Last year Médecins Sans Frontières (MSF) refused free vaccinations for pneumonia from Pfizer, who had offered the medicines as a corporate donation to the humanitarian organisation. The explanation MSF provided (available here) makes for an interesting, if uncomfortable read. Looming large is the lengthy history of negotiations between MSF with the only manufacturers of the vaccine, GlaxoSmithKline and Pfizer. MSF claim that the only sustainable solution to a disease that claims the lives of almost a million children each year is an overall reduction in the cost of the vaccine, and not one-off donations that come with restrictions on where MSF may use the medicines, and a constant power disparity between the parties, where Pfizer may release the medication on their own timeline, and revoke access as they see fit.
The costs for accepting donations are, according to MSF, higher than may appear. Accepting the vaccine as a donation removes the impetus to lower prices, and artificially floods needy markets with medicines that competitors might otherwise provide at lower cost while making MSF complicit in the continual higher prices charged to other NGOs and regional governments. PCV13 – the relevant donation in this case – is a blockbuster drug for Pfizer and GSK. Pneumonia vaccines are the world’s best-selling vaccinations, and PCV13 brought in $6 billion for Pfizer in 2015 alone. MSF calculate that it is 68 times more expensive to vaccinate a child against pneumonia in 2015 than it was in 2001. Against the backdrop of this growing power disparity between providers of essential care and those who hold the keys to the global medicine cabinet, drastic stands such as this may become increasingly commonplace.
Taking the projected costs of accepting donations into account, as a purely economic transaction, the decision is justifiable. But at the same time, it seems a strange calculus to make on MSF’s part, given MSF’s particular role in this crisis. It is a trade-off commonly made by governments when balancing books – current lives against future lives – but not for an NGO whose existence is predicated on solving immediate crises that individual governments cannot mobilise quickly enough, or with sufficient expertise to solve. To project themselves on a trajectory that envisages a continual loss of life seems to position MSF as the arbiter of long term solutions for entire regions, and not, as might appear to be their mission, to save lives in the immediate term – lives that will now be lost, in a way that seems even more avoidable and less comprehensible than Pfizer’s refusal to lower the cost of the PCV13 vaccine. With this framing, the decision would make sense if MSF had any guarantee that the cost of the vaccine would drop; that the effect of the negative publicity would be sufficient to push Pfizer to lower the cost of the medication for all needy purchasers, but this was by no means guaranteed, or even likely. It allows pharmaceutical corporations to cast MSF as the unreasonable actor, and gloss over the aspects of their own sales strategies that ensure the continual, preventable deaths of millions.
But here, this objection to MSFs course of action butts up against another common complaint about NGO action; that they are not sufficiently “long-term” in their planning, are overly reactive to emotively charged emergencies, and their reliance on large donors drives NGO action to regions and emergencies that are ‘marketable’, to the exclusion of crises that don’t resonate with the intended audience. MSF are pursuing exactly the policies that their critics often accuse them of neglecting: participating in the creation of sustainable infrastructure that allows for the saving of lives in the long term and explicitly depriving their donors of the benefits of PR that drives problematic NGO incentives. From this perspective, to do anything other than refuse the donations in the short term would be unethical precisely because it actively hampers efforts to develop long-term sustainable change for individuals suffering from endemic and completely treatable diseases. The WHO and UNICEF, amongst others, recommend against accepting corporate donations for exactly this reason. In a rare victory for NGO lobbying, following MSFs announcement that they would refuse the donations, and a sustained global campaign prior to World Pnuemonia Day on 12 November 2016, Pfizer agreed to supply PCV13 to humanitarian organisations at a reduced cost (though it remains meaningless to call this a below-market rate, given that the market in vaccines for pneumonia remains a fiercely protected duopoly between GSK and Pfizer). MSF have continued to fight the expansion of pharmaceutical control of these vital vaccinations, contesting the granting of a patent to Pfizer for PCV13 in India and South Korea following a European Patent Office revocation protection for PCV13 last year.
Perhaps the most significant message to take from the interlude is the fraught position many medical organisations find themselves in due to the concentration of power in the hands of pharmaceutical organisations; playing the dual roles of activists and medical professionals, administering care and designing the terms on which future individuals may or may not receive medical treatment. It is a terrifying trade-off for a medical organisation to make so publicly and so explicitly, but given the lack of alternatives for activism and the abject failure of governments and international organisations to provide for individuals who die of curable diseases, it is a laudable position to take.