Some may have become aware that Médecins Sans Frontières (MSF), also known in the United States as Doctors Without Borders, has recently turned down a large donation of pneumonia vaccines from Pfizer. I originally had no plans to write about this, but given that it keeps popping up on almost all of my social media, I now feel like I have to at least mention it.

Before I get into that, let me briefly mention that I absolutely adore this apparel item I received in the most recent Stylish Surprise from Modcloth. It's a teeny bit big for an XS, but that's about what I'd expect from Modcloth's sizing, which is rarely consistent. Still, it's incredibly soft and I'm going to be wearing it a lot with this crazily variable weather that starts the day at 50 degrees and then gets up to 90.

I follow MSF on Twitter, so it was from them that I first heard the story, published by Jason Cone, the Executive Director of Doctors Without Borders and titled "There is no such thing as 'free' vaccines: Why we rejected Pfizer's donation offer of pneumonia vaccines". I later became aware of this article in The Atlantic, which added more information from Pfizer's side but still seemed to come down on the side of MSF.

First, a bit of background. In 1999, MSF launched its Access Campaign to push for access to medications and for medication development for those most in need. One of the major areas this campaign focuses on is vaccine access. According to MSF, the high cost of vaccines and the patents held on vaccines prevent aid organisations from being able to administer those vaccines to the populations with which they work. For the past few years, MSF has been in negotiations with GlaxoSmithKline (GSK) and Pfizer - two manufacturers of pneumonia vaccines - to reduce the price of the vaccine for nongovernmental organizations. Earlier this year GSK agreed to offer the vaccine at a discounted price, for about $9 per child for all doses. However, Pfizer has still not agreed to lower the cost of the vaccine. Instead, they offered to donate 1 million free vaccines to MSF.

Here is where the debate begins. Should MSF have accepted the donation? (Pfizer mentions it is still available, should MSF decide to accept.) Accepting the donation may have translated to saving the lives of hundreds of thousands of children who would otherwise have died of pneumonia. Or did MSF make the correct decision in refusing, at the cost of human lives?

Personally - and I may be biased because of my belief in MSF's value of témoignage, "witnessing" or "speaking out" about injustices and institutional oppression - I think that MSF made the best choice from the options it was given. Yes, MSF turned down a donation in order to make a statement, but I think that statement is perfectly valid. Because there is such little competition for pediatric pneumonia vaccines, accepting a donation from a company that refuses to lower its prices to a competitive price would encourage the maintenance of a harmful status quo. In the past, MSF accepted a donation of vaccines, but that was before GSK lowered its price. Accepting a donation now that GSK has more competitive pricing would be tantamount to saying to Pfizer "It's ok that you refuse to lower the price, as long as you give us vaccines for free." and would effectively be throwing away the years of work MSF has put into fighting for vaccine access. Refusing the donation says to Pfizer, "What you are doing is not enough. If you refuse to negotiate, we will not pay you - because we cannot afford your prices - and our money will go to your competitor."

Then there is of course the issue that there tend to be stipulations placed on donations, regarding which populations can receive the vaccines. Neither MSF nor Pfizer have released a statement noting whether there were any restrictions place on the donation, or if there were population-specific restrictions. Instead both parties leave that up to speculation. In Jason Cone's blog he mentions that such restrictions have been placed on donations in the past, but intuitively I would think that he would mention what restrictions may or may not have been placed on this vaccine donation, unless he were legally restricted from doing so.

Will this decision come at the cost of the deaths of those who need that vaccine but will not receive it? Maybe. I even hesitantly will say that probably children will die. I really don't want to devalue these lives that may be lost. I also want to be clear in expressing the fact that in relief work lives will be lost because much of the time it is not possible to give aid to everyone who needs it. Costs are high, number of personnel is low. MSF was faced with a difficult decision and chose the option that they believed would result in the greatest good for the least cost, and that aligned with their core organizational values. In the long run, I can only think that MSF believes this decision will encourage Pfizer - and likely other companies that may be in a similar situation in the future - to price their products competitively for NGOs or risk losing business (and potentially the accompanying good faith of the general populace and maybe even that of their stockholders) and that this will in turn increase the amount of aid NGOs are able to give because they will be able to afford to do so.