Muabshar Nadeem
Pakistan’s move toward joint local vaccine production under its Expanded Programme on Immunisation, in partnership with Saudi Arabia, represents far more than a routine health policy adjustment. It signals a potentially transformative shift in the country’s approach to public health infrastructure and industrial self-reliance, one that could reshape how Pakistan protects its population from preventable diseases while reducing dangerous dependence on foreign suppliers.
The journey toward this decision reveals how crisis can sometimes catalyze long-overdue strategic thinking. What initially appeared as a temporary supply chain disruption caused by regional tensions has ultimately exposed a profound structural vulnerability in Pakistan’s healthcare system. This exposure, uncomfortable as it may be, has created an opening for a more sustainable and sovereign approach to one of the most fundamental aspects of public health, ensuring that children and adults have access to life-saving vaccines regardless of international political dynamics.
For decades, Pakistan operated under an arrangement that seemed efficient on paper. The country relied heavily on imported vaccines, with a significant proportion manufactured in India and procured through various international partners and intermediaries. This system appeared to function adequately, delivering vaccines at reasonable costs while allowing Pakistan to focus its limited resources on distribution rather than production. The arrangement was convenient, tested and familiar.
However, recent events have shattered any illusions about the sustainability of this model. When Indian manufacturers refused to supply vaccines intended for Pakistan, even when orders were placed through third-party intermediaries, the fragility of the entire system became impossible to ignore. This was not merely an inconvenience or temporary hiccup, it was a stark reminder that Pakistan had effectively outsourced a critical public health function to entities and countries over which it had no control and with whom relations could be unpredictable at best.
The implications of such dependence extend far beyond inconvenience. Vaccines are not luxury items that can be delayed or substituted easily, they are essential medical interventions that must be delivered according to strict schedules to maintain population immunity and prevent outbreaks. Any disruption in vaccine supply can quickly translate into unvaccinated children, rising disease incidence and the potential reversal of decades of public health progress.
The financial dimension of local vaccine production presents a compelling case for action. Federal Health Minister Syed Mustafa Kamal recently provided the Senate committee with sobering figures that underscore both the current costs and future challenges Pakistan faces. The country currently spends between 300 and 400 million US dollars annually on vaccines, a substantial sum by any measure. However, what makes this figure particularly significant is that nearly half of this expenditure is currently financed by development partners including Gavi, the World Health Organization, UNICEF and the Gates Foundation.
This external support, while crucial and appreciated, comes with an expiration date. International development assistance is not designed to be permanent, and donor priorities shift over time. By 2030, just a few years from now, Pakistan is expected to lose most of this external assistance and will need to fully self-finance its immunisation programme. According to the health minister’s projections, annual vaccine requirements at that point could reach as much as 1.2 billion US dollars, a nearly fourfold increase from current spending levels.
Meeting such costs exclusively through imports would place an enormous and potentially unsustainable strain on Pakistan’s public finances. The country already struggles with fiscal constraints, external debt obligations and competing demands on limited resources. Adding over a billion dollars in annual vaccine imports to this burden could force difficult choices between immunisation and other essential services, or simply result in inadequate vaccine coverage with predictable public health consequences.
Beyond the immediate financial calculus, vaccine security represents a strategic imperative that transcends cost considerations. Public health experts understand that immunisation programmes are among the most cost-effective health interventions available, preventing disease, disability and death while reducing broader healthcare costs. However, these benefits only accrue if vaccine supply remains consistent and reliable.
Disruptions in vaccine availability can rapidly reverse hard-won gains against diseases such as polio, measles, diphtheria, pertussis and hepatitis. Pakistan has struggled for years to eliminate polio, coming tantalizingly close to eradication multiple times only to see the virus resurge. Any interruption in routine immunisation coverage could undermine this progress and allow vaccine-preventable diseases to reestablish themselves in the population. The human toll of such setbacks would be measured in sick children, overwhelmed hospitals and preventable deaths. The economic consequences would include lost productivity, increased healthcare expenditures and damage to Pakistan’s international standing.
Developing domestic or joint production capacity would substantially reduce Pakistan’s exposure to multiple categories of risk. Geopolitical tensions between Pakistan and neighboring countries or shifts in international relations would no longer threaten vaccine supply. Currency volatility, which can make imported products suddenly unaffordable, would have less impact if vaccines were produced locally or in partnership with regional allies. Global supply bottlenecks of the kind that plagued the world during the Covid-19 pandemic would be less likely to leave Pakistan without essential vaccines.
The Covid-19 experience provided a harsh education in the dangers of vaccine dependence. Wealthy nations secured supplies through advance purchase agreements and domestic production, while countries reliant on imports found themselves at the back of the queue, watching helplessly as their populations remained vulnerable. Pakistan cannot afford to repeat this experience with routine immunisations that protect against diseases which, unlike Covid-19, we already know how to prevent.
The phased approach outlined by Pakistani authorities demonstrates thoughtful planning. Rather than attempting to immediately establish full-scale vaccine manufacturing from raw materials, the strategy begins with packaging and finishing of vaccines produced elsewhere, then gradually progresses toward complete domestic production. This incremental approach allows for capacity building at each stage, provides opportunities to develop technical expertise and regulatory frameworks, and manages the substantial financial risks inherent in establishing biopharmaceutical manufacturing.
However, success will require more than signing memoranda of understanding with Saudi Arabia or other partners. Pakistan must make serious, sustained investments in several critical areas. Research and development capacity needs to be built or significantly enhanced, as vaccine production is a technically demanding field requiring expertise in microbiology, immunology, process engineering and quality control. The regulatory system must be strengthened to ensure that any locally produced vaccines meet World Health Organization quality standards and international best practices. Manufacturing facilities require substantial capital investment, specialized equipment and trained personnel. Supply chains for raw materials and components must be established and maintained.
Without these investments, local vaccine production risks becoming either inefficient, producing vaccines at costs higher than imports, or substandard, creating products that fail to provide adequate protection or worse, cause adverse effects. Either outcome would defeat the purpose of the entire initiative and could actually leave Pakistan worse off than its current import-dependent situation.
The partnership with Saudi Arabia offers potential advantages, including shared costs, technology transfer and access to regional markets that could improve economies of scale. However, Pakistan must ensure that any joint venture genuinely builds domestic capacity rather than simply replacing one form of dependence with another.
This moment represents both challenge and opportunity. Pakistan can continue muddling along with an import-dependent model until the next crisis exposes its vulnerabilities again, or it can seize this opportunity to build genuine vaccine security through local production capacity. The path forward requires vision, sustained commitment and substantial investment, but the alternative growing vulnerability in an increasingly uncertain world is far more costly.
