Critics of this collaboration point out that training and educating health personnel under the AMR project would give Pfizer access not just to doctors but also to policymakers. This is particularly useful for the company given its recent declaration that it will stop sponsoring and gifting doctors. Last year, ICMR organised four workshops in partnership with Pfizer on antimicrobial stewardship training in which 150 healthcare staff from 32 medical colleges and hospitals were trained.
Admitting that there was no selection process by which ICMR decided to partner with Pfizer from among dozens of Indian and multinational pharma companies that manufacture antibiotics, Dr Kamini Walia, programme officer for AMR in ICMR, said “Pfizer came forward on its own and offered its CSR funds with no strings attached.” She also confirmed that it was not dearth of funds for the AMR project which made ICMR collaborate with Pfizer.
“Pfizer’s role is in the communication campaign, which they are more equipped to handle. They are making radio jingles and so on for which they have hired a creative agency. They have retained Rs 2-3 crore of the funds they offered for developing the communication material. But all the communication material is approved by ICMR. The rest of the money, Rs 4.47 crore, has been transferred to the ICMR,” explained Dr Walia.
Pfizer, like many other antibiotic manufactures, gives sales representatives incentives to meet stiff targets. The annual target for sterile injectables (including high-end antibiotics) for a single district or territory could be as high as Rs 3 crore, according to sales representatives.
Pharma sales representatives, under pressure to meet targets or face the threat of losing their jobs, have been known to push sales by bribing doctors with the incentive money they get for meeting the target and by pushing antibiotics through quacks. Such aggressive marketing was identified as one of the factors for rising resistance to antibiotics by the World Health Organisation (WHO).
Pfizer’s spokesperson told TOI that its collaboration with ICMR is a CSR initiative formalised in 2017 and added that this was not aimed at promoting any Pfizer product. At Pfizer, ethical marketing takes priority over achieving commercial goals and it does not support or accept unethical promotion, the spokesperson insisted.
“The ICMR-Pfizer collaboration will lead to serious Conflicts of interest (COI), with a significant potential for the academic and surveillance activities of ICMR to be influenced by the collaborating pharmaceutical firm. Such an influence will have negative impact on the AMR policymaking process and derail our national AMR action plan implementation,” stated Dr Abdul Ghafur, technical advisory member for the national antibiotic policy, in a letter sent to the current DG of ICMR, Dr Balram Bhargava.
Demanding that all members of the ICMR-AMR committee and similar committees of the National Centre for Disease Control (NCDC), the nodal agency for AMR in India, and others involved in surveillance and educational activities of the network must disclose their conflicts of interest in the WHO declaration format, Dr Ghafur urged ICMR not to go ahead with the Pfizer partnership and to instead explore PPPs with funding to a common pool as recommended by WHO.
The Alliance Against Conflict of Interest has also written to the ICMR DG urging him to disband the partnership. “Pfizer being one of the leading manufacturer marketing antibiotics and vaccines in India has its primary interest in making more profit for its shareholders, while, ICMR is the premier public institute with primary responsibility to guide and regulate research including research on drugs and vaccines. Therefore, ICMR-Pfizer collaboration is an institutional conflicts of interest (COI),” stated the Alliance.