Pfizer owns patents on three important drugs for infectious diseases - the antifungal flucanazole, the antiretroviral nelfinavir and the antibiotic azithromycin. In each of these cases Pfizer charges very high prices in the developing world as well. Typically, the company does not even pretend that the drugs are being made available "at cost" since that is so hard to justify given the variety of prices available.
 
The case of flucanazole has received special worldwide attention because of its life-saving role in treating opportunistic infections associated with HIV-AIDS. Cipla of India makes a generic equivalent that costs $0.65, while Biolab of Thailand produces one at a price of only $0.29. By contrast, Pfizer charges $8.25 for the drug in South Africa, $10.50 in Kenya, $12.20 in the US and $20.24 in Brazil. There is clear evidence of Pfizer charging very high prices for the other drugs as well.
 
In fact, where generic substitutes are available, as in Thailand, Pfizer has significantly reduced its prices to compete, although it has led the fight to prevent such substitutes being made available through parallel imports in other countries. The company has also not responded to the offer by Cipla in December 2000, to pay royalty of up to 5 per cent of sales in return for licenses to produce flucanazole.  
 
The irony is that it is not as if all the research involved in developing the drug was conducted within or solely funded by Pfizer. Like all private companies, Pfizer has benefited greatly from and extensively used the results of publicly funded research in this area, although it has been quick to file patents for final results.
 
It is now much more widely recognised that there is no correlation between socially desirable and necessary R&D in drug development, and a tight patent regime which is supposed to encourage innovation by offering pecuniary rewards. Indeed, much of the major research in pharmaceuticals and medicine, both in the past and currently, is under the aegis of publicly funded institutions across the world.
 
The response of Pfizer and other drug companies to widespread public criticism, has been to engage in "philanthropy" in the form of some limited but well-publicised drug donation programmes. However, as the Oxfam report points out, such programmes not only are minuscule compared to the scale of the problem, but tend to be "piecemeal, reversible and frequently conditional".
 
Of course, citizens in developing countries are not the only victims of the power of the multinational drug companies. Oxfam's previous Company Briefing Paper was about GlaxoSmithKline, the second largest drug multinational. That company was in the news again recently, for hiring a public relations agency in the US to "spread awareness" about a new psychological problem called "social anxiety disorder", apparently a debilitating form of shyness, which could be treated with a drug - Paxil - coincidentally patented by the company. The advertising campaign covered newspapers, radio and TV, satellite and Internet communications, and used testimonials from advocates and doctors who said social anxiety was America's third most common mental disorder with more than 10 million suffer.
 
Subsequently health experts in the US have been alarmed at sudden rise of both media reportage of the spread of social anxiety disorder, and the number of people who have taken to using the drug. Paxil, which had been lagging behind other antidepressants in the market such as Prozac, has now jumped in sales and is on the way to becoming market leader. As one bioethics professor pointed out, "the way to sell drugs is to sell psychiatric illness."
 
Of course, such misuse of advertising power, while reprehensible, is still not on par with pricing and marketing policies that effectively deny access to life-saving drugs to the world's poor. But they point to a similar problem - that of increasing concentration and lack of regulation of an international drug industry that has been given much greater power by the current multilateral trade regime.