In the immediate future, the Ministry will add it to the list of centralized bidding to resolve it as quickly as possible. Then, submit it to the competent authority for permission to purchase expanded immunization (EPI) vaccines centrally as before using the central budget.
People take their children to get vaccinated at Ward 13 Medical Station, Tan Binh District (HCMC) on June 13.
Why the lack of vaccines?
On June 13, speaking with Thanh Nien reporters, the leader of the Ho Chi Minh City Department of Health said that the city has run out of DPT-VGB-HiB vaccines (a 5-in-1 vaccine, combined to prevent 5 diseases: diphtheria, whooping cough, tetanus, hepatitis B, pneumonia/purulent meningitis caused by Hib bacteria) and DPT (diphtheria, whooping cough, tetanus). Currently, there are very few vaccines left in the EPI program in the city. It is expected that by the end of June, the city will run out of hepatitis B vaccines, Japanese encephalitis vaccines, and tuberculosis vaccines (BCG). By July, the polio vaccine (bOPV) and measles vaccine will run out. By August, the tetanus vaccine (VAT) will run out and by the end of September, the measles and rubella (MR) vaccine will run out.
A leader of Ho Chi Minh City Department of Health
According to the demand from now until the end of 2023 and the first 6 months of 2024, Ho Chi Minh City needs about 1.8 million doses of EPI vaccine. The most needed is oral polio vaccine with 247,000 doses, tuberculosis vaccine with 191,224 doses. Ho Chi Minh City has also developed a supply plan and sent it to the Ministry of Health at the Ministry's request.
"Without a vaccine, there will be no protective immunity for a group of children, and there is a risk of an outbreak in the near future, leading to overlapping epidemics," a leader of the Department of Health shared.
On the same day, Mr. Doan Tan Buu, Director of Dong Thap Department of Health, said: "The province is lacking, scarce and not enough vaccines to serve the EPI. The Department is synthesizing the demand to propose to the Ministry of Health for consideration."
Vaccination under the expanded immunization program at Hai Ba Trung District Medical Center, Hanoi
National Assembly delegate Pham Khanh Phong Lan (HCMC delegation) said that not only HCMC, many localities have reported a serious shortage of EPI vaccines, especially the 5-in-1 vaccine. According to Ms. Lan, with imported vaccines, the Ministry of Health has so far conducted centralized bidding and then allocated them to localities. In 2022, the Ministry of Health bid for the 5-in-1 vaccine and failed due to the lack of bidders. If the national centralized bidding cannot be implemented, it must report to the Government to reduce the bidding conditions and not conduct centralized bidding, switch to price negotiation or use some simpler method. The Ministry of Health did not choose these solutions, so it is natural that by 2023 there will be a shortage of the 5-in-1 vaccine, and this vaccine has been out since February.
"The Ministry of Health said that in 2023, the budget will be transferred to localities, and localities will be asked to bid on their own. Centralized bidding is not completed and pushed back to localities, breaking up the bidding package. Are there any companies that do not participate in the national centralized bidding but participate separately in 63 provinces? That is the key to the lack of 5-in-1 vaccines," Ms. Lan analyzed and said that the drugs to be bid on are also from the local budget, but some items are still selected for national bidding. "Why can drugs be made but vaccines are not? The job of the Ministry of Health is to bid and set a price frame, sign contracts with companies, bring goods to regional hospital warehouses, and when it is time to transfer money, it is transferred from the local budget. As for domestic vaccines, the Ministry said that due to this decree, that circular, the Bidding Law... centralized bidding is not possible," Ms. Lan said.
Do localities bid for TCMR vaccines themselves?
On April 3, the Ministry of Health issued Official Dispatch 1810 on the implementation of tasks under the health-population target program, converting them into regular expenditure tasks (provinces purchase by themselves using local budgets). After that, 16 provinces and cities responded with official dispatches, saying that bidding was not possible due to insufficient conditions.
The leaders of the Ho Chi Minh City Department of Health said that if localities were allowed to bid by themselves, it would be very difficult, especially in large cities like Hanoi and Ho Chi Minh City due to large population fluctuations. In addition, because each locality bids by itself, the implementation time will be different, and there will be disruptions in supply in each locality. On the other hand, getting the planned price of vaccines for EPI is difficult due to the lack of information on the winning bid price, because these vaccines are currently ordered by the Ministry of Health, so most of these types do not participate in bidding. If based on the order price of the Ministry of Health (information on the vaccine delivery forms of the National Institute of Hygiene and Epidemiology), there is a huge difference between this price and the declared price. Therefore, it is very difficult to build a planned price.
On June 13, the Department of Health of Da Nang City said that regarding the difficulties and obstacles in purchasing EPI vaccines, the People's Committee of Da Nang City has sent a document to the Ministry of Health requesting. According to the People's Committee of Da Nang City, the normal procurement bidding process lasts 3-4 months, so the assignment of the locality to organize the purchase of vaccines according to the direction of the Ministry of Health, it is possible that the bidding results will not be available until the end of 2023. There may be a shortage of vaccines due to unsuccessful bidding (due to no participating contractors, no items meeting technical/financial requirements...).
Dr. Pham Phu Truong Giang, Deputy Director of the Can Tho Department of Health, said that the local health sector is very confused about this issue. The reason is that in order to use the local budget, the health sector must consult the People's Council to establish a spending norm for that content. Then submit it to the People's Council for approval before it can be gradually implemented. If this goes smoothly, it will take several months. Meanwhile, the amount of vaccines is seriously lacking, especially the 5-in-1 vaccine.
Regarding the shortage of some vaccines for children in the EPI in recent times, the Ministry of Health said that in recent years, the National Institute of Hygiene and Epidemiology (the unit in charge of the national EPI project) has placed orders and signed contracts with domestic vaccine manufacturers to supply some types of vaccines (DPT, tetanus, tuberculosis, Japanese encephalitis, hepatitis B, measles, measles-rubella, polio bOPV) for EPI.
These vaccines are managed, coordinated and delivered to regional Pasteur/VSDT institutes, then supplied to localities for vaccination. Vaccine supply is carried out according to regulations on prices and orders, based on the needs of units and localities. The difficulty and problem in ensuring EPI vaccines is that after implementing the regulations, from 2023, localities will bid to buy vaccines from their local budgets, instead of the Ministry of Health ordering and purchasing centrally from the central budget to allocate to localities as in previous years. Meanwhile, recently, some EPI vaccines that were supplied according to the ordering mechanism have not been declared for prices, so they are not eligible for bidding and procurement. In addition, the mechanism for inspecting vaccine batches before vaccination also causes difficulties for localities if implemented separately.
Proposing the Ministry of Health to take the lead
According to the leader of the Can Tho Department of Health, Can Tho proposed that the Government assign the Ministry of Health to carry out centralized bidding, place orders or negotiate prices, purchase vaccines and then distribute them to localities.
According to the representative of the Central Institute of Hygiene and Epidemiology: "Recently, localities proposed that the Ministry of Health take the lead in bidding for centralized procurement of TCMR vaccines to unify prices. Because if localities purchase separately, it is very easy for each locality to buy at different prices, as happened with drug procurement bidding. Recently, the Government also directed the Ministry of Health to consider the option of ordering or centralized bidding at the national level, and negotiate prices."
Regarding the bidding and centralized procurement of TCMR vaccines, on the afternoon of June 13, speaking with Thanh Nien , Mr. Le Thanh Dung, Director of the National Center for Centralized Drug Procurement (Ministry of Health), said that the Ministry of Health is adding a number of drugs, including TCMR vaccines, to the list of national centralized bidding and procurement. After this list is approved by the national advisory council and if the Ministry of Health assigns the center as the focal point, the center will purchase and negotiate the price of TCMR vaccines.
"If the procedures are favorable, from implementation, document appraisal to vaccine price approval, it will take at least about 3 months," Mr. Dung added.
Regarding the source of vaccines for EPI, according to the Ministry of Health, there is no shortage of supply from manufacturers in the country. In particular, vaccines such as measles, rubella, neonatal hepatitis B, polio, Japanese encephalitis... have been produced and supplied domestically for EPI for many years. The 5-in-1 vaccine is supplied from abroad. To avoid the risk of shortage and interruption of the 5-in-1 vaccine injection for young children, the National Institute of Hygiene and Epidemiology has held working sessions with international organizations and will soon receive support for this vaccine.
Information from the Ministry of Health said that in order to soon stabilize the supply of TCMR vaccines, the Ministry of Health will submit to the competent authority for approval to purchase TCMR vaccines centrally as before, from the central budget.
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