Pfizer Will Donate Fluconazole to South Africa

On April 3, Pfizer Inc. announced that it will donate its drug fluconazole (Diflucan®) to the South African government for use by patients with cryptococcal meningitis, a serious infection that occurs in many persons with AIDS. The disease is usually fatal unless treatment is continued for life. The drug costs more than 10 times as much in South Africa as it does in Thailand, where a generic version is available -- and outside the free distribution program, the price is not being changed. Until now, most South African patients have not been treated because of the cost.

This unexpected announcement, an important victory for South Africa, followed a campaign by MSF (Doctors Without Borders), TAC (the Treatment Action Campaign, the main HIV/AIDS treatment activist organization in South Africa), ACT UP in the U.S., and others.

For more information, see "Giving it Away: An American Pharmaceutical Giant Offers to Donate an AIDS Drug to South Africa," by Mark Schoofs, the Village Voice, April 4-10, 2000.

Comment

While important, this program is limited to one country, and to one disease. And no one knows how long the company will continue it.

There are many theories as to why Pfizer was willing to offer this program, which was unexpected:

• South Africans were preparing legal action to force the company to lower its price. If successful, it might have set precedents going beyond South Africa.
  
  Pfizer is in merger talks to acquire Warner-Lambert, to create the world's second largest drug company; a key shareholder's meeting is April 27 in New York. The company may not want controversy which could interfere with the merger.
  
  
• People dying because they cannot afford a drug which clearly can be sold profitably at a tenth the price is a natural story for the press and television, likely to lead to endless bad publicity. South Africa is a leader in the fight for wider drug access, and news there is likely to come to world attention. Thailand already has access to an affordable generic fluconazole; most countries do not, but treatment activists are usually much less organized than in South Africa or Thailand.
  
  
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• Giving a vital resource which could later be cut off creates leverage which may influence policy in the future.
  
  
• It is easier for a company to give product away than to sell it for a low price, which could lead to problems with customers who are paying more.

For all of these reasons, we believe, donating the drug made more sense to Pfizer than not doing so.

But still we do not have a model for access which is "broader and sustainable and global" [Eric Sawyer of ACT UP/New York, quoted in the Village Voice article]. The difficulty is one of public relations. Under our system of drug development, patented pharmaceuticals need to be sold at a high markup in richer countries, to cover development and marketing expenses. At those prices, most of the world's people who need them cannot afford to buy them at all. But most drugs are inexpensive to manufacture, so access could be available at a generic price plus modest profit, either privately or through government or nonprofit programs -- and corporate profits could even increase. But then those paying the high prices might complain. So millions of people are denied drugs they need and potentially could afford, in order to avoid public-relations complications for a few corporations.

Finding a path through this obstacle is a central problem of our age.

ISSN # 1052-4207

Copyright 2000 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

Back to the AIDS Treatment News April 7, 2000 contents page.