Vaccines sell out in Pakistan as the private market opens, raising concerns of inequality

A vial of the Sputnik V Covid-19 vaccine at a cold storage facility in Karachi, Pakistan

(CNN)Pakistan is in a tight spot: Covid-19 cases are surging during a third wave, hospital beds are filling up, and the government vaccination program is progressing slowly due to delayed deliveries and limited supplies.

So last month, it became one of the few countries to allow the private sector to import and sell vaccines.
Initial sales of the Russian Sputnik V vaccine in the first weekend of April caused a frenzy, with crowds rushing to vaccination centers and queuing for hours for their shot.
    Several centers sold out in days. Others that had initially allowed walk-ins switched to online sign-ups after being inundated with people. Many online booking systems have since been paused, as clinics slowly work through a backlog of inquiries.
      One major importer is private pharmaceutical company AGP Pharma, which has received 50,000 doses of the two-shot Sputnik vaccine. Other companies and private hospitals are in the process of applying and placing orders.
        People receive the Sinopharm Covid-19 vaccine at a vaccination center in Lahore, Pakistan, on April 1.
        The government has received 2.56 million doses of vaccines, all from China, according to local reports citing the health ministry. About one million people have been vaccinated with those shots since February, mostly in priority groups such as health care workers and those above age 50 -- leaving a huge percentage of the country's 238 million residents left waiting, according to official figures.
        The private vaccines, however, are open to everyone -- and many people, otherwise ineligible for the government's program, are now hoping to secure a slot in private clinics.
          "It's good that it's available privately, I have no idea when our turn will come through the government," said Anushka Jatoi, 35, who got the vaccine with her family at a private hospital in the southern city of Karachi.
          But the private sales have also raised concerns about pricing and accessibility, and highlighted the country's deep-rooted social inequality. Most private sales are in large cities, such as Karachi and Islamabad, and remain inaccessible to residents in more rural areas -- and the price remains beyond most of Pakistan's population.
          The Sputnik vaccine currently costs 12,000 Pakistani rupees ($80) for two doses, according to the Drug Regulatory Authority of Pakistan (DRAP).
          That's four times the international market price, which is less than $20 for two doses, according to the vaccine developers. And it's about 30% of an average household's monthly income, at $273.2 (41,545 rupees), according to the most recent available data by the Pakistan Bureau of Statistics.

          The third wave

          Pakistan has only approved a handful of vaccines for emergency use, including three Chinese vaccines, Russia's Sputnik V, and the Oxford-AstraZeneca vaccine. So far, it has largely relied on donations from other countries -- chiefly China, which has provided more than a million doses of Sinopharm.
          A worker transports a crate of the Sputnik V Covid-19 vaccine in Karachi, Pakistan, on March 19.
          Pakistan is set to import three million more doses of China's CanSinoBio vaccine this month. Russia also announced in April that it will soon supply Pakistan with 150,000 doses of the Sputnik vaccine. It's not clear if the Sputnik and CanSinoBio vaccines are donations or purchases.
          And Pakistan is still awaiting more than 17 million of doses of vaccines allocated by COVAX, a global vaccine-sharing initiative with discounted or free doses for lower-income countries.
          With long delays in the COVAX program, and vaccines arriving from Russia and China relatively slowly, Pakistan's government has allowed the private sector to step in. Companies and private hospitals must fill out an application to the country's regulator, DRAP, to receive a No Objection Certificate (NOC) -- the document which allows them to import and sell vaccines.
          There are some rules, however, including around the prohibition of selling the vaccine on the retail market; private institutes and clinics can only administer the vaccine on their premises and under the supervision of healthcare professionals, according to DRAP. Private clinics must also have their facilities assessed by the provincial director of general health.
          People wait to receive a dose of Russia's Sputnik V vaccine in Karachi, Pakistan, on April 5.