In a pointed rebuke to Pfizer, Doctors Without Borders has rejected an offer by the big drug maker to donate 1 million doses of a pneumonia vaccine because such a move might “undermine long-term efforts” to increase access for people in poor countries. Instead, the organization pushed once again for Pfizer to lower its price.

The rejection follows seven years of haggling with Pfizer over its Prevnar 13 vaccine and comes one month after GlaxoSmithKline agreed to cut the price of its own pneumonia vaccine. The decision was posted in an essay on Medium this week by Jason Cone, Doctors Without Borders’s executive director in the United States, who called the move a “difficult task” before explaining his reasoning.

“Free is not always better,” he maintained. Notably, he argued that donations can include restrictions on distribution. Cone also suggested that companies use donations as an excuse for maintaining existing pricing. And he fretted that donations can remove incentives for other companies to enter the market for a particular product, which means less competition that can also lower pricing.

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The decision to publicly chastise Pfizer comes after Doctors Without Borders had openly pushed both drug makers to cut their vaccine prices to $5 per child. The organization has argued that, for years, that Pfizer and Glaxo were overcharging both donors and developing countries for vaccines that have generated billions of dollars in wealthy countries.

In a report issued early last year, Doctors Without Borders maintained the vaccines were 68 times more expensive than in 2001 and attributed 45 percent of the increased cost to pricing. Pneumococcal disease, by the way, kills about 1 million children per year, mostly in poor and developing nations.

After Glaxo agreed last month to lower its price to $9 a child, the organization declared the company had removed a “significant barrier to humanitarian access” to pneumonia vaccines. But the concession by Glaxo apparently failed to get Pfizer to budge, prompting Cone to try yet another round of public pressure on Pfizer executives.

“In contrast, Pfizer has not made any pricing concessions, and has yet to announce any meaningful solutions,” Cone wrote. “They continue to offer donations that give Pfizer a tax break rather than offer a sustainable solution by lowering the price of the vaccine overall. Accepting Pfizer’s donation today would not do anything for the millions of children living in countries like Iraq, Jordan, Philippines, Romania, and Thailand, among many others, where neither their parents nor their governments can afford the expensive vaccine.”

For its part, a Pfizer spokeswoman sent us a note saying the drug maker is “committed to making vaccines available to as many people as possible, particularly those needing emergency humanitarian assistance. We are actively exploring a number of new options to enable greater access to our vaccine to aid [non-government organizations] facing humanitarian emergency settings.

She added that Pfizer is “ready to build on the significant donation previously provided to [the organization] with a donation of at least 1 million additional doses, including an offer of 100,000 doses earmarked for immediate delivery. Pfizer strongly disagrees with [the organization’s] stated policy and believes product donations play a crucial role in addressing humanitarian crises around the world.”

Cone, by the way, acknowledged Doctors Without Borders had, in fact, previously accepted a donation from Pfizer two years ago, which the organization called an exception to its policy. However, he also maintained that both companies offered assurances that longer-term solutions to pricing and access would be found.

We should note that Doctors Without Borders, meanwhile, has also challenged an application that Pfizer filed with Indian patent regulators, arguing the drug maker should not be awarded a patent for the vaccine because the patent is not original. A hearing was held this summer, but no decision has been issued.

And here are excerpts from Cone’s essay about donations:

“Donations are often used as a way to make others ‘pay up.’ By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine.

“Donation offers can disappear as quickly as they come. The donor has ultimate control over when and how they choose to give their products away, risking interruption of programs should the company decide it’s no longer to their advantage. For example, Uganda is now facing a nationwide shortage of Diflucan, an essential crytpococcal meningitis drug, in spite of Pfizer’s commitment to donate the drugs to the government.”

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  • DWB started out with the noble objective of bring medical care to underserved parts of the world. Over the years they have devolved from a medical group to a political advocacy group, and this story is a good example of how their devolution has come at the expense of the people they were supposed to serve.

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