Recently, pharmaceutical giant Pfizer donated one million pneumonia vaccine doses to medical aid organisation, Doctors Without Borders, also known as Médecins Sans Frontières (MSF), but it was rejected.

The humanitarian organisation's executive director Jason Cone recently explained that the organisation is trying to raise awareness on the issue of medical affordability for many nations around the world, where the cost of the vaccine makes it out of reach, therefore the acceptance of Pfizer's donation would mean undermining "long-term efforts to increase access to affordable vaccines and medicines."

The vaccine is critical for many children especially in developing countries, but it is "incredibly high-priced," says Kate Elder, Doctors Without Borders' vaccine policy advisor.

"We believe that we should have to pay the lowest global price," she added.

Creating awareness through rejection

Indeed, the world has been abuzz since the rejection of the vaccines, with most aghast by the rejection of an altruistic act of a pharmaceutical company.

Pneumonia is the leading cause of death in children. 1.4 million children get infected by the bacterium Streptococcus pneumoniae and decades ago, scientists managed to isolate components of the bacteria and expose children to the benign molecules of the bacteria. The children's immune system learnt how to recognise and destroy the bacterium afterward.

Only two pharmaceutical companies are manufacturing the vaccines and both are effective in preventing pneumonia. However, in sub-Saharan Africa and Southeast Asia, where pneumonia is prevalent, their governments are unable to afford the vaccines. So when MSF refused a million doses from Pfizer, it shocked the world.

"Pfizer is committed to making vaccines available to as many people as possible," company spokesperson Sally Beatty said, "particularly those needing emergency humanitarian assistance."

She also explained that Pfizer "strongly disagrees" with MSF's decision and that "to suggest that donations are not valuable defies logic."

Governments and NGOs unable to afford vaccines

But MSF does understand the value. It has been trying to get its hands on the vaccine since 2009, just that the cost was deemed too high. And so, for the past seven years, Doctors Without Borders has been trying to negotiate with two pharmaceutical companies to lower the price of the vaccine.

"We have heard repetitively from governments that are trying to purchase this vaccine to protect their children's health that it's just too costly for them," Elder said. Approximately 60 governments around the world have yet to introduce the pneumonia vaccine into their immunisation programmes.

"One large inhibitor to them being able to introduce this vaccine and protect their children is the price itself," Elder said.

MSF: Donations are often used “as an excuse for why others need to pay up, so to speak"

Cone explained that the donations from pharmaceutical companies are ineffective against a problem of this scale. In immediate effect, the donation would benefit people under the care of MSF, but accepting it means the rise of long-term problems.

"I'm not absolutely against donations," MSF's vaccine pharmacist Alain Alsahani said. For neglected disease where there is little or no market for a product, he explained, "donation becomes a more interesting option for some countries to get access. Bu in the case of PCV, that's not a solution at all, in any way."

In addition, accepting a donation meant restrictions that are often placed by the donor in terms of who the product can be used for, and where, have to be followed.

“It’s not just a, ‘Here, take the donation and use it wherever you want,’” Elder said. “There are restrictions, and as you get into negotiating these things which are incredibly time-consuming contracts to negotiate, you see all of the fine print.”

Pfizer "actively exploring a number of new options... to aid NGOs..."

MSF wants a "fair and low price so that we can buy a product as any other consumer and use it where the medical needs are," she added.

The rejection of the donation was a difficult choice but Elder claims that their policy aligns with that of the WHO and UNICEF, which try to "limit the negative consequence of in-kind donations." Pfizer has "strongly disagreed" with MSF, as it "believes product donations play a crucial role in addressing humanitarian crises around the world."

Elder said that "Another negative consequence of accepting donations is that it can inhibit the entrance of additional manufacturers." 

There are only two manufacturers of the pneumonia vaccine: Pfizer and GlaxoSmithKline (GSK). According to Elder, GSK has now reduced their price of the pneumonia vaccine for the humanitarian community to the lowest global price. Pfizer is still "actively exploring a number of new options to enable greater access to our pneumococcal vaccine... to aid NGOs facing humanitarian emergency settings" - according to Beatty - and the donation might just be the first step. MIMS

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