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[e-drug] Pfizer: Donations Vs Price Reduction

E-drug: Pfizer: Donations Vs Price Reduction
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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 
monitoring ?
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.

Khalil Elouardighi
Act Up-Paris
gerrold@wanadoo.fr


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