International charity Médecins Sans Frontières has urged Pfizer for years to cut the prices on its pneumococcal vaccines. After all, Prevnar and Prevnar 13 deliver billions in sales, and vaccinating children in developing countries is very costly. So why did the charity turn down Pfizer's offer of a million free doses?

In the words of MSF U.S. Director Jason Cone, “free is not always better.” In a post on the charity’s decision, Cone said the conditions that come with such donations can delay vaccination campaigns and “undermine long-term efforts to increase access.”

Companies can also use big donations to defend high prices, Cone said. Responding to public health emergencies shouldn't have to rely on corporate “goodwill,” and donations "can disappear as quickly as they come," he said.

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“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,” Cone said, emphasizing that other countries and organizations besides his own need access to vaccines.

Pfizer, for its part, “strongly disagrees” with that take, adding that “donations play a crucial role in addressing humanitarian crises around the world,” a spokesperson told FiercePharma.

The New York-based pharma offered at least 1 million doses, with 100,000 available immediately. Even after MSF’s refusal to accept the donation, the company says it is “actively exploring a number of new options to enable greater access” to its vaccine for humanitarian purposes.

Pfizer’s Prevnar 13 was the world’s bestselling vaccine last year, leading a franchise that hauled in more than $6 billion in sales for the pharma giant.

MSF’s decision follows a move by GSK last month to lower the price of its own pneumococcal vaccine, Synflorix, for refugees. MSF called the U.K. pharma’s decision an “important step” in increasing access, while continuing to blast Pfizer for its lack of “meaningful solutions.” GSK brought in $496 million in Synflorix sales last year.

Both developments follow years of dissatisfaction directed at the pharma companies from MSF, which has resorted to petitions and desperate pleas to call for lower prices. It has asked for the vaccines to be available at $5 per child--for all three doses--in emerging markets and for humanitarian organizations. Last year, Pfizer lowered the price of Prevnar 13 from $3.30 to $3.10 per dose in certain situations, a reduction MSF dubbed "inadequate."

According to the WHO, pneumonia is the leading cause of death in children worldwide, accounting for 1.4 million deaths in children under 5 each year.

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