Doctors Without Borders is refusing 1 million free pneumonia vaccines from Pfizer because it objects to restrictions that often come with donated vaccines. The not-for-profit is also concerned about how Pfizer and other drugmakers use donations to justify charging high prices to other buyers.
It's yet another example of a major drugmaker offering a short-term solution to the long-term problem of rising drug prices. In the U.S. and around the world, drugmakers have programs that offer free drugs and discounts, but largely refuse to address underlying prices, which continue to rise.
Doctors Without Borders, known internationally as Médecins sans frontières, has waged a public relations battle with New York-based Pfizer and U.K.-based GlaxoSmithKline over the past few years. It's pushing the companies to lower the prices of their pneumonia vaccines. GSK finally relented in September, saying it will offer its pneumococcal conjugate vaccine to humanitarian organizations at the lowest global price, about $9.15 per child for all three doses.
But Pfizer still hasn't made any pricing concessions on its Prevnar 13 vaccine, Doctors Without Borders said, and has yet to offer any “meaningful solutions” beyond donations, which can count as tax breaks for drugmakers, the group pointed out. Doctors Without Borders and other aid organizations are typically opposed to donations because drugmakers often restrict them to certain patient populations or geographic areas, which can delay vaccination campaigns and allow shortages to persist in other areas.
Donations also undermine long-term efforts to increase access to medicines, because they can remove incentives for competitors to enter a market that's already covered by a donation agreement, according to an essay written by Jason Cone, executive director of Doctors Without Borders in the U.S. Similar to high-priced drugs in the U.S. market, lack of competition has led to unaffordable prices.
A Pfizer spokeswoman said in a statement that the company is "actively exploring a number of new options to enable greater access" to the vaccine for humanitarian aid groups. The company stood by its offer and said it strongly disagrees with Doctors Without Borders' policy on donations.
Donations, coupon cards and patient assistance programs are an unsustainable fix to the larger problem of rising drug prices – an issue that most drugmakers refuse to address directly. And when drugmakers give away free drugs in exclusive arrangements, the cost ultimately gets passed on to full-price buyers, including other aid groups that don't have such agreements, Cone points out.
“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,” Cone said. “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.”
If you're doubting Doctors Without Borders' rationale for rejecting free vaccines, go back and look at Mylan's response to the outrage over the pricing of its EpiPen. The British drugmaker has repeatedly invoked its programs that give free EpiPens to schools and poor families as a defense of the drug's $608 price tag.
“Since the start of the EpiPen4Schools initiative in 2012, more than 700,000 free EpiPen Auto-Injectors have been distributed, and more than 65,000 schools, approximately half of all U.S. schools, have participated in the program,” Mylan said in its statement in August. CEO Heather Bresch also mentioned the program in her testimony to Congress (PDF).
And to Doctors Without Borders' point on donation restrictions: an aspect of the EpiPen4Schools program that allows schools to buy additional EpiPens at a discount is under investigation by the New York attorney general for anti-competitive terms. Drugmakers sometimes strike exclusive, restrictive agreements with humanitarian organizations to offer drugs at an non-commercial price, which is considered a de-facto donation.
Mylan has pledged to increase its discount card value to $300 from $100, expand its patient assistance program and launch a generic version priced at $300, but it still refuses to directly lower the list price of its brand-name drug. It's unclear when exactly Mylan will release the generic device, and it's unclear why the company just now decided to offer that option to consumers. And even though it raised the value of its discount card, a sizable amount of patients is ineligible.
It's not just EpiPens. Discount programs are offered on a wide array of drugs, even as patients and physicians protest what they say is the artificial raising of drug prices, including those used to treat cancer, rheumatoid arthritis and heart issues.