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Millions for Viagra, Pennies for Diseases of the Poor | The Nation

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Millions for Viagra, Pennies for Diseases of the Poor

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In one case where a drug company put Third World health before profit--Merck's manufacture of Ivermectin--governmental inertia nearly scuttled the good deed. It was the early eighties, and a Pakistani researcher at Merck discovered that the drug, until then used only in veterinary medicine, performed miracles in combating river blindness disease. With one dose per year of Ivermectin, people were fully protected from river blindness, which is carried by flies and, at the time, threatened hundreds of millions of people in West Africa.

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Ken Silverstein
Ken Silverstein is a Washington, DC–based investigative reporter.

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Merck soon found that it would be impossible to market Ivermectin profitably, so in an unprecedented action the company decided to provide it free of charge to the WHO. (Vagelos, then chairman of Merck, said the company was worried about taking the step, "as we feared it would discourage companies from doing research relevant to the Third World, since they might be expected to follow suit.") Even then, the program nearly failed. The WHO claimed it didn't have the money needed to cover distribution costs, and Vagelos was unable to win financial support from the Reagan Administration. A decade after Ivermectin's discovery, only 3 million of 120 million people at risk of river blindness had received the drug. During the past few years, the WHO, the World Bank and private philanthropists have finally put up the money for the program, and it now appears that river blindness will become the second disease, after smallpox, to be eradicated.

Given the industry's profitability, it's clear that the companies could do far more. It's equally clear that they won't unless they are forced to. The success of ACT UP in pushing drug companies to respond to the AIDS crisis in America is emblematic of how crucial but also how difficult it is to get the industry to budge. In late 1997, a coalition of public health organizations approached a group of major drug companies, including Glaxo-Wellcome and Roche, and asked them to fund a project that would dedicate itself to developing new treatments for major tropical diseases. Although the companies would have been required to put up no more than $2 million a year, they walked away from the table. Since there's no organized pressure--either from the grassroots or from governments--they haven't come back. "There [were] a number of problems at the business level," Harvey Bale, director of the Geneva-based International Federation of Pharmaceutical Manufacturers' Association, told Science magazine. "The cost of the project is high for some companies."

While the industry's political clout currently insures against any radical government action, even minor reforms could go a long way. The retired drug company executive points to public hospitals, which historically were guaranteed relatively high profit margins but were obligated to provide free care to the poor in return. There's also the example of phone companies, which charge businesses higher rates in order to subsidize universal service. "Society has tolerated high profit levels up until now, but society has the right to expect something back," he says. "Right now, it's not getting it."

The US government already lavishly subsidizes industry research and allows companies to market discoveries made by the National Institutes of Health and other federal agencies. "All the government needs to do is start attaching some strings," says the Malaria Project's Attaran. "If a company wants to market another billion-dollar blockbuster, fine, but in exchange it will have to push through a new malaria drug. It will cost them some money, but it's not going to bankrupt them."

Another type of "string" would be a "reasonable pricing" provision for drugs developed at federal laboratories. By way of explanation, Attaran recounted that the vaccine for hepatitis A was largely developed by researchers at the Walter Reed Army Institute. At the end of the day, the government gave the marketing rights to SmithKline Beecham and Merck. The current market for the vaccine, which sells for about $60 per person, is $300 million a year. The only thing Walter Reed's researchers got in exchange for their efforts was a plaque that hangs in their offices. "I'll say one thing for the companies," says Attaran. "They didn't skimp on the plaque; it's a nice one. But either the companies should have paid for part of the government's research, or they should have been required to sell the vaccine at a much lower price."

At the beginning of this year, Doctors Without Borders unveiled a campaign calling for increased access to drugs needed in Third World countries. The group is exploring ideas ranging from tax breaks for smaller firms engaged in research in the field, to creative use of international trade agreements, to increased donations of drugs from the multinational companies. Dr. Bernard Pécoul, an organizer of the campaign, says that different approaches are required for different diseases. In the case of those plaguing only the Southern Hemisphere--sleeping sickness, for example--market mechanisms won't work because there simply is no market to speak of. Hence, he suggests that if multinational firms are not willing to manufacture a given drug, they transfer the relevant technology to a Third World producer that is.

Drugs already exist for diseases that ravage the North as well as the South--AIDS and TB, for example--but they are often too expensive for people in the Third World. For twenty-five years, the WHO has used funding from member governments to purchase and distribute vaccines to poor countries; Pécoul proposes a similar model for drugs for tropical diseases. Another solution he points to: In the event of a major health emergency, state or private producers in the South would be allowed to produce generic versions of needed medications in exchange for a small royalty paid to the multinational license holder. "If we can't change the markets, we have to humanize them," Pécoul says. "Drugs save lives. They can't be treated as normal products.

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