
Why we rejected Pfizer’s donation offer of pneumonia vaccines - beefield
https://medium.com/@MSF_access/there-is-no-such-thing-as-free-vaccines-why-we-rejected-pfizers-donation-offer-of-pneumonia-6a79c9d9f32f#.3nojz64n4
======
hannob
It's texts like this that make me feel my occasional donations to MSF are well
spent. They're not only helping people, they seem to care how to do it and
consider political implications. Because after all, we won't fix the lack of
global health access purely based on donations, we need political and
economical changes that make medicine affordable to everyone who needs it.

------
luso_brazilian
_> 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._

 _> Countries, which continue to voice their frustration at being unable to
afford new and costly vaccines such as PCV, need lower prices as well to
protect children’s health._

Medicine and the pharmaceutical industry must strike a balance between the
increase in innovation only healthy competition can bring (the promise of
capitalism) and the public utility of their discoveries.

When that doesn't happen governments sometimes are forced to step in and take
harsh measures. It happened in Brazil in the first years of the XXI century,
when the government forced compulsory licensing of anti-HIV drug patents [1]
so it could produce it cheaply on their own laboratories.

[1] [http://www.doctorswithoutborders.org/news-stories/press-
rele...](http://www.doctorswithoutborders.org/news-stories/press-release/us-
action-wto-threatens-brazils-successful-aids-program)

~~~
wolfgke
> It happened in Brazil in the first years of the XXI century, when the
> government forced compulsory licensing of anti-HIV drug patents [1] so it
> could produce it cheaply on their own laboratories.

The mistake rather lies in the fact that the patents were granted. If you want
competition instead of a monopoly dictating the prizes you should better not
allow patents in this area.

~~~
afarrell
The problem here is that we are currently paying for vaccine research by
promising the monopoly to allow research to recoup their costs (and the risks
of plausible therapies that go nowhere). Removing that monopoly and not
replacing it with something else will mean that no new therapies get
developed. If we want new therapies to be developed, then we have to pay for
it somehow.

We could also reduce the cost of bringing new therapies to market by having
the FDA say "if your drug is approved by the EU, you can sell it in the US" as
per S. 2388

~~~
beefield
> Removing that monopoly and not replacing it with something else will mean
> that no new therapies get developed.

Given that medical research is probably as close as you can get to a textbook
case where patents are useful, and how obviously true many smart people think
this statement is, there just _must_ be lots of robust peer reviewed academic
research empirically supporting that statement.

Could someone point me to one such peer-reviewed paper?

Note that there are also opposing views. Switzerland did not have
pharmaceutical patents until 1978. A quote from a famous anti-IP book[1]:

"In particular, at least between 1850 and 1980, most drugs and medical
products should have been invented and produced in the United States and the
United Kingdom, and very little if anything in continental Europe. Further,
countries such as Italy, Switzerland and, to a lesser extent, Germany, should
have been the laggards of the pharmaceutical industry until recently. Instead
the opposite was true for longer than a century"

[1]
[http://levine.sscnet.ucla.edu/papers/imbookfinalall.pdf](http://levine.sscnet.ucla.edu/papers/imbookfinalall.pdf)

~~~
true_religion
Reading the opposing viewpoint paper is confusing. Drugs will be developed
wherever the talent for their development lives, then exported to a protected
environment to be sold.

Even if 100% of drugs are available patent-free in Germany, it wouldn't be
very helpful to people living in the US.

------
xgbi
> _Donations often involve numerous conditions and strings attached, including
> restrictions on which patient populations and what geographic areas are
> allowed to receive the benefits._

What?? Is it a "DONATION" or a "CONTRACT"? I don't understand how this could
be called a donation if it has "strings attached".

Once I donate money to a charity, I expect them to spend it wisely, but I do
not make them sign a freaking contract!

~~~
ensignavenger
There are IRS rules regarding this if using it as a tax deduction, too. Donors
can 'advise' the charity in what it does with the donation, but generally
cannot control it with a legally binding contract. (I am not a lawyer, but
that is how I understand the rules, anyway.)

~~~
Declanomous
Restricted donations are very common. Donors often have the choice of
designating a fund when giving money to a charity. I believe the money in a
restricted fund is legally required to be used for the designated purpose. As
far as I'm aware, the legal limitations on fund restrictions are designed to
prevent restrictions which are designed to circumvent the tax code.

As an example, lets say you give money to a charity. You could require the
funds be used to create and administer a scholarship for youth from your home
town. You could not require the funds be used for a scholarship for children
who live in your household.

This is based on what I've incidentally learned working for a non-profit. I'm
not an accountant or a lawyer, so I might have missed some nuance, but I think
that's the gist of it.

Here's a link to some information on managing restricted funds:

[https://www.thebalance.com/restricted-unrestricted-
nonprofit...](https://www.thebalance.com/restricted-unrestricted-nonprofit-
funds-2502167)

------
Shivetya
I have no problem with asking them to lower their prices, but does anyone know
what it actually cost Pfizer to actually produce, package, and ship? I would
assume with the amount of money attributed to this product that initial
investment/research costs are paid but is there room in current charges to
cover new research into the same? Plus if heavily discounted it would be an
expectation that someone else would see an increased price to cover for the
discount another has received; unless of course we are looking for Pfizer to
offset the cost of this particular drug by charging other drug users higher
prices of obfuscate the discounts impact.

When it comes down to it I am more against using children as pawns to make
political statements. If the other drug is more cost effective then people
should just skip the Pfizer drug until they in turn adjust pricing for the
market.

~~~
icebraining
_If the other drug is more cost effective then people should just skip the
Pfizer drug until they in turn adjust pricing for the market._

Isn't this what they're doing? They specifically mention that a competitor
(GSK) has lowered their prices for the same vaccine, so presumably they'll use
that instead until Pfizer lowers the price, exactly as you're suggesting.

------
anexprogrammer
Donations make great headlines but rarely sustainable fixes. Pfizer do seem to
be odd one out here. _" They continue to offer donations that give Pfizer a
tax break"._ That seems damning, but I know nothing about global drug pricing,
and current developing world issues, so let's take 20 lunchtime minutes and
see what I can find out.

    
    
      wholesale price     $17.00
       (developing world src:wikipedia)
      AMC subsidised price $3.50
      GSK Offer            $3.05
      MSF Want             $1.66
    

For a vaccine introduced in the US in 2000 and France, Germany, and the UK in
2006. There's a need to research further strains mainly found in the
developing world.

There's also the AMC programme (Gates Foundation and 5 Govt contributions),
GAVI (Gates, World Bank, WHO, Unicef).

GSK charge less than Pfizer as their vaccine covers slightly fewer strains.

GAVI seems to have been remarkably successful [1], and $10bn in funding over
its lifetime, 75% infectious disease control, 25% basic healthcare. They're in
more countries than currently targeted but rollout within countries is
slightly behind. Countries are still applying to join GAVI. They have
systematically increased manufacturers for vaccines, including developing
world producers for all.

Two or three more manufacturers of Pneumococcal vaccine are in pipeline. Not
clear when, but MSF seem to indicate next year for first.

\--

So, what do I get from that?

20, OK 25 minutes doesn't get you much, reports tend to be _long._ :)

I've a new found respect for Bill Gates. From a world where vaccination rates
were declining in the 90s, he's achieved a _huge_ change.

$3.50 a dose is perhaps a better ask, given strains covered and other
subsidised prices. Get that then ask everyone to go lower. Or ask $1.66 and
get ignored.

Can't quickly find out research cost of these, or production cost, so
impossible to estimate what cost price becomes, or additional costs to
research additional developing world strains. High price doesn't only mean
profiteering.

Products appear to be in pipeline from GSK (in collaboration with London
School of Hygiene & Tropical Medicine, and Medical Research Council, Gambia) -
near Phase III, Serum Institute of India - under development, Merck has a
candidate going into Phase II. So competition coming soon(tm).

[1] [http://gaviprogressreport.org](http://gaviprogressreport.org)

~~~
slim
MSF just said that donation is actually harmful and you're still praising Bill
Gates?

I suggest you spend 20 minutes thinking about the impact of medication
funneled through corrupt gov. in third world countries. And the influence of
gates on those govs.

~~~
anexprogrammer
The actual quote from the MSF piece:

"To avoid these risks and to limit the use of in-kind medical products
donations, the World Health Organization (WHO), and other leading global
health organizations such as UNICEF and _Gavi, the Vaccine Alliance,_ have
clear recommendations against donation offers from pharmaceutical
corporations." My emphasis.

GAVI, an organisation Gates was involved in creating, and has given $2.5bn (a
little under 22% of their total budget) to since 99 _is agreeing the
recommendation._

They're in 75 of the poorest nations on earth - of course there is some fraud
and corruption, but vaccination is progressing very well and more countries
are continually joining. I'm sure they try to minimise it.

He's put another $1bn into two other vaccination programmes: polio and
malaria.

Yes, I stand by what I said.

Would you prefer MSF, a fine charity with an honourable history but almost
endless call on their limited resources do it? In addition to the training,
basic healthcare, vaccination, disaster relief, clean water supply, and
refugee missions? And probably a dozen other things I forget. They're not
immune to fraud and corruption either - no organisation that size can be. I'm
sure they try to minimise it too.

What would you do?

~~~
slim
I would exempt third world from intellectual property by amending human rights
charter

------
jbb555
Spoiler: Because they are more interested in pushing their own politics than
helping people.

~~~
chrisbennet
I rarely down-vote but you've earned it. Actually read the article and _then_
articulate a reason to disagree with the article and I'll un-down-vote you.

 _" Donations can also undermine long-term efforts to increase access to
affordable vaccines and medicines. They remove incentives for new
manufacturers to enter a market when it’s absorbed through a donation
arrangement. We need competition from new companies to bring down prices
overall — something we don’t have currently for the pneumonia vaccine.
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. Countries, which continue to voice their frustration at being unable
to afford new and costly vaccines such as PCV, need lower prices as well to
protect children’s health."_

