Pfizer’s modern iteration of this vaccine is known among doctors as PCV13. It’s recommended to be given to all children by medical authorities worldwide. Since its introduction, cases of severe Strep pneumonia in the U.S. have gone down by 88 percent.

Elsewhere, death from pneumonia remains commonplace, especially in subsaharan Africa and southeast Asia. This is where much work is done by Doctors Without Borders—known outside the U.S. as Médecins Sans Frontières (MSF)—to provide care. So I was initially shocked to hear MSF refused a million PCV13 doses from Pfizer, who seemed shocked themselves.

“Pfizer is committed to making vaccines available to as many people as possible,” company spokesperson Sally Beatty told me by email, “particularly those needing emergency humanitarian assistance.”

Beatty explained that Pfizer “strongly disagrees” with MSF’s decision, and that “to suggest that donations are not valuable defies logic.”

Of course, the doctors do see donations as valuable—simply not worth the costs in this context, which transcends seemingly straightforward philanthropy and medical science.

Pfizer sells its PCV13 pneumonia vaccine under the name Prevnar 13. Among the best-selling vaccines on the market, its technology is protected by multiple patents—not just on the final product, but also on the process by which the vaccine is made. This makes it difficult for competitors to produce anything comparable at all. The South Korean company SK Chemicals came close to producing an analogue, but Pfizer sued the company and was supported by the country’s Intellectual Property Tribunal in 2015.

MSF has been trying to get their hands on Prevnar 13 since it was introduced in 2009, but the price has been too high. Outside of dire situations—as when the group purchased some Prevnar from pharmacies in Athens a few months ago (for 60 euros per dose)––the group has lacked the resources to purchase it.

And this cost is the fundamental issue to Jason Cone, the executive director of Doctors Without Borders in the United States. He explained that donations from pharmaceutical companies are ineffective against a problem of this scale. While the donation would benefit people under the care of Doctors Without Borders immediately, accepting it could mean problems for others, and problems longer-term. Donations, he writes, are “often used as a way to make others ‘pay up.’ By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine.”

Which is to say that for a disease of this scale, isolated donations are inadequate.

“I'm not absolutely against donations,” MSF’s vaccine pharmacist Alain Alsahani told me by phone from Paris. In cases of neglected disease where there is little or no market for a product, he explained, “donation becomes a more interesting option for some countries to get access. But in the case of PCV, that's not a solution at all, in any way.”