The Wall Street Journal - April 3, 2000
Michael Waldholz, Staff Reporter

Pfizer's decision to provide the drug for free is expected to startle government health officials and AIDS activists here who have been pressing the New York drug maker to slash the price of Diflucan, a powerful antifungal medicine. Pfizer, which sold about $1 billion of the drug last year, hadn't given the government or activists any advance indication it would respond to the pressure by providing the drug without charge for South Africans diagnosed with cryptoccocal meningitis, a lethal brain infection.

Diflucan Dilemma

It is estimated that about two million of the 27 million people with HIV in sub-Saharan Africa have become infected by the deadly fungal infection that can be adequately treated only with one drug, Diflucan. Until now, however, Diflucan has been out of reach for most South Africans because of its very high cost -- between $13 and $17 a day at retail -- and because once therapy is begun, it must be continued on a daily basis for a person's entire life.

Beginning early in March, several AIDS activist groups, along with the nonprofit Paris-based organization Doctors Without Borders, launched a public-relations and letter-writing campaign against Pfizer in about 18 countries. The activists pointed out that generic versions of the drug, also known as fluconazole, sell for about $1.50 a day in Thailand, where Pfizer's patent isn't being honored.

The advocacy effort, led here by a coalition called the Treatment Action Campaign, accelerated several weeks ago when activists in New York slipped past guards at Pfizer's headquarters and confronted the company's chairman and chief executive, William Steere, in his 23rd floor office. Pfizer officials told the activists at that time that it would respond to their requests by Monday.

The company, like other drug makers that market high-price AIDS medicines that are largely unavailable in poor nations, has been struggling for weeks to find a solution to the activists' demands. It is believed that Pfizer was worried about the public-relations fallout from a demonstration against the company's offices here planned for Monday. Company officials also were concerned by activists' plans to disrupt the drug maker's annual meeting in May and take Wall Street's attention away from the company's announcements regarding the status of its acquisition of Warner-Lambert Co.

Surprise Move

Still, giving away the drug wasn't anticipated. The government here hoped Pfizer would consider either letting generic makers market the drug or discounting the price significantly. But even an 80% or 90% price cut would keep the drug out of reach of most Africans, their governments or donor organizations. Reducing the price also would make it hard for Pfizer to sustain its high price elsewhere, some critics said.

In a letter dated March 31 to Mark Heywood of the Treatment Action Campaign, Pfizer said it has requested a meeting Monday with South Africa's Ministry of Health to "seek their advice and collaboration in a program to deliver Diflucan free of charge through appropriate medical specialists ..."

George Flouty, Pfizer's medical director for public-health programs, said the company is seeking a meeting with the South African health minister to work out such details as who would be eligible for the free drugs, how the drugs would be administered and for how long. Mr. Flouty said Pfizer is offering the drug only to people who can't afford it, though he isn't sure how eligibility will be determined.

Lifelong Responsibility

Despite the potentially large size of Pfizer's giveaway program, critics are expected to be skeptical about some aspects of it. By giving the drug to patients, the company takes on a responsibility to provide it to them for life, something that will require an unprecedented commitment. In addition, other countries in Africa and elsewhere are certain to press Pfizer for a similar gift.

Between 2% and 8% of people infected by HIV become susceptible to cryptococcal meningitis, an infection that is harmless to most people whose immune system hasn't been crippled by AIDS. In Uganda, where 10% of the nation is infected with HIV, "when we have patients with 'crypto,' we simply try to make the person comfortable, ease their pain and watch them die," said Peter Mugenyi, a leading AIDS research physician in Kampala.

"It is frustrating for a doctor to know a treatment exists to keep people alive and not be able to use it simply because of its cost," said Dr. Mugenyi last week.

Several major drug companies, including Merck & Co., Bristol-Myers Squibb Co. and Glaxo Wellcome PLC, in the past two years have somewhat reduced the prices of their potent anti-AIDS drugs. But even at discounted prices, the drugs aren't commonly available here because their monthly cost can dwarf a typical African's annual income. But the drug makers are coming under increasing pressure to provide help to the developing nations, especially because the World AIDS conference this year will be held in Durban, South Africa, in July, where world-wide media attention will be focused on the lack of access to the drugs in the developing world.

Write to Michael Waldholz at michael.waldholz@wsj.com1
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