any vaccine in medicare reimbursements.
, it's not just the new crown vaccine, it's not all vaccines, it's not paid for by Medicare.
, the Social Insurance Law of the People's Republic of China reiterated this point in the Interim Measures for the Administration of Essential Medical Insurance Drugs, published in July this year: preventive vaccines are not included in the scope of medical insurance payments.
However, the National Health Insurance Administration's reply this time also mentioned the current stage of the new crown vaccine into the reality of health insurance obstacles, urban and rural residents low level of financing, the average in 2019 down to only about 800 yuan, what does this mean, there are experts, "a person only a few hundred yuan a year insurance, just out of the vaccine price of two needles will be about 600 yuan, if everyone wants to fight, it can not help the risk, where the money to see a doctor?" "A class of vaccines or a category two of vaccines?" Not being covered doesn't mean vaccines aren't important.
, vaccines are so important that no product or technology can match vaccines in reducing mortality, except for safe drinking water.
, in China, immunization programmes have been in place since 1978, and there is a special financial fund for vaccines that are included in immunization programmes.
in China, vaccines are classified as one and two.
a class of vaccines, vaccines that are included in immunization programmes and are available free of charge to people who are paid for by the State finances, share the common attribute that they are extremely cheap, sufficiently produced and have the greatest social benefits when immunized in certain disease groups.
second type of vaccine, which is voluntary out-of-the-nation vaccination.
, 14 vaccines are included in compulsory immunization programmes in China, mainly to prevent 15 diseases.
view is that it may be expected that the new crown vaccine will be included in the immunization programme and that the state finances will bear the cost of the new crown vaccine.
, new vaccines are constantly being included in national immunization programmes as new vaccines become available and revenues increase.
But China's last expanded immunization programme was 13 years ago: in 2007, five vaccines, the hepatitis A vaccine, the flow-brain vaccine, the B-brain vaccine, the measles mumps rubella vaccine, and the cellless white-crack vaccine, were included in the national immunization programme.
China, as a big country with hepatitis B, has reached the high incidence rate of "ten people and one hepatitis B", which has had a profound impact on the economy and politics of Chinese society, but the hepatitis B vaccine has gone through a long 13 years from entering China to entering the immunization program.
to include a class of vaccines, that is to say, immunization programs in China need to go through an extremely long and complex audit mechanism, the new crown vaccine is limited to too high cost, capacity can not be satisfied, at this stage to include a class of vaccines is probably not high.
The new crown vaccine as a new thing, we know it is still very early stage, do not even know whether it is a lifetime immunization, or like the flu vaccine needs to be vaccinated every year, the development of immunization programs is even less likely.
important issue that cannot be ignored is money, and price is always an important consideration in measuring access to immunization programmes.
the price of vaccines developed by foreign companies ranges from a few dollars to tens of dollars, and inactivated vaccines, represented by The National Pharmaceutical Group and Koxing, are the mainstream products of domestic vaccines at higher prices.
, who works in research and development for a pharmaceutical company abroad, told Eight News that the high price of inactivated vaccines is related to the vaccine's production process.
On the one hand, because inactivated vaccines first need to prepare live viruses, and then inactivated treatment, culture of live viruses for the virus operating workshop requirements are very high, need to invest in a higher plant and operating workshop costs.
, on the other hand, because of the production process, inactivated vaccine production capacity is limited, compared to other technology pathways of vaccines.
the high input cost and low production capacity of the two factors, resulting in a higher cost of inactivated vaccines.
Inactivated vaccine produced by the National Pharmaceutical Group with this media revealed 600 yuan two doses (completing the need for two vaccinations to form a vaccine protection effect), even at the cost of the second-class vaccine expensive imported influenza medical treatment, the price is lower than the current domestic market price of the new coronary pneumonia vaccine.
And now included in the immunization program of a class of vaccines, one thing in common is that the price is extremely cheap, the former Shanghai CDC vaccine expert Tao Ina once calculated that if a child completes all the immunization program vaccinations, the financial cost of procurement is 135 yuan (excluding transportation, syringes, labor and other costs).
2017 data, the central government's guarantee of immunization programs amounted to 3,564 million yuan, mainly for free vaccination of 11 types of vaccines.
, an expert in virology at the University of Hong Kong, told Time Financial on October 12th that at least 60-70% of people need to be vaccinated to achieve group immunity.
at least 840 million to 980 million people will need to be vaccinated against the new crown if they are to reach group immunization, at a cost of about 336 billion to 392 billion yuan.
estimates, it would cost almost 100 times as much as China spends on 14 types of vaccinations.
step pricing? In fact, for a whole new infectious disease, a whole new vaccine, past practice may not be a shackle to future possibilities.
Japan, for example, the Japanese government announced on September 8th that it would allocate 671.4 billion yen ($43.2 billion) from this year's emergency budget reserves to buy the new crown vaccine.
In the U.S., where the outbreak is out of control, congress passed the Coronavirus Assistance, Relief and Economic Security Act in March, which ensures that people who provide the coronavirus vaccine are vaccinated free of charge, including Medicare, at no cost.
U.S. government has spent hundreds of millions of dollars on new crown vaccines from major pharmaceutical companies, which has been criticized as "vaccine nationalism."
part of the current vaccine purchase, the U.S. government has actually borne the cost.
but the circulation of vaccines, such as transportation, distribution, and clinic fees for injections, has not yet been clearly paid.
but in China, the situation will be more complicated.
First, China's outbreak has been better controlled, and vaccines are not as available as those in countries with the second wave of outbreaks;
Jiang Qingfu, a professor at Fudan University's School of Public Health, suggests that, in general, we need 60%-70% of people to develop immunity to stop the spread of the disease. But in a year or two, it is almost impossible to get 60-70 per cent vaccination rates for 1.4 billion people.
From the point of view of vaccination strategy, Professor Jiang Qing-wu suggested starting with the high-risk groups, "first of all to ensure that those who are most dangerous, the most vulnerable to disease, to protect this part of the population first."
protect our professional population - the health care community, quarantine workers, couriers and so on, as well as our elderly people.
to the company or the government for the first time, and to protect the elderly, the government pays for it.
" But even as a second-class vaccine, it doesn't necessarily require individuals to pay for it.
some parts of the country, according to the level of economic development, financial affordability, effectiveness, population needs and other factors, a part of the second-class vaccine into the local immunization program, equivalent to the inclusion of a class of vaccine management, that is, all by the local financial burden.
such as Shanghai, in 2013, the elderly over 60 years old in Shanghai free of charge vaccination against pneumonia.
also included the flu vaccine in its immunization programme, and free flu vaccination is available to seniors over the age of 60, as well as to primary and secondary school students.
's step-by-step pricing strategy is a realistic and possible option for an industry insider pushing for international cooperation on vaccines in China.
GAVI's New Crown Vaccine Supply Program (COVAX) is to class classes countries into different levels, with developed countries spending the most on vaccines, middle-class countries spending less on vaccines, and the poorest countries getting vaccines free of charge.
GAVI to negotiate with the big vaccine companies, price geometry, also depends on the negotiations between it and the enterprise, but behind it there is a big market, on behalf of dozens of countries and even hundreds of countries to talk to enterprises, that is obviously a large scale, so enterprises generally will have a substantial price reduction.
" We also have developed areas, but also backward areas, how to pass a Gavi-like mechanism: for a public health problem that endangers all people, vaccine is one of the best solutions, how to make developed regions a little more financial, backward regions less financial, can also achieve in China, vaccine relatively fair coverage.
is not to say that it is completely free or entirely self-owned, dividing the region into levels and burdening them to varying degrees.
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