When free is not fair: the case of vaccine donations

On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer\'s proposed donation of 1 million doses of its branded pneumococcal conjugate vaccine (PCV).1 The news caused a stir in the global health community; after all, free essential health goods might be considered something to be celebrated.

This decision represents the latest development in a prolonged advocacy campaign spearheaded by MSF, which aims to reduce the cost of PCV, and presents a timely opportunity to examine the case for vaccine donations. In their rejection of Pfizer\'s offer, MSF cited several concerns related to the donation of pharmacological agents—namely, conditions attached to donation agreements, the sustainability of programmes dependent on donations, and the deleterious effect of donations on the incentive to reduce prices.