E-drug: Pfizer: Donations Vs Price Reduction
Obviously Pfizer's announcement of Diflucan donations is our greatest
victory toward treatment-accessibility so far. However, drug donations, as
opposed to price reduction, poses some questions :
1) What is Pfizer's angle here ?
I think we will all agree that the company will spin these Diflucan
donations as unprecedented generousity/charity on their part. It will serve
to show to the public that Western multinationals are taking care of the
AIDS crisis in Africa instead of "those ineffectual Africans" (that is,
supposing Pfizer eventually extends these donations
to the rest of the continent, and that the other pharmcos follow suit). In
any case, it will muddy the PR issue.
Moreover, drug donations will now allow the industry to kill the
'unaffordability argument' that those few compulsory licensing-inclined
countries have been planning to base their defense on, if later threatened
of legal action by the industry.
2) What will the access criteria be, in terms of patient eligibility and
Drug donations can only take place in the form of programmes, because the
company needs to control what happens to its donated products. This
requires for example that 'reliable' doctors in 'reliable' departments in
'reliable' hospitals be identified, and that these hospital departments
follow a company-dictated prescription protocol. Only
*these* doctors may prescribe donated drugs, and only in cases where they
can adhere to the company-dictated prescription protocol.
What a lot of this 'reliability' and 'protocol' boil down to, is resources:
drug donation programmes require significant resources. In developed
countries the level of resources necessary for a drug donation programme
may be consistent, on average, with the already-existing healthcare
facilities. In developing countries, and especially in least
developed countries, to *require* any level of infrastructure resources for
access to drugs is to significantly limit access to drugs.
So the question is: will these programme requirements exclude from drug
donations people who can nonetheless benefit by the drug ?
3) Does this give the pharmaceutical too much power ?
Drug donation programmes are nothing more than corporate charity. Their
continuance is dependent upon the pharmaceutical's good will, and even
though the company may commit to sustained donations on paper, there is no
real way of *making* them stick to it if they've changed their mind.
Pharmaceuticals frequently renege on their sustained-procurement
obligations, as is beautifully examplified in Pharmacia & Upjohn's recent
rifabutin production suspension (rifabutin is one of those two or three,
hyperexpensive MDR-TB drugs, and P&U has a world monopoly on it) even
though law requires that any proprietary drug be manufactured in at least
three different facilities (rifabutin had only one, located in Italy, when
it broke down a few weeks ago). This goes to show that it would be naive
for anyone to expect pharmaceuticals engaged in drug donation programmes to
refrain from using the position as a handle against lobbying - and from
putting their threats to acts if opposed.
Personally, I think that *programmes*, even when they are not too
demanding, will never reach 26 million Africans, and that effective mass
access will require another avenue than donation programmes. Still, it
seems better strategy to start with this compromise now and work on
expanding it later. In any case, every single inch that the industry gives
is ours for good. Let's see how Glaxo, BMS and the others manage to ignore
our demands now that such an already-big name as Pfizer 'Viagra'
Pharmaceuticals has announced AIDS drug donations for Africa.
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