Pfizer to Expand Fluconazole Donation Program to More than 50 Developing NationsPfizer Inc. announced yesterday that it will expand the donation program for the antifungal medication fluconazole, brokered earlier this year with South Africa, to include five other countries in the region -- Botswana, Lesotho, Malawi, Namibia and Swaziland -- and "invit[ed]" the governments of the 50 countries considered by the United Nations to be "the world's poorest and most affected by AIDS" to also partake in the offer, the New York Times reports. Pfizer began providing the drug, marketed under the brand name Diflucan, free of charge to South Africa earlier this year to treat cryptococcal meningitis, an inflammation of the membranes around the brain and spinal cord seen in about 10% of AIDS patients in that country, and esophageal candidiasis, a fungal infection of the throat that affects between 20% to 40% of AIDS patients in South Africa. The initiative will also include "medical training and patient education," Pfizer CEO Dr. Henry McKinnell announced (Crossette, New York Times, 6/7). This "commitment to infrastructural support" was a "key element" to the deal, South African ambassador Sheila Sisulu told Newsday. "[U]nless there's a real partnership that recognizes that infrastructure is critical ... unless you actually have people who are able to administer and monitor the use of these medications and their effects on people, eventually you end up creating new, worse problems," she added. The expansion of the program to other parts of the region also is intended to prevent "mass immigrations of AIDS-sufferers" to South Africa for treatment with the drug, she said (Garrett, Newsday, 6/7). The donation program will be operated in conjunction with the United Nations and the World Health Organization, which will "identify" eligible countries and "help negotiate distribution and monitoring agreements" for the drug. The organizations estimate that the latest offer will reach about 12 million AIDS patients (Warner, Philadelphia Inquirer, 6/7). The exact cost of the program is not known, but the South African program alone is estimated to cost $50 million over the next two years. "There is no time or dollar limit set on this program. We are ready to begin providing Diflucan immediately," McKinnell said.
UNAIDS Director Peter Piot "welcomed" the announcement, saying it would have a "significant impact" in the fight against AIDS-related diseases. Joel Pressley, executive director of the New York AIDS Coalition, said at a press conference, "Pfizer has made a step in the right direction, a major step. However, it and other pharmaceuticals along with policymakers near and far must make giant strides to find proactive and comprehensive solutions to stem and stop the tide of despair and misery" (New York Times, 6/7). Other activists were more "skeptical" of the deal. "It's a light you can switch on, and it's a light you can switch off when the spotlight is off you," Kate Krauss, a spokesperson for the Health GAP Coalition, said. Kris Torgeson of Doctors Without Borders said her organization is regarding the announcement with "careful happiness because we think it's good that people will have access. But we know that, in the past, these donation schemes have not worked out for providing drugs to people in need" (Philadelphia Inquirer, 6/7).
Donations Versus Price Cuts
Pfizer chose the donation program for the drug, which costs about $10 a dose in the United States, instead of offering the price cuts many other pharmaceutical companies have recently announced for other medications. Diflucan was patented in 1982 and will remain patented in the United States and many other nations through 2004, but Pfizer recently has been "under pressure" from generic drug makers in Thailand, Bangladash and India, where manufacturers produce and sell generic versions of fluconazole. McKinnell "acknowledged" yesterday that Pfizer was "intent on keeping its market share" for the drug even after its patent expires. The donations are one way of "boost[ing]" the image of the company, critics say. Paul Zeitz, founder of the Global AIDS Alliance, called the donation program "a strategy to block access to generically manufactured drugs" and called for the agreements to be "carefully ... scrutinized." He said, "We don't know the details of the written deal. What kind of influence are they buying with this? Are there unwritten ways that the pharmaceutical companies are influencing the governments? ... A free donor program effectively blocks the demand for generically manufactured drugs" (New York Times, 6/7). "This is one approach we think is right for us. We don't claim this is a be-all and an end-all," Pfizer spokesperson Andrew McCormick said (Philadelphia Inquirer, 6/7). Pfizer also announced yesterday that it is "partially underwriting" the Academic Alliance for AIDS Care and Prevention in Africa and will finance the building of its headquarters in Kampala, Uganda (Newsday, 6/7).