To almost everyone involved with global health, Medicins sans Frontiers (Doctors Without Borders, or MSF) is — for good reason — considered to be the almost unrivaled pinnacle player in this important field. Their bold, brash and courageous efforts to provide care in the most austere environments is heroic and the stuff of adventure stories.
Not surprisingly, many of the group's fans are likely cheering MSF's recent stance in the matter of pneumonia vaccine donations and pricing by pharmaceutical giant Pfizer.
I am not one of them.
MSF's principled and intransigent refusal of Pfizer's offer to donate 1 million doses of their lifesaving vaccine Prevnar-13, which provides protection against 13 strains of one of the most important causes of bacterial pneumonia, while viewed as a long-term means to ameliorate pneumonia, is, at root, designed to cripple pharmaceutical companies like Pfizer.
In lieu of the donation, MSF is urging — and attempting to embarrass — Pfizer to lower prices of the vaccine for the many markets in which the price has been deemed too high by MSF. Make no mistake, the vaccine donation would, as MSF acknowledges, in real time, positively impact those in need of vaccination.
However, MSF deems their larger goal of fundamental price restructuring to be of higher value, citing the likelihood that Pfizer will use the donation as a means of adhering to their pricing strategy while also obtaining a tax deduction. While this may be true, there is nothing wrong with this strategy despite MSF's attempt to publicly rebuke Pfizer for pursuing its rational self-interest.
While MSF has, thankfully, not appealed for the use of government force in this matter, their entire approach is frightening for it evades the crucial fact that Prevnar-13 is the property, intellectually and materially, of Pfizer. The life-or-death consequences of vaccine availability in the developing world in which MSF operates is a major problem that has been addressed by various groups and individuals who have offered myriad solutions and incentives.
MSF's solution is no solution at all but a "moral" blackmailing attempt that relies on the unquestioning belief that free enterprise and the quest for higher profits cannot be allowed in health care, especially in resource-poor regions. MSF wishes for Pfizer to abandon their pricing structure and acquiesce to an alternative version in which Pfizer's analyses are rendered moot by "humanitarian" considerations which seek their product at terms untenable to Pfizer.
Ultimately, MSF would likely desire Pfizer to relinquish all rights whatsoever to Prevnar-13, the vaccine that Pfizer itself financed and developed.
The problem, in essence, stems from the large demand for vaccines by those unwilling or unable to pay the price set by the manufacturer. If this was anything other than a medical product, this scenario would not be viewed any differently as, for example, scenarios that exist in the automobile or computer industry, where products are not expected to be regularly made available at prices which do not allow profit maximization.
However, for many reasons, health care is viewed differently and the laws of economics have long been suspended from operating in their normal fashion. Onerous regulations create almost insurmountable barriers to entry, for example.
It is not surprising then, given this high burden of regulations, that a relatively few number of firms, largely major pharmaceutical companies like Pfizer, are the dominant market participants. Instead of commending these few who continue to engage in global health despite the obstacles, the fruits of these pharmaceutical companies efforts are, in the name of altruism and sacrifice, enviously transformed into common goods, and "dirty" revenues are not pursued by right, but by permission.
The idea that pharmaceutical companies will or should just engage in research, development, production, and distribution without any thought of profit is a fantasy and, if implemented on a large scale, would lead to stagnation, a shrinking of the industry and a worse life for all. Profit is the lifeblood of a company and the goal to maximize shareholder value is laudable and has led to the development of an innumerable quantity of vaccines and medications.
As MSF accedes, there is no such thing as a "free vaccine." Vaccines are the result of painstaking research, enormous financial investment and massive risk. The benefit that vaccines offer the human race are incalculable and priceless. The continued involvement of companies like Pfizer in vaccine research and development, in which a sizable opportunity cost of not directing all resources toward the next blockbuster lifestyle drug exists, is essential, and actions such as those by MSF have the potential to provide a disincentive for global health involvement.
As a former fan of MSF and rabid vaccine advocate, I hope Pfizer stands strong and is not swayed by bullying tactics that threaten the long-term prospects of this industry that is so vital to human flourishing worldwide.
- Dr. Adalja is a board-certified infectious-disease physician. He blogs at www.trackingzebra.com and can be followed on Twitter at @AmeshAA.
